Polycystic ovary syndrome and pregnancy
Objective. To carry out a systematic analysis of the data given in the current literature on obstetric complications in women with polycystic ovary syndrome (PCOS).Ananyev E.V.
Materials and methods. The review includes the data of foreign and Russian studies, which have been published in the electronic databases Medline, PubMed, and Cochrane Library over the past 10 years.
Results. The given review considers data on pregnancy complications in PCOS, such as miscarriage, multiple pregnancy, gestational hypertension and preeclampsia, gestational diabetes, birth of premature babies and macrosomic ones, as well as some pathophysiological processes that may underlie these complications.
Conclusion. Hyperandrogenia, insulin resistance, obesity, and dyslipidemia, which are characteristic of PCOS, are likely to be crucial factors for the processes of trophoblast invasion and placentation and can affect the health of mother and child. Pregravid counseling in women with PCOS and close monitoring during pregnancy are recommended to prevent adverse pregnancy outcomes.
Keywords
polycystic ovary syndrome
hyperandrogenia
insulin resistance
miscarriage
gestational diabetes
hypertension
preeclampsia
References
1. Bozdag G., Mumusoglu S., Zengin D., Karabulut E., Yildiz B.O. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum. Reprod. 2016; 31(12): 2841-55.
2. Чернуха Г.Е., Блинова И.В., Купрашвили М.И. Эндокринно-метаболические характеристики больных с различными фенотипами синдрома поликистозных яичников. Акушерство и гинекология. 2011; 2: 70-6. [Chernukha G.E., Blinova I.V., Kuprashvili M.I. Endocrine and metabolic characteristics of patients with different phenotypes of polycystic ovary syndrome. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2011; (2): 70-6. (in Russian)]
3. Orio F., Palomba S. Reproductive endocrinology: New guidelines for the diagnosis and treatment of PCOS. Nat. Rev. Endocrinol. 2014; 10(3): 130-2.
4. Boomsma C.M., Fauser B.C., Macklon N.S. Pregnancy complications in women with polycystic ovary syndrome. Semin. Reprod. Med. 2008;26(1): 72-84.
5. Зыкова Т.А., Малейков Н.В., Милавкина И.А. Возможно ли предупредить развитие гестационного диабета? Акушерство и гинекология. 2012; 4-2: 10-5. [Zykova T.A., Maleikov N.V., Milavkina I.A. Can the development of gestational diabetes be prevented? Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2012; (4-2): 10-5. (in Russian)]
6. Boomsma C.M., Eijkemans M.J., Hughes E.G., Visser G.H., Fauser B.C., Macklon N.S. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum. Reprod. Update. 2006; 12(6): 673-83.
7. Kjerulff L.E., Sanchez-Ramos L., Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a meta-analysis. Am. J. Obstet. Gynecol. 2011; 204(6): 558. e1-e6.
8. Qin J.Z., Pang L.H., Li M.J., Fan X.J., Huang R.D., Chen H.Y. Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod. Biol. Endocrinol. 2013; 11: 56.
9. Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS). Hum. Reprod. 2012; 27(1): 14-24.
10. Heijnen E.M., Eijkemans M.J., Hughes E.G., Laven J.S., Macklon N.S., Fauser B.C. A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome. Hum. Reprod. Update. 2006; 12: 13-21.
11. Sterling L., Liu J., Okun N., Sakhuja A., Sierra S., Greenblatt E. Pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization. Fertil. Steril. 2016; 105(3): 791-7. e2.
12. Joham A.E., Boyle J.A., Ranasinha S., Zoungas S., Teede H.J. Contraception use and pregnancy outcomes in women with polycystic ovary syndrome: data from the Australian Longitudinal Study on Women’s Health. Hum. Reprod. 2014; 29(4): 802-8.
13. Joham A.E., Palomba S., Hart R. Polycystic ovary syndrome, obesity, and pregnancy. Semin. Reprod. Med. 2016; 34(2): 93-101.
14. Wang Q., Luo L., Lei Q., Lin M.M., Huang X., Chen M.H., Zeng Y.H., Zhou C.Q. Low aneuploidy rate in early pregnancy loss abortuses from patients with polycystic ovary syndrome. Reprod. Biomed. Online 2016;33(1): 85-92.
15. Чернуха Г.Е. Ожирение как фактор риска нарушений репродуктивной системы у женщин. Consilium medicum. 2007; 6: 84-6.
16. Hamilton-Fairley D., Kiddy D., Watson H., Peterson C., Franks S. Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin. Br. J. Obstet. Gynecol. 1992; 99(2): 128-131.
17. Wang J.X., Davies M.J., Norman R.J. Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment. Hum. Reprod. 2001; 16(12): 2606-2609.
18. Moran L.J., Hutchison S.K., Norman R.J., Teede H.J. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst. Rev. 2011; (7): CD007506.
19. De Frene V., Vansteelandt S., T’Sjoen G., Gerris J., Somers S., Vercrusse L., Sutter D.P. A retrospective study of the pregnancy, delivery and neonatal outcome in overweight versus normal weight women with polycystic ovary syndrome. Hum. Reprod. 2014; 29(10): 2333-2338.
20. Luo L., Wang Q., Chen M., Yuan G., Wang Z., Zhou C. IGF-1 and IGFBP-1 in peripheral blood and decidua of early miscarriages with euploid embryos: comparison between women with and without PCOS. Gynecol. Endocrinol. 2016; 32(7): 538-42.
21. Lee C.L., Lam K.K., Koistinen H., Seppala M., Kurpisz M., Fernandez N. et al. Glycodelin-A as a paracrine regulator in early pregnancy. J. Reprod. Immunol. 2011; 90(1): 29-34.
22. Vrijkotte T.G., Krukziener N., Hutten B.A., Vollebregt K.C., van Eijsden M., Twickler M.B. Maternal lipid profile during early pregnancy and pregnancy complications and outcomes: the ABCD study. J. Clin. Endocrinol. Metab. 2012; 97(11): 3917-25.
23. Cocksedge K.A., Li T.C., Saravelos S.H., Metwally M. A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage. Reprod. Biomed. Online. 2008; 17(1): 151-60.
24. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome. Fertil. Steril. 2004; 81(1): 19-25.
25. Palomba S., Falbo A., Chiossi G., Tolino A., Tucci L., La Sala G.B., Zullo F. Early trophoblast invasion and placentation in women with different polycystic ovary syndrome phenotypes. Reprod. Biomed. Online. 2014; 29(3): 370-81.
26. Maliqueo M., Echiburú B., Crisosto N. Sex steroids modulate uterine-placental vasculature: implications for obstetrics and neonatal outcomes. Front. Physiol. 2016; 7: 152.
27. Palomba S., de Wilde M.A., Falbo A., Koster M.P., La Sala G.B., Fauser B.C. Pregnancy complications in women with polycystic ovary syndrome. Hum. Reprod. Update. 2015; 21(5): 575-92.
28. Shetelig Løvvik T., Stridsklev S., Carlsen S.M., Salvesen Ø., Vanky E. Cervical length and androgens in pregnant women with polycystic ovary syndrome: has metformin any effect? J. Clin. Endocrinol. Metab. 2016;101(6): 2325-31.
29. Caanen M.R., Kuijper E.A., Hompes P.G., Kushnir M.M., Rockwood A.L., Meikle W.A. et al. Mass spectrometry methods measured androgen and estrogen concentrations during pregnancy and in newborns of mothers with polycystic ovary syndrome. Eur. J. Endocrinol. 2016; 174(1): 25-32.
30. Daan N.M., Koster M.P., Steegers-Theunissen R.P., Eijkemans M.J., Fauser B.C. Endocrine and cardiometabolic cord blood characteristics of offspring born to mothers with and without polycystic ovary syndrome. Fertil. Steril. 2017; 107(1): 261-8. e3.
31. Falbo A., Rocca M., Musso T., D’Ettore A., Tolino A., Zullo F., Orio F., Palomba S. Changes in androgens and insulin sensitivity indexes throughout pregnancy in women with polycystic ovary syndrome (PCOS): relationships with adverse outcomes. J. Ovarian. Res. 2010; 3: 23.
32. Palomba S., Falbo A., Orio F. Jr., Zullo F. Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Fertil. Steril. 2009; 92(5): 1646-58.
33. Zeng X.L., Zhang Y.F., Tian Q., Xue Y., An R.F. Effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome A meta-analysis. Medicine (Baltimore). 2016; 95(36): e4526.
34. Johnston J., Gusmano M.K., Patrizio P. Preterm births, multiples, and fertility treatment: recommendations for changes to policy and clinical practices. Fertil. Steril. 2014; 102(1): 36-9.
35. Ghazeeri G.S., Nassar A.H., Younes Z., Awwad J.T. Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome: an overview. Acta Obstet. Gynecol. Scand. 2012; 91(6): 658-78.
36. Lovvik T.S., Wikstrom A.K., Neovius M., Stephansson O., Roos N., Vanky E. Pregnancy and perinatal outcomes in women with polycystic ovary syndrome and twin births: a population based cohort study. BJOG. 2015; 122(10):1295-1302.
37. Duckitt K., Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005; 330(7491): 565.
38. Rees D.A., Jenkins-Jones S., Morgan C.L. Contemporary reproductive outcomes for patients with polycystic ovary syndrome: A Retrospective Observational Study. J. Clin. Endocrinol. Metab. 2016; 101(4): 1664-72.
39. Roos N., Kieler H., Sahlin L., Ekman-Ordeberg G., Falconer H., Stephansson O. Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population-based cohort study. BMJ. 2011; 343: d6309.
40. Naver K.V., Grinsted J., Larsen S.O., Hedley P.L., Jørgensen F.S., Christiansen M., Nilas L. Increased risk of preterm delivery and pre-eclampsia in women with polycystic ovary syndrome and hyperandrogenaemia. BJOG. 2014;121(5): 575-81.
41. Torloni M.R., Betrán A.P., Horta B.L., Nakamura M.U., Atallah A.N., Moron A.F., Valente O. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes. Rev. 2009; 10(2):194-203.
42. Joham A.E., Ranasinha S., Zoungas S., Moran L., Teede H.J. Gestational diabetes and type 2 diabetes in reproductive-aged women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 2014; 99(3):E447-52.
43. Ngai I., Govindappagari S., Neto N., Marji M., Landsberger E., Garry D.J. Outcome of pregnancy when gestational diabetes mellitus is diagnosed before or after 24 weeks of gestation. Obstet. Gynecol. 2014; 123(Suppl. 1):162-3.
44. Иванов Д.О., Шабалов Н.П., Петренко Ю.В. Гипогликемия новорожденных. Акушерство и гинекология. 2014; 5: 19-26. [Ivanov D.O., Shabalov N.P., Petrenko Yu.V. Neonatal hypoglycemia. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2014; (5): 19-26. (in Russian)]
45. Poolsup N., Suksomboon N., Amin M. Effect of treatment of gestational diabetes mellitus: a systematic review and meta-analysis. PLoS One. 2014; 9(3): e92485.
46. Зыкова Т.А., Уледева Л.В. Взаимодополняющие эффекты гипогликемических препаратов в процессе коррекции доклинических нарушений метаболизма при синдроме поликистозных яичников. Акушерство и гинекология. 2014; 11: 102-6. [Zykova T.A., Uledeva L.V. Complementary effects of hypoglycemic drugs in the correction of preclinical metabolic disturbances in polycystic ovary syndrome. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2014; (11): 102-6. (in Russian)]
47. Vanky E., Stridsklev S., Heimstad R., Romundstad P., Skogøy K., Kleggetveit O. et al. Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study. J. Clin. Endocrinol. Metab. 2010; 95(12): E448-55.
48. Rowan J.A., Hague W.M., Gao W., Battin M.R., Moore M.P. Metformin versus insulin for the treatment of gestational diabetes. N. Engl. J. Med. 2008; 358(19): 2003-15.
49. Conway G., Dewailly D., Diamanti-Kandarakis E., Escobar-Morreale H.F., Franks S., Gambineri A. et al. European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS Special Interest Group’s Questionnaire. Eur. J. Endocrinol. 2014; 171(4):489-98.
50. Мосесова Ю.Е., Дьяконов С.А. Предварительные результаты применения миоинозитола и фолиевой кислоты перед программой экстракорпорального оплодотворения у пациенток с синдромом поликистозных яичников. Кремлевская медицина. 2015; 3: 60-3. [Mosesova Yu.E., Dyakonov S.A. Preliminary results of the use of myoinositol and folic acid before the program of in vitro fertilization in patients with polycystic ovary syndrome. Kremlevskaya meditsina. 2015; 3: 60-3. (in Russian)]
Received 20.12.2016
Accepted 23.12.2016
About the Authors
Ananyev E.V., senior researcher of maternity department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79857679777. E-mail: new_vision@mail.ru
For citations: Ananyev E.V. Polycystic ovary syndrome and pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (9): 5-11. (in Russian)
http://dx.doi.org/10.18565/aig.2017.9.5-11
Similar Articles
