Perinatal outcomes in women with polycystic ovary syndrome

Abstract

Introduction. Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders that affects women in reproductive age, with a reported incidence between 6 and 15%. It is a very heterogeneous and complex disorder characterised by amenorrhea or oligomenorrhea, polycystic ovarian morphology and hyperandrogenism with its clinical features as hirsutism, acne. According to the Rotterdam 2003 criteria, PCOS is diagnosed when two of the three following criteria were present: oligo- or anovulation, clinical or biochemical hyperandrogenism and polycystic ovaries. Many women with PCOS have encountered difficulties in achieving a pregnancy due to ovulatory dysfunction. However, there are a few successful treatment options for women with anovulatory infertility, which have made progress in achieving a pregnancy or reducing multiple gestation. Nevertheless, PCOS has been closely linked to maternal, neonatal and perinatal complications. It is associated with increased risk of spontaneous miscarriage, preterm deliveries, gestational diabetes mellitus, hypertensive disease-preeclampsia and a higher caesarean delivery risk. Aim of study. The purpose of this review was to research articles which reveal the possible perinatal complications in women with PCOS. Methods and materials. This review study was done by using different specific literature in databases of PubMed, BMC-biomedcentral, NCBI, Circulation Research, Springer. The articles were selected by using Keywords: “polycystic ovary syndrome”, “hyperandrogenism”, “anovulation”, “infertility”, “perinatal complications in women with PCOS”, “insulin resistance in women with PCOS”, “preeclampsia in women with PCOS”. Results. This study revealed that early pregnancy loss is usually common post conception, at first trimester. There isn’t a well-known reason why it occurs, but several mechanisms can enhance the risk of spontaneous EPL. Such as elevated luteinizing hormone, hyperandrogenemia -elevated the free or total testosterone ratio antagonise estrogen and as a result affect endometrial development and implantation as well as it downregulates the expression of HOXA10 gene, consequently it decreases the uterine receptivity and implantation. Another possible mechanism of EPL could be high plasminogen activator inhibitor-1 (PAI-1) levels which results in impaired fibrinolysis and lead to placental insufficiency through increased thrombosis in the placental bed. Insulin resistance which results in gestational diabetes mellitus is the most described complication in women with PCOS, and it occurs in up to 40%-50% of PCOS pregnancies. Also, an increased BMI could be a great predictor for GMD. Hypertensive disease includes pregnancy induced hypertension as new-onset in pregnancy after 20 weeks of gestation and preeclampsia- a PIH with proteinuria. Accordingly, women with PCOS are more likely to have PIH. Conclusion. PCOS is obviously associated with adverse perinatal outcomes and that risk increases in the presence of comorbidities such as insulin resistance, increased body mass index and dyslipidemia. There are many factors that contribute to their development and should be taken into consideration, in order to adopt a suitable management. Throughout gestation, a special attention has to be paid to an early establishment of dyslipidemia, hypertension and increased glucose level in blood.