Objective: to assess pregnancy outcomes in a cohort of polycystic ovary syndrome (PCOS) women, and to quantify the risk of these pregnancy outcomes according to the pre-pregnancy body mass index (BMI). Study design: ...
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Objective: to assess pregnancy outcomes in a cohort of polycystic ovary syndrome (PCOS) women, and to quantify the risk of these pregnancy outcomes according to the pre-pregnancy body mass index (BMI). Study design: retrospective and monocentric study including all PCOS women in a French tertiary-care university hospital in Bordeaux, from January 2016 through November 2022. Data about characteristics of women, pregnancy, delivery, and newborns were collected from medical charts. Our cohort was stratified according to the pre-pregnancy BMI into three groups: normal weight, overweight and obesity. Were assessed pregnancy outcomes, including gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), preeclampsia, and others outcomes such as preterm birth, fetuses small for age gestational (SGA), fetal growth restriction (FGR), macrosomia, cesarean delivery and operative vaginal delivery. Association between pre-pregnancy BMI and each complication of pregnancy were analyzed by univariate and multivariate logistic regression with adjustment on available confounders. Results: among 39,178 births during the study period, 406 (1.0%) women were identified PCOS, and after exclusion of 66 women, the final sample comprised 340 PCOS women : 176 (51,8%) had normal weight, 72 (21,2%) were overweight and 92 (27%) were obeses. In our population, the rate of GDM was 29.1%, PIH 1.5%, preeclampsia 4.4%, SGA 1.5%, FGR 5.6%, cesarean delivery 17.1%, operative vaginal delivery 15.6%, macrosomia 8.8%, and preterm birth (before 34 weeks) 4.7%. Stratifying by the BMI, a significantly higher risk of pregnancy complications was found for metabolic pathologies such as GDM or PIH. The rate of GDM was significantly higher in obese (48.8%) and overweight women groups (33.3%) compared to the normal weight group (p <0.01), as the rate of PIH wich was significantly higher in overweight women group (4.4%) and obese women (2.4%) (p=0.03). We did not find any significant difference on the overall rate of cesarean delivery (p=0.08) but there was significantly more cesarean delivery for maternal cause in obese and overweight women group compared to normal weight women group (p=0.04). We did not find any significant difference between groups about other studied complications of pregnancy (preeclampsia, SGA, FGR, macrosomia, preterm birth, and operative vaginal delivery). After adjustment for available counfonders, all pregnancy complications seemed to be gradually increased in case of obesity more than in overweight but the difference is significant only for GDM (aOR 3.5, 95% CI 1.6-5.7 and aOR 6.7, 95% CI 3.8-10.5 respectively for overweight and obese women groups). Conclusion: in our population of PCOS women, the rate of GDM and preeclampsia appeared to be higher than in a general population of pregnant women. Having a higher pre-pregnancy BMI is an additional risk factor of GDM and PIH among PCOS women, and it appears to be a tendency for increasing the risk of other outcomes studied. It could be useful to inform women with PCOS of the increased risk of complications during pregnancy, and to encourage weight loss in women with a high BMI, in order to limit this risk.
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