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Polycystic ovary syndrome and the risk of preeclampsia

      Background

      Data suggests that patients with polycystic ovary syndrome (PCOS) are at increased risk of developing preeclampsia; however several studies have failed to find an association between the two. The precise mechanism that links PCOS to preeclampsia remains unknown, although aberrant placental growth may play a role. In addition, many PCOS patients ultimately conceive through assisted reproductive technology, a process that has been independently associated with preeclampsia.

      Objective

      This study aimed to quantify the association between PCOS and preeclampsia.

      Materials and Methods

      We performed a retrospective case-control study of singleton deliveries at a tertiary care hospital from 2011-2015. Each patient with preeclampsia (case) was matched to the next delivery without preeclampsia (control) who delivered at the same gestational age. We abstracted data from medical records. Preeclampsia was defined as the presence of elevated blood pressure (>140/90) during the delivery admission, and either symptoms of preeclampsia, seizures, or abnormal laboratory values (proteinuria, alanine aminotransferase/aspartate aminotransferase >80 units per liter, or platelets <100,000) before delivery. We abstracted diagnosis of PCOS and clinical features of PCOS from the medical record. We compared data with the Chi-square test and used conditional logistic regression to calculate odds ratios (OR), adjusting for age and race, and 95% confidence intervals (CI).

      Results

      We included 435 cases and 435 controls. The median patient age was 32.0 years (interquartile range (IQR) 28.5-35.4) in cases and 32.5 years (IQR 29.2-35.5) in controls. There were differences in race/ethnicity between the two groups (p<0.001); cases were more likely to be Black (17.0%) than controls (12.2%). History of pre-gestational diabetes, chronic hypertension, antiphospholipid antibody syndrome, lupus, and renal disease were all similar between cases and controls (all p≥0.16). The prevalence of infertility was similar between cases (15.2%) and controls (13.6%; p=0.47), and the use of in vitro fertilization also was similar (9.0% in cases and 6.0% in controls; p=0.09). Though women with preeclampsia were more likely to have a history of PCOS (6.9%) than those without preeclampsia (5.1%), this difference was not significant (adjusted OR 1.5, 95% CI 0.8-2.6). There were no differences in the features of PCOS, including menstrual irregularity, hyperandrogenism, and polycystic ovaries between the two groups (all p≥0.22).

      Conclusion

      In this study, a history of PCOS was not significantly associated with the risk of preeclampsia. The association between PCOS and preeclampsia remains inconsistent, and this may be due to heterogeneity within the PCOS population. We did not see a difference in infertility or use of in vitro fertilization between the groups, which may explain why we did not see the expected association between PCOS and preeclampsia. Recent data suggests that the risk of adverse pregnancy outcomes varies with PCOS phenotype, and the hyperandrogenic features of PCOS may drive the association between PCOS and preeclampsia. Further investigation is necessary to determine if there are particular subgroups of PCOS patients who are at increased risk for preeclampsia or if the association is due to infertility.

      Financial Support

      AMM was supported by NIH T32 HD052458 - Boston University Reproductive, Perinatal and Pediatric Epidemiology Training Program. Support also was provided by Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers.

      References

      • Palomba, S., de Wilde, M. A., Falbo, A., Koster, M. P. H., La Sala, G. B., & Fauser, B. C. J. M. (2015). Pregnancy complications in women with polycystic ovary syndrome. Human Reproduction Update, 21(5), 575–592. https://doi.org/10.1093/humupd/dmv029
      • Naver, K., Grinsted, J., Larsen, S., Hedley, P., Jørgensen, F., Christiansen, M., & Nilas, L. (2014). Increased risk of preterm delivery and pre-eclampsia in women with polycystic ovary syndrome and hyperandrogenaemia. BJOG: An International Journal of Obstetrics & Gynaecology, 121(5), 575–581. https://doi.org/10.1111/1471-0528.12558
      • Wan, H. L. T., Hui, P. W., Li, H. W. R., & Ng, E. H. Y. (2015). Obstetric outcomes in women with polycystic ovary syndrome and isolated polycystic ovaries undergoing in vitro fertilization: a retrospective cohort analysis. The Journal of Maternal-Fetal & Neonatal Medicine, 28(4), 475–478. https://doi.org/10.3109/14767058.2014.921673