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Considerations and Challenges for Pregnancy in Polycystic Ovary Syndrome

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Polycystic Ovary Syndrome

Abstract

Although the relationship of polycystic ovary syndrome (PCOS) with subfertility is well established, postconception implications of PCOS on pregnancy remain debated. Increased risk for miscarriage, gestational diabetes, hypertensive diseases of pregnancy, intrauterine growth abnormalities, perinatal mortality, and operative delivery are described in women with PCOS. Unfortunately, our understanding of definitive causal relationship to the observed associations is limited by the heterogeneity of the syndrome as well as by a paucity of large randomized controlled trials studying pregnancy in PCOS.

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References

  1. Boomsma CM, Fauser BC, Macklon NS. Pregnancy complications in women with polycystic ovary syndrome. Semin Reprod Med. 2008;26(1):72–84 [Review].

    Article  PubMed  Google Scholar 

  2. Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts KA, Nestler JE. Effects of metformin on early pregnancy loss in polycystic ovary syndrome. JCEM. 2002;87(2):524–9.

    PubMed  CAS  Google Scholar 

  3. Sagle M, Bishop K, Ridley N, Alexander FM, Michel M, Bonney RC, et al. Recurrent early miscarriage and polycystic ovaries. BMJ. 1988;297(6655):1027–8.

    Article  PubMed  CAS  Google Scholar 

  4. Rai R, Backos M, Rushworth F, Regan L. Polycystic ovaries and recurrent miscarriage—a reappraisal. Hum Reprod. 2000;15(3):612–5.

    Article  PubMed  CAS  Google Scholar 

  5. Cocksedge KA, Li TC, Saravelos SH, Metwally M. A reappraisal of the role of polycystic ovary syndrome in recurrent miscarriage. Reprod Biomed Online. 2008;17(1):151–60.

    Article  PubMed  Google Scholar 

  6. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25.

    Article  Google Scholar 

  7. Hamilton-Fairley D, Kiddy D, Watson H, Paterson 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 Gynaecol. 1992;99(2):128–31.

    Article  PubMed  CAS  Google Scholar 

  8. Al-Azemi M, Omu FE, Omu AE. The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet. 2004;270(4):205–10.

    Article  PubMed  Google Scholar 

  9. Wang JX, Davies MJ, Norman RJ. Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment. Hum Reprod. 2001;16(12): 2606–9.

    Article  PubMed  CAS  Google Scholar 

  10. Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011;7, CD007506.

    PubMed  Google Scholar 

  11. Glueck CJ, Wang P, Kobayashi S, Phillips H, Sieve-Smith L. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril. 2002;77(3):520–5.

    Article  PubMed  CAS  Google Scholar 

  12. Craig LB, Ke RW, Kutteh WH. Increased prevalence of insulin resistance in women with a history of recurrent pregnancy loss. Fertil Steril. 2002;78(3):487–90.

    Article  PubMed  Google Scholar 

  13. Jakubowicz DJ, Essah PA, Seppala M, Jakubowicz S, Baillargeon JP, Koistinen R, et al. Reduced serum glycodelin and insulin-like growth factor-binding protein-1 in women with polycystic ovary syndrome during first trimester of pregnancy. J Clin Endocrinol Metab. 2004;89(2):833–9.

    Article  PubMed  CAS  Google Scholar 

  14. Glueck CJ, Wang P, Fontaine RN, Sieve-Smith L, Tracy T, Moore SK. Plasminogen activator inhibitor activity: an independent risk factor for the high miscarriage rate during pregnancy in women with polycystic ovary syndrome. Metabolism. 1999;48(12):1589–95.

    Article  PubMed  CAS  Google Scholar 

  15. Glueck CJ, Awadalla SG, Phillips H, Cameron D, Wang P, Fontaine RN. Polycystic ovary syndrome, infertility, familial thrombophilia, familial hypofibrinolysis, recurrent loss of in vitro fertilized embryos, and miscarriage. Fertil Steril. 2000;74(2):394–7.

    Article  PubMed  CAS  Google Scholar 

  16. Okon MA, Laird SM, Tuckerman EM, Li TC. Serum androgen levels in women who have recurrent miscarriages and their correlation with markers of endometrial function. Fertil Steril. 1998;69(4):682–90.

    Article  PubMed  CAS  Google Scholar 

  17. van Wely M, Bayram N, van der Veen F, Bossuyt PM. Predicting ongoing pregnancy following ovulation induction with recombinant FSH in women with polycystic ovary syndrome. Hum Reprod. 2005;20(7):1827–32.

    Article  PubMed  Google Scholar 

  18. Blank SK, McCartney CR, Marshall JC. The origins and sequelae of abnormal neuroendocrine function in polycystic ovary syndrome. Hum Reprod Update. 2006;12(4):351–61.

    Article  PubMed  CAS  Google Scholar 

  19. Clifford K, Rai R, Watson H, Regan L. An informative protocol for the investigation of recurrent miscarriage: preliminary experience of 500 consecutive cases. Hum Reprod. 1994;9(7):1328–32.

    PubMed  CAS  Google Scholar 

  20. Li TC, Makris M, Tomsu M, Tuckerman E, Laird S. Recurrent miscarriage: aetiology, management and prognosis. Hum Reprod Update. 2002;8(5):463–81.

    Article  PubMed  CAS  Google Scholar 

  21. Clifford K, Rai R, Watson H, Franks S, Regan L. Does suppressing luteinising hormone secretion reduce the miscarriage rate? Results of a randomised controlled trial. BMJ. 1996;312(7045):1508–11.

    Article  PubMed  CAS  Google Scholar 

  22. Bayram N, van Wely M, Kaaijk EM, Bossuyt PM, van der Veen F. Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial. BMJ. 2004;328(7433):192.

    Article  PubMed  CAS  Google Scholar 

  23. Palomba S, Orio Jr F, Nardo LG, Falbo A, Russo T, Corea D, et al. Metformin administration versus laparoscopic ovarian diathermy in clomiphene citrate-resistant women with polycystic ovary syndrome: a prospective parallel randomized double-blind placebo-controlled trial. J Clin Endocrinol Metab. 2004;89(10):4801–9.

    Article  PubMed  CAS  Google Scholar 

  24. Palomba S, Orio Jr F, Falbo A, Manguso F, Russo T, Cascella T, et al. Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90(7):4068–74 [Clinical Trial Randomized Controlled Trial].

    Article  PubMed  CAS  Google Scholar 

  25. Usadi RS, Legro RS. Reproductive impact of polycystic ovary syndrome. Curr Opin Endocrinol Diabetes Obes. 2012;19(6):505–11.

    Article  PubMed  CAS  Google Scholar 

  26. Palomba S, Falbo A, Orio Jr F, 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.

    Article  PubMed  CAS  Google Scholar 

  27. Gestational diabetes. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2001;98:525–38.

    Google Scholar 

  28. Moore TR, Catalano P. Diabetes in pregnancy. In: Creasy RK, Resnick R, Iams JD, editors. Creasy and Resnik’s maternal-fetal medicine: principles and practice. 6th ed. Philadelphia: Saunders Elsevier; 2009. p. 953–93.

    Chapter  Google Scholar 

  29. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24): 2477–86.

    Article  PubMed  CAS  Google Scholar 

  30. Legro R, Castracane V, Kauffman R. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Surv. 2004;59:141–54.

    Article  PubMed  Google Scholar 

  31. Dunaif A. Hyperandrogenic anovulation (PCOS): a unique disorder of insulin action associated with an increased risk of non-insulin-dependent diabetes mellitus. Am J Med. 1995;98(1A):33S–9.

    Article  PubMed  CAS  Google Scholar 

  32. Ryan EA, Enns L. Role of gestational hormones in the induction of insulin resistance. J Clin Endocrinol Metab. 1988;67(2):341–7.

    Article  PubMed  CAS  Google Scholar 

  33. Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12(6):673–83 [Meta-Analysis Research Support, Non-U.S. Gov’t Review].

    Article  PubMed  CAS  Google Scholar 

  34. Holte J, Gennarelli G, Wide L, Lithell H, Berne C. High prevalence of polycystic ovaries and associated clinical, endocrine, and metabolic features in women with previous gestational diabetes mellitus. J Clin Endocrinol Metab. 1998;83(4):1143–50.

    Article  PubMed  CAS  Google Scholar 

  35. Ghazeeri GS, Nassar AH, Younes Z, Awwad JT. 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 [Review].

    Article  PubMed  Google Scholar 

  36. Torloni MR, Betran AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev. 2009;10(2):194–203.

    Article  PubMed  CAS  Google Scholar 

  37. Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2010(1):CD003053.

    Google Scholar 

  38. Vanky E, Stridsklev S, Heimstad R, Romundstad P, Skogoy 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 [Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov’t].

    Article  PubMed  CAS  Google Scholar 

  39. Glueck CJ, Goldenberg N, Pranikoff J, Khan Z, Padda J, Wang P. Effects of metformin-diet intervention before and throughout pregnancy on obstetric and neonatal outcomes in patients with polycystic ovary syndrome. Curr Med Res Opin. 2013;29(1):55–62.

    Article  PubMed  CAS  Google Scholar 

  40. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358(19):2003–15.

    Article  PubMed  CAS  Google Scholar 

  41. National High Blood Pressure E. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183(1):S1–22.

    Article  Google Scholar 

  42. Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No. 33. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2002;99:159–67.

    Google Scholar 

  43. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005;330(7491):565 [Review].

    Article  PubMed  Google Scholar 

  44. Nohr EA, Bech BH, Davies MJ, Frydenberg M, Henriksen TB, Olsen J. Prepregnancy obesity and fetal death: a study within the Danish National Birth Cohort. Obstet Gynecol. 2005;106(2):250–9.

    Article  PubMed  Google Scholar 

  45. Roos N, Keiler H, Sahlin L, Ekman-Ordeberg G, Falconer H, Stephansson O. Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population basedcohort study. BMJ. 2011;343:d6309.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, 208063, New Haven, CT, 06520, USA

    Christina Shih-chi Han M.D.

  2. Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, University of Brown, 120 Dudley Street, Phipps 228, Providence, RI, 02960, USA

    Erika F. Werner M.D., M.S.

Authors
  1. Christina Shih-chi Han M.D.
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  2. Erika F. Werner M.D., M.S.
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Correspondence to Christina Shih-chi Han M.D. .

Editor information

Editors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine Program for Polycystic Ovary Syndrome Yale Reproductive Endocrinology, New Haven, Connecticut, USA

    Lubna Pal

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Han, C.Sc., Werner, E.F. (2014). Considerations and Challenges for Pregnancy in Polycystic Ovary Syndrome. In: Pal, L. (eds) Polycystic Ovary Syndrome. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8394-6_15

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  • DOI: https://doi.org/10.1007/978-1-4614-8394-6_15

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8393-9

  • Online ISBN: 978-1-4614-8394-6

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