Higher risk of adverse outcomes among pregnant women with PCOS

Key clinical point: The low-grade chronic inflammation in polycystic ovary syndrome (PCOS) persists during pregnancy and was associated with an increased risk for adverse pregnancy outcomes.

Major finding: In pregnant women with PCOS, higher white blood cell counts (hazard ratio, 1.52), and higher levels of C-reactive protein (HR, 1.19) and ferritin (HR, 1.12), are associated with higher rates of adverse obstetric or neonatal outcomes (32%), compared with women without PCOS (11.3%).

Data source: A prospective study of 150 pregnant women with PCOS and 150 healthy pregnant controls matched by age and body mass index, recruited between February 2003 and April 2012 at the "Pugliese-Ciaccio" Hospital of Catanzaro in Italy.

Disclosures: No funding source was noted. The authors reported no disclosures.



The low-grade chronic inflammation that accompanies polycystic ovary syndrome increases during pregnancy, thereby increasing the risk of adverse pregnancy outcomes, according to a recent study of 300 women.

The results "confirmed higher markers of chronic low-grade inflammation in PCOS patients," and suggested "that pregnancy enhances the chronic low-grade inflammation typical of the syndrome," Dr. Stefano Palomba of the Istituto di Ricovero e Cura a Carattere Scientifico in Reggio Emilia, Italy, and his associates reported online May 29 in the Journal of Clinical Endocrinology & Metabolism (doi: 10.1210/jc.2014-1214).

The researchers recruited 150 women with PCOS and 150 healthy controls, matched by age and body mass index, who were pregnant for the first time and at less than 7 weeks’ gestation when they enrolled in the study between February 2003 and April 2012. Ovulation was stimulated by using gonadotropins or clomiphene citrate in 83 of the 150 women with PCOS to induce pregnancy; 118 of the PCOS patients had clinical or biochemical hyperandrogenism, or both.

At the start of the study, and then at 12, 20, and 32 weeks’ gestation, the women underwent a standard clinical assessment, received ultrasounds, and provided serum for white blood cell (WBC) counts and measurements of C-reactive protein (CRP) and ferritin. Each woman’s pregnancy and perinatal outcomes were classified as normal or pathological. Among the adverse (pathological) outcomes were miscarriages, gestational diabetes, preterm birth, pregnancy-induced hypertension, and being large or small for gestational age.

Nearly a third (32%) of the women with PCOS had adverse outcomes, compared with 11.3% of women without PCOS. The researchers identified in the PCOS patients an increased risk for adverse obstetric/neonatal outcomes for WBC (for 1 standard-deviation increase in WBC distribution, the hazard ratio was 1.52), as well as CRP and ferritin (for 1 SD increase in the distributions of CRP and ferritin, HR was 1.19 and 1.12, respectively). Yet in the women without PCOS, only an increased CRP (HR, 1.21) was associated with adverse outcomes.

No funding source was noted. The authors reported no disclosures.

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