Pregnant women with Polycystic ovarian syndrome and Diabetes have Adverse Pregnancy Outcomes: Study

A recent study found that
pre-existing diabetes can have adverse outcomes during pregnancy when
associated with polycystic ovarian syndrome. The study results were published
in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

Polycystic ovarian syndrome
(PCOS) is the most prevalent endocrine disorder among reproductive-age women.
It can result in various reproductive and metabolic consequences. Women with
PCOS have high complications during pregnancy and perinatal period. Previous
literature showed the association between preexisting diabetes and increased
adverse outcomes. Increased rates of preeclampsia, cesarean delivery, operative
delivery, and spontaneous preterm birth have been observed in women with preexisting
diabetes mellitus (DM). Due to common pathogenesis, PCOS is often found to
coexist with type 2 diabetes. However, there is ambiguity on the association between
pregestational DM and pregnancy outcomes in PCOS. Hence, researchers conducted a
study to establish the association between the two.

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A retrospective population-based
study was carried out by using data from the Healthcare Cost and Utilization
Project Nationwide Inpatient Sample (HCUP-NIS) database. Using the ICD-9, all
deliveries between 2004 and 2014 were studied. During this period about 14,882
women had a diagnosis of PCOS, of which 673 (4.7%) had a diagnosis of
pregestational diabetes. Demographics were compared using the Chi-squared tests.
Multivariate logistic regression analysis was performed to calculate unadjusted
and adjusted odds ratios (aORs) and corresponding 95% confidence intervals
(CI), controlling for confounding effects.

Findings:

  • Women with PCOS and pre-gestational DM were more
    likely to develop pregnancy complications.
  • After controlling for confounding demographics,
    the pregnancy outcomes were found to be pregnancy-induced hypertension,
    preeclampsia, preeclampsia or eclampsia superimposed on pre-existing
    hypertension, and placenta previa.
  • Women with PCOS who had pregestational diabetes
    were at increased risk of preterm delivery and delivery by cesarean section.
  • No difference was found in the rate of women between
    the two groups who gave birth to small for gestational age (SGA) infants, the
    rate of intrauterine fetal demises (IUFD), and the rate of infants with
    congenital anomalies.
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Thus, the study concluded that pregestational
diabetes in women with PCOS increased the risk of pregnancy complications like pregnancy-induced
hypertension, preeclampsia, preeclampsia or eclampsia superimposed on
pre-existing hypertension, and placenta previa. The researchers highlight the
importance of considering the effect of preexisting diabetes in managing
pregnant women with PCOS to optimize perinatal care.

Further reading: Association
between pre-gestational diabetes in women with polycystic ovary syndrome and
adverse obstetric outcomes. Doi: https://doi.org/10.1016/j.ejogrb.2024.11.021.

Take home points:

  • Women with PCOS and pre-gestational diabetes
    develop adverse pregnancy outcomes.
  • These include pregnancy-induced hypertension,
    preeclampsia, preeclampsia or eclampsia superimposed on pre-existing
    hypertension, placenta previa, preterm delivery, and delivery by cesarean
    section.
  • Hence, the effect of pre-existing DM and PCOS on
    pregnancy outcomes should be considered when counseling and planning care for
    pregnant women for improved outcomes.
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