Abstract
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility and may be associated with adverse pregnancy and neonatal outcomes. However, it is difficult to establish how much of this risk is due to PCOS and how much to obesity. This study aimed to determine the effect of PCOS upon fertility, pregnancy, and neonatal outcomes. Data were extracted from the Clinical Practice Research Datalink (CPRD), a longitudinal anonymized primary care research database in the United Kingdom. Patients with a diagnosis of PCOS were matched to controls (1:2) by age (±1 y), body mass index (± 3 U), and CPRD practice. Standardized fertility ratios before and after diagnosis (index date) were calculated. Rates of miscarriage, pre-eclampsia, gestational diabetes, premature delivery, delivery method, and neonatal outcomes were compared. Nine thousand sixty-eight women with PCOS matched study criteria. Prior to index date the standardized fertility ratio for patients with PCOS was 0.80 (95% confidence interval, 0.77–0.83); following index date it was 1.16 (1.12–1.20). The adjusted odds ratios (95% CI) for miscarriage (1.70; 1.56–1.84), pre-eclampsia (1.32; 1.16–1.49), gestational diabetes (1.41; 1.2–1.66), and premature delivery (1.25; 1.1–1.43) were all increased compared with controls. Of PCOS births, 27.7% were by Caesarean section compared with 23.7% of controls (1.13; 1.05–1.21). Infants born to mothers with PCOS had an increased risk of neonatal jaundice (1.20; 1.03–1.39) and respiratory complications (1.20; 1.06–1.37). PCOS is associated with subfertility but fertility rates are restored to those of the background population following diagnosis. Pregnancy complications and adverse neonatal outcomes are more prevalent for women with PCOS independently of obesity.
Highlights
Context: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility and may be associated with adverse pregnancy and neonatal outcomes
The adjusted odds ratios for miscarriage (1.70; 1.56 –1.84), pre-eclampsia (1.32; 1.16 –1.49), gestational diabetes (1.41; 1.2–1.66), and premature delivery (1.25; 1.1–1.43) were all increased compared with controls
PCOS is associated with subfertility but fertility rates are restored to those of the background population following diagnosis
Summary
The study used a retrospective cohort design using data from the Clinical Practice Research Database (CPRD), a longitudinal, anonymized research database derived from more than 700 primary-care practices in the United Kingdom [10]. Approximately 60% of those practices are linked to other English data sources including the Hospital Episode Statistics (HES) dataset. This provides data on all inpatient and outpatient contacts occurring within National Health Trusts. Patient selection and matching of controls Women age 15– 44 years with a diagnosis of PCOS defined by the Read code classification (Supplemental Table 1) or 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) classification (E28.2) between 2000 and 2012 were selected and defined as cases. The OR of caesarean delivery for PCOS was 1.13 (1.05–1.21) after adjustment for other covariates including pre-eclampsia (2.54; 2.14 –3.00) and GDM (2.63; 2.25–3.06). After adjustment for age, BMI, GDM, pre-eclampsia, and premature delivery, the respective means were 3.7 vs 3.5 days (P Ͻ .001).
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