Abstract
Research questionDo women with polycystic ovary syndrome (PCOS) have higher testosterone levels during pregnancy and what role does high testosterone play in the development of obstetric complications? DesignRetrospective cohort study from Uppsala University Hospital, Sweden. The study population consisted of women with PCOS (n = 159) and a comparison group of women without PCOS matched for body mass index (n = 320). Plasma testosterone levels were measured in the early second trimester by liquid chromatography with tandem mass spectrometry, and women with PCOS were grouped into tertiles according to their testosterone levels. Possible associations with obstetric complications, maternal metabolic factors and offspring birth weight were explored by multivariable logistic and linear regression models. ResultsCompared with women who do not have PCOS, women with PCOS had higher total testosterone (median 1.94, interquartile range [IQR] 1.21–2.64 versus 1.41, IQR 0.89–1.97; P < 0.001), and free androgen index (median 0.25, IQR 0.15–0.36 versus 0.18, IQR 0.11–0.28; P < 0.001). Women with PCOS who had the highest levels of testosterone had increased risk for preeclampsia, even when adjusted for age, parity, country of birth and smoking (adjusted OR 6.16, 95% CI 1.82 to 20.91). No association was found between high testosterone in women with PCOS and other obstetric complications. ConclusionsWomen with PCOS have higher levels of total testosterone and free androgen index during pregnancy than women without PCOS matched for body mass index. Preliminary evidence shows that women with PCOS and the highest maternal testosterone levels in early second trimester had the highest risk of developing preeclampsia. This finding, however, is driven by a limited number of cases and should be interpreted with caution.
Highlights
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of childbearing age, with a prevalence between 5–13% depending on the population studied and definition used (Bozdag et al, 2016)
Women with polycystic ovary syndrome (PCOS) who had the highest levels of testosterone had increased risk for preeclampsia, even when adjusted for age, parity, country of birth and smoking
Preliminary evidence shows that women with PCOS and the highest maternal testosterone levels in early second trimester had the highest risk of developing preeclampsia
Summary
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of childbearing age, with a prevalence between 5–13% depending on the population studied and definition used (Bozdag et al, 2016). The syndrome is characterized by hyperandrogenism, anovulation and polycystic ovaries (Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome [PCOS], 2004), and the polycystic ovarian morphology is associated with high levels of antiMüllerian hormone (AMH) (Indran et al, 2018). Infertility is one of the most common problems in women with PCOS, but with assisted reproductive technology, longitudinal studies suggest overall high fecundity (Persson et al, 2019). High levels of AMH, in contrast, seem protective of gestational hypertension, and unrelated to other obstetric and neonatal complications (Shand et al, 2014; Valdimarsdottir et al, 2019)
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