The Risk of Subsequent Miscarriage in Pregnant Women with Prior Polycystic Ovarian Syndrome: A Nationwide Population-Based Study.

Mei-Lien Pan,Li-Ru Chen,Kuo-Hu Chen

doi:10.3390/ijerph18168253

Abstract

Objective: To assess the risk of subsequent miscarriage in pregnant women with a prior diagnosis of polycystic ovarian syndrome (PCOS). Methods: Using a nationwide, population-based database (Taiwan National Health Insurance Research Database) during 1998–2012, the study retrieved 1,000,000 randomly-sampled insured citizens as research subjects. The women with a diagnosis of pre-pregnancy PCOS (n = 13,562) who had chromosomal anomalies, artificial abortion, inconsistent diagnoses, and who were initially diagnosed with PCOS at >45 or <15 year-old were excluded, respectively. The records of gynecologic ultrasonography and/or blood tests were checked to verify the accuracy of the diagnoses of both PCOS and miscarriage (ICD-9 CM codes). After pregnancy, every woman with prior PCOS was age-matched to four women without prior PCOS. Results: Pregnant women with prior PCOS (the case group; n = 1926) and those without prior PCOS (the control group; n = 7704) were compared. The incidence of subsequent miscarriage was much higher in the case group compared with the control group (33.80% vs. 4.09%, p < 0.0001). Logistic regression analysis revealed that the risk of subsequent miscarriage was significantly higher in the case group than the control group (odds ratio [OR] 11.98; 95% CI 10.34–13.87, p < 0.0001), and the result remained similar while adjusted with covariates (adjusted OR 11.97; 95% CI 10.27–13.95, p < 0.0001). In the case group, the patient who used metformin had a lower risk of subsequent miscarriage (adjusted OR 9.53; 95% CI 6.69–13.57) when compared with those who did not receive metformin treatment (adjusted OR 12.13; 95% CI 10.38–14.18). Conclusion: For pregnant women, a pre-pregnancy diagnosis of PCOS is an independent and significant risk factor for subsequent miscarriage. The risk of subsequent miscarriage is reduced by about 1/4 for the PCOS patients who undergo metformin treatment compared with those who do not.

Highlights

For the prevention of incorrect diagnosis by wrong coding, the records of gynecologic ultrasonography and blood tests were checked to verify the accuracy of the diagnoses of polycystic ovarian syndrome (PCOS)
Logistic regression analyses demonstrated that the risk of subsequent miscarriage was much higher in the case group than in the control group, and the result remained similar while adjusted with covariates
For affected women, counselling and management can be arranged in response to potentially physical effects and psychological impacts

Summary

Introduction

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women [1]. According to the Rotterdam criteria [2], it refers to ovarian dysfunction presented with two of the following three features: chronic anovulation, hyperandrogenism, and special morphologic changes of bilateral ovaries [1,2,3,4,5]. PCOS is characterized by the presence of multiple small follicles in both ovaries and/or increased ovarian volume [2,4] (Figure 1). The prevalence of PCOS is estimated to be 12%–20% among women of reproductive-age [1,4,6,7], and affected 4.0/).

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Discussion

Conclusion