Early life adversity and polycystic ovary syndrome among North American pregnancy planners.

Abstract

Adverse childhood experiences have been associated with several long-term health outcomes, yet their relation to polycystic ovary syndrome-renamed as polyendocrine metabolic ovarian syndrome in 2026-is understudied. Adverse childhood experiences may influence polycystic ovary syndrome risk via disruption of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes. We used cross-sectional data to evaluate the association between early life adversities and self-reported polycystic ovary syndrome in Pregnancy Study Online, a North American preconception cohort of females aged 21 to 45 years enrolled during 2013 to 2025. At enrollment, participants completed a baseline questionnaire to ascertain sociodemographics, behavioral factors, and medical history. Thirty days after enrollment, participants completed a supplemental questionnaire that included the Behavioral Risk Factor Surveillance System's 8-item adverse childhood experience module and Brief Trauma Questionnaire. Participants reported physician-diagnosed polycystic ovary syndrome on baseline and follow-up questionnaires during preconception. We fit modified Poisson regression models to estimate prevalence ratios and 95% confidence intervals, adjusting for age, race, ethnicity, childhood financial hardship, and highest level of parental education. We used inverse probability weights to account for supplemental questionnaire nonresponse. Among 10,856 participants, 52% and 26% reported 1 to 3 and ≥4 adverse childhood experiences, respectively; 1169 (10.8%) reported a polycystic ovary syndrome diagnosis. Self-reported polycystic ovary syndrome prevalence ranged from 7.4% (no adverse childhood experiences) to 14.2% (≥4 adverse childhood experiences). Weighted and fully adjusted prevalence ratios for 1 to 3 and ≥4 (vs 0) adverse childhood experiences were 1.33 (95% confidence interval, 1.11-1.60) and 1.64 (95% confidence interval, 1.33-2.01), respectively (per 1-adverse childhood experience increase, prevalence ratio=1.08; 95% confidence interval, 1.05-1.11). Specific adverse childhood experiences associated with the largest increase in polycystic ovary syndrome prevalence included sexual abuse (prevalence ratio=1.82; 95% confidence interval, 1.45-2.29), parental interpersonal violence (prevalence ratio=1.68; 95% confidence interval, 1.29-2.17), emotional abuse (prevalence ratio=1.54; 95% confidence interval, 1.28-1.86), physical abuse (prevalence ratio=1.52; 95% confidence interval, 1.21-1.90), household mental illness (prevalence ratio=1.46; 95% confidence interval, 1.21-1.77), and parental separation/divorce (prevalence ratio=1.43; 95% confidence interval, 1.15-1.77). Results based on Brief Trauma Questionnaire‑derived measures of childhood sexual and physical abuse were consistent with those based on adverse childhood experience measures. In this North American cross-sectional study, higher exposure to early life adversities was associated with a higher lifetime prevalence of self-reported physician-diagnosed polycystic ovary syndrome. These findings add to growing evidence that childhood adversities may have lasting effects on gynecologic health and underscore the need for attention to early life stressors in understanding polycystic ovary syndrome.