Maternal and Neonatal Complications in Pregnant Women With Polyendocrine Metabolic Ovarian Syndrome: A Nested Prospective Cohort Study.

Abstract

To investigate associations between polyendocrine metabolic ovarian syndrome (PMOS) and maternal and neonatal outcomes and explore interactions with BMI and ethnicity. This was a prospective nested cohort study of pregnant women with risk factors for hyperglycemia enrolled in an international, multicenter, randomized controlled trial of gestational diabetes mellitus (GDM) treatment. We compared baseline and pregnancy characteristics, evaluated adverse maternal and neonatal outcomes by PMOS status, and used multivariable regression models to evaluate factors (maternal age, baseline BMI, ethnicity, parity, smoking, and level of education) that independently affected maternal and neonatal outcomes. Of 3,645 participants, PMOS prevalence was 17.1% (95% CI 15.9, 18.3). At booking visits, women with PCOS (vs. without) were younger (30.6 ± 4.7 vs. 31.3 ± 5.2 years; P < 0.001) and had higher median (interquartile range) BMI at baseline (29.8 [25.1-35.7] vs. 28.1 [24.1-33.9] kg/m2; P < 0.001), and more were primigravid (30.2% [n = 188] vs. 25.7% [n = 778]; P = 0.022). There were positive associations between PCOS and early GDM, with an adjusted odds ratio (aOR) of 1.37 (95% CI 1.10, 1.72), a composite of adverse neonatal outcomes (aOR 1.28 [95% CI 1.04, 1.58]), admission to a neonatal special care nursery or neonatal intensive care unit (aOR 1.32 [95% CI 1.05-1.65]), and negative associations between PMOS and gestational age at birth (-1.60 days [95% CI -2.82, -0.39]) and birth length (-0.33 cm [95% CI -0.61, -0.04]). No interactions were found with baseline BMI and ethnicity. PMOS was associated with higher odds of early GDM, and neonatal outcomes were poorer on adjusted analyses, highlighting independent pregnancy risks in PMOS and the need to identify, monitor, and treat women with PMOS to mitigate risks of adverse pregnancy outcomes.