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Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6309 (Published 13 October 2011) Cite this as: BMJ 2011;343:d6309
  1. Nathalie Roos, resident in obstetrics and gynaecology12,
  2. Helle Kieler, associate professor and senior consultant in obstetrics and gynaecology2,
  3. Lena Sahlin, associate professor and senior researcher3,
  4. Gunvor Ekman-Ordeberg, professor and senior consultant in obstetrics and gynaecology1,
  5. Henrik Falconer, PhD and senior consultant in obstetrics and gynaecology1,
  6. Olof Stephansson, associate professor and senior consultant in obstetrics and gynaecology2
  1. 1Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, H2:01, SE-171 76 Stockholm, Sweden
  2. 2Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Women’s and Children’s Health, Division for Reproductive Endocrinology, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to: N Roos nathalie.roos{at}karolinska.se
  • Accepted 11 September 2011

Abstract

Objective To study the risk of adverse pregnancy outcomes in women with polycystic ovary syndrome, taking into account maternal characteristics and assisted reproductive technology.

Design Population based cohort study.

Setting Singleton births registered in the Swedish medical birth register between 1995 and 2007.

Participants By linkage with the Swedish patient register, 3787 births among women with a diagnosis of polycystic ovary syndrome and 1 191 336 births among women without such a diagnosis.

Main outcome measures Risk of adverse pregnancy outcomes (gestational diabetes, pre-eclampsia, preterm birth, stillbirth, neonatal death, low Apgar score (<7 at five minutes), meconium aspiration, large for gestational age, macrosomia, small for gestational age), adjusted for maternal characteristics (body mass index, age), socioeconomic factors (educational level, and cohabitating with infant’s father), and assisted reproductive technology.

Results Women with polycystic ovary syndrome were more often obese and more commonly used assisted reproductive technology than women without such a diagnosis (60.6% v 34.8% and 13.7% v 1.5%). Polycystic ovary syndrome was strongly associated with pre-eclampsia (adjusted odds ratio 1.45, 95% confidence interval 1.24 to 1.69) and very preterm birth (2.21, 1.69 to 2.90) and the risk of gestational diabetes was more than doubled (2.32, 1.88 to 2.88). Infants born to mothers with polycystic ovary syndrome were more prone to be large for gestational age (1.39, 1.19 to 1.62) and were at increased risk of meconium aspiration (2.02, 1.13 to 3.61) and having a low Apgar score (<7) at five minutes (1.41, 1.09 to 1.83).

Conclusions Women with polycystic ovary syndrome are at increased risk of adverse pregnancy and birth outcomes that cannot be explained by assisted reproductive technology. These women may need increased surveillance during pregnancy and parturition.

Footnotes

  • Contributors: NR, HK, and OS designed the study. NR did the statistical analyses, reviewed the research, and wrote the introduction, methods, results, discussion, and conclusions. LS, GE-O, HF, HK, and OS helped write and review the methods, results, discussion, and conclusions. OS assisted in the statistical analyses. GE-O, LS, and OS are the guarantors.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: that this study received financial support from the Swedish Research Council (projects 73X-20137 (LS) 73X-14612 (GEO)) and the board of postgraduate education at Karolinska Institutet, Stockholm, Sweden (Karolinska Institutet Doctoral Student Financing Funds (KID)) (NR) for the submitted work, and that financial support was also provided through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet (LS); no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Karolinska Institute’s local ethics committee.

  • Data sharing: No additional data available.

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