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Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England

BACKGROUND: Polycystic ovary syndrome (PCOS) affects up to one in five women of childbearing age. Observational studies assessing the association between maternal PCOS and adverse obstetric outcomes have reported varying results, depending on patient population, diagnostic criteria for PCOS and cova...

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Autores principales: Subramanian, Anuradhaa, Lee, Siang Ing, Phillips, Katherine, Toulis, Konstantinos A., Kempegowda, Punith, O’Reilly, Michael W., Adderley, Nicola J., Thangaratinam, Shakila, Arlt, Wiebke, Nirantharakumar, Krishnarajah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9425992/
https://www.ncbi.nlm.nih.gov/pubmed/36038914
http://dx.doi.org/10.1186/s12916-022-02473-3
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author Subramanian, Anuradhaa
Lee, Siang Ing
Phillips, Katherine
Toulis, Konstantinos A.
Kempegowda, Punith
O’Reilly, Michael W.
Adderley, Nicola J.
Thangaratinam, Shakila
Arlt, Wiebke
Nirantharakumar, Krishnarajah
author_facet Subramanian, Anuradhaa
Lee, Siang Ing
Phillips, Katherine
Toulis, Konstantinos A.
Kempegowda, Punith
O’Reilly, Michael W.
Adderley, Nicola J.
Thangaratinam, Shakila
Arlt, Wiebke
Nirantharakumar, Krishnarajah
author_sort Subramanian, Anuradhaa
collection PubMed
description BACKGROUND: Polycystic ovary syndrome (PCOS) affects up to one in five women of childbearing age. Observational studies assessing the association between maternal PCOS and adverse obstetric outcomes have reported varying results, depending on patient population, diagnostic criteria for PCOS and covariates accounted for in their analyses. We aimed to assess the risk of obstetric outcomes among a population-based representative cohort of women with PCOS compared to an age-matched cohort of women without PCOS. METHODS: A retrospective cohort study was conducted of pregnancies of women in England aged 15–49 years identified from the Clinical Practice Research Datalink (CPRD) GOLD pregnancy register and linked Hospital Episodes Statistic (HES) data between March 1997 and March 2020. Pregnancies from the register that had a linked HES delivery record were included. Linked CPRD primary care data was used to ascertain maternal PCOS exposure prior to pregnancy. To improve detection of PCOS, in addition to PCOS diagnostic codes, codes for (1) polycystic ovaries or (2) hyperandrogenism and anovulation together were also considered. Sensitivity analysis was limited to only pregnant women with a diagnostic code for PCOS. Primary outcomes ascertained from linked HES data were (1) preterm delivery (gestation < 37 weeks), (2) mode of delivery, (3) high (> 4000 g) or low birthweight (< 2500 g) and (4) stillbirth. Secondary outcomes were (1) very preterm delivery (< 32 weeks), (2) extremely preterm delivery (< 28 weeks), (3) small and (4) large for gestational age. Conditional logistic regression models were performed adjusting for age, ethnicity, deprivation, dysglycaemia, hypertension, thyroid disorders, number of babies born at index pregnancy, and pre-gravid BMI. Multiple imputation was performed for missing outcome data. RESULTS: 27,586 deliveries with maternal PCOS were matched for age (± 1 year) to 110,344 deliveries without PCOS. In the fully adjusted models, maternal PCOS was associated with an increased risk of (1) preterm birth [aOR: 1.11 (95% CI 1.06–1.17)], and (2) emergency caesarean, elective caesarean and instrumental vaginal compared to spontaneous delivery [aOR: 1.10 (1.05–1.15), 1.07 (1.03–1.12) and 1.04 (1.00–1.09), respectively]. There was absence of association with low birthweight, high birthweight and stillbirth. In the sensitivity analysis, the association with preterm birth [aOR: 1.31 (95% CI 1.13–1.52)], emergency caesarean [aOR: 1.15 (95% CI 1.02–1.30)], and elective caesarean [aOR: 1.03 (95% CI 1.02–1.03)] remained. While there was no significant association with any of the secondary outcomes in the primary analysis, in the sensitivity analysis maternal PCOS was associated with increased risk of extremely preterm delivery [aOR: 1.86 (95% CI 1.31–2.65)], and lower risk of small for gestational age babies [aOR: 0.74 (95% CI 0.59–0.94)]. CONCLUSIONS: Maternal PCOS was associated with increased risk of preterm and caesarean delivery. Association with low birthweight may be largely mediated by lower gestational age at birth. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-022-02473-3.
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spelling pubmed-94259922022-08-31 Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England Subramanian, Anuradhaa Lee, Siang Ing Phillips, Katherine Toulis, Konstantinos A. Kempegowda, Punith O’Reilly, Michael W. Adderley, Nicola J. Thangaratinam, Shakila Arlt, Wiebke Nirantharakumar, Krishnarajah BMC Med Research Article BACKGROUND: Polycystic ovary syndrome (PCOS) affects up to one in five women of childbearing age. Observational studies assessing the association between maternal PCOS and adverse obstetric outcomes have reported varying results, depending on patient population, diagnostic criteria for PCOS and covariates accounted for in their analyses. We aimed to assess the risk of obstetric outcomes among a population-based representative cohort of women with PCOS compared to an age-matched cohort of women without PCOS. METHODS: A retrospective cohort study was conducted of pregnancies of women in England aged 15–49 years identified from the Clinical Practice Research Datalink (CPRD) GOLD pregnancy register and linked Hospital Episodes Statistic (HES) data between March 1997 and March 2020. Pregnancies from the register that had a linked HES delivery record were included. Linked CPRD primary care data was used to ascertain maternal PCOS exposure prior to pregnancy. To improve detection of PCOS, in addition to PCOS diagnostic codes, codes for (1) polycystic ovaries or (2) hyperandrogenism and anovulation together were also considered. Sensitivity analysis was limited to only pregnant women with a diagnostic code for PCOS. Primary outcomes ascertained from linked HES data were (1) preterm delivery (gestation < 37 weeks), (2) mode of delivery, (3) high (> 4000 g) or low birthweight (< 2500 g) and (4) stillbirth. Secondary outcomes were (1) very preterm delivery (< 32 weeks), (2) extremely preterm delivery (< 28 weeks), (3) small and (4) large for gestational age. Conditional logistic regression models were performed adjusting for age, ethnicity, deprivation, dysglycaemia, hypertension, thyroid disorders, number of babies born at index pregnancy, and pre-gravid BMI. Multiple imputation was performed for missing outcome data. RESULTS: 27,586 deliveries with maternal PCOS were matched for age (± 1 year) to 110,344 deliveries without PCOS. In the fully adjusted models, maternal PCOS was associated with an increased risk of (1) preterm birth [aOR: 1.11 (95% CI 1.06–1.17)], and (2) emergency caesarean, elective caesarean and instrumental vaginal compared to spontaneous delivery [aOR: 1.10 (1.05–1.15), 1.07 (1.03–1.12) and 1.04 (1.00–1.09), respectively]. There was absence of association with low birthweight, high birthweight and stillbirth. In the sensitivity analysis, the association with preterm birth [aOR: 1.31 (95% CI 1.13–1.52)], emergency caesarean [aOR: 1.15 (95% CI 1.02–1.30)], and elective caesarean [aOR: 1.03 (95% CI 1.02–1.03)] remained. While there was no significant association with any of the secondary outcomes in the primary analysis, in the sensitivity analysis maternal PCOS was associated with increased risk of extremely preterm delivery [aOR: 1.86 (95% CI 1.31–2.65)], and lower risk of small for gestational age babies [aOR: 0.74 (95% CI 0.59–0.94)]. CONCLUSIONS: Maternal PCOS was associated with increased risk of preterm and caesarean delivery. Association with low birthweight may be largely mediated by lower gestational age at birth. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-022-02473-3. BioMed Central 2022-08-30 /pmc/articles/PMC9425992/ /pubmed/36038914 http://dx.doi.org/10.1186/s12916-022-02473-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Subramanian, Anuradhaa
Lee, Siang Ing
Phillips, Katherine
Toulis, Konstantinos A.
Kempegowda, Punith
O’Reilly, Michael W.
Adderley, Nicola J.
Thangaratinam, Shakila
Arlt, Wiebke
Nirantharakumar, Krishnarajah
Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England
title Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England
title_full Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England
title_fullStr Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England
title_full_unstemmed Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England
title_short Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England
title_sort polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in england
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9425992/
https://www.ncbi.nlm.nih.gov/pubmed/36038914
http://dx.doi.org/10.1186/s12916-022-02473-3
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