Offspring of women with polycystic ovary syndrome (PCOS) may have higher odds of preterm birth, fetal growth restriction, low birth weight, and lower mean birthweight compared with offspring of women without the condition, according to a systematic review and meta-analysis published in Nature Communications.
The analysis included 73 studies with 92,881 offspring of women with and without PCOS, from inception until July 13, 2022. Researchers found that women with PCOS were younger and had higher body mass index (BMI) around conception and greater gestational weight gain compared with women without PCOS.
Researchers reported a 53% to 57% higher odds of preterm birth among the offspring of women with PCOS (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.33-1.75), which remained significant in sensitivity analyses excluding studies of women taking metformin after conception or who conceived after bariatric surgery. There was an 84% higher odds of fetal growth restriction among women with PCOS vs women without the condition (OR, 1.84; 95% CI, 1.09-3.10), a 28% higher odds of low birth weight (OR, 1.28; 95% CI, 1.04-1.59), and a 57.87 g lower mean birthweight (95% CI, -97.57 to -18.17 g).
The associations with preterm birth and low birthweight remained significant in subgroup analyses of post–assisted reproductive technology pregnancies. Higher preterm birth and lower birthweight also remained associated with maternal PCOS in prospective and high-quality studies.
In studies where women with and without PCOS were matched for age or BMI, PCOS was associated with lower mean birthweight and a higher chance of being small for gestational age, but not with fetal growth restriction. Meta-regression did not find confounding effects from variations in maternal age, BMI, or gestational weight gain across studies.
The authors noted that PCOS is poorly captured in pregnancy and not widely recognized as a risk factor for adverse birth outcomes. They said the report's findings emphasize that PCOS status should be identified during pregnancy to provide appropriate monitoring and support.
The authors used the Newcastle-Ottawa Scale to assess the risk of bias, with 82% of studies having a moderate to high risk, mainly due to confounding bias (53.4%) and selection bias (38.35%). The certainty of evidence for the outcomes was very low to moderate, mainly due to a high risk of bias, serious inconsistency, and serious indirectness. No publication bias was found for any of the outcomes.
Ethics declarations can be found in the study.