Systematic review and meta-analysis of birth outcomes in women with polycystic ovary syndrome

Khomami Mahnaz Bahri; Somayeh Hashemi; Soulmaz Shorakae; Cheryce L. Harrison; Terhi T. Piltonen; Chau Thien Tay Daniela Romualdi,; Vanky AyaMousa, Eszter; Helena J. Teede

doi:10.1530/ey.22.2.17

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ESPE Yearbook of Paediatric Endocrinology (2025) 22 2.17 | DOI: 10.1530/ey.22.2.17

ESPEYB25 2. Antenatal and Neonatal Endocrinology PCOS and Birth Outcome (1 abstracts)

2.17. Systematic review and meta-analysis of birth outcomes in women with polycystic ovary syndrome

Mahnaz Bahri Khomami , Somayeh Hashemi , Soulmaz Shorakae , Cheryce L. Harrison , Terhi T. Piltonen , Daniela Romualdi , Chau Thien Tay , AyaMousa , Eszter Vanky & Helena J. Teede

Nature Communications. July 2024; 15:5592. doi: 10.1038/s41467-024-49752-6

Brief Summary: Given the increasingly frequent use of metformin during pregnancies characterised by PCOS as well as other confounders affecting birth outcomes, these investigators sought to determine whether PCOS is an independent risk factor. They also investigated to what extent other maternal characteristics such as BMI and assisted reproductive technology (ART) influence these associations. This systematic review and meta-analysis of 73 studies included 92,881 offspring of women with and without PCOS.

Key findings from this comprehensive study are: 1) Women with PCOS were on average younger but had higher BMI and gestational weight gain. 2) The odds of preterm birth were higher in PCOS (OR: 1.53), consistent across ART and high-quality prospective studies, but attenuated when matched for age and BMI. 3) Mean birthweight was lower in PCOS offspring (MD: −57.87g), and the odds of low birth weight were increased (OR: 1.28). 4) PCOS was associated with higher odds of fetal growth restriction (OR: 1.84), but not small for gestational age (SGA) except in age/BMI-matched subsets, where SGA odds increased (OR: 2.91). 5) The odds of macrosomia and large for gestational age were no different, suggesting a complex interplay between factors promoting both restricted and excessive fetal growth.

This study emphasizes the need for PCOS recognition in pregnancy care due to increased risks in offspring, particularly related to prematurity and impaired fetal growth independent of treatment modalities. Strengths are its comprehensive design and subgroup analyses. These findings informed the 2023 International PCOS Guidelines, emphasizing the importance of considering PCOS as a relevant factor in perinatal risk assessment.