Polycystic ovary syndrome (PCOS) or Stein-Leventhal syndrome, is an endocrine disorder in women that has varying degrees of early and long-term reproductive and metabolic risk. PCOS is the most common female endocrinopathy during childbearing age with around 6%-10% of the population afflicted. (Palomba et al. , 2015). While many that have been diagnosed with PCOS have ovarian cyst, it is not the symptom required for diagnoses.
To be diagnosed with PCOS one must be afflicted with at least two of three main symptoms, high androgen levels, lack of ovulation leading to absence or irregular menstrual cycles, and/or at least 12 or more ovarian cyst. (Tehrani 2015) Those with PCOS are at a higher risk of endometrial cancer, cardiovascular issues, type-2 diabetes, mood disorders, and fertility issues. PCOS is associated with causing weight gain, but the severity of PCOS is effected by obesity. It is not fully known what the cause of PCOS is, but it is believed that genetics and environmental may play a factor in its development.
Typically, women who have PCOS, also have a close blood relative who is effected with PCOS. Women pregnant with polycystic ovary syndrome are subject to higher risk of gestational diabetes, hypertension, preeclampsia, premature delivery, and higher C-section rate. Polycystic ovarian syndrome is an endocrine disorder that is associated with polycystic ovaries, insulin resistance, excess androgen levels, obesity, infertility, and obstetric complications. The polycystic ovaries develop when the pituitary gland does not produce enough luteinizing hormone or follicle releasing hormone.
Some follicles grow, but are not released and others remain cyst. Due to this ovulation does not occur, and progesterone is not released. Due to progesterone not being released, there is no spike in progesterone levels to thicken the lining of the uterus to support a pregnancy or a decrease leading to menstruation. To treat insulin resistance, it is recommended to treat those with PCOS with Metformin, which helps the body use the insulin. The excess androgen levels can lead to a varying symptoms. The most common symptom of excess androgen levels is in women with PCOS is hirsutism.
Hirsutism is excess hair growth, which tends to grow in a male pattern such as above the lip, on the chin, chest and other areas. Symptoms associated with PCOS can vary by race, as Asians are less likely to experience hirsutism than any other ethnic background. (Tehrani 2015) In addition to treatment with metformin, birth control pills, which would regulate the androgen levels and menstrual cycles, could help to combat some of the symptoms such as hirsutism. (Joham et al. , 2014) PCOS & Fertility Issues PCOS is the most common cause of infertility that results from the lack of ovulation.
Even those with PCOS who experience regular menstruation bleeding can experience anovulation, with 21% of those with regular menstrual bleeding have an ovulatory cycles. (Fica et al. , 2008) A combination of insulin resistance and excess androgen levels can potentially cause an increased risk of miscarriage. A study conducted by Okon of women with and without PCOS that had higher testosterone levels compared to normal testosterone level controls found higher levels of concentration of testosterone in women who had recurrent pregnancy loss with or with PCOS. Kaalanathan et al. , 2013)
It is suspected that the high androgen levels opposed estrogen which could affect the development of the endometrium and implantation. (Kaalanathan et al. , 2013) After conception women with PCOS are at an increased risk of early pregnancy loss. (Kaalanathan et al. , 2013) This early pregnancy loss happens in around 30% to 50% of women with PCOS compared to 10% to 15% of non-PCOS women. (Chakraborty et al. , 2013) In addition to women with PCOS experiencing early pregnancy loss, they are also subject to frequent miscarriages.
In women with PCOS, recurrent pregnancy loss is a frequent complication that happens in around 50% of pregnancies. Women with PCOS who experience a pregnancy without having a previous mensuration are at an increased risk of early pregnancy loss, preeclampsia, and preterm delivery due to endometrial progesterone. (Brosens et al. , 2015) It is suggested that having a menstrual cycle induced by clomiphene citrate (clomid), the ovulation stimulating fertility drug, could lead to better responses of the endometrial progesterone. (Brosens et al. , 2015) PCOS & Insulin Resistance
Polycystic ovarian syndrome is an endocrine disorder that involves insulin resistance and excess androgen levels. As a result, gestational diabetes is the most common pregnancy complication with the risk three times as greater than those without PCOS. Gestational diabetes is found to be a complication in around 40% to 50% of PCOS pregnancy. (Kaalanathan et at. , 2015) Gestational diabetes is high blood glucose levels during pregnancy. In pregnancy, gestational diabetes can cause the baby to grow larger than normal leading to a higher chance of needing a cesarean section.
Typically, in a non-PCOS pregnancy, gestational diabetes diagnoses is prevalent between the 24th and 28th week of pregnancy. The diagnoses of gestational diabetes is higher during the first trimester than in non-PCOS pregnancies (Kamalanathan et al. , 2013) Being overweight or obese with PCOS can lead to severe insulin resistance, which would lead to high levels of fasting insulin. As of this, those who had PCOS and a higher body mass index before pregnancy had higher diagnoses of gestational diabetes. (Sawada et al. , 2015)
The drug metformin, usually prescribed for type-2 diabetes, is commonly used as treatment of polycystic ovarian syndrome (PCOS) and gestational diabetes in women. In women with PCOS, metformin can cause a decrease in the levels of androgens, which are high with the disorder. (Bertoldo et al. , 2014) Metformin can cause persistent nausea and gastrointestinal discomfort. Metformin is given orally either as an immediate or extended release form at doses ranging from 500 to 2500mg per day. For many, ovulation seemingly returns after around three months of treatment with metformin.
In addition to metformin, weight control is an important factor in reducing the risk of gestational diabetes in PCOS. Metformin treatment during pregnancy reduced the rate of miscarriage. PCOS & Hypertension & Preeclampsia After successfully passing the first trimester, a common pregnancy complication faced by those with PCOS is pregnancy-induced hypertension and preeclampsia. In a study conducted it was observed that women with PCOS are at greater risk of pregnancy-induced hypertension than others. The increased risk was observed regardless of the weight of the women with PCOS who developed pregnancy-induced hypertension.
It was also observed that women above 30 years old with PCOS are more likely to develop pregnancy-induced hypertension than younger women. Whoever, those who conceived via in-vitro fertilization are not at a higher risk of developing pregnancy-induced hypertension (Wang et al. , 2013) Preeclampsia is a disorder that occurs during pregnancy that is associated with high blood pressure and proteinuria, or protein in the urine. (Katsikis et al. , 2006) There is a diagnoses of pregnancy-induced hypertensive disease in 5%-10% of PCOS pregnancy (Kaalanathan et at. 2015) 20% of the women who had hypertension before pregnancy are at an increased risk of developing preeclampsia. (Katsikis et al. , 2006) PCOS & Preterm Delivery Multiple studies have shown an association between PCOS and preterm birth in both singleton and multiples pregnancies. The risk of preterm delivery is twice as high as in those without PCOS. (Palomba et al. , 2015)
While metformin is helpful in treating some symptoms, treatment with metformin has been shown to increase the rate of preterm birth (Bertoldo et al. 2014) Pf the with PCOS in the United States, African Americans had the highest rate of preterm delivery compared to any group (Yamamoto et al. , 2013) Women with PCOS demonstrated a significantly higher chance of delivering by Caesarean section. As a result of the high diagnoses of preeclampsia associated with PCOS, there is a higher risk factor of preterm deliveries. This increased risk of preterm delivery and caesarean section is also increased due to the use of clomiphene citrate, in-vitro fertilization, and other assisted reproductive technologies as they are associated with multiples pregnancies.
Pregnancies of multiples have been associated with increased risk of preterm delivery and cesarean section delivery. (Qin et al. , 2013) PCOS & Neonatal Complications Babies born to those with PCOS are a risk for having a small birth weight for gestational age or having a larger than normal birth weight. (Kaalanathan et at. , 2015) They are also at an increased risk of meconium aspiration syndrome, which is when the newborns fecal matter is present in the lungs.
The Apgar test, performed on newborns at one and five minutes to assess the health of the newborn, is usually less than seven in babies born to PCOS mothers at five minutes. Newborns born to women with PCOS are twice as likely to be admitted to the neonatal intensive care and possible morality increase three times. (Palomba et al. , 2015) As a result of some with PCOS needing fertility treatments to get pregnant, women with PCOS typically have multiples, leading to an increased risk of premature delivery. Conclusions
In conclusions, women that have PCOS are at a higher risk of pregnancy and neonatal complications. Due to this, women with PCOS should be aware of the importance of lifestyle regulation, glucose control, and medical treatment. Additional monitoring during and after pregnancy would be needed in an attempt to have the most desirable outcomes. For some of the increased risk associated with PCOS, such a premature birth and low birth weight, is due to the assisted reproductive technologies leading to a pregnancy of multiples.
Data suggest that those pregnant with PCOS may benefit from metformin treatment in terms of pregnancy complications and postpartum complications, as those treated with a placebo were subjected to severe pregnancy complications. (Vanky et al. , 2004) Weight loss that is seen with treatment with Metformin could potentially improve pregnancy and pregnancy outcomes in those with PCOS. Further study is needed to investigate the effects of Metformin on fetal development and any other potential complications.