Diagnosis and management of infertility in patients with polycystic ovary syndrome (PCOS): guidelines from the Italian Society of Human Reproduction (SIRU) and the Italian Centers for the Study and Conservation of Eggs and Sperm (CECOS Italy)

Persistence of hypertension after pregnancy-related hypertensive disorders in women with polycystic ovary syndrome

OBJECTIVE

To assess whether polycystic ovary syndrome (PCOS) increases the risk of persistent hypertension in women with a history of pregnancy-related hypertensive disorder (PHD).

DESIGN

A single-center, prospective cohort study.

SUBJECTS

A total of 124 patients with PHD were enrolled. Pregnancy-related hypertensive disorder was diagnosed on the basis of the presence of pregnancy-induced hypertension or preeclampsia. All patients with PHD were screened for PCOS diagnosis, which was confirmed or excluded on the basis of patient history and clinical reports. Sixty-two patients diagnosed with PCOS (n = 62 cases) were included as the study group. After 1-to-1 matching process on the basis of age, body mass index, and infertility treatment, 62 control patients without PCOS were also included.

EXPOSURE

Polycystic ovary syndrome diagnosis according to the national and international criteria.

MAIN OUTCOME MEASURES

The primary outcome was the persistence of hypertension 12 months after delivery. The secondary outcomes included persistence of hypertension at 3 and 6 months from delivery, pregnancy complications, and data on antihypertensive treatment.

RESULTS

After 12 months from delivery, the risk of persistent hypertension was significantly higher in patients with PHD with PCOS than in controls [adjusted odds ratio, 5.01; 95% confidence interval (CI), 1.63-15.94]. At 6 months, that risk was also significantly higher (adjusted odds ratio, 5.01; 95% CI, 1.63-15.94). Additionally, pregnant patients with PCOS had an earlier onset of PHD (30.0 vs. 31.1 weeks), required a higher dose of nifedipine (37.5 mg vs. 30 mg), and were more likely to receive antihypertensive therapy with multiple drugs (24.2% vs. 9.7%) than controls. The incidence of fetal growth restriction (19.4% vs. 6.5%), abnormal Doppler velocimetry (16.1% vs. 4.8%), and cesarean delivery (35.5% vs. 19.4%) was also significantly higher in the PCOS group than in controls.

CONCLUSION

Polycystic ovary syndrome is associated with an increased risk of persistent hypertension in patients with a history of PHD. Preventive interventions before pregnancy, specific pregnancy surveillance, and long-term follow-up should be recommended for women with PCOS.

Global burden of polycystic ovary syndrome among women of childbearing age, 1990-2021: a systematic analysis using the global burden of disease study 2021

BACKGROUND

The escalating global incidence of polycystic ovary syndrome (PCOS) necessitates a thorough examination of its epidemiological trends and sociodemographic correlations. Our study bridges this gap by analyzing the global impact of PCOS among women of childbearing age (WCBA) from 1990 to 2021, aiming to inform strategies for enhanced prevention and management.

METHODS

We extracted data from the Global Burden of Disease Study 2021 (GBD 2021), focusing on the burden of PCOS among women aged 15-49 years. We assessed incidence, prevalence, and disability-adjusted life years (DALYs) trends using the estimated annual percentage change (EAPC) and explored the link between PCOS burden and sociodemographic index (SDI).

RESULTS

In 2021, the prevalence cases of PCOS worldwide were 65.77 million, the incidence cases were 1,175.07 thousand, and the DALYs cases were 576.05 thousand. Compared with 1990, the percentage changes were 89, 49, and 87%, respectively. The EAPCs indicated upward trends in prevalence and DALYs rates, with a less pronounced increase in incidence rates. The middle SDI region had the highest PCOS case numbers, and the 45-49 age group in this region experienced the most significant burden increase. A strong positive correlation existed between PCOS prevalent rates and SDI (r = 0.582, p < 0.001).

CONCLUSION

The global burden of PCOS among WCBA has significantly increased over the past three decades, particularly in the 45-49 age group in middle SDI regions. The correlation between PCOS prevalent rates and SDI highlights the role of socio-economic factors in PCOS epidemiology. Tailored prevention and management strategies are crucial for reducing the global burden of PCOS and improving female health outcomes.