Pregnancy Outcomes in women with Coexisting PCOS and GDM

Polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) alone increased the risks for complications like preeclampsia and preterm birth, their coexistence did not significantly amplify the risks beyond those associated with GDM alone, according to a study of over 280,000 women published in Acta Obstetricia et Gynecologica Scandinavica.¹

Ragnheidur Valdimarsdottir from the Dept. of Women's and Children's Health, Uppsala University in Sweden and coauthors conducted this study to determine if the coexistence of GDM and PCOS affects maternal and neonatal outcomes.

A total of 281,806 women from Sweden who had singleton births between 1997 and 2015 were examined in the nationwide register-based historical cohort study. Of these, 40,272 had only PCOS, 2236 had only GDM, while 1036 had both PCOS and GDM. The control group included 238,262 women without PCOS or GDM. Postpartum hemorrhage, gestational hypertension, preeclampsia and obstetric anal sphincter injury were the maternal adverse outcomes examined. The neonatal outcomes were preterm birth, stillbirth, macrosomia, low Apgar score, shoulder dystocia, born small or large for gestational age, birth trauma, neonatal hypoglycemia, meconium aspiration syndrome and respiratory distress. 

The study found no significant interaction between PCOS and GDM regarding maternal and neonatal outcomes. PCOS alone was associated with an 18% higher risk for preeclampsia with adjusted odds ratio (aOR) of 1.18; the aOR for pre-eclampsia in women with GDM alone was 1.77, while it was 1.86 among women who had both PCOS and GDM. The study reported aORs for preterm birth in the groups analysed; 1.34 in PCOS-only group, 1.64 in GDM-only group and 2.08 in the group with both PCOS and GDM. The risk of stillbirth was increased 1.5 times in women with PCOS (aOR 1.52), but no such risk was observed in women with GDM (aOR 0.58).

Based on these findings, the study concluded that although the coexistence of PCOS and GDM does not multiply the risk, nevertheless PCOS is an underrecognized pregnancy risk factor, as demonstrated by its association with an increased risk of stillbirth, a risk that was not observed with GDM alone.

Reference

1.   Valdimarsdottir R, et al. Polycystic ovary syndrome and gestational diabetes mellitus association to pregnancy outcomes: A national register-based cohort study. Acta Obstet Gynecol Scand. 2024 Oct 30. doi: 10.1111/aogs.14998.