Abstract
•In women with PCOS, multiple gestation increases the risk of preterm delivery 8-fold.•Multiple gestation increases the risk of pre-eclampsia 2.9-fold in women with PCOS.•Women with PCOS and multiple gestation are at increased risk of gestational diabetes.•In women with PCOS, multiple gestation increases the risk of Caesarean delivery 5-fold.•Neonates born to mothers with PCOS and multiple gestation are more likely to be SGA.
Research question: Does multiple gestation alter the risks for adverse obstetric outcomes in women with polycystic ovary syndrome (PCOS)?
Design: Retrospective population-based cohort study using data from the HCUP-NIS from 2004 to 2014. A total of 14,882 women with PCOS, who delivered within that time period, were identified. The study group comprised women with PCOS who had had a multiple gestation (n = 880); the reference group was comprised of the remaining women with PCOS and singleton gestation (n = 14,002).
Results: In women with PCOS, multiple gestation increased the risks of pregnancy complications including pregnancy-induced hypertension (adjusted odds ratio [aOR] 2.030; 95% confidence interval [CI] 1.676–2.460), pre-eclampsia (aOR 2.879; 95% CI 2.277–3.639), pre-eclampsia and eclampsia superimposed on pre-existing hypertension (aOR 1.917; 95% CI 1.266–2.903) and gestational diabetes (aOR 1.358; 95% CI 1.114–1.656). Multiple gestation increases the risk of preterm premature rupture of membranes (aOR 5.807; 95% CI 4.153–8.119), preterm delivery (aOR 8.466; 95% CI 7.071–10.135), Caesarean section (aOR 5.146; 95% CI 4.184–6.329), post-partum haemorrhage (aOR 1.540; 95% CI 1.065–2.228) and the need for transfusion (aOR 3.268; 95% CI 2.010–5.314), as well as wound complications (aOR 3.089; 95% CI 1.647–5.794). Neonates born to mothers with PCOS and having multiple gestations are more likely to be small for gestational age when compared to singleton neonates born to mothers with PCOS (aOR 4.606; 95% CI 3.480–6.095). Among PCOS women with multiple gestations, obesity increased the risks of developing pregnancy-induced hypertension (P < 0.001), pre-eclampsia (P < 0.001) and wound complications (P = 0.045).
Conclusion: These results highlight the importance of single embryo transfer and ovulation induction to develop a single follicle in women with PCOS. Obesity further increases obstetrical complications.