Perinatal outcomes in pregnancies with and without polycystic ovary syndrome assessed by the Composite Adverse Perinatal Outcome score: a propensity score–matched retrospective study

Year 2026, Volume: 8 Issue: 2, 283 - 290, 10.03.2026

Melisa Gölgelioğlu , Halenur Öner Soy Nuseybe Artıran

https://doi.org/10.38053/acmj.1858024

https://izlik.org/JA95SP58KJ

Abstract

Aims: To quantify severity-weighted perinatal morbidity in pregnancies complicated by polycystic ovary syndrome (PCOS) using the Composite Adverse Perinatal Outcome (CAPO) score and to assess robustness after propensity score matching and BMI-focused sensitivity analyses.
Methods: We conducted a two-center retrospective cohort study (January 2022-October 2025). Among 3.616 eligible singleton deliveries, 318 (8.8%) had documented PCOS. Propensity scores were estimated using maternal age, gravidity, parity, prior abortion/miscarriage, and prior curettage. Using 1:1 nearest neighbor matching (caliper 0.2 SD logit), 262 PCOS pregnancies were matched to 262 controls. CAPO total and subscores were compared in matched pairs; BMI-adjusted conditional regression was performed. Sensitivity analyses included BMI-stratified comparisons and BMI-inclusive rematching.
Results: In the matched cohort (n=524), CAPO total scores were higher in PCOS pregnancies (median [IQR] 150 [0-280] vs 75 [0–200]; p=0.004), and CAPO>0 occurred more frequently (45.0% vs 36.3%; p=0.02). PCOS remained associated with higher CAPO after BMI adjustment (β=+40.2; 95% CI 14.3-66.1; p=0.003). PCOS pregnancies had higher rates of severe preeclampsia, postpartum hemorrhage, preterm birth, low birth weight, and neonatal intensive care unit (NICU) admission >24 h. Under BMI-inclusive matching, 244 pairs were retained with balanced BMI (SMD=0.04); CAPO differences were attenuated but persisted (p=0.045; β=+22.5, p=0.024).
Conclusion: PCOS pregnancies show a higher severity-weighted perinatal morbidity burden by CAPO, distributed across hypertensive and prematurity-linked outcomes. Associations persisted after BMI adjustment and conservative BMI-inclusive sensitivity analyses, suggesting that adiposity explains part but not all-of the excess morbidity signal.

Keywords

Polycystic ovary syndrome , perinatal morbidity , preeclampsia , preterm birth , low birth weight

Ethical Statement

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Yozgat Bozok University (Approval Date: 03/12/2025, Approval Number: 2025-GOKAEK-2521_2025.12.03_828). The requirement for informed consent was waived by the ethics committee due to the retrospective design and use of anonymized data.

Supporting Institution

No funding

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