Adverse Perinatal Outcomes in Women with Polycystic Ovary Syndrome: A Retrospective Analysis of the Associations Between Phenotype, Body Mass Index, and Mode of Delivery

Abstract

Objective: The aim of this study was to evaluate the relationship between different polycystic ovary syndrome (PCOS) phenotypes, pregestational body mass index (BMI), gestational age at birth, and mode of delivery, and their impact on adverse perinatal outcomes in women with PCOS compared to a control group without PCOS. Method: This retrospective study included women with singleton deliveries at a tertiary university hospital between 2015 and 2025. A total of 203 women diagnosed with PCOS according to the Rotterdam 2003 criteria and 215 women without PCOS (controls) were included (total n = 418). Data on demographics, PCOS phenotype, BMI categories, and maternal and neonatal outcomes were collected from medical records. Multivariable logistic and linear regression analyses adjusted for maternal age, parity, and smoking status were used to assess associations. Results: In multivariable analyses, a PCOS diagnosis was identified as an independent risk factor for gestational diabetes mellitus (GDM) (aOR = 2.85, 95% CI 1.98–4.10), hypertensive disorders of pregnancy (aOR = 1.90, 95% CI 1.25–2.89), cesarean delivery (aOR = 1.72, 95% CI 1.28–2.31), and large for gestational age (LGA) infants (aOR = 1.95, 95% CI 1.34–2.83). Obesity (BMI ≥ 30 kg/m²) was a strong independent risk factor for GDM (aOR = 3.55), hypertensive disorders (aOR = 2.80), cesarean delivery (aOR = 2.10), and LGA (aOR = 2.40) (all p < 0.001). Hyperandrogenic phenotypes were associated with higher adjusted risks for GDM and LGA compared with controls and Phenotype D. No significant independent association was found between PCOS and preterm birth or small for gestational age (SGA) infants (p > 0.05). Conclusion: PCOS is a significant risk factor for adverse perinatal outcomes; however, these risks are heterogeneous and strongly influenced by the patient’s phenotype and, particularly, pregestational BMI. These findings underscore the need for personalized risk assessment and management strategies for pregnant women with PCOS.

Keywords

• polycystic ovary syndrome
• PCOS phenotypes
• perinatal outcomes
• gestational diabetes mellitus

Polikistik Over Sendromunda Olumsuz Perinatal Sonuçlar: Fenotip, Vücut Kitle İndeksi ve Doğum Şekli İlişkisinin Retrospektif Değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı; polikistik over sendromu (PCOS) fenotipleri, gebelik öncesi vücut kitle indeksi (BMI), doğumdaki gebelik yaşı ve doğum şekli ile PCOS'lu kadınlarda olumsuz perinatal sonuçlar arasındaki ilişkiyi PCOS'lu olmayan bir kontrol grubu ile karşılaştırarak değerlendirmektir. Yöntem: Bu retrospektif çalışması, 2015 ile 2025 tarihleri arasında üçüncü basamak bir Şehir Hastanesinde tekil doğum yapan kadınları içermektedir. Rotterdam 2003 kriterlerine göre PCOS tanısı konulan toplam 203 kadın ve kontrol grubu olarak PCOS'suz 215 kadın çalışmaya dâhil edilmiştir. Demografik veriler, PCOS fenotipi, BMI kategorileri, maternal ve yenidoğan sonuçları tıbbi kayıtlar üzerinden değerlendirilmiştir. Grupların birbirleriyle ilişkisini değerlendirmek amacıyla çok değişkenli lojistik ve doğrusal regresyon analizleri kullanılmıştır. Bulgular: Çok değişkenli analizlerde, PCOS tanısı GDM (aOR: 2,85, %95 CI: 1,98-4,10), gebelikte hipertansif bozukluklar (aOR: 1,90, %95 CI: 1,25-2,89), sezaryen doğum (aOR: 1,72, %95 CI: 1,28-2,31) ve LGA (aOR: 1,95, %95 CI: 1,34-2,83) için bağımsız bir risk faktörüydü. Obezite (BMI ≥30 kg/m²) GDM (aOR: 3,55), hipertansif bozukluklar (aOR: 2,80), sezaryen doğum (aOR: 2,10) ve LGA (aOR: 2,40) için güçlü bir bağımsız risk faktörü olarak tanımlanmıştır (tümü p<0,001). Hiperandrojenik fenotipler, kontrol grubu ve Fenotip D ile karşılaştırıldığında GDM ve LGA için daha yüksek düzeltilmiş risklerle ilişkilendirildi. Çalışmada PCOS ile preterm doğum veya SGA arasında anlamlı bir bağımsız ilişki bulunmadı (p>0,05). Sonuç: PCOS, olumsuz maternal ve perinatal sonuçlar için önemli bir risk faktörüdür, ancak bu risk heterojendir ve hastanın pregestasyonel BMI’i ve fenotipiyle yakından ilişkilidir. Bu bulgular, PCOS'lu hamile kadınlar için kişiselleştirilmiş risk değerlendirmesi ve yönetim stratejilerinin gerekliliğini vurgulamaktadır.

Keywords

• polikistik over sendromu
• PCOS fenotipleri
• perinatal sonuçlar
• gestasyonel diyabet

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