Skip to main content
SpringerLink
Log in

PCOS and Pregnancy: Impact of Endocrine and Metabolic Factors

  • Chapter
Book cover Metabolic Syndrome and Complications of Pregnancy

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrine–metabolic disorders, characterized by hyperandrogenism, hyperinsulinism, and polycystic ovaries. The origin of PCOS includes genetic factors and lifestyle influences. Elevated estrogen and androgens, low levels of progesterone, anovulation, and hyperinsulinemia contribute to endometrial, hormonal, and metabolic dysfunctions leading to adverse pregnancy outcome. In fact, women with PCOS have an increased risk of gestational diabetes, pregnancy-induced hypertension, preeclampsia, preterm birth, and need of cesarean section. Moreover, the comorbidity of obesity may increase the risk of obstetric complications since excess adipose tissue acts as an endocrine and inflammatory organ, with altered concentrations in leptin, TNF-α, and IL-6. Lifestyle modification may improve biochemical and endocrinological parameters, preventing progression of PCOS to type 2 diabetes and cardiovascular diseases later in life. Nutritional interventions, with or without metabolic drugs, are used as therapeutic tool.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Balen AH, Rutherford AJ. Managing anovulatory infertility and polycystic ovary syndrome. BMJ. 2007;335:663–6. Review.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Bjercke S, Dale PO, Tanbo T, Storeng R, Ertzeid G, Abyholm T. Impact of insulin resistance on pregnancy complications and outcome in women with polycystic ovary syndrome. Gynecol Obstet Invest. 2002;54:94–8.

    Article  CAS  PubMed  Google Scholar 

  3. Boomsma CM, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12:673–83.

    Article  CAS  PubMed  Google Scholar 

  4. Cakmak H, Taylor HS. Implantation failure: molecular mechanisms and clinical treatment. Hum Reprod Update. 2011;17:242–53.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Cermik D, Selam B, Taylor HS. Regulation of HOXA-10 expression by testosterone in vitro and in the endometrium of patients with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88:238–43.

    Article  CAS  PubMed  Google Scholar 

  6. Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, Kelestimur F, Macut D, Micic D, Pasquali R, et al. European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOs Special Interest Group’s Questionnaire. Eur J Endocrinol. 2014;171(4):489–98.

    Article  CAS  PubMed  Google Scholar 

  7. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33:981–1030.

    Article  CAS  PubMed  Google Scholar 

  8. Douglas CC, Gower BA, Darnell BE, Ovalle F, Oster RA, Azziz R. Role of diet in the treatment of polycystic ovary syndrome. Fertil Steril. 2006;85:679–88.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Duleba AJ, Dokras A. Is PCOs an inflammatory process? Fertil Steril. 2012;97:7–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Escobar-Morreale HF, San Millán JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab. 2007;18:266–72. Review.

    Article  CAS  PubMed  Google Scholar 

  11. Falbo A, Rocca M, Russo T, D’Ettore A, Tolino A, Zullo F, Orio F, Palomba S. Changes in androgens and insulin sensitivity indexes throughout pregnancy in women with polycystic ovary syndrome (PCOs): relationships with adverse outcomes. J Ovarian Res. 2010;3:23.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Fauser BC, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet. 2005;365:1807–16.

    Article  PubMed  Google Scholar 

  13. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, Carmina E, Chang J, Yildiz BO, Laven JS, Boivin J, Petraglia F, Wijeyeratne CN, Norman RJ, Dunaif A, Franks S, Wild RA, Dumesic D, Barnhart K. Consensus on women’s health aspects of polycystic ovary syndrome (PCOs): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOs Consensus Workshop Group. Fertil Steril. 2012;97:28–38.

    Article  PubMed  Google Scholar 

  14. Feigenbaum SL, Crites Y, Hararah MK, Yamamoto MP, Yang J, Lo JC. Prevalence of cervical insufficiency in polycystic ovarian syndrome. Hum Reprod. 2012;27:2837–42.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Franks S, Berga SL. Does PCOs have developmental origins? Fertil Steril. 2012;97:2–6.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Galazis N, Docheva N, Nicolaides KH, Atiomo W. Proteomic biomarkers of preterm birth risk in women with polycystic ovary syndrome (PCOs): a systematic review and biomarker database integration. PLoS One. 2013;8:e53801.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Ghazeeri GS, Nassar AH, Younes Z, Awwad JT. Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome: an overview. Acta Obstet Gynecol Scand. 2012;91:658–78.

    Article  PubMed  Google Scholar 

  18. Giudice LC. Endometrium in PCOs: implantation and predisposition to endocrine CA. Best Pract Res Clin Endocrinol Metab. 2006;202:235–44. Review.

    Article  Google Scholar 

  19. Gower BA, Chandler-Laney PC, Ovalle F, Goree LL, Azziz R, Desmond RA, Granger WM, Goss AM, Bates GW. Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOs. Clin Endocrinol (Oxf). 2013;79:550–7.

    Article  CAS  Google Scholar 

  20. Homburg R. Androgen circle of polycystic ovary syndrome. Hum Reprod. 2009;24:1548–55.

    Google Scholar 

  21. Insenser M, Montes-Nieto R, Murri M, Escobar-Morreale HF. Proteomic and metabolomic approaches to the study of polycystic ovary syndrome. Mol Cell Endocrinol. 2013;370:65–77.

    Article  CAS  PubMed  Google Scholar 

  22. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK, Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J ClinEndocrinol Metab. 2013;98:4565–92.

    Article  CAS  Google Scholar 

  23. Makieva S, Saunders PT, Norman JE. Androgens in pregnancy: roles in parturition. Hum Reprod Update. 2014;204:542–59. Review.

    Article  Google Scholar 

  24. Maliqueo M, Lara HE, Sánchez F, Echiburú B, Crisosto N, Sir-Petermann T. Placental steroidogenesis in pregnant women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2013;166:151–5.

    Article  CAS  PubMed  Google Scholar 

  25. Marsh KA, Steinbeck KS, Atkinson FS, Petocz P, Brand-Miller JC. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92:83–92.

    Article  CAS  PubMed  Google Scholar 

  26. Mikola M, Hiilesmaa V, Halttunen M, Suhonen L, Tiitinen A. Obstetric outcome in women with polycystic ovarian syndrome. Hum Reprod. 2001;16:226–9.

    Article  CAS  PubMed  Google Scholar 

  27. Nestler JE, Jakubowicz DJ, Reamer P, Gunn RD, Allan G. Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome. N Engl J Med. 1999;340:1314–20.

    Article  CAS  PubMed  Google Scholar 

  28. Norman RJ, Noakes M, Wu R, Davies MJ, Moran L, Wang JX. Improving reproductive performance in overweight/obese women with effective weight management. Hum Reprod Update. 2004;10:267–80.

    Article  PubMed  Google Scholar 

  29. Palomba S, Russo T, Falbo A, Di Cello A, Tolino A, Tucci L, La Sala GB, Zullo F. Macroscopic and microscopic findings of the placenta in women with polycystic ovary syndrome. Hum Reprod. 2013;28:2838–47.

    Article  CAS  PubMed  Google Scholar 

  30. Reyes-Muñoz E, Castellanos-Barroso G, Ramírez-Eugenio BY, Ortega-González C, Parra A, Castillo-Mora A, De la Jara-Díaz JF. The risk of gestational diabetes mellitus among Mexican women with a history of infertility and polycystic ovary syndrome. Fertil Steril. 2012;97:1467–71.

    Article  PubMed  Google Scholar 

  31. Roos N, Kieler H, Sahlin L, Ekman-Ordeberg G, Falconer H, Stephansson O. Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study. BMJ. 2011;343:d6309.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Rotterdam ESHRE/ASRM-Sponsored PCOs consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOs). Hum Reprod. 2004;191:41–7. Review.

    Article  Google Scholar 

  33. Samy N, Hashim M, Sayed M, Said M. Clinical significance of inflammatory markers in polycystic ovary syndrome: their relationship to insulin resistance and body mass index. Dis Markers. 2009;26:163–70.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Sathishkumar K, Elkins R, Chinnathambi V, Gao H, Hankins GD, Yallampalli C. Prenatal testosterone-induced fetal growth restriction is associated with down-regulation of rat placental amino acid transport. Reprod Biol Endocrinol. 2011;9:110.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Sir-Petermann T, Echiburú B, Maliqueo MM, Crisosto N, Sánchez F, Hitschfeld C, Cárcamo M, Amigo P, Pérez-Bravo F. Serum adiponectin and lipid concentrations in pregnant women with polycystic ovary syndrome. Hum Reprod. 2007;22:1830–6. Seppala et al., 2002.

    Article  CAS  PubMed  Google Scholar 

  36. Sun M, Maliqueo M, Benrick A, Johansson J, Shao R, Hou L, Jansson T, Wu X, Stener-Victorin E. Maternal androgen excess reduces placental and fetal weights, increases placental steroidogenesis, and leads to long-term health effects in their female offspring. Am J Physiol Endocrinol Metab. 2012;303:E1373–85.

    Article  CAS  PubMed  Google Scholar 

  37. Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D chiro-inositol) for women with polycystic ovary syndrome, oligoamenorrhoea and subfertility. Cochrane Database Syst Rev. 2012;(5):CD003053.

    Google Scholar 

  38. Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BG, Wong JL, Norman RJ, Costello MF. Guideline Development Groups. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust. 2011;195:S65–112.

    Google Scholar 

  39. Toulis KA, Goulis DG, Kolibianakis EM, Venetis CA, Tarlatzis BC, Papadimas I. Risk of gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Fertil Steril. 2009;92:667–77.

    Article  PubMed  Google Scholar 

  40. Xu X, Du C, Zheng Q, Peng L, Sun Y. Effect of metformin on serum interleukin-6 levels in polycystic ovary syndrome: a systematic review. BMC Womens Health. 2014;14:93–100.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Yamamoto M, Feigenbaum SL, Crites Y, Escobar GJ, Yang J, Ferrara A, Lo JC. Risk of preterm delivery in non-diabetic women with polycystic ovarian syndrome. J Perinatol. 2012;32:770–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy

    Felice Petraglia, Cinzia Orlandini & Silvia Vannuccini

  2. Robinson Research Institute, University of Adelaide, Adelaide, Australia

    Vicki L. Clifton

Authors
  1. Felice Petraglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cinzia Orlandini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvia Vannuccini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vicki L. Clifton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Felice Petraglia .

Editor information

Editors and Affiliations

  1. Woman, Mother and Neonate Department, University of Milan, Buzzi Children's Hospital, Milan, Italy

    Enrico Ferrazzi

  2. Inflammation Research Foundation, Marblehead, Massachusetts, USA

    Barry Sears

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Petraglia, F., Orlandini, C., Vannuccini, S., Clifton, V.L. (2015). PCOS and Pregnancy: Impact of Endocrine and Metabolic Factors. In: Ferrazzi, E., Sears, B. (eds) Metabolic Syndrome and Complications of Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-16853-1_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-16853-1_7

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16852-4

  • Online ISBN: 978-3-319-16853-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation