James Kent1, William C Dodson2, Allen Kunselman3, Jaimey Pauli2, Alicia Stone2, Michael P Diamond4, Christos Coutifaris5, William D Schlaff6, Ruben Alvero6, Peter Casson7, Gregory M Christman8, R Mitchell Rosen9, Karl R Hansen10, Randall D Robinson11, Valerie Baker12, Rebecca Usadi13, Nanette Santoro6, Heping Zhang14, Esther Eisenberg15, Richard S Legro2. 1. Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania. 2. Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania. 3. Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania. 4. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan. 5. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. 6. Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado. 7. Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont. 8. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan. 9. Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California. 10. Department of Obstetrics and Gynecology University of Oklahoma, Oklahoma City, Oklahoma. 11. Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, Texas. 12. Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California. 13. Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina. 14. Department of Biostatistics, Yale University, New Haven, Connecticut. 15. Infertility and Fertility Branch, National Institute of Child Health and Human Development, Rockville, Maryland.
Abstract
Context: Women with polycystic ovary syndrome (PCOS) have increased risk for pregnancy complications, possibly related to pre-existing obesity and excessive gestational weight gain (GWG). Objectives: To assess the contributions of diagnosis and preconception weight on GWG and perinatal outcomes. Research Design and Methods: Prospective cohort study of singleton pregnancies in PCOS (n = 164) and ovulatory controls (n = 176) from infertility treatment. Main Outcome Measures: GWG, birthweight, pregnancy complications. Results: From preconception baseline, normal-weight women with PCOS gained 2.3 pounds more during the first trimester (95% CI, 0.3 to 4.3; P = 0.02), and by the end of the second trimester, 4.2 pounds more than controls (95% CI, 0.7 to 7.7; P = 0.02). Women who were overweight with PCOS gained significantly more weight than did controls by the end of the second trimester (5.2 pounds; 95% CI, 0.2 to 10.2; P = 0.04), whereas women with obesity and PCOS and control women had similar weight gain throughout pregnancy. Within normal-weight, overweight, and obese groups, prevalence of pre-eclampsia and gestational diabetes did not differ between the PCOS and control groups, nor was there a difference in birthweight. Preconception body mass index (BMI) was significantly associated with GWG; for every 1-kg/m2 increase in preconception BMI, GWG decreased by 0.62 pounds (95% CI, -0.85 to -0.40; P < 0.001). Conclusions: Women with PCOS who are of normal weight or are overweight before conception experience more GWG than do ovulatory controls. Within normal-weight, overweight, and obese groups, rates of perinatal complications do not significantly differ between women with PCOS and controls. Preconception BMI is the strongest predictor of GWG.
Context:Women with polycystic ovary syndrome (PCOS) have increased risk for pregnancy complications, possibly related to pre-existing obesity and excessive gestational weight gain (GWG). Objectives: To assess the contributions of diagnosis and preconception weight on GWG and perinatal outcomes. Research Design and Methods: Prospective cohort study of singleton pregnancies in PCOS (n = 164) and ovulatory controls (n = 176) from infertility treatment. Main Outcome Measures: GWG, birthweight, pregnancy complications. Results: From preconception baseline, normal-weight women with PCOS gained 2.3 pounds more during the first trimester (95% CI, 0.3 to 4.3; P = 0.02), and by the end of the second trimester, 4.2 pounds more than controls (95% CI, 0.7 to 7.7; P = 0.02). Women who were overweight with PCOS gained significantly more weight than did controls by the end of the second trimester (5.2 pounds; 95% CI, 0.2 to 10.2; P = 0.04), whereas women with obesity and PCOS and control women had similar weight gain throughout pregnancy. Within normal-weight, overweight, and obese groups, prevalence of pre-eclampsia and gestational diabetes did not differ between the PCOS and control groups, nor was there a difference in birthweight. Preconception body mass index (BMI) was significantly associated with GWG; for every 1-kg/m2 increase in preconception BMI, GWG decreased by 0.62 pounds (95% CI, -0.85 to -0.40; P < 0.001). Conclusions: Women with PCOS who are of normal weight or are overweight before conception experience more GWG than do ovulatory controls. Within normal-weight, overweight, and obese groups, rates of perinatal complications do not significantly differ between women with PCOS and controls. Preconception BMI is the strongest predictor of GWG.
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