Endocrine Traits During Pregnancy in Women with Polycystic Ovary Syndrome - Insights from a Prospective Cohort Study in China

Abstract Background Polycystic ovary syndrome (PCOS) poses a significant endocrine-metabolic health concern. During pregnancy, PCOS-related endocrine and metabolic disorders are likely to worsen, leading to adverse maternal and fetal health outcomes. Despite existing studies, there is a lack of prospective research focused on Chinese populations. It is imperative to establish a cohort of Chinese women with PCOS to investigate pregnancy-related endocrine traits, providing valuable insights into maternal and neonatal outcomes specific to this demographic. Methods A total of 91 participants (33 PCOS, 58 non-PCOS) were enrolled in this study. Thorough evaluations of endocrine metabolic parameters were conducted at 12–16 weeks, 24–28 weeks, and 32–36 weeks of gestation. Primary outcome: Total testosterone (T), hormone binding protein (SHBG), free androgen index (FAI). Secondary outcome: Fasting insulin (FINS), fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Logistic regression models were employed for group comparisons and confounder control. Results PCOS women exhibited higher T and FAI levels compared to non-PCOS women across all gestational windows (All P < 0.001), even after adjusting for factors including pre-pregnancy BMI. PCOS women exhibited elevated FINS levels and homeostasis model assessment-insulin resistance (HOMA-IR) at 12–16 weeks of gestation, as well as higher FINS levels at 32–36 weeks of gestation. Upon adjusting for factors including pre-pregnancy BMI, the initial differences in glucose metabolism dissipated. PCOS women displayed a subtle departure in lipid metabolism, manifesting solely as decreased levels of HDL at 12–16 weeks of gestation (P = 0.046). Conclusion This investigation sheds light on the intricate metabolic landscape of PCOS during pregnancy, characterized by persistent testosterone elevation and altered glucose metabolism. Elevated pre-pregnancy BMI played a crucial role in exacerbating altered glucose metabolism, rather than elevated androgens. The findings offer a nuanced insight into the interplay between PCOS, pregnancy, and metabolic dynamics, enriching our understanding of this multifaceted relationship.