Persistence of hypertension after pregnancy-related hypertensive disorders in women with polycystic ovary syndrome.

Abstract

OBJECTIVE This study aims to assess whether polycystic ovary syndrome (PCOS) increases the risk of persistent hypertension in women with a history of pregnancy-induced hypertensive disorder (PHD). DESIGN A single-center, prospective cohort study. SUBJECTS A total of 124 patients with PHD were enrolled. PHD was diagnosed based on the presence of pregnancy-induced hypertension (PIH) or preeclampsia (PE). All PHD patients were screened for PCOS diagnosis, which was confirmed or excluded based on patient history and clinical reports. Sixty-two patients diagnosed with PCOS (n=62, cases) were included as the study group. After one-to-one matching process based on age-, body mass index-, and infertility treatment, 62 control patients without PCOS were also included. EXPOSURE PCOS diagnosis according to National and International criteria. MAIN OUTCOME MEASURES The primary outcome was the persistence of hypertension 12 months after delivery. Secondary outcomes included persistence of hypertension at 3 and 6 months from delivery, pregnancy complications and data on antihypertensive treatment. RESULTS After 12 months from delivery, the risk of persistent hypertension was significantly higher in PHD patients with PCOS compared to controls (adjusted odds ratio [aOR] 4.51, 95% confidence interval [CI] 1.43-14.19, p=0.010). At 6 months, that risk was also significantly higher (aOR 5.01, 95% CI 1.63-15.94, p=0.005). Additionally, pregnant PCOS patients had an earlier onset of PHD (30.0 vs. 31.1 weeks, p=0.013), required a higher dose of nifedipine (37.5 mg vs. 30 mg, p=0.001), and were more likely to receive antihypertensive therapy with multiple drugs (24.2% vs. 9.7%, p=0.032) compared to controls. The incidence of fetal growth restriction (19.4% vs. 6.5%, p=0.033), abnormal Doppler velocimetry (16.1% vs. 4.8%, p=0.041), and cesarean delivery (35.5% vs. 19.4%, p=0.019) was also significantly higher in the PCOS group compared to controls. CONCLUSION PCOS is associated with an increased risk of persistent hypertension in patients with a history of PHD. Preventive interventions before pregnancy, specific pregnancy surveillance, and long-term follow-up should be recommended for women with PCOS.