Utero-placental (vascular) development throughout pregnancy in women with polycystic ovary syndrome: the Rotterdam Periconceptional Cohort

Objective

To study utero-placental vascular development from the first trimester onward in pregnant women with polycystic ovary syndrome (PCOS) and successful live births, compared with pregnant women without PCOS, after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment or natural conception.

Design

Prospective periconceptional cohort study in a single tertiary hospital.

Subjects

Participants with ongoing pregnancies with available serial three-dimensional ultrasound scans were divided into 3 groups: women with PCOS; subfertile group, pregnancies who conceived via IVF/ICSI without PCOS; and fertile group, pregnancies who conceived naturally without PCOS.

Exposure

PCOS diagnosis.

Main Outcome Measures

During the first-trimester, placental volume (PV) and utero-placental vascular volume (uPVV) were measured offline in three-dimensional ultrasound volumes obtained at 7, 9, and 11 weeks’ gestational age (GA) using Virtual Organ Analysis and Virtual Reality. Serial measurements were obtained from uterine artery pulsatility and resistance indices (UtA PI and UtA RI) measured by pulsed-wave Doppler ultrasound as well as mean arterial pressure at 7, 9, 11, 13, 22, and 32 weeks’ GA. Similarly, the umbilical artery PI and RI were measured at 22 and 32 weeks’ GA.

Results

We included 206 pregnancies in our study (PCOS n = 41; subfertile n = 63; fertile n = 102). Significantly negative associations were observed between PCOS and placental measurements (PV, uPVV, and their ratio) at 11 weeks’ GA with both the subfertile and fertile group as reference (e.g., uPVV 11 weeks’ GA: beta_PCOS-fertile –0.18 ∛cm³ [95% confidence interval: –0.30; –0.06]). UtA PI and RI were significantly lower throughout pregnancy in women with PCOS compared with the subfertile and fertile group. Women with PCOS showed a negative association with umbilical artery PI and RI at 32 weeks’ GA compared with the subfertile and fertile group as reference.

Conclusion

Women with PCOS show decreased first-trimester placental development at 11 weeks’ GA compared with pregnancies without PCOS in the subfertile and fertile group. Additionally, these women also display lower UtA PI and UtA RI compared with women without PCOS. These results support the hypothesis that PCOS impacts early placental development, potentially contributing to adverse pregnancy outcomes. Further research should focus on the underlying pathophysiology and the modifying role of IVF/ICSI treatment.