Pre-conception weight loss interventions in women with polycystic ovary syndrome and the effect on perinatal outcomes: A quantitative synthesis of surrogate outcomes.

Aims: Polycystic ovary syndrome (PCOS) guidelines recommend weight optimisation to improve anthropometric, metabolic and androgenic complications, but data is lacking for pregnancy outcomes.

Materials and methods: We aimed to assess which weight loss interventions improve pregnancy outcomes for women with PCOS and overweight or obesity. A systematic search of Embase, Medline (Ovid) and the Cochrane Clinical Trials Registry for English language articles from database inception until 22 July 2024 was conducted. We included weight loss intervention randomised controlled trials (RCTs) for women with PCOS and body mass index (BMI) ≥25 kg/m². Primary outcomes were pregnancy rates, live births and miscarriages. Secondary outcomes were anthropometric, androgenic, metabolic and other perinatal complications.

Results: Of 9010 articles, 7077 abstracts were screened and 37 RCTs included. One study reported increased pregnancy rates with a 12-month lifestyle intervention versus standard care (23.3%-26.7% vs. 16.7%) (low certainty) but no difference in live birth rate, time to conception or antenatal outcomes. Lifestyle interventions reduced BMI by -0.34 kg/m² (-0.65 to -0.02) on quantitative meta-analysis. Limitations include outcome measure heterogeneity, intervention heterogeneity, inconsistent definitions and low use of core outcome sets.

Conclusions: Limited data on antenatal outcomes highlight a knowledge gap amongst a group at high perinatal risk.