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Glintborg D, Ollila MM, Møller JJK, Pesonen P, Persson S, Elenis E, Rubin KH, Gissler M, Andersen MS, Sundström-Poromaa I, Piltonen T. Prospective risk of Type 2 diabetes in 99 892 Nordic women with polycystic ovary syndrome and 446 055 controls: national cohort study from Denmark, Finland, and Sweden. Hum Reprod 2024:deae124. [PMID: 38859639 DOI: 10.1093/humrep/deae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
STUDY QUESTION What is the prospective risk of Type 2 diabetes (T2D) in Nordic women with polycystic ovary syndrome (PCOS) compared to controls? SUMMARY ANSWER A diagnosis of PCOS and BMI ≥30 kg/m2 is a high-risk phenotype for a prospective risk of T2D diagnosis across Nordic countries. WHAT IS KNOWN ALREADY The risk of T2D in women with PCOS is increased. The risk of T2D is related to BMI and the magnitude of risk in normal weight women with PCOS has been discussed. However, prospective data regarding risk of T2D in population-based cohorts of women with PCOS are limited. STUDY DESIGN, SIZE, DURATION This national register-based study included women with PCOS and age-matched controls. The main study outcome was T2D diagnosis occurring after PCOS diagnosis. T2D was defined according to ICD-10 diagnosis codes and/or filled medicine prescriptions of anti-diabetic medication excluding metformin. PARTICIPANTS/MATERIALS, SETTING, METHODS The study cohort included women originating from Denmark (PCOS Denmark, N = 27 016; controls, N = 133 994), Finland (PCOS Finland, N = 20 467; controls, N = 58 051), and Sweden (PCOS Sweden, N = 52 409; controls, N = 254 010). The median age at cohort entry was 28 years in PCOS Denmark, Finland, and Sweden with a median follow-up time (interquartile range) in women with PCOS of 8.5 (4.0-14.8), 9.8 (5.1-15.1), and 6.0 (2.0-10.0) years, respectively. Cox regression analyses were adjusted for BMI and length of education. MAIN RESULTS AND THE ROLE OF CHANCE The crude hazard ratio (HR, 95% CI) for T2D diagnosis in women with PCOS was 4.28 (3.98-4.60) in Denmark, 3.40 (3.11-3.74) in Finland, and 5.68 (5.20-6.21) in Sweden. In adjusted regression analyses, BMI ≥30 vs <25 kg/m2 was associated with a 7.6- to 11.3-fold risk of T2D. In a combined meta-analysis (PCOS, N = 99 892; controls, N = 446 055), the crude HR for T2D in PCOS was 4.64 (3.40-5.87) and, after adjustment for BMI and education level, the HR was 2.92 (2.32-3.51). LIMITATIONS, REASONS FOR CAUTION Inclusion of more severe cases of PCOS in the present study design could have lead to an overestimation of risk estimates in our exposed population. However, some women in the control group would have undiagnosed PCOS, which would lead to an underestimation of T2D risk in women with PCOS. BMI data were not available for all participants. The present study should be repeated in study cohorts with higher background risks of T2D, particularly in populations of other ethnicities. WIDER IMPLICATIONS OF THE FINDINGS The prospective risk for diagnosis of T2D is increased in women with PCOS, and the risk is aggravated in women with BMI ≥30 kg/m2. STUDY FUNDING/COMPETING INTEREST(S) Funding in Denmark was from the Region of Southern Denmark, Overlægerådet, Odense University Hospital. Funding in Finland was from Novo Nordisk Foundation, Finnish Research Council and Sigrid Juselius Foundation, the National Regional Fund, Sakari Alhopuro Foundation and Finnish Diabetes Research Foundation. E.E. has received a research grant from Ferring Pharmaceuticals (payment to institution) and serves as medical advisor for Tilly AB, not related to this manuscript. The remaining authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Meri-Maija Ollila
- Research Unit of Clinical Medicine, Department of Obstetrics and Gynaecology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jens-Jakob Kjer Møller
- OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Paula Pesonen
- Faculty of Medicine, Infrastructure for Population Studies, University of Oulu, Oulu, Finland
| | - Sofia Persson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Evangelia Elenis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Katrine Hass Rubin
- OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Terhi Piltonen
- Research Unit of Clinical Medicine, Department of Obstetrics and Gynaecology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Kaur I, Kishore K, Suri V, Sahni N, Rana SV, Singh A. Determinants of polycystic ovary syndrome: A matched case-control study. J Hum Nutr Diet 2024; 37:583-592. [PMID: 38234173 DOI: 10.1111/jhn.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a multifaceted endocrine disorder of women of reproductive age with a multifactorial aetiology. Despite much research, there is still inconclusive data on the impact of dietary, lifestyle and socio-economic factors on PCOS aetiology. Thus, the present study explored the association of PCOS with diet, eating behaviour, other lifestyle and socio-economic factors. METHODS A matched-pair case-control study was conducted on 150 women with PCOS and 150 healthy controls. Information on diet, eating behaviour and physical activity, and also anthropometric and socio-economic data were collected through standard questionnaires. The adjusted odds ratios (AmOR) were calculated and reported using conditional multivariable logistic regression. RESULTS The results showed low education level (AmOR = 8.44; 95% confidence interval [CI] = 1.63-43.68), high sugar consumption (AmOR = 11.61; 95% CI = 2.05-65.72) along with higher body mass index (BMI) and inactivity to be significantly associated with PCOS. Also, a significant protective effect was found for cognitive dietary restraint (AmOR = 0.79; 95% CI = 0.66-0.93), crude fibre (AmOR = 0.61; 95% CI = 0.45-0.82) and protein intake. CONCLUSIONS Low education status may contribute to higher receptiveness to choosing unhealthy diets and lifestyles, resulting in adiposity and an increased risk of PCOS.
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Affiliation(s)
- Ishwarpreet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamal Kishore
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nancy Sahni
- Department of Dietetics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satya Vati Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Kim C, Schreiner PJ, Siscovick D, Wang A, Wellons MF, Ebong I, Vu TH, Appiah D, Catov J, Schisterman EF, Yin Z, Lewis CE. Factors associated with self-report of polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults study (CARDIA). BMC Womens Health 2023; 23:248. [PMID: 37161406 PMCID: PMC10170674 DOI: 10.1186/s12905-023-02394-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is underdiagnosed, but factors associated with women's report of diagnosis are not well-understood, particularly social determinants of health. Therefore, in a population-based cohort, we compared the characteristics of women with self-reported PCOS vs. women who have unrecognized PCOS vs. women without PCOS. METHODS We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a population-based, prospective cohort of Black and White women. Participants were women (n = 2028) who responded to the question, "Did a doctor or nurse ever tell you that you had polycystic ovarian syndrome or polycystic ovarian disease?" at the year 15 examination. Women who answered "yes" were defined as having self-reported PCOS. Women who answered "no or not sure" were defined as having unrecognized PCOS if they also had irregular menses and hyperandrogenemia between 20 and 30 years of age. Exposures of interest included social determinants of health, symptoms including irregular menses and hirsutism, and comorbid conditions. RESULTS Forty-three (2.1%) of women had self-reported PCOS, 135 (6.7%) had unrecognized PCOS, and 1850 (91%) women were without PCOS. In logistic regression models adjusting for age, race, and center, women with self-reported PCOS were more likely to have obesity (OR 1.83, 95% CI 1.22, 2.75) and diabetes (OR 2.37, 95% CI 1.05, 5.33) compared to women without PCOS. Women with unrecognized PCOS were more likely to have hypertension (OR 1.68, 95% CI 1.03, 2.74) and food insecurity (OR 1.94, 95% CI 1.25, 3.01) compared to women without PCOS. CONCLUSIONS Unrecognized PCOS is common. Self-report of PCOS is not associated with access to healthcare. Women who report PCOS are more often obese and comorbidities may contribute to recognition of PCOS.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, North Campus Research Center, 2800 Plymouth Road, Building 16, Room 405E, Ann Arbor, MI, 48109, USA.
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Ange Wang
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Melissa F Wellons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Imo Ebong
- Department of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Thanh-Huyen Vu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Duke Appiah
- Department of Public Health, School of Public and Population Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Janet Catov
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Enrique F Schisterman
- Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhe Yin
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Glintborg D, Petersen TG, Rubin KH, Andersen MS. Diabetes Mellitus Mediates Risk of Depression in Danish Women with Polycystic Ovary Syndrome—A National Cohort Study. Biomedicines 2022; 10:biomedicines10102396. [PMID: 36289658 PMCID: PMC9598722 DOI: 10.3390/biomedicines10102396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 12/04/2022] Open
Abstract
Aim: To investigate the risk of depression in Danish women with PCOS compared to controls and possible mediators for depression in PCOS. National register-based study in Danish women with PCOS (PCOS Denmark, N = 25,203) and age-matched controls (N = 112,414). PCOS Odense University Hospital (PCOS OUH, N = 998) was a sub-cohort of women with PCOS with available clinical and biochemical results. The main study outcome was depression occurring after PCOS diagnosis. Depression was defined according to hospital ICD-10 diagnosis codes and/or inferred from filled medicine prescription of antidepressants. Diabetes, medical comorbidity, infertility, hormonal anti-contraception and low family income were entered as mediators in Cox regression analyses for depression. In PCOS OUH, PCOS characteristics (age, BMI, Ferriman-Gallwey score) were entered in Cox regression analyses. The median age at cohort entry was 28 (interquartile range (IQR) 23; 35) years. The median follow-up time to incident depression or censuring was 4.8 (IQR 2.2; 8.8) years in PCOS Denmark and 5.2 (IQR 2.4; 9.2) years in controls. Women with PCOS had a 40% increased risk of depression compared to controls (Hazard Ratio 1.42 (95% CI 1.38; 1.47). In regression analyses, diabetes, medical comorbidity, infertility, hormonal anticonception, and low family income were significant mediators of depression. Mediation analyses showed that the proportion of the association explained by diabetes was 12.5% (95% CI 10.4; 14.5). In PCOS OUH, BMI, waist and Ferriman-Gallwey score predicted development of depression. Conclusion: The risk of depression was increased in PCOS. Diabetes was an important mediator of depression in PCOS.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
- Correspondence:
| | - Tanja Gram Petersen
- OPEN—Odense Patient Data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
| | - Katrine Hass Rubin
- OPEN—Odense Patient Data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
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Kujanpää L, Arffman RK, Vaaramo E, Rossi HR, Laitinen J, Morin-Papunen L, Tapanainen J, Ala-Mursula L, Piltonen TT. Women with polycystic ovary syndrome have poorer work ability and higher disability retirement rate at midlife: a Northern Finland Birth Cohort 1966 study. Eur J Endocrinol 2022; 187:479-488. [PMID: 35900320 PMCID: PMC9422246 DOI: 10.1530/eje-22-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) presents with multiple comorbidities potentially affecting function. This was the first general population-based study to evaluate work ability, participation in working life, and disability retirement in middle-aged women with and without PCOS. DESIGN This is a cohort study. METHODS Women with PCOS (n = 280) and women without PCOS symptoms or diagnosis (n = 1573) were identified in the Northern Finland Birth Cohort in 1966 and were evaluated for self-rated work ability and potential confounders at age 46. Next, incidence rate ratios (IRRs) for disability and unemployment days were extracted from national registers during a prospective 2-year follow-up. Lastly, we assessed hazard ratios (HRs) for disability retirement between 16 and 52 years of age from national registers. RESULTS The women with PCOS reported poorer ability to work at age 46, especially due to poorer health. During the 2-year follow-up period, the affected women gained on average an additional month of disability and unemployment days, corresponding to an approximately 25% higher risk for both disability (IRR (95% CI): 1.25 (1.22-1.27)) and unemployment days (IRR (95% CI): 1.26 (1.23-1.28)) in models adjusted for health and socioeconomic factors. Lastly, we found a two-fold higher cumulative risk for disability retirement by age 52 compared to non-PCOS women (HR (95% CI): 1.98 (1.40-2.80)), which remained after adjusting for confounding factors (aHR (95% CI): 1.55 (1.01-2.38)). CONCLUSIONS PCOS is associated with lower participation in working life already in midlife. Acknowledging PCOS-related multimorbidity, concerted efforts are needed to support sustainable careers for women with PCOS.
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Affiliation(s)
- Linda Kujanpää
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Riikka K Arffman
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Eeva Vaaramo
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Henna-Riikka Rossi
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | | | - Laure Morin-Papunen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Juha Tapanainen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Leena Ala-Mursula
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Terhi T Piltonen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Correspondence should be addressed to T T Piltonen;
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Liu R, Li M, Wang P, Yu M, Wang Z, Zhang GZ. Preventive online and offline health management intervention in polycystic ovary syndrome. World J Clin Cases 2022; 10:3060-3068. [PMID: 35647126 PMCID: PMC9082701 DOI: 10.12998/wjcc.v10.i10.3060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/24/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, hyperinsulinemia, ovarian polycystic changes, and irregular ovulation, often occurring in women of childbearing age for whom it can be a cause of infertility. Hypothalamus-pituitary-ovarian axis dysregulation is important in the pathogenesis of PCOS and the associated chronic excess of sex hormones can lead to cardiovascular and cerebrovascular diseases, diabetes, and malignancies such as endometrial cancer, and breast cancer. At present, most scholars agree that lifestyle interventions in conjunction with drug treatment can help PCOS patients achieve their goals of successful pregnancy and childbirth.
AIM To investigate the clinical effect of an online and offline (O2O) preventive health management model on PCOS with kidney deficiency and phlegm dampness.
METHODS A total of 82 patients with PCOS of the kidney deficiency and phlegm dampness type who were admitted to Beijing Luhe Hospital Affiliated to Capital Medical University from April 2019 to June 2020 were randomly divided into two groups. The treatment group was treated with oral Diane-35 for 3 mo and received preventive O2O medical health management for 6 mo (including eating and living, exercise, drug management). The control group was treated with oral Diane-35 for 3 mo and completed outpatient health education. The traditional Chinese medicine (TCM) syndrome score, acne score, hair score, sex hormone level and clinical effects were compared between the two groups before and after the intervention.
RESULTS After treatment, the TCM syndrome score, acne score, and serum luteinizing hormone/follicle stimulating hormone level were significantly lower in the treatment group than in the control group (P < 0.05). After 3 mo of treatment, the TCM syndrome curative effect index in the treatment group was 97.30% compared to 54.05% in the control group (P < 0.05), whereas the total treatment effect in the treatment group was 91.89%, compared to 54.05% in the control group (P < 0.05).
CONCLUSION An integrated therapeutic approach incorporating medication, TCM methods and social media is more effective than standard treatment for PCOS.
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Affiliation(s)
- Rui Liu
- Dermatological Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 101100, China
- Chinese Medicine Department, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China
| | - Min Li
- Chinese Medicine Department, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China
| | - Pei Wang
- Chinese Medicine Department, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China
| | - Man Yu
- Chinese Medicine Department, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China
| | - Zheng Wang
- Chinese Medicine Department, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China
| | - Guang-Zhong Zhang
- Dermatological Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 101100, China
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Fernandez RC, Moore VM, Rumbold AR, Whitrow MJ, Avery JC, Davies MJ. Diagnosis delayed: health profile differences between women with undiagnosed polycystic ovary syndrome and those with a clinical diagnosis by age 35 years. Hum Reprod 2021; 36:2275-2284. [PMID: 33963388 PMCID: PMC8289294 DOI: 10.1093/humrep/deab101] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/18/2021] [Indexed: 01/16/2023] Open
Abstract
STUDY QUESTION Are reproductive, metabolic or psychological health profiles of women with clinically diagnosed polycystic ovary syndrome (PCOS) different from those with undiagnosed PCOS? SUMMARY ANSWER Obtaining a clinical diagnosis of PCOS is strongly linked to the experience of fertility problems, but not clinical depression or poor metabolic health, although these were highly prevalent in women with PCOS irrespective of when they were diagnosed. WHAT IS KNOWN ALREADY PCOS is an endocrine disorder that is relative common, but heterogeneous in presentation. This may impact on the pathways to diagnosis and timely treatment. STUDY DESIGN, SIZE, DURATION A cross-sectional analysis of a community-based cohort of 974 women, established retrospectively when women were around 30 years of age. PARTICIPANTS/MATERIALS, SETTING, METHODS In this cohort of women born in Adelaide, South Australia, half of women who met the Rotterdam criteria for PCOS were previously undiagnosed. We compared women with prior clinical diagnosis of PCOS, those diagnosed through participation in this research, and the remainder in the cohort. Sociodemographic characteristics, reproductive, metabolic and psychological health, including medical conditions and medications were considered. Logistic regression was undertaken to identify independent predictors of prior clinical diagnosis. MAIN RESULTS AND THE ROLE OF CHANCE There were 56 women with a prior clinical diagnosis of PCOS (5.7%) and a further 64 (6.6%) were undiagnosed until study entry. The great majority of women with a prior diagnosis of PCOS reported having had problems with periods (95%) and excess body hair (63%). Corresponding proportions for women undiagnosed until study participation were slightly lower (81% and 45%, respectively). Although the proportion of women attempting or achieving pregnancy was similar across all groups, those with a prior diagnosis of PCOS were four times more likely to have reported difficulties becoming pregnant than those undiagnosed (odds ratio = 4.05, 95% CI 1.74–9.45) and frequently sought medical assistance. Metabolic problems were higher in both PCOS groups compared to women without PCOS. In both PCOS groups, the prevalence of clinical depression was 50% higher than in those with no PCOS (P = 0.021). LIMITATIONS, REASONS FOR CAUTION The number of women who were diagnosed with PCOS both prior to and during the study limited statistical power available to detect modest differences between the PCOS groups. Some women in the group classified as not having PCOS may have remained undiagnosed, but any bias from this source would contribute to more conservative findings. WIDER IMPLICATIONS OF THE FINDINGS Findings reinforce the need for early detection of PCOS symptoms from adolescence, ensuring timely diagnosis and appropriate health care. The high prevalence of depression among clinically diagnosed and undiagnosed women with PCOS suggests this is a feature of the condition and supports recent recommendations in the international PCOS guidelines to screen all women with PCOS for depression and anxiety. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a project grant (2017) from the National Health and Medical Research Council of Australia (NHMRC) Centre for Research Excellence in Polycystic Ovary Syndrome (Grant ID APP1078444). R.C.F. and J.C.A. were supported by Robinson Research Institute Lloyd Cox Career Development Fellowships (2018). Establishment of the cohort was funded by an NHMRC Strategic Award No. 465455, a Career Development Award in Population Health (No. 349548) and the Australian Research Council (Future Fellowship FT100101018) awarded to M.J.D. All authors declared no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Renae C Fernandez
- The University of Adelaide, Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.,The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia.,Robinson Research Institute, Adelaide, South Australia, Australia
| | - Vivienne M Moore
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia.,Robinson Research Institute, Adelaide, South Australia, Australia.,Fay Gale Centre for Research on Gender, Adelaide, South Australia, Australia
| | - Alice R Rumbold
- Robinson Research Institute, Adelaide, South Australia, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Melissa J Whitrow
- The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia.,Robinson Research Institute, Adelaide, South Australia, Australia
| | - Jodie C Avery
- Robinson Research Institute, Adelaide, South Australia, Australia
| | - Michael J Davies
- The University of Adelaide, Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.,Robinson Research Institute, Adelaide, South Australia, Australia
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Schmidt AB, Lund M, Wohlfahrt J, Melbye M. Polycystic ovary syndrome and offspring risk of congenital heart defects: a nationwide cohort study. Hum Reprod 2021; 35:2348-2355. [PMID: 32797231 DOI: 10.1093/humrep/deaa168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION Is maternal polycystic ovary syndrome (PCOS) associated with increased offspring risk of congenital heart defects? SUMMARY ANSWER This study does not support a strong association between PCOS and an increased risk of congenital heart defects. WHAT IS KNOWN ALREADY In addition to affecting reproductive health, PCOS may involve insulin resistance. Maternal pregestational diabetes is associated with an increased risk of congenital heart defects and therefore PCOS may increase the risk of congenital heart defects in the offspring. STUDY DESIGN, SIZE, DURATION In this nationwide cohort study, we used data from Danish health registers collected from 1995 to 2018. The study included 1 302 648 offspring and their mothers. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were live singleton offspring born during the study period. Information on maternal PCOS and offspring congenital heart defects was obtained from the National Patient Register. Logistic regression analysis was used to compute prevalence (odds) ratio (PR) of the association between PCOS and offspring congenital heart defects. MAIN RESULTS AND THE ROLE OF CHANCE Among 1 302 648 live-born singletons, 11 804 had a mother with PCOS. Of these, 143 offspring had a congenital heart defect (prevalence 121 per 10 000) as compared with 12 832 among mothers without PCOS (prevalence 99 per 10 000). The adjusted PR was 1.22, 95% CI 1.03-1.44 comparing prevalence of congenital heart defects in offspring of women with PCOS with offspring of women without. After adjusting for the potentially mediating effect of pregestational diabetes, the PR was 1.16, 95% CI 0.98-1.37. LIMITATIONS, REASONS FOR CAUTION PCOS may be underdetected in the National Patient Register. However, we expect that the mothers that we identified with PCOS truly had PCOS, thus, the estimated associations are not likely to be affected by this misclassification. The study does not provide evidence to rule out a moderate or weak association. WIDER IMPLICATIONS OF THE FINDINGS These findings provide reassurance to clinicians counselling pregnant women with PCOS that the disease does not pose a markedly increased risk of offspring congenital heart defects. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Novo Nordisk Foundation. M.L. reports personal fees from Dansk Lægemiddel Information A/S outside the submitted work. The remaining authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A B Schmidt
- Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark
| | - M Lund
- Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark.,Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, 2400 Copenhagen NV, Denmark
| | - J Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark
| | - M Melbye
- Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Panjeshahin A, Salehi-Abargouei A, Anari AG, Mohammadi M, Hosseinzadeh M. Association between empirically derived dietary patterns and polycystic ovary syndrome: A case-control study. Nutrition 2020; 79-80:110987. [DOI: 10.1016/j.nut.2020.110987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 08/01/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
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Nielsen JH, Birukov A, Jensen RC, Kyhl HB, Jørgensen JS, Andersen MS, Glintborg D. Blood pressure and hypertension during pregnancy in women with polycystic ovary syndrome: Odense Child Cohort. Acta Obstet Gynecol Scand 2020; 99:1354-1363. [DOI: 10.1111/aogs.13914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Julie Hougård Nielsen
- Department of Endocrinology and Metabolism Odense University Hospital Odense Denmark
| | - Anna Birukov
- Charité – Universitätsmedizin BerlinCorporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Department of Gynecology and Obstetrics Odense University Hospital Odense Denmark
- Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité‐Universitätsmedizin Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK) Berlin Germany
- Department of Molecular Epidemiology German Institute of Human Nutrition Potsdam‐Rehbrücke Nuthetal Germany
| | - Richard Christian Jensen
- Department of Endocrinology and Metabolism Odense University Hospital Odense Denmark
- Department of Environmental Medicine University of Southern Denmark Odense Denmark
| | - Henriette Boye Kyhl
- Odense Child Cohort Hans Christian Andersen Children’s HospitalOdense University Hospital Odense Denmark
- OPEN Patient data Explorative Network (OPEN) University of Southern Denmark Odense Denmark
| | - Jan Stener Jørgensen
- Department of Gynecology and Obstetrics Odense University Hospital Odense Denmark
| | | | - Dorte Glintborg
- Department of Endocrinology and Metabolism Odense University Hospital Odense Denmark
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