Photo Credit: Menshalena

Women with PCOS, who have a significantly higher risk for preeclampsia, require earlier and more intensive screening to identify and manage the condition.

“Although there may be differences in the pathogenesis of early-onset (<34 weeks’ gestation) and late-onset [preeclampsia], the pathophysiology and maternal/fetal consequences can be similar,” Shaun Brennecke, MBBS, DPhil, and colleagues wrote. “Pre-existing maternal pathological features such as chronic systemic inflammation, insulin resistance, and hyperandrogenemia, as occur in women with polycystic ovary syndrome (PCOS), may alter normal placental development, metabolism, and physiology at all stages of pregnancy.”

For a study published in the Journal of Clinical Medicine, Dr. Brennecke and colleagues aimed to develop recommendations for the screening and management of women with PCOS to decrease the risk for preeclampsia during pregnancy. They examined systematic reviews, observational studies, and molecular research on the risk for preeclampsia in women with PCOS.

The researchers examined multiple factors that drive the increased risk for preeclampsia in women with PCOS, including nutrition and lifestyle, insulin resistance, chronic systemic inflammation, hyperandrogenism, and the maternal microbiome.

Preeclampsia Risk Assessment

The extensive literature on this link indicates a significantly increased risk for preeclampsia in women with PCOS, according to Dr. Brennecke and colleagues.

“These data, coupled with the increasing availability of early-pregnancy screening for [preeclampsia], suggest that women with PCOS should be included in risk assessment algorithms and be considered for screening and possible treatment to reduce their risk of developing [preeclampsia],” the researchers wrote.

They also performed an extensive review of screening protocols for this patient population. Initial screening measurements for high-risk patients with PCOS include:

• mean arterial blood pressure;
• mean uterine artery pulsatility index (measured via ultrasound); and
• maternal serum biochemical markers, including pregnancy-associated plasma protein A and/or placental growth factor.

According to the study results, several prospective studies demonstrate the benefit of measuring the serum soluble fms-like tyrosine kinase-1/placental growth factor ratio for diagnosing, monitoring, and managing those at high risk for preeclampsia.

After reviewing screening protocols, Dr. Brennecke and colleagues developed an algorithm for preeclampsia screening, lifestyle considerations, and management in patients with PCOS (Figure).

Preeclampsia Management & Directions for Research

The use of low-dose aspirin starting before 16 weeks and up to 37 weeks has been found to significantly decrease—by 62%—the likelihood of preterm preeclampsia, preterm birth, and related complications.

“Since women with PCOS may have an increased risk of early-onset PE, prophylactic treatment with aspirin may be particularly beneficial in this patient group,” the researchers wrote.

However, only one small study with 105 patients examined the use of low-dose aspirin in pregnant women with PCOS, they noted. While those results showed a significant decrease in UtAPI at 20 weeks, “the paucity of studies evaluating the use of aspirin in pregnant women with PCOS may reflect a lack of appreciation for the increased risk of complications and highlights the need for the inclusion of women with PCOS in risk assessment models.”