Analysis of peculiarities of miscarriage in women of reproductive age with different PCOS phenotypes

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INTRODUCTION

Women with PCOS are considered to be a risk group for adverse pregnancy outcomes. Previous studies have shown that women with PCOS have an increased risk of pregnancy loss compared to women without PCOS. Frequency of spontaneous termination of pregnancy depended on the age of women and the phenotype of PCOS. Currently, there are 4 phenotypes of PCOS associated with varying degrees of severity of insulin resistance (IR), impaired glucose tolerance (IGT), diabetes mellitus (DM). Combination of these pathological factors (hyperandrogenemia, anovulation) and comorbid conditions (obesity, carbohydrate metabolism disorders) can contribute to development of unfavorable pregnancy outcomes in women with PCOS.

OBJECTIVE

To investigate peculiarities of miscarriage in women of reproductive age with different PCOS phenotypes.

MATERIALS AND METHODS

The study included 86 women of reproductive age from 22 to 37 years (the average age was 26.6±4.3 years), who were divided into four groups according to the phenotypes of PCOS (A, B, C, D). Levels of AMH, FSH, LH, prolactin, estradiol, androgens from the 2nd to the 5th day of menstrual cycle were studied. Levels of progesterone in blood serum were studied by enzyme immunoassay method (using test systems Alkor-bio, Russia) on the 20—23 day of menstrual cycle for three consecutive cycles. Also we used echographic method for diagnostics of polycystic ovaries. All the women underwent oral glucose tolerance test (OGTT) with a study of level of glucose in blood plasma fasting and 2 hours after 75 g of glucose intake accompanied by determination of blood insulin level fasting and 2 hours after OGTT. HOMA index was used to assess insulin resistance.

RESULTS

Phenotype A was detected in 40 (46.5%) women with PCOS; phenotype B — in 22 (25.6%); phenotype C — in 10 (11.6%); phenotype D (nonandrogenic) —in 14 (16.3%) patients. Miscarriage rate in women with PCOS was 31.4% and it significantly depended (p<0.005) on PCOS phenotype. Women included into the study did not have cervical insufficiency (CI). Miscarriage was significantly more often (p<0.005) observed in women with hyperandrogenic PCOS phenotypes (A, B, C), which were diagnosed in 92.6% of women. In patients with nonandrogenic phenotype D, spontaneous miscarriage in anamnesis occurred only in 7.4% of cases. In most women with ovulatory phenotype C, spontaneous pregnancies (without luteal phase support) terminated as early spontaneous miscarriage. In addition, in patients with miscarriage, disorders of carbohydrate metabolism and excess body weight were significantly more common (p<0.005 and p<0.05, respectively) in hyperandrogenic phenotypes of PCOS (A, B, C).

CONCLUSIONS

Women with PCOS should be informed about higher risk of pregnancy complications and possibility of adverse outcomes for their offspring. Adequate support should be offered to make changes in a woman’s lifestyle at pre-pregnancy stage. Personalized comprehensive preconceptional training is necessary in such patients, which should include normalization of BMI, correction of hormonal and metabolic disorders.

Keywords:

PCOS

phenotype

miscarriage

IGT

insulin resistance

HOMA index

hyperandrogenemia

Authors:

Abashova E.I.

Ott Research Institute of Obstetrics, Gynecology and Reproductology — Department of Gynecology and Endocrinology

SPIN RSCI: 2133-0310
Scopus AuthorID: 36503679200
ResearcherID: J-5436-2018
ORCID: 0000-0003-2399-3108

Yarmolinskaya M.I.

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology;
I.I. Mechnikov North-Western State Medical University

ORCID: 0000-0002-6551-4147

Bulgakova O.L.

Ott Research Institute of Obstetrics, Gynecology and Reproductology — Department of Gynecology and Endocrinology

Scopus AuthorID: 57214317015
ORCID: 0000-0001-8967-2986

Tkachenko N.N.

Ott Research Institute of Obstetrics, Gynecology and Reproductology

SPIN RSCI: 9633-6701
Scopus AuthorID: 57202288472

Misharina E.V.

Ott Scientific Research Institute of Obstetrics, Gynecology and Reproductology

SPIN RSCI: 7350-5674
Scopus AuthorID: 57200069538
ORCID: 0000-0002-0276-7112

Received:

16.08.2021

Accepted:

19.05.2022

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