Poster Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

The impact of preconception weight loss interventions on pregnancy outcomes in women with Polycystic Ovary Syndrome (#94)

Amelia Fernandes 1 2 3 , Adrienne Gordon 2 3 4 , Arianne Sweeting 1 2 3
  1. Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Sydney Institute for Women, Children and their Families, Sydney, NSW, Australia
  3. Faculty of Medicine and Health, Sydney, NSW, Australia
  4. Department of Neonatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

Background

Polycystic Ovary Syndrome (PCOS) is a common condition affecting up to 26% of women with overweight and obesity [1]. PCOS is associated with a longer time to spontaneous or assisted conception, greater risk of early pregnancy loss, three- to four-fold increased risk of gestational diabetes (GDM) and pre-eclampsia, and an almost two-fold increased risk of still birth [2, 3, 4].

Weight loss prior to pregnancy improves the metabolic and hormonal profile of women with PCOS and reduces their risk of pregnancy complications [5]. However, it is unclear which type of weight loss intervention is most effective for improving these reproductive, metabolic and hormonal parameters.

Aim

We conducted a systematic review to assess the impact of pre-pregnancy lifestyle, surgical or pharmacological weight loss interventions on fertility and pregnancy outcomes in women with PCOS and overweight or obesity.

Method

A comprehensive literature search was performed on PubMed, Embase and Cochrane CENTRAL from the inception of the databases dating up to May 2022. We included all randomized controlled trials (RCTs) comparing lifestyle, surgical or pharmacological weight loss interventions in women of reproductive age between 18-40 years with PCOS and a body mass index (BMI) greater than or equal to 25 kg/m2. The Cochrane Handbook of Systematic Reviews and the Quality of Reporting of Meta-Analyses checklist was used to conduct quality analysis.

Main outcome measures

Primary outcomes: Preconception weight loss, rates of spontaneous pregnancy, live birth, spontaneous abortion.
Secondary pregnancy outcomes: Time to conception, GDM, pre-eclampsia, hypertension in pregnancy, stillbirth, preterm delivery or NICU admission.
Secondary reproductive measures: anthropometric, androgenic and metabolic parameters associated with PCOS.

Results

5908 studies were extracted for screening. Our review is ongoing, results will be available by the time of the IADPSG meeting.

Significance and Objectives

This data will inform the methodology for our PreBabe PCOS Substudy, nested within the MRFF funded PreBabe study (MRF1200791), a multi-centre RCT evaluating a pre-conception weight loss intervention on reducing perinatal complications for women with overweight and obesity [6].

  1. Miazgowski T, Martopullo I, Widecka J, Miazgowski B, Brodowska A. National and regional trends in the prevalence of polycystic ovary syndrome since 1990 within Europe: the modeled estimates from the Global Burden of Disease Study 2016. Archives of Medical Science. 2021;17(2):343-351. doi:10.5114/aoms.2019.87112.
  2. Azziz, R., et al., Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. Journal of Clinical Endocrinology & Metabolism, 2006. 91(11): p. 4237-45
  3. Treloar, A., et al., Variation of the human menstrual cycle through reproductive life. International Journal of Fertility, 1967. 12: p. 77.
  4. Teede H, Misso M, Costello M, Dokras A, Laven J, Moran L, et al on behalf of the International PCOS Network. International evidence based guideline for the assessment and management of polycystic ovary syndrome. https://www.monash.edu/_ _ data/assets/pdf_ file/0004/1412644/PCOS_ Evidence-Based- Guidelines_ 20181009.pdf 2018.
  5. Muirhead R, Kizirian N, Lal R, Black K, Prys-Davies A, Nassar N, et al. A Pilot Randomized Controlled Trial of a Partial Meal Replacement Preconception Weight Loss Program for Women with Overweight and Obesity. Nutrients 2021.13:3200.
  6. Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006 Nov-Dec;12(6):673-83. doi: 10.1093/humupd/dml036. Epub 2006 Aug 4. PMID: 16891296.