Persistence of hypertension after pregnancy-related hypertensive disorders in women with polycystic ovary syndrome.

OBJECTIVE

To assess whether polycystic ovary syndrome (PCOS) increases the risk of persistent hypertension in women with a history of pregnancy-related hypertensive disorder (PHD).

DESIGN

A single-center, prospective cohort study.

SUBJECTS

A total of 124 patients with PHD were enrolled. Pregnancy-related hypertensive disorder was diagnosed on the basis of the presence of pregnancy-induced hypertension or preeclampsia. All patients with PHD were screened for PCOS diagnosis, which was confirmed or excluded on the basis of patient history and clinical reports. Sixty-two patients diagnosed with PCOS (n = 62 cases) were included as the study group. After 1-to-1 matching process on the basis of age, body mass index, and infertility treatment, 62 control patients without PCOS were also included.

EXPOSURE

Polycystic ovary syndrome diagnosis according to the national and international criteria.

MAIN OUTCOME MEASURES

The primary outcome was the persistence of hypertension 12 months after delivery. The secondary outcomes included persistence of hypertension at 3 and 6 months from delivery, pregnancy complications, and data on antihypertensive treatment.

RESULTS

After 12 months from delivery, the risk of persistent hypertension was significantly higher in patients with PHD with PCOS than in controls [adjusted odds ratio, 5.01; 95% confidence interval (CI), 1.63-15.94]. At 6 months, that risk was also significantly higher (adjusted odds ratio, 5.01; 95% CI, 1.63-15.94). Additionally, pregnant patients with PCOS had an earlier onset of PHD (30.0 vs. 31.1 weeks), required a higher dose of nifedipine (37.5 mg vs. 30 mg), and were more likely to receive antihypertensive therapy with multiple drugs (24.2% vs. 9.7%) than controls. The incidence of fetal growth restriction (19.4% vs. 6.5%), abnormal Doppler velocimetry (16.1% vs. 4.8%), and cesarean delivery (35.5% vs. 19.4%) was also significantly higher in the PCOS group than in controls.

CONCLUSION

Polycystic ovary syndrome is associated with an increased risk of persistent hypertension in patients with a history of PHD. Preventive interventions before pregnancy, specific pregnancy surveillance, and long-term follow-up should be recommended for women with PCOS.