Objective: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women and increasingly understood as a significant cardiometabolic condition. We aimed to identify the risk factors for gestational hypertension in all forms of PCOS phenotypes and tried to establish a prediction model to evaluate the risk. Design and method: 73 primiparous women with PCOS were examined after 20 weeks of gestation due to suspected gestational hypertension. All patients underwent ambulatory blood pressure monitoring (ABPM). Gestational hypertension was diagnosed in 41 patients. Retrospectively were analyzed pre-gestational cardiometabolic risk factors: obesity, insulin resistance, diabetes, high cholesterol, family history of hypertension, oral contraceptive pill (OCP) use, and long-term smoking history. Laboratory evaluation included glycemia, uric acid, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), liver enzymes (AST/ALT, GGT), albumin, eGFR. Pre-gestational Anti-Müllerian hormone (AMH) levels and routines urine and liver and kidney function analysis during pregnancy were collected too. Insulin resistance was assessed with the use of the homeostasis model assessment (HOMA2-IR) In the statistical analysis the group of patients with gestational hypertension (n=41) was compared with normotensive patients according to ABPM (n=32). Results: Hypertensive patients were older (36.8±4.5 vs 40.5±4.6; p=0,001), more obese before pregnancy (30.8±4.5 vs 27.3±3.4; p=0.001), with significantly higher values of uric acid (338.6±89.0 vs 293.0±71.7; p=0.021), HOMA2-IR (2.90±0.62 vs 2.59±0.46;p=0,021), total cholesterol (5.2±1.12 vs 5.0±1.14,;p=0,006), LDL-C (3.7±1.13 vs 3.5±1.25,;p=0,002), and lower HDL-C (1.11±0.28 vs 1,16±0.43;p=0,046). They had a positive family history of hypertension (27(67.5%) vs 14 (34.1%), p=0.028). Women with gestational hypertension more frequently had the hyperandrogenic phenotype of PCOS (34(82.9%) vs 7(17.1%);p=0.005). Independent predictors of gestational hypertension in women with PCOS included older age (1.237(1.066-1.437);p=0,005), excess body weight before pregnancy (1.223(1.028-1.454);p=0,023) and hyperandrogenic phenotype of PCOS (0.139(0.030-0.6430;p=0.012). In women 35 years of age or older the prevalence of hypertension was significantly higher (37 (90.2%) vs 4(9.8%);p=0.022). Conclusions: PCOS traits like obesity, high androgens, and insulin resistance, combined with older maternal age (35 years of age or older), create a high-risk profile for gestational hypertension and other complications, making pre-conception lifestyle management crucial for identifying at-risk individuals and improving outcomes.
Stevanovic et al. (Fri,) studied this question.