Risk of Preeclampsia in Women with Polycystic Ovarian Syndrome

Introduction/Objective: Polycystic Ovarian Syndrome (PCOS) is considered a heterogeneous disorder of clinical and biochemical manifestations. There is little evidence confirming the correlation between PCOS and Preeclampsia (PE), as some suggest that both have shared risk factors. Therefore, this study aimed to determine the risk of developing PE in pregnant women with a history of PCOS in addition to other pregnancy complications. Methods: A retrospective case-control study included 200 singleton pregnancies presented at delivery, of which 100 were diagnosed with PE (cases) and the other 100 without PE (controls), at the Kirkuk Maternity Teaching Hospital, Kirkuk, Iraq, from the 1st April 2023 to 1st April 2025. Demographic information, PCOS history, pregnancy complications, and status of the current delivery were used to analyze the risk of PE and pregnancy complications in women with PCOS. Results: In comparing to control group, cases were significantly older (33.3 ± 5.2 vs. 31.4 ± 2.3 years, p=0.002), had higher body mass index (26.7 ± 5.0 vs. 24.4 ± 1.8 kg/m2, p< 0.001), multiple pregnancies (10% vs. 0%, p=0.001), Assisted Reproductive Technology (ART) with ovarian stimulation (31% vs. 19%, OR=1.92, 95% CI: 1.00-3.68, p=0.049), and showed more PCOS-related features, including menstrual irregularity (33% vs. 14%, OR=3.06, 95% CI: 1.50-6.23, p=0.002) and polycystic ovaries on ultrasound (37% vs. 20%, OR=2.33, 95% CI: 1.24-4.38, p=0.008). PCOS prevalence was higher in cases than controls (67% vs. 57%, OR=1.53, 95% CI: 0.86-2.72, p=0.145), but the association was not significant after adjustment (OR=1.47, 95% CI: 0.80-2.70, p=0.218). Cases had significantly increased risks of preterm birth (adjusted OR=13.45, 95% CI: 1.67-7.12, p=0.001) and gestational diabetes mellitus (GDM) (adjusted OR=2.89, 95% CI: 0.92-9.08, p=0.006). Discussion: Patients’ age, weight, use of ART with ovarian stimulation, together with menstrual irregularity and polycystic ovaries, were identified as risk factors for PE development. Conclusion: Concurrent PCOS and PE were significantly associated with patients’ age, body mass index, and menstrual irregularities. Also, these conditions increase the risk of preterm birth and GDM.