Dysglycemia and Adverse Pregnancy Outcomes Among Individuals with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) has been associated with adverse pregnancy outcomes, although reported risks vary across studies. Metabolic heterogeneity within PCOS may contribute to this variability. Dysglycemia during pregnancy may identify a subgroup at increased obstetric risk. The study aims to evaluate whether dysglycemia is associated with preeclampsia and other adverse pregnancy outcomes among individuals with PCOS. Methods: We performed a secondary analysis of the prospective Fatty Liver in Pregnancy (FLIP) cohort ( n = 1,321). PCOS was defined by chart review of the electronic health record. Dysglycemia was defined as current or prior gestational diabetes, abnormal glucose tolerance testing, hemoglobin A1c > 5.7% during pregnancy, or pregestational diabetes. Participants were categorized as PCOS with dysglycemia ( n = 36), PCOS without dysglycemia ( n = 44), or non-PCOS controls ( n = 1,238). The primary outcome was preeclampsia. Secondary outcomes included gestational hypertension, preterm birth, abnormal neonatal weight, and neonatal hypoglycemia. Multivariable logistic regression adjusted for maternal age and body mass index. Results: Among 80 individuals with PCOS, 45% had evidence of dysglycemia. Preeclampsia occurred in 33% of those with PCOS and dysglycemia, 7% of those with PCOS without dysglycemia, and 12% of controls ( p = 0.005 for PCOS with dysglycemia versus controls). In adjusted analyses, PCOS with dysglycemia was associated with preeclampsia (odds ratio OR 2.9; 95% confidence interval CI: 1.4–6.1), whereas PCOS without dysglycemia was not (adjusted odds ratio aOR 0.53; 95% CI: 0.16–1.73). PCOS with dysglycemia was also associated with increased preterm birth (OR: 2.3; 95% CI: 1.04–5.14), abnormal neonatal weight (OR: 2.87; 95% CI: 1.36–6.10), neonatal hypoglycemia (OR: 2.8; 95% CI: 1.38–5.77), and any adverse pregnancy outcome (aOR: 4.49; 95% CI: 1.94–10.40). Conclusions: In this prospective cohort, dysglycemia was associated with higher rates of hypertensive and metabolic pregnancy complications among individuals with PCOS. These findings suggest that coexisting dysglycemia may contribute to heterogeneity in obstetric risk among individuals with PCOS and warrant confirmation in larger studies.