Fertility and age at childbirth in polycystic ovary syndrome: results from a longitudinal population-based cohort study.

BACKGROUND

There are few studies in unselected populations describing reproductive outcomes in women with polycystic ovary syndrome (PCOS) at the end of their reproductive years.

OBJECTIVE

To compare parity and maternal age at deliveries and explore factors associated with advanced maternal age in a large, unselected population-based cohort, followed prospectively for 25 years.

STUDY

DESIGN

Women randomly selected from the general population and included in the prospective Australian Longitudinal Study on Women's Health were assessed approximately every third year from 1996 (age 18-23 years) to 2021 (age 43-48 years). Women with and without self-reported PCOS diagnosis (n=981 and n=13,266, respectively) were compared.

RESULTS

Overall 9.9% of women reported having PCOS by 43 to 48 years. Compared to women without PCOS, those with PCOS had fewer births (1.7±1.3 vs 1.9±1.2, P<.001), and more were nulliparous (23% vs 18%, P=.003). Women with PCOS were older at their first and second childbirths (29.5±5.5 vs 28.8±5.5 years and 32.1±5.2 vs 31.1±5.0 years, P<.001 for both). PCOS was associated with increased odds of advanced maternal age at first childbirth, adjusted odds ratio (aOR) 1.40 (95% confidence interval 1.10-1.80), and increased odds of gestational diabetes, aOR 3.90 (2.99-5.10). However, type 2 diabetes and hypertension were not associated with advanced maternal age (aOR 0.81 (0.43-1.50) and aOR 0.78 (0.59-1.03)), respectively. Within the PCOS group, a late PCOS diagnosis was associated with increased odds of advanced maternal age, aOR 1.98 (1.22-3.22).

CONCLUSION

Women with PCOS have lower parity and give birth at a later age than women without PCOS. PCOS is associated with advanced maternal age, with subsequent increased pregnancy complications. Later PCOS diagnosis is associated with double the rate of advanced maternal age at birth, emphasizing the importance of timely diagnosis.