Placental morphology and histology in different phenotypes of polycystic ovary syndrome.

INTRODUCTION

Alterations in placental histology and morphology are critical determinants of pregnancy outcomes, contributing to complications such as preeclampsia, gestational diabetes, growth restriction, and preterm birth. Given the heterogeneity of polycystic ovary syndrome (PCOS), it is plausible that placental changes differ by clinical phenotype. This study aimed to compare placental morphological and histological features among pregnant women with different PCOS phenotypes and healthy controls.

METHODS

A case-control study enrolled 195 pregnant women (65 controls, 65 non-hyperandrogenic PCOS, 65 hyperandrogenic PCOS) at Alzahra Hospital (2023-2024). PCOS was diagnosed per the Rotterdam 2003 criteria. Placentas underwent standardized macroscopic evaluation and blinded histopathological assessment. Statistical analysis included ANOVA/χ2 tests with Bonferroni correction (α = 0.05, SPSS v22.0)

RESULTS

Most placental parameters were comparable across groups. Median placental diameter was larger in the hyperandrogenic PCOS group compared with controls (16.0 vs. 15.0 cm; P = 0.042). Chronic villous inflammation was more frequent in the non-hyperandrogenic phenotype (7.7%) than in controls (1.5%) and absent in the hyperandrogenic group (P = 0.049). No significant differences were found in placental weight, placental-to-birth weight ratio, or common histologic lesions such as thrombosis, chorioamnionitis, or calcification.

DISCUSSION: Even in uncomplicated pregnancies, women with PCOS may exhibit subtle, phenotype-dependent placental changes. Hyperandrogenism was associated with increased placental diameter, whereas the non-hyperandrogenic phenotype showed more chronic villous inflammation. These findings suggest phenotype-specific placental adaptations rather than universal alterations in PCOS. Larger, longitudinal studies are warranted.