Low-Grade Chronic Inflammation in Pregnant Women With Polycystic Ovary Syndrome: A Prospective Controlled Clinical Study

Context: Polycystic ovary syndrome (PCOS) and pregnancy are conditions characterized by an increased low-grade chronic inflammation state. A higher incidence of pregnancy complications has been detected in pregnant PCOS women. Objective: The objective of the study was to test the hypothesis that the low-grade chronic inflammation state typical of PCOS patients persists during gestation and is exacerbated by pregnancy and contributes to the increased risk of obstetric/neonatal complications. Design: This was a prospective controlled clinical study. Setting: The study was conducted at the Academic Department of Obstetrics and Gynecology of the “Pugliese-Ciaccio” Hospital of Catanzaro (Catanzaro, Italy). Patients: One hundred fifty pregnant PCOS women and 150 age- and body mass index-matched healthy pregnant controls participated in the study. Interventions: Interventions included serial clinical, biochemical, and ultrasonographic assessments before and throughout pregnancy. Main Outcome Measures: Serum levels of white blood cell count (WBC), C-reactive protein (CRP), and ferritin were measured. Results: Pregnant women with PCOS had higher WBC, CRP, and ferritin levels at study entry and at all gestational ages than controls. Changes in serum WBC and ferritin levels were significantly higher in PCOS than in controls starting from the 12thweekof gestation whereas those in CRP from the 20th week of gestation. By multivariable Cox proportional hazard analysis, in the PCOS group, a significant association with the risk of adverse obstetric/neonatal outcomes was found for WBC [hazard risk (HR) 1.52, 95% confidence interval (CI) 1.31–1.64; P .010], CRP (HR 1.19, 95% CI 1.06–1.34; P .019), and ferritin levels (HR 1.12, 95% CI 1.03–1.26; P .011). Conclusions: In PCOS patients, the low-grade chronic inflammation persists during gestation and is exacerbated by pregnancy, and it is associated with adverse pregnancy outcomes.