WOMEN with polycystic ovary syndrome (PCOS) have fewer children and give birth later in life compared to women without PCOS, with a higher likelihood of advanced maternal age and associated pregnancy complications. A later diagnosis of PCOS is linked to nearly double the risk of advanced maternal age, highlighting the importance of early detection and intervention.
This population-based cohort study followed 14,247 women from the Australian Longitudinal Study on Women’s Health over 25 years. Participants, aged 18–23 at baseline, were assessed approximately every three years until 2021. PCOS status was self-reported, with 9.9% of women (n=981) reporting a diagnosis. Reproductive outcomes, including parity and maternal age at childbirth, were compared between women with and without PCOS, alongside exploration of factors contributing to advanced maternal age.
By ages 43–48, women with PCOS had significantly fewer births on average than those without PCOS (1.7 ± 1.3 vs. 1.9 ± 1.2; p<0.001) and were more likely to remain nulliparous (23% vs. 18%; p=0.003). 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<0.001 for both). PCOS increased the odds of advanced maternal age at first childbirth (adjusted odds ratio [aOR] 1.40; 95% confidence interval [CI], 1.10–1.80) and gestational diabetes (aOR 3.90; 95% CI, 2.99–5.10). However, advanced maternal age was not associated with higher rates of type 2 diabetes or hypertension. Late PCOS diagnosis further heightened the likelihood of advanced maternal age (aOR 1.98; 95% CI, 1.22–3.22).
These findings highlight the complex reproductive challenges faced by women with PCOS, including delayed childbirth and increased risk of pregnancy complications. For clinical practice, this study emphasises the necessity of early PCOS diagnosis and tailored reproductive planning to mitigate risks. Strategies to address advanced maternal age and associated complications, particularly in women with late-diagnosed PCOS, could improve outcomes for both mothers and children.
Reference
Forslund M et al. Fertility and age at childbirth in Polycystic Ovary Syndrome: Results from a longitudinal population-based cohort study. Am J Obstet Gynecol. 2024:S0002-9378(24):01135-9.
