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Placentas of women with PCOS are twice as likely to be defective

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A new study published on June 11, 2013 has found for the first time that the placentas of women with PCOS are at least twice as likely to be defective in several different respects when compared with the placentas of healthy women.

The present study is the first to demonstrate that the morphology and microscopic structure of placenta in patients with PCOS with an uncomplicated pregnancy are altered.

Further studies are needed to assess a correlation of these changes with the increased risk of obstetric complications observed in some pregnancies of women with PCOS.

Women with PCOS were 2.8 times more likely to have placental alterations of some form with 73% of women with PCOS had placentas with some degree of abnormality, not including size, weight or thickness, compared to only 42% of healthy women in the control group.

Researchers from the Obstetrics and Gynaecology Unit of the University of Modena and Reggio Emilia in Italy examined the placentas of 30 women with polycystic ovarian syndrome and 60 women who had neither a diagnosis of PCOS nor any of the features of PCOS to determine whether there was any difference in the structure of the placenta between the two groups.  All women were enrolled in the study at the very beginning of their pregnancies, prior to the seventh week of pregnancy, or around 3 weeks from the first missed period.  Blood tests, ultrasounds and clinical and obstetric examination data were collected at the beginning of the study and throughout the pregnancies.  Once the women had delivered their babies, the placenta was examined by a pathologist and under a microscope.

To reduce the chance that the results may be affected by factors such as obesity or the effects of fertility drugs, only women with PCOS who had a body mass index (BMI) of less than 30 kg/m2 and who had conceived naturally, without the aid of ovulation induction drugs or other methods of assisted reproduction and who were experiencing an uncomplicated pregnancy were included in the study.

The researchers, led by Stefano Palomba, found that women with PCOS did indeed tend to have more abnormalities in their placentas than women without the condition, which may contribute towards explaining the higher rate of pregnancy complications that women with PCOS encounter compared to the general population.

The size of the placenta, as measured by weight, volume and thickness, were “significantly inferior” in women with PCOS and they were more likely to have an irregular shape and a greater number of coils in the umbilical cord.  The average umbilical cord has one coil every five centimetres.  Cords which coil significantly more or less than this, tend to be associated with a higher incidence of moderate or severe decreases in foetal heart rate.

The majority of pregnancy complications are due to two things: problems with the way the placenta is growing or the way it is attaching to the uterine wall, or defects in the cells called trophoblasts that encapsulate the embryo when it is very young and which supply nutrients to it before the placenta develops.  Trophoblasts also form a large part of the placenta later on.

Women with PCOS have been observed to have alterations in endovascular trophoblast invasion or the connection of the baby’s blood supply to the blood supply of the mother’s uterus.  This is related to the insulin resistance and high levels of androgens present in women with PCOS.

Under the microscope, differences were also noted in the extent of villous and intervillous spaces, the extent of fibrosis, endovascular trophoblast depth, extension and structure, mitotic activity or the rate at which the cells were growing and dividing.  Women with PCOS averaged 3.5 ‘placental lesions’ versus only 1.4 in the control group.

Whilst no research has, to date, been performed on the effect that d-chiro inositol may have on the health of a placenta, it is reasonable to assume that the significant reductions in insulin resistance and androgen production that it causes in women with PCOS would be very likely to have a positive effect on the growing placenta.

More information:

Palomba, S. (2013-06-11) Macroscopic and microscopic findings of the placenta in women with polycystic ovary syndrome. . DOI: 10.1093/humrep/det250  PMID: 23756703

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