Associations of preconception Body Mass Index in women with PCOS and BMI and blood pressure of their offspring

Figures & data

Figure 1. Schematic representation of the current analysis: Offspring health might be directly and indirectly associated with preconception and pregnancy characteristics in women with PCOS. Abbreviation: BMI: body mass index; BP: blood pressure; HOMA-IR: insulin resistance; in blue: the investigated associations in this paper; in gray: the potential role of pregnancy in mother-offspring associations; LDL: low-density lipoprotein-cholesterol; PCOS: polycystic ovary syndrome.

Table 1. Offspring characteristics in the two age groups.

Birth	Offspring 2.5–4 year old n = 42	Offspring 6–8 year old n = 32
Female gender	19 (45%)	17 (53%)
Birth weight (gram)	3.310 ± 730	3.298 ± 535
SGA	4 (10%)	3 (9%)
LGA	4 (10%)	2 (6%)
Age (years, ±)	3.3 ± 0.6	7.0 ± 0.8
Follow-up
BMI (kg/m^2)	15.9 ± 1.6	15.3 ± 1.5
BMI SDS	0.07 ± 1.3	−0.16 ± 1.0
Systolic blood pressure (mm/Hg)	99 ± 8	107 ± 7
Systolic blood pressure percentile	51 ± 21	66 ± 17
Diastolic blood pressure (mm/Hg)	59 ± 3	56 ± 7
Diastolic blood pressure percentile	44 ± 19	40 ± 20
Heart rate (rate/min)	99 ± 10	82 ± 12

±: standard deviation; %: percentage; BMI: body mass index, kg/m²: kilograms per square meter; LGA: large for gestational age; min: minute; mm/Hg: millimeters mercury; n: number; PCOS: polycystic ovary syndrome; SDS: standard deviation score; SGA: small for gestational age.

Table 2. Preconception characteristics of mothers with PCOS from the two offspring age groups.

	Women with offspring 2.5–4 year	Women with offspring 6–8 year
	n = 42	n = 32
Current age (mean, ±)	34.1 ± 6.5	38.8 ± 6.0
Race
Caucasian	40 (95%)	32 (100%)
Non-Caucasian	2 (5%)	0 (0%)
Waist (cm)	86 ± 15	83 ± 17
Hip (cm)	106 ± 14	101 ± 11
Overweight	21 (50%)	15 (47%)
BMI (kg/m^2)	26.3 ± 6.7	24.9 ± 4.8
Smoking
Never	34 (81%)	25 (78%)
Current smoker	6 (14%)	6 (19%)
Stopped smoking	2 (5%)	1 (3%)
Alcohol consumption
Never	11 (26%)	15 (47%)
>2 a week	16 (38%)	9 (28%)
F&G score ≥4	10 (24%)	15 (47%)
F&G score ≥8	4 (10%)	5 (16%)
Systolic blood pressure	125 ± 13	129 ± 15
Diastolic blood pressure	79 ± 12	80 ± 10
Biochemical markers
Fasting glucose	5.2 ± 0.6	5.3 ± 1.2
Fasting insulin	8 ± 5	8 ± 7
Total cholesterol	4.7 ± 0.7	5.1 ± 1.1
Triglycerides	0.8 ± 0.5	1.0 ± 0.4
LDL-cholesterol	2.8 ± 0.7	2.9± 0.9
HDL-cholesterol	1.6 ± 0.5	1.7 ± 0.4
Androstenedione	7.6 ± 2.9	8.3 ± 3.5
Testosterone	2.1 ± 0.9	2.4 ± 0.9
FAI	5.0 ± 3.0	4.9 ± 2.7
Sex hormone-binding globulin	52 ± 24	55 ± 22
TSH	2.8 ± 6.9	2.1 ± 1.9

±: standard deviation; %: percentage; cm: centimeter; F&G score: Ferriman and Gallwey; FAI: Free Androgen Index: ([testosterone]/[SHBG])×100%= FAI); HDL-cholesterol: high-density lipoprotein cholesterol; LDL-cholesterol: low-density lipoprotein cholesterol; n: number; overweight: BMI> 25 kg/m²; TSH: thyroid-stimulating hormone.

Table 3. Associations between preconception parameters and BMI and blood pressure of offspring per age group.

Preconception factors of women with PCOS	Offspring 2.5–4 year old BMI β (95% CI)	p Value	Offspring 6–8 year old BMI β (95% CI)	p Value	With interaction term for age-group p Value		Offspring 2.5–4 year old Blood pressure β (95% CI)	p Value	Offspring 6–8 year old Blood pressure β (95% CI)	p Value	With interaction term for age-group p Value
Primary endpoint
BMI	−0.04 (−0.46 to 0.39)	.9	0.55* (0.12 to 0.97)	.012	.096		2.50 (−2.9 to 7.9)	.4	−4.93 (−12.95 to 3.10)	.2	.054
Secondary endpoint
Systolic blood pressure	−0.29 (−0.79 to 0.21)	.3	−0.20 (−0.55 to 0.15)	.3	.7		4.18 (−2.32 to 10.68)	.2	−3.6 (−9.58 to 2.29)	.3	.5
Free Androgen Index	0.18 (−0.30 to 0.66)	.5	0.21 (−0.21 to 0.63)	.3	1.0		4.42 (−1.86 to 10.70)	.2	−1.77 (−8.47 to 4.94)	.4	.2
HOMA-IR	0.06 (−0.46 to 0.47)	1.0	−0.02 (−0.33 to 0.37)	.9	1.0		0.41 (−5.58 to 6.40)	.9	−1.35 (−7.44 to 4.74)	.6	.6
LDL-cholesterol	−0.01 (−0.56 to 0.53)	1.0	−0.03 (−0.30 to 0.36)	.9	.9		−0.40 (−7.33 to 6.53)	.9	−1.54 (−7.31 to 4.22)	.6	.7

β (95% CI): standardized beta’s with 95% confidence intervals; *: the unstandardized significant β is: 0.092 (95% CI: 0.02–0.16); BMI: body mass index; HOMA-IR: homeostasis model assessment-estimated insulin resistance; LDL-cholesterol: low-density lipoprotein; PCOS: polycystic ovary syndrome.

Additionally the interaction term is added which describes a potential difference of maternal influence in the younger, versus the older age group.

Table

	Women with	Women with
	offspring 2.5–4 years	offspring 6–8 years
	n = 42	n = 32
Conception:
Spontaneous	13 (31%)	20 (63%)
Ovulation induction (Clomiphene citrate)	11 (26%)	9 (28%)
Ovulation induction (gonadotrophins)	8 (19%)	5 (16%)
IUI (with or without stimulation)	3 (7%)	3 (9%)
IVF/ICSI	6 (14%)	1 (3%)
GDM	8 (19%)	2 (6%)
PIH	1 (2%)	6 (19%)
PE	1 (2%)	0
HELLP	0	1 (3%)
Preterm delivery	5 (12%)	3 (9%)
GDM/PIH/PE	10 (24%)	8 (25%)
Hypertensive complications	2 (5%)	7 (22%)
Any maternal complication	10 (24%)	9 (28%)
Instrumental delivery	13 (31%)	10 (31%)
Secondary cesarean section	4 (10%)	7 (22%)

Legend: % = percentage, GDM = gestational diabetes, PIH = pregnancy induced hypertension, HELLP = Hemolysis Elevated Liver enzymes Low Platelets Syndrome, hypertensive complications: PE, PIH or HELLP, ICSI = intracytoplasmic sperm injection, IUI = intrauterine insemination, IVF = in vitro fertilization, n = number, PE = Preeclampsia, maternal complications = GDM, PIH, PE or HELLP.

Table

	Offspring BMI		Offspring Systolic blood pressure
Preconception factors of women with PCOS	β (95%CI)	p-value	β (95%CI)	p-value
Primary endpoint
BMI	0.02	0.4	−0.012	1.0
	(-0.03-0.78)
Secondary endpoint
Systolic blood pressure	−0.27	0.07	0.5	0.8
	(-0.55-0.19)		(-4.19-5.12)
Free Androgen Index	0.17	0.3	1.75	0.5
	(-0.14-0.48)		(-3.01-6.52)
HOMA-IR	−0.05	0.9	−0.19	0.9
	(-0.28-0.3)		(-4.62-4.23)
LDL-cholesterol	−0.01	0.9	−1.13	0.6
	(-0.29-0.32)		(-5.62-3.36)

Legend: β (95%CI) = standardized Beta with 95% Confidence Intervals, BMI = body mass index, HOMA-IR = homeostasis model assessment-estimated insulin resistance, LDL-cholesterol = low-density lipoprotein cholesterol.