The impact of hyperandrogenemia on pregnancy complications and outcomes in patients with PCOS: a systematic review and meta-analysis

Figures & data

Figure 1. Preferred reporting items for systematic reviews and meta-analyses flow diagram of study selection.

Figure 2. Risk of bias and clinical applicability of the included studies.

Table 1. Basic characteristics of the included studies.

NO.	Study	Country	Year	Type	PCOS number	non-HA number	HA number	Age	HA standard	Outcomes/Complications
1	Wan Yang (22)	China	2018	retrospective study	583	335	248	20–35	testosterone level ≥2.2 nmol/L or/and level ≥12 nmol/L	Miscarriage, Live-birth, Preterm, Caesarean section, Admission to the neonatal intensive care unit/-
2	Fatemeh Foroozanfard (24)	Iran	2019	prospective cohort study	43	9	32	15–40	hirsutism score based on hirsutism score greater than 7 or obvious acne	Miscarriage, Preterm, Caesarean section/Pregnancy-induced hypertension, Preeclampsia, Gestational diabetes mellitus
3	HANNE MUMM (19)	Denmark	2015	retrospective cohort study	157	32	125	26–35	Clinical HA was defined as a total Ferriman-Gall wey score 8 and hyperandrogenemia was defined as serum total testosterone >1.8 nmol/L and/or serum free testosterone >0.034 nmol/L	Preterm, Caesarean section, Admission to the neonatal intensive care unit/Pregnancy-induced hypertension, Preeclampsia, Gestational diabetes mellitus, Small-for-gestational age, Large-for-gestational age
4	Marlieke A. de Wilde (18)	Netherlands	2017	Prospective multicenter cohort study	188	97	76	27–34	free androgen index (FAI)>4.5nmol/L	Preterm/Pregnancy-induced hypertension, Preeclampsia, Gestational diabetes mellitus, Small-for-gestational age, Large-for-gestational age
5	Akramsadat Dehghani Firoozabadi (25)	Iran	2020	prospective cross-sectional study	198	74	124	22–36	not clear	Miscarriage, Live-birth, Preterm, Caesarean section, Admission to the neonatal intensive care unit/Pregnancy-induced hypertension, Preeclampsia, Gestational diabetes mellitus, Small-for-gestational age, Large-for-gestational age
6	Shari Mackens (26)	Russia	2020	retrospective cohort study	320	160	160	25–34	the presence of hirsutism (Ferriman–Gallwey score >8) and/or severe acne and alopecia; bio chemical hyperandrogenism was defined as total serum testosterone >1.735 nmol/L and calculated free testosterone >0.022 nmol/L,	Miscarriage, Live-birth/-
7	Stefano Palomba (20)	Italy	2010	prospective cohort study	93	5	88	19–34	not clear	Miscarriage, Preterm, Caesarean section, /Pregnancy-induced hypertension, Preeclampsia, Gestational diabetes mellitus, Small-for-gestational age, Large-for-gestational age
8	Ragnheidur Valdimarsdottir (27)	Sweden	2021	retrospective cohort study	159	107	52	25–35	Testosterone tertiles >2.36 nmol/l.	Preterm/Pregnancy-induced hypertension, Preeclampsia, Gestational diabetes mellitus, Large-for-gestational age
9	LUO Lu (21)	China	2010	retrospective study	260	105	155	28–34	not clear	Live-birth/-
10	Wei Daimin (23)	China	2018	Prospective multicenter cohort study	484	366	118	20–34	the presence of hirsutism (Ferriman–Gallwey score > 6) and/or Total testosterone levels exceed the normal diagnosis of the respective laboratories	Miscarriage, Preterm/Preeclampsia, Gestational diabetes mellitus, Small-for-gestational age, Large-for-gestational age

(NO.: number; PCOS: polycystic ovary syndrome; HA: hyperandrogenism; BMI: body mass index).

Figure 3. Pregnancy outcomes comparison: hyperandrogenic PCOS phenotype (polycystic ovary syndrome) versus non-hyperandrogenic PCOS phenotype (A: miscarriage; B: live-birth; C: preterm; D: caesarean section; E: admission to the neonatal intensive care unit).

Figure 4. Pregnancy complications comparison: hyperandrogenic PCOS phenotype (polycystic ovary syndrome) versus non-hyperandrogenic PCOS phenotype (A: pregnancy-induced hypertension; B: preeclampsia; C: gestational diabetes mellitus; D: small-for-gestational age; E: large-for-gestational age).

Figure 5. Funnel plot of comparison: hyperandrogenic PCOS phenotype (polycystic ovary syndrome) versus non-hyperandrogenic PCOS phenotype (A: miscarriage; B: live-birth; C: preterm; D: caesarean section; E: pregnancy-induced hypertension; F: preeclampsia; G: gestational diabetes mellitus; H: small-for-gestational age; I: large-for-gestational age; J: admission to the neonatal intensive care unit).

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