scholarly journals Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

BMJ ◽  
2020 ◽  
pp. m3502 ◽  
Author(s):  
Kelvin Okoth ◽  
Joht Singh Chandan ◽  
Tom Marshall ◽  
Shakila Thangaratinam ◽  
G Neil Thomas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Polycystic Ovary Syndrome ◽  
Oral Contraceptives ◽  
Polycystic Ovary ◽  
Reproductive Age ◽  
Ovary Syndrome ◽  
Combined Oral Contraceptives

Abstract Objective To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. Design Umbrella review. Data sources Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. Review methods Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. Results 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. Conclusions From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. Systematic review registration PROSPERO CRD42019120076.

Diagnosis and management of patients with hyperandrogenism in early reproductive age

2021 ◽  
Vol 20 (5) ◽  
pp. 124-130
Author(s):  
E.P. Khashchenko ◽  
◽  
O.I. .Lisitsyna ◽  
E.V. Uvarova ◽  
◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Congenital Adrenal Hyperplasia ◽  
Oral Contraceptives ◽  
Clinical Symptoms ◽  
Polycystic Ovary ◽  
Reproductive Age ◽  
Adrenal Hyperplasia ◽  
Ovary Syndrome ◽  
Combined Oral Contraceptives ◽  
Diagnosis And Management

Hyperandrogenism is characterized by the presence of clinical symptoms and / or biochemical parameters of high androgen levels. Dermopathy and particularly acne and hirsutism are regarded as the main clinical markers of hyperandrogenism. Cosmetic problems associated with hyperandrogenism are often the reason for young woman to seek medical attention. Body hair growth in atypical areas, acne and trophic skin changes have a significant effect on the emotional state, provoke a sense of imperfection and loss of attractiveness, and reduce the quality of life. Concomitant menstrual disorders (up to 50–75%) complicate the patient’s state and determine an increased risk of gynecological disorders in the future. The causes of hyperandrogenism in early reproductive age can be varied: from more common physiological hyperandrogenism in adolescence, idiopathic hyperandrogenism, polycystic ovary syndrome (PCOS) and the atypical form of congenital adrenal hyperplasia to less common hyperthecosis, acromegaly, hyperprolactinemia, hypothyroidism, Cushing’s disease, and androgen-secreting tumors. The diagnostic search should begin with assessing complaints and clinical symptoms, and a complete physical examination. To confirm biochemical hyperandrogenism, total and free testosterone, and free androgen index are evaluated. Additional methods of examination are used to clarify the diagnosis. Treatment is prescribed in accordance with the established diagnosis. Androgen-secreting tumors require surgical intervention. Other causes of hyperandrogenism are usually treated with medication. According to current recommendations, combined oral contraceptives are the first-line therapy for the most common conditions accompanied by hyperandrogenism (hirsutism, acne vulgaris, PCOS) in early reproductive age. A clinical solution may be a combined administration of microdoses of ethinylestradiol (20 μg) and drospirenone (3 mg), progestagen with antiandrogenic property in the mode 24 + 4 (for instance: Dimia). This article presents clinical cases of diagnosis and management tactics for patients of early reproductive age with hyperandrogenism. Conclusion. The differential diagnosis of physiological and pathological conditions accompanied by hyperandrogenism is one of the current challenges for obstetrician-gynecologist. A properly developed algorithm of examination, interpretation of its results, therapy and prevention of complications are of great importance. Key words: acne, alopecia acreata, congenital adrenal hyperplasia, hyperandrogenism, hirsutism, girls, drospirenone, combined oral contraceptives, contraception, adolescents, early reproductive age, polycystic ovary syndrome, ethinylestradiol

scholarly journals Polycystic ovary syndrome and risk factors for gestational diabetes

2018 ◽  
Vol 7 (7) ◽  
pp. 859-869 ◽  
Author(s):  
Sanna Mustaniemi ◽  
Marja Vääräsmäki ◽  
Johan G Eriksson ◽  
Mika Gissler ◽  
Hannele Laivuori ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Multivariate Logistic Regression Analysis ◽  
Early Screening ◽  
Ovary Syndrome ◽  
Increased Risk ◽  
History Of

Objective To study the roles of self-reported symptoms and/or prior diagnosis of polycystic ovary syndrome (PCOS) and other potential risk factors for gestational diabetes mellitus (GDM) and to clarify whether the screening of GDM in early pregnancy is beneficial for all women with PCOS. Design The FinnGeDi multicentre case-control study including 1146 women with singleton pregnancies diagnosed with GDM and 1066 non-diabetic pregnant women. There were 174 women with PCOS (symptoms and/or diagnosis self-reported by a questionnaire) and 1767 women without PCOS (data missing for 271). Methods The study population (N = 1941) was divided into four subgroups: GDM + PCOS (N = 105), GDM + non-PCOS (N = 909), non-GDM + PCOS (N = 69), and controls (N = 858). The participants’ characteristics and their parents’ medical histories were compared. Results The prevalence of PCOS was 10.4% among GDM women and 7.4% among non-diabetics (odds ratios (OR) 1.44, 95% CI: 1.05–1.97), but PCOS was not an independent risk for GDM after adjustments for participants’ age and pre-pregnancy BMI (OR 1.07, 95% CI: 0.74–1.54). In a multivariate logistic regression analysis, the most significant parameters associated with GDM were overweight, obesity, age ≥35 years, participant’s mother’s history of GDM, either parent’s history of type 2 diabetes (T2D) and participant’s own preterm birth. Conclusions The increased risk of GDM in women with PCOS was related to obesity and increased maternal age rather than to PCOS itself, suggesting that routine early screening of GDM in PCOS women without other risk factors should be reconsidered. Instead, family history of GDM/T2D and own preterm birth were independent risk factors for GDM.

Polycystic ovary syndrome, diabetes and cardiovascular disease: risks and risk factors

2004 ◽  
Vol 24 (6) ◽  
pp. 613-621 ◽  
Author(s):  
K Lakhani ◽  
GM Prelevic ◽  
AM Seifalian ◽  
WU Atiomo ◽  
P Hardiman
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Ovary Syndrome ◽  
Disease Risks

scholarly journals The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome

Medicine ◽  
2021 ◽  
Vol 100 (31) ◽  
pp. e26521
Author(s):  
Xiaocui Li ◽  
Xinru Liu ◽  
Yan Zuo ◽  
Jiejun Gao ◽  
Yan Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Gestational Diabetes ◽  
Polycystic Ovary Syndrome ◽  
Gestational Diabetes Mellitus ◽  
Polycystic Ovary ◽  
Ovary Syndrome

scholarly journals Polycystic Ovary Syndrome, Combined Oral Contraceptives, and the Risk of Dysglycemia: A Population-Based Cohort Study With a Nested Pharmacoepidemiological Case-Control Study

2021 ◽  
Author(s):  
Balachandran Kumarendran ◽  
Michael W O'Reilly ◽  
Anuradhaa Subramanian ◽  
Dana Šumilo ◽  
Konstantinos Toulis ◽  
...  
Keyword(s):  
Cohort Study ◽  
Polycystic Ovary Syndrome ◽  
Oral Contraceptives ◽  
Case Control Study ◽  
Polycystic Ovary ◽  
Population Based ◽  
Case Control ◽  
Ovary Syndrome ◽  
Combined Oral Contraceptives ◽  
Control Study

<b>Objectives: </b>Irregular menstrual cycles are associated with increased cardiovascular mortality. Polycystic ovary syndrome (PCOS) is characterized by androgen excess and irregular menses; androgens are drivers of increased metabolic risk in women with PCOS. Combined oral contraceptives (COCPs) are used in PCOS both for cycle regulation and to reduce the biologically active androgen fraction. We examined COCP use and risk of dysglycemia (pre-diabetes and type 2 diabetes) in women with PCOS. <p><b>Research Design and Methods: </b>Utilizing a large UK primary care database (The Health Improvement Network, THIN; 3.7 million patients from 787 practices), we carried out a retrospective population-based cohort study to determine dysglycemia risk (64,051 women with PCOS, 123,545 matched controls), as well as a nested pharmaco-epidemiological case-control study to investigate COCP use in relation to dysglycemia risk (2407 women with PCOS with [=cases] and without [=controls] a diagnosis of dysglycemia during follow-up).<b> </b>Cox models were used to estimate the unadjusted and adjusted hazard ratio and conditional logistic regression was used to obtain adjusted odds ratios (aORs). </p> <p><b>Results: </b>The adjusted hazard ratio for dysglycemia in women with PCOS was 1.87 (95% CI 1.78-1.97, p<0.001; adjustment for age, social deprivation, BMI, ethnicity, and smoking), with increased rates of dysglycemia in all BMI subgroups. Women with PCOS and COCP use had a reduced dysglycemia risk (aOR 0.72, 95% CI 0.59 to 0.87).</p> <p><b>Conclusions: </b>In this study limited by its retrospective nature and the use of routinely collected electronic general practice record data, which does not allow to exclude the impact of prescription-by-indication bias, women<b> </b>with PCOS exposed to COCPs had a reduced risk of dysglycemia across all BMI subgroups. Future prospective studies should be considered to further understand these observations and potential causality. </p>

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