Persistence of hypertension after pregnancy-related hypertensive disorders in women with polycystic ovary syndrome

Objective: To assess whether polycystic ovary syndrome (PCOS) increases the risk of persistent hypertension in women with a history of pregnancy-related hypertensive disorder (PHD). Design: A single-center, prospective cohort study. Subjects: A total of 124 patients with PHD were enrolled. Pregnancy-related hypertensive disorder was diagnosed on the basis of the presence of pregnancy-induced hypertension or preeclampsia. All patients with PHD were screened for PCOS diagnosis, which was confirmed or excluded on the basis of patient history and clinical reports. Sixty-two patients diagnosed with PCOS (n = 62 cases) were included as the study group. After 1-to-1 matching process on the basis of age, body mass index, and infertility treatment, 62 control patients without PCOS were also included. Exposure: Polycystic ovary syndrome diagnosis according to the national and international criteria. Main Outcome Measures: The primary outcome was the persistence of hypertension 12 months after delivery. The secondary outcomes included persistence of hypertension at 3 and 6 months from delivery, pregnancy complications, and data on antihypertensive treatment. Results: After 12 months from delivery, the risk of persistent hypertension was significantly higher in patients with PHD with PCOS than in controls [adjusted odds ratio, 5.01; 95% confidence interval (CI), 1.63–15.94]. At 6 months, that risk was also significantly higher (adjusted odds ratio, 5.01; 95% CI, 1.63–15.94). Additionally, pregnant patients with PCOS had an earlier onset of PHD (30.0 vs. 31.1 weeks), required a higher dose of nifedipine (37.5 mg vs. 30 mg), and were more likely to receive antihypertensive therapy with multiple drugs (24.2% vs. 9.7%) than controls. The incidence of fetal growth restriction (19.4% vs. 6.5%), abnormal Doppler velocimetry (16.1% vs. 4.8%), and cesarean delivery (35.5% vs. 19.4%) was also significantly higher in the PCOS group than in controls. Conclusion: Polycystic ovary syndrome is associated with an increased risk of persistent hypertension in patients with a history of PHD. Preventive interventions before pregnancy, specific pregnancy surveillance, and long-term follow-up should be recommended for women with PCOS.