Children born to women with PCOS at higher risk of autism, ADHD and other mental disorders, finds study
Children born to mothers with Polycystic Ovary Syndrome (PCOS) are at greater risk of multiple psychiatric and neurodevelopmental disorders. A research team studied over one million babies born between 1996 and 2014 and followed up until the end of 2018, and found links between PCOS and a wide range of disorders, which include emotional and behavioral problems, delayed development, learning, speech and language problems, autism and attention-deficit/hyperactivity disorder (ADHD).
The risk of being diagnosed with any psychiatric disorder increased 1.3-fold among children of mothers with PCOS. In particular, the risk of sleeping disorders increased 1.5-fold, ADHD, conduct and tic disorders 1.4-fold, and intellectual disabilities and autism spectrum disorders 1.4-fold. The analysis also reveals that the risk of specific developmental and eating disorders increased nearly 1.4-fold, anxiety disorders 1.3-fold, mood disorders nearly 1.3-fold, and other behavioral and emotional disorders nearly 1.5-fold.
There was no significant difference between sexes. According to researchers, these findings may potentially help in counseling and managing pregnancies. September is PCOS awareness month. It is a common hormonal disorder in which there is an excess of male hormones and the ovaries do not function correctly.
It is the most common cause of anovulatory infertility when the ovaries do not release eggs during the menstrual cycle and it is estimated to affect between 6-20% women of reproductive age, say experts. Women with PCOS may experience irregular menstrual cycles, higher incidence of miscarriage and other health problems such as hirsutism (excessive male-pattern hair growth on a woman’s face, chest and back), acne, obesity and diabetes.
"Maternal PCOS and/or anovulatory infertility are associated with increased risks in offspring for almost all groups of psychiatric and mild neurodevelopmental disorders with onset in childhood or adolescence. The risks are increased for both female and male offspring, and further increased when maternal PCOS/ anovulatory infertility is combined with obesity, perinatal problems, cesarean delivery or gestational diabetes," first author of the paper, Xinxia Chen, an associate professor at Shandong University, China, tells MEA WorldWide (MEAWW).
Chen, who also worked at the Karolinska Institutet, Sweden, in 2019, explains that while highly prevalent, PCOS remains one of the most poorly understood medical disorders for patients, doctors and scientists. "In particular, the long-term health consequences of PCOS for both affected women and their families are less well known, although some previous epidemiological studies have reported an increased risk of autism spectrum disorders and ADHD.
However, until now, it was not known whether PCOS was associated with a wide range of neuropsychiatric effects and whether the effects were independent of other, common medical problems such as obesity, diabetes, and infertility. "Our study shows that children of mothers with PCOS are in need of psychological support and longer follow-up for mental health," she says.
For the analysis, the team, led by Catharina Lavebratt, an associate professor at the Karolinska Institutet, compared data from 24,682 (2.2%) children in Finland born to mothers with PCOS or anovulatory infertility with 1,073,071 (97.8%) children born to mothers without PCOS. A total of 105,409 (9.8%) children were diagnosed with a neurodevelopmental or psychiatric disorder during the follow-up period.
They found that children born to mothers with PCOS have a higher risk of neurodevelopmental or psychiatric disorders. “The higher risk applied to a number of psychiatric diagnoses, including mood, anxiety, eating and sleeping disorders, intellectual disabilities, specific developmental, autism spectrum, attention deficit hyperactivity, conduct and tic disorders, and other behavioral and emotional disorders.
"This is the first study to report an increased risk of a wide range of neuropsychiatric disorders in offspring exposed to maternal PCOS, indicating a broad adverse effect of PCOS on neurodevelopment," writes Professor Lavebratt. The findings have been published in Human Reproduction.
"During the follow-up period, 2,532 out of 24,682 children — 10.3% — born to mothers with PCOS were given a neuropsychiatric diagnosis compared to 102,877 out of 1,073,071 children — 9.6% — born to mothers without PCOS. The risk of neuropsychiatric disorders was 1.3 times higher in children with PCOS exposure compared to those without. This means that 700 more children per 100,000 are born with any sort of mental health problems due to maternal PCOS," explains Professor Lavebratt.
When the authors examined the risks according to the mothers’ body mass index (BMI), they found that the risk of being diagnosed with any neuropsychiatric disorder among offspring of normal-weight women with PCOS increased 1.2-fold compared to those without PCOS, but more than doubled in offspring of PCOS mothers who were severely obese.
The risk also doubled in mothers with PCOS who experienced perinatal problems and increased 1.7-fold in mothers who experienced gestational diabetes or had a cesarean delivery. To check whether the increased risk of neuropsychiatric disorders could be due to perinatal problems, gestational diabetes, cesarean delivery or fertility treatment rather than to PCOS, researchers analyzed the data to exclude mothers with these conditions, but they still observed a 1.2- to 1.3-fold increased risk.
"Taken together, our findings suggest that PCOS status alone is a risk factor for offspring neurodevelopment, with more detrimental influences if joint with obesity. Given that mothers with PCOS are often obese before pregnancy and are likely to gain excess weight during gestation, health professionals should be aware of their offspring as targets for mental health care," the findings state.
As the study is observational, it cannot show with certainty that PCOS causes the psychiatric and neurodevelopment problems, only that it is associated with them. The researchers are planning further studies to confirm the results of the study and investigate potential mechanisms. They, however, suggest that healthcare providers should consider that children born to mothers with PCOS are at high risk of mental health problems, even those born to normal-weight mothers.
According to investigators, counseling for women with PCOS and monitoring of their offspring should be offered routinely to help prevent these problems. "Children born to mothers with PCOS and/or anovulatory infertility should be considered as targets for mental health care. For mothers with PCOS and/or anovulatory infertility, to lose weight before pregnancy and prevent pregnancy complications such as gestational diabetes may, in part, help reduce the risk of psychiatric and mild neurodevelopmental disorders in their offspring," Chen tells MEAWW.