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Towards a healthy pregnancy in women with polycystic ovary syndrome
The research focuses on how the ovaries function normally and on disorders of the ovary.
For the last 15 years this work has been a collaboration between Stephen Franks and Kate Hardy. A major area of research is on the very common disorder of polycystic ovary syndrome (PCOS) that can lead to fertility problems and to problems with long-term health. Stephen is a world-leading figure in this important area.
Polycystic ovary syndrome (PCOS) is a very common hormone disturbance, which affects nearly one in ten women during her child bearing years. The ovaries are typically a bit larger than average and contain many small cysts. Small cysts are normally present in the ovaries (they contain the eggs) but there are more of them in women with PCOS ('polycystic' actually means 'many cysts'). PCOS is often associated with irregular, infrequent or absent periods and is a major cause of infertility. Importantly, in addition to the implications for fertility, having PCOS means an increased risk of developing diabetes, particularly in those women who are overweight.
Non-insulin dependent diabetes, also called type 2 diabetes is much commoner than type 1 (insulin-dependent) diabetes and is getting even more common. Type 2 diabetes (T2D) is a disease that, until recently, occurred most often in middle and old age. Women and men who are overweight or obese are much more likely to develop T2D than those who are lean and in recent years, the increasing rate of obesity amongst the UK population has led to a huge increase in the prevalence of T2D. Worryingly, it is being diagnosed more and more commonly in young people. PCOS can be considered to be a pre-diabetic state and it is therefore important to try to identify women with PCOS who are most at risk of developing diabetes. We have managed to do this by taking a careful history and performing a simple series of blood tests.
We think that women with PCOS are also more likely to develop diabetes in pregnancy (gestational diabetes) and may also suffer more frequently from other complications of pregnancy such as high blood pressure but the information we have to date is based on results from rather small studies. These are conditions that seriously threaten the health of both mother and baby. Treatment to stimulate ovulation in infertile women with PCOS has become increasingly successful in our clinic and around the country and so more and more women with PCOS are getting pregnant.
The questions that we would like to be able to answer are:
1) Are diabetes and high blood pressure more common during pregnancy in women with PCOS compared with a reference population of women without PCOS?
2) How can we predict which women at particular risk and what measures can we introduce to reduce that risk to mother and baby?
To answer these questions we need a multi-centre study, co-ordinated here at Imperial Healthcare NHS Trust, to follow up pregnancies in women with PCOS, to determine the true prevalence of gestational diabetes and high blood pressure and to identify factors that are associated with increased risk. This will help us to prevent those at risk from going on to get diabetes. In this respect, diet and lifestyle interventions can be enormously effective. The results from this important study will provide the means to ensure a healthy pregnancy in women with PCOS.