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27 June 2005
PCOS May Begin In The Womb 
Dr Michael Davies, a senior research fellow at the University of Adelaide in Australia, has been conducting research into the maternal factors during pregnancy that may impact on the subsequent development of polycystic ovarian syndrome (PCOS). He is the first to reconcile previous conflicting research on the developmental origins of the syndrome. "Our research suggests that, during pregnancy and birth, there are several different factors working through different pathways that are implicated in the overlapping and varying symptoms of PCOS that emerge in the offspring's later life," he told attendees at the annual conference of the European Society of Human Reproduction and Embryology. "Existing research has already established links between fetal growth restriction, postnatal growth and metabolic disorders such as diabetes in adulthood. The idea that events in very early life can have an enduring, complex and important influence on subsequent disease is referred to as developmental programming, and this research theme has been applied to PCOS. Different studies have produced conflicting evidence that shows that large babies grow to become heavier adults with polycystic ovaries, but that the most severe symptoms of PCOS are associated with growth restriction as a fetus," Davies said. "Our research examines the relationship between symptoms of PCOS in adulthood and fetal conditions in women born in a major hospital in Adelaide in the 1970s. Our findings support the proposition that there is an inter-generational growth path leading to menstrual irregularity, while, at the same time, other symptoms may be one of number of consequences of restricted fetal growth." The researchers studied a group of young women born between 1973 and 1975. To date, they have interviewed 544 women who were born between 1973 and 1974 and who are aged between 30 and 32 at present. They took a medical history of the young women and compared it with information about their births, including birth weight, placental weight, and weight of their mothers at their last clinical examination before giving birth. "Symptoms of PCOS were relatively common. One in five women had more facial and/or body hair than normal, and one in four reported menstrual irregularities of greater than four days. Five percent of women reported that they had an existing diagnosis of PCOS. Compared with their counterparts, young women without a diagnosis of PCOS but with irregular periods were heavier at birth, with larger placentas, and they tended to have mothers who were heavier in late pregnancy. In contrast, women with an existing diagnosis of PCOS tended to have birth weights that were, on average, 196g lighter than women without PCOS and smaller placentas," Davies told the conference. "Our data suggest that different developmental pathways are implicated in the overlapping symptoms of PCOS. One pathway may be mediated by high maternal weight in late pregnancy, which is linked to irregular periods in the daughter, and possibly obesity and weight-related reproduction problems. A second pathway may involve reduced placental and fetal growth, which is linked to the more severe symptoms of PCOS in the daughter, usually resulting in an early clinical diagnosis of the syndrome. A fetus that has been affected by restricted growth is more likely to have problems with insulin metabolism in later life due to an underlying metabolic problem. In women this problem appears to be associated with PCOS, and is most evident where there is a constellation of symptoms of increasing severity. I suspect there are at least two pathways that can give rise to overlapping symptoms." Davies told the conference that other research had shown that events that happen to the mother and grandmother could have a bearing on the development of a fetus. "To understand the growth of a child, we need to also understand the growth of the parents and possibly the grandparents. A good predictor of one's own birth weight is the birth weight of one's mother," concluded Davies.
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