Postpartum Weight Retention in Women with Polycystic Ovary Syndrome

Abstract Background Among women with polycystic ovary syndrome (PCOS), there is a higher prevalence of cardiometabolic risk factors compared to women without PCOS. Postpartum weight retention has been shown to contribute to these risks in the general population, but little is known about postpartum weight retention among women with PCOS. Objective(s): To compare postpartum weight retention and peripartum weight trends between women with PCOS and controls Study Design Data on live, full-term singleton deliveries from January 1, 2014-2019 in women with and without PCOS were abstracted from the electronic medical record. Weights during the pregestational period, pregnancy, and up to 12 months postpartum were collected. The primary outcome was likelihood of high postpartum weight retention five or more kilograms (kg) above pregestational weight at 12 months postpartum. Secondary outcomes included the prevalence of high weight retention at other postpartum time points (six weeks, three months, six months), absolute postpartum weight retention, gestational weight gain, and excess weight gain above Institute of Medicine (IOM) guidelines for weight gain in pregnancy. Results A total of 6333 women had the requisite weight information (pregestational, peak pregnancy, and at least one postpartum weight), including 429 (5.5%) with PCOS. After adjusting for age, pregestational body mass index (BMI), race, gestational diabetes, and parity, women with PCOS were less likely to be high weight retainers at 6 weeks postpartum (adjusted odds ratio [aOR] 0.71, p = 0.02). There was no difference in postpartum weight retention between groups at three, six, and 12 months postpartum. Overall, the prevalence of high weight retainers at 12 months postpartum was high in both groups (22.7% in PCOS versus 29.2% in controls, p = 0.13), and there was no difference in absolute weight retention (1.69 kg in PCOS versus 2.05 kg in controls, p = 0.25). Although women with PCOS had a higher pregestational BMI, they had lower gestational weight gain (median 12.7 kg) compared to controls (median 13.5 kg, p = 0.01). These findings were driven by the group with obesity. The percentage of women who surpassed IOM guidelines for gestational weight gain based on BMI category was similar between groups (43.4% in PCOS versus 47.3% in controls, p = 0.12). Overall, 18.5% of women with PCOS and 23.4% of controls had a higher BMI category at 12 months postpartum compared to before pregnancy. Conclusions Women with PCOS had lower gestational weight gain and lower likelihood of high weight retention at six weeks postpartum but similar weight retention at 12 months when compared to controls. Overall, the large proportion of women with high postpartum weight retention highlights the importance of the peripartum time period for weight management, particularly in this high-risk group predisposed to obesity and cardiometabolic disease.