Shocking news
It is shocking to see new studies coming out with evidence of neurodevelopmental problems in children born to PCOS women, which includes ADHD and ASD.
ADHD and ASD
ADHD is Attention-Deficit/Hyperactivity Disorder and it is the most common childhood neurodevelopmental disorder. They have difficulty in paying attention, controlling impulses, and may be overactive. The boys have two to three times increased risk of ADHD than girls. ASD is Autism Spectrum Disorder and also has more incidences in boys and the kids have difficulty in communication and interaction with others, they generally have restricted interests and repetitive behaviors. Children with ADHD or ASD either separately or together have symptoms, which makes them have difficulty in school, work, and other areas of life.
Research
A beautiful study done in Sweden was published in 2016 by a team lead by Kyriaki Kosidou. They managed to collect more than fifty thousand ADHD cases from the registers born between 1984 and 2008. That is a fairly good number!
They have clearly shown that PCOS woman has a high risk of having ADHD/ASD or both in combination in their children.
The results also showed that the chances of ADHD grew higher with the worsening of the metabolic profiles of women with PCOS. This means that, if they had more abnormalities in the blood levels, they had higher chances of ADHD/ASD.
Obesity also was found to be an independent risk factor. So if the mother is obese with PCOS, they have a two-fold increased risk for ADHD than a lean woman with PCOS.
Infertility/fertility treatments increase the risk of ADHD
The above study also showed that there is an increased chance of the offspring having ADHD/ASD if the PCOS patient had infertility treatment or procedures like IVF or ICSI. But they found out that this risk was related to the disease rather than the treatment itself.
The risk for ADHD is independent of ASD
The study highlighted that, the pregnant PCOS woman had a high risk of the child having ADHD/ASD and that the risk of ADHD was independent of the ASD. Some children also had both problems together. So they suggest that the high androgens in PCOS patients had a damaging effect on nerve development.
Excess androgen affects brain development
The brain development of the intrauterine baby is influenced by the level of male hormones [androgens]. Studies have shown that measuring the level of testosterone of the fetus is linked to the development of the brain. There is abnormal brain lateralization and there is a reduced volume of the right brain hemisphere, which are seen in conditions like ADHD.
It might sound complicated but in simple words if you have PCOS and if you are pregnant, your baby has the risk of developing abnormalities in the nerve connections of the brain. This is related to the level of androgens in your blood.
How to avoid brain developmental problems in kids born to PCOS women?
As the abnormalities are related to the level of fetal testosterone, which is in turn related to the level of androgens of the mother, a pregnant PCOS woman can plan her pregnancy by achieving an optimal body weight and achieving a low level of androgens and insulin even before pregnancy. This can be achieved by alteration in lifestyle, medications, or even laparoscopic ovarian drilling. A healthy diet during pregnancy and adequate exercise can ensure low levels of androgens and a better hormonal profile in pregnancies, which can, in turn, helps the normal development of a healthy fetus.
Unfortunately, this information is fairly new and unknown to many. It is very important for the patients and their health care providers like doctors, to understand the significance of proper management of PCOS before planning a pregnancy.
Author
Dr. Anita Mani MRCOG
Gynecologist with special interest in PCOS
www.anita.doctor