Background: Polycystic ovary syndrome (PCOS) is characterised by hyperandrogenism, oligo/amenorrhoea and subfertility but the effects on mental health outcomes are unclear. Offspring neurodevelopment might also be influenced by gestational androgen exposure.
Aims: To determine if (i) there is an association between PCOS and psychiatric outcomes, and (ii) rates of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are higher in the offspring of mothers with PCOS.
Methods: Data were extracted from the Clinical Practice Research Datalink. Patients with a diagnosis of PCOS (2000-2014) were matched to two control sets (ratio 1:1) by age, BMI and primary care practice. Control set 2 were additionally matched on prior mental health status. Primary outcomes were the incidence of depression, anxiety and bipolar disorder. Secondary outcomes were the prevalence of ADHD or ASD in offspring. Rates of progression to each primary outcome were compared using Cox proportional hazard models. Prevalence of ADHD and ASD in offspring were compared using logistic regression.
Results: 16,986 eligible PCOS patients were identified; 16,938 (99.7%) and 16,355 (96.3%) were matched to control sets 1 and 2 respectively. Compared to control set 1, baseline prevalence was 23.1% versus 19.3% for depression (P<0.001), 11.5% versus 9.3% for anxiety (P<0.001) and 3.2% versus 1.5% for bipolar disorder (P<0.001). The hazard ratio for time to each endpoint was 1.26 (95% CI 1.19-1.32; P<0.001), 1.20 (1.11-1.29 P<0.001), and 1.21 (1.03-1.42; P<0.001) for cohort 1 and 1.38 (1.30-1.45 P<0.001), 1.39 (1.29-1.51 P<0.001) and 1.44 (1.21-1.71) for cohort 2. The odds ratio for ASD and ADHD in offspring were 1.54 (1.12-2.11) and 1.64 (1.16-2.33) for cohort 1, and 1.76 (1.27-2.46) and 1.34 (0.96-1.89) for cohort 2.
Conclusions: PCOS is associated with psychiatric morbidity and increased risk of ADHD and ASD in the offspring. Screening for mental health disorders should be considered during assessment.