Phenotypes and body mass in women with PCOS identified in Referral vs. Unselected populations: systematic review and meta-analysis

Project Summary Title and Description

Title
Phenotypes and body mass in women with PCOS identified in Referral vs. Unselected populations: systematic review and meta-analysis
Description
Objective: To compare the prevalence of PCOS phenotypes and obesity of PCOS women seen in the clinical (referred) setting vs. those identified in general population.
Attribution
N/A
Authors of Report
N/A
Methodology description
Objective: To compare the prevalence of polycystic ovary syndrome (PCOS) phenotypes and obesity among patients detected in referral versus unselected populations. Design: Systematic review and meta-analysis. Setting: Not applicable. Patient(s): Thirteen thousand seven hundred ninety-six reproductive-age patients with PCOS, as defined by the extended 2003 Rotterdam criteria. Intervention(s): Review of PUBMED, EMBASE, and Cochrane Library, 2003–2016. Only observational studies were included. Data were extracted using a web-based, piloted form and combined for meta-analysis. Main Outcome Measure(s): PCOS phenotypes were classified as follows: phenotype A, clinical and/or biochemical hyperandrogenism (HA) + oligo-/anovulation (OA) + polycystic ovarian morphology (PCOM); phenotype B, HA+OA; phenotype C, HA+PCOM; and phenotype D, OA+PCOM. Result(s): Forty-one eligible studies, reporting on 43 populations, were identified. Pooled estimates of detected PCOS phenotype prevalence were consequently documented in referral versus unselected populations, as [1] phenotype A, 50% (95% confidence interval [CI], 46%–54%) versus 19% (95% CI, 13%–27%); [2] phenotype B, 13% (95% CI, 11%–17%) versus 25% (95% CI, 15%–37%); [3] phenotype C, 14% (95% CI, 12%–16%) versus 34% (95% CI, 25–46%); and [4] phenotype D, 17% (95% CI, 13%–22%) versus 19% (95% CI, 14%– 25%). Differences between referral and unselected populations were statistically significant for phenotypes A, B, and C. Referral PCOS subjects had a greater mean body mass index (BMI) than local controls, a difference that was not apparent in unselected PCOS. Conclusion(s): The prevalence of more complete phenotypes in PCOS and mean BMI were higher in subjects identified in referral versus unselected populations, suggesting the presence of significant referral bias.
PROSPERO
CRD42015015710
DOI
10.7301/Z06D5QXR
Notes
data was entered into this project prospectively (using SRDR's built-in data abstraction function and templates)
Funding Source
Funds from the Career Development Award (MD Medical Group) were used to support D.L. throughout the manuscript preparation. No other funding recourses were identified.

Key Questions

1. The prevalence of PCOS phenotypes and possibly obesity in PCOS women seen in the clinical (referred, biased) settings.
2. The prevalence of PCOS phenotypes and possibly obesity in PCOS women identified in (unselected, unbiased) studies.

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Oligoanovulation with polycystic ovaries but not overt hyperandrogenism.2006
Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria.2007
Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes.
Metabolic profiles characterizing different phenotypes of polycystic ovary syndrome: plasma metabolomics analysis.
A 20-year follow-up of young women with polycystic ovary syndrome.2012
The frequency of metabolic syndrome is higher among PCOS Brazilian women with menstrual irregularity plus hyperandrogenism.2011
Anthropometric, clinical and laboratory comparison of four phenotypes of polycystic ovary syndrome based on Rotterdam criteria.2011
Metabolic profile of the different phenotypes of polycystic ovary syndrome in two Latin American populations.
Metabolic profile of the different phenotypes of polycystic ovary syndrome in two Latin American populations.
Prevalence of polycystic ovary syndrome in women in China: a large community-based study.2013
Cardiovascular and metabolic characteristics of infertile Chinese women with PCOS diagnosed according to the Rotterdam consensus criteria.2010
CD4(+)CD28(null) T lymphocyte frequency, a new marker of cardiovascular risk: relationship with polycystic ovary syndrome phenotypes.2012
Characteristics of abnormal menstrual cycle and polycystic ovary syndrome in community and hospital populations.
Characteristics of different phenotypes of polycystic ovary syndrome based on the Rotterdam criteria in a large-scale Chinese population.2009
Characteristics of different phenotypes of polycystic ovary syndrome based on the Rotterdam criteria in the Croatian population.2013
Diagnostic criteria for polycystic ovary syndrome in Taiwanese Chinese women: comparison between Rotterdam 2003 and NIH 1990.2007
Different phenotypes of polycystic ovary syndrome in Turkish women: clinical and endocrine characteristics.2013
Elevated serum androstenedione is associated with a more severe phenotype in women with polycystic ovary syndrome (PCOS).-- Not Found --
Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study.
Is hyperandrogenemia protective for fibrocystic breast disease in PCOS?2012
Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic.2011
Polycystic ovary syndrome in Salvador, Brazil: a prevalence study in primary healthcare.
Prevalence of polycystic ovary syndrome and related disorders in mexican women.2010
Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria.2012
Serum anti-Mullerian hormone levels in the main phenotypes of polycystic ovary syndrome.2013
The different phenotypes of polycystic ovary syndrome: no advantages for identifying women with aggravated insulin resistance or impaired lipids.2011
The prevalence of phenotypic subgroups in Greek women with polycystic ovarian syndrome.2013
The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria.2010
The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study.2011
The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Mullerian hormone.2014
Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospective study of 634 women with PCOS.2007
The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran.2014
Characteristics of abnormal menstrual cycle and polycystic ovary syndrome in community and hospital populations.2010
The prevalence of metabolic syndrome and insulin resistance according to the phenotypic subgroups of polycystic ovary syndrome in a representative sample of Iranian females.2011
Is the PCOS diagnosis solved by ESHRE/ASRM 2003 consensus or could it include ultrasound examination of the ovarian stroma?2006
Adrenocortical steroid response to ACTH in different phenotypes of non-obese polycystic ovary syndrome.2012
Polycystic ovary syndrome: cardiovascular risk factors according to specific phenotypes.2015
Characteristics and contributions of hyperandrogenism to insulin resistance and other metabolic profiles in polycystic ovary syndrome.
Are Dieting and Dietary Inadequacy a Second Hit in the Association with Polycystic Ovary Syndrome Severity?2015
Antioxidant properties of high-density lipoproteins are impaired in women with polycystic ovary syndrome.2015
A case-control observational study of insulin resistance and metabolic syndrome among the four phenotypes of polycystic ovary syndrome based on Rotterdam criteria.2015
The Role of Anti-Müllerian Hormone in the Characterization of the Different Polycystic Ovary Syndrome Phenotypes.2016
Hyperandrogenism and phenotypes of polycystic ovary syndrome are not associated with differences in obstetric outcomes.2015

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