Early pregnancy biomarkers of inflammation and metabolic regulation in polycystic ovary syndrome.

Abstract

OBJECTIVE: To profile biomarkers of inflammation and metabolic regulation in early pregnancy among women with and without polycystic ovary syndrome (PCOS), and to assess whether these biomarkers influence the relationship between PCOS and adverse maternal or neonatal outcomes. DESIGN: Cross-sectional study with interaction analyses using pooled baseline data from two international multicentre clinical trials. SUBJECTS: 151 pregnant women (at <24 weeks' gestation) at risk of gestational diabetes mellitus, including 65 with PCOS and 86 without PCOS. MAIN OUTCOME MEASURES: Early pregnancy markers of inflammation and metabolic regulation were assessed, including C-reactive protein, tumour necrosis factor-alpha, interleukins, monocyte chemoattractant protein-1 (MCP1), fatty acid binding protein-4 (FABP4), growth differentiation factor-15, and adipokines (total adiponectin, leptin, resistin, chemerin, vaspin and cathepsin-S. Biomarkers differing by PCOS status were further examined for interaction effects on maternal and neonatal outcomes. RESULT(S): MCP1 concentrations were 15% higher in women with PCOS compared with those without (geometric mean ratio [GMR]: 1.15; 95% CI: 1.01, 1.31; p=0.04), but this association was attenuated after adjustment for maternal age and BMI. Early pregnancy FABP4 concentrations were 32% higher in women with PCOS compared to those without (GMR: 1.32; 95% CI: 1.04, 1.68; p=0.02), and this association remained significant after adjustment for maternal age (GMR: 1.34; 95% CI: 1.05-1.71; p=0.02), but was attenuated after adjustment for BMI. No other biomarkers differed by PCOS status, and MCP1 or FABP4 showed no interactions with maternal or neonatal outcomes. CONCLUSION(S): MCP1 and FABP4 concentrations were elevated in early pregnancy among women with PCOS, largely reflecting maternal adiposity. These markers did not modify associations between PCOS and pregnancy outcomes. Larger longitudinal studies are needed to clarify underlying inflammatory and metabolic pathways.Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the Endocrine Society.