Maternal polycystic ovary syndrome and the risk of neurodevelopmental outcomes in preterm neonates

Introduction
Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with increased obstetric complications. However, its impact on the neurodevelopment of preterm neonates remains underexplored, particularly in low-resource settings. The study aimed to assess the association between maternal PCOS and the risk of neurodevelopmental disorders in preterm neonates.

Material and methods
A prospective case-control study was conducted at Azadi Teaching Hospital, Kirkuk, Iraq, from June 2023 to June 2025. A total of 200 women with preterm labor were enrolled and divided into two groups – Group A (PCOS, n = 100) and Group B (non-PCOS, n = 100) – based on the Rotterdam criteria. Neonatal outcomes – including gestational age, birth weight, Apgar scores, neonatal intensive care unit (NICU) stay, intraventricular hemorrhage (IVH), periventricular leukomalacia, seizures, and neurodevelopment – were assessed. Neurodevelopmental evaluation was performed at 6, 12, and 24 months using the Denver II screening test. Logistic regression was used to identify predictors of developmental delay.

Results
Neonates born to mothers with PCOS had significantly lower birth weights, longer NICU stays, higher rates of IVH and seizures, and lower Apgar scores. Developmental delays – particularly in fine motor, language, and gross motor domains – were significantly more prevalent in the PCOS group (p < 0.001). Logistic regression identified maternal PCOS, NICU stay, Homeostatic Model Assessment for Insulin Resistance, IVH, and 1-minute Apgar score as independent predictors of neurodevelopmental delay.

Conclusions
Maternal PCOS is associated with an increased risk of neurodevelopmental disorders in preterm neonates. Targeted screening and follow-up are necessary for women at high risk.