Context: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women, affecting approximately 5-20% of women of reproductive age. A previous estimate noted that the economic burden of PCOS approximates $3.7 billion annually in 2020 USD when considering only the costs of the initial diagnosis and of reproductive endocrine morbidities, not considering the costs of pregnancy-related and long-term morbidities.

Objective: To estimate the excess prevalence and economic burden of pregnancy-related and long-term health morbidities attributable to PCOS.

Data Sources: PubMed, EmBase and Cochrane Library.

Study Selection: Studies in which the diagnosis of PCOS was consistent with the Rotterdam, National Institutes of Health (NIH), or Androgen Excess & PCOS (AE-PCOS) Society criteria, or that used electronic medical record diagnosis codes, or diagnosis based on histopathologic sampling were eligible for inclusion. Studies that included an outcome of interest and a control group of non-PCOS patients who were matched or controlled for body mass index (BMI) were included.  

Data Extraction: Two investigators working independently extracted data on study characteristics and outcomes. 

Data Synthesis: Data was pooled using random-effects meta-analysis. The I ² statistic was used to assess inter-study heterogeneity. The quality of selected studies was assessed using the Newcastle-Ottawa Scale.

Results: The additional total healthcare-related economic burden due to pregnancy-related and long-term morbidities associated with PCOS in the United States is estimated to be $4.3 billion annually in 2020 USD.

PubMed, EmBase, and the Cochrane Library were searched to identify English-language articles with no date restriction. Observational, controlled studies that examined the risk of adverse pregnancy outcomes (GDM, gHTN, and preeclampsia), or long-term health outcomes (T2DM, MI, or stroke) in women with PCOS compared with a control group were eligible for inclusion. Studies without a control group, or that did not match or control for body mass index (BMI) were excluded. Studies that reported relative risks, odds ratios, or incidence data were eligible for inclusion, while those reporting hazard ratios were excluded. 

Search strategy and study identification was performed by one investigator (C.R.) using a standardized approach. Articles selected for inclusion were then screened by a second author (A.Z.). Two investigators worked in duplicate to independently extract data on study characteristics