Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations

systematic review and meta-analysis

Daria Lizneva, Richard Kirubakaran, Kateryna Mykhalchenko, Larisa Suturina, Galina Chernukha, Michael Peter Diamond, Ricardo Azziz

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1510-1520.e2
JournalFertility and Sterility
Volume106
Issue number6
DOIs
StatePublished - Aug 13 2016

Fingerprint

Polycystic Ovary Syndrome
Meta-Analysis
Referral and Consultation
Phenotype
Population
Confidence Intervals
Anovulation
Hyperandrogenism
MASS syndrome
Body Mass Index
Libraries
Observational Studies
Obesity

Keywords

  • epidemiology
  • meta-analysis
  • phenotypes
  • Polycystic ovary syndrome
  • prevalence
  • referral bias

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations : systematic review and meta-analysis. / Lizneva, Daria; Kirubakaran, Richard; Mykhalchenko, Kateryna; Suturina, Larisa; Chernukha, Galina; Diamond, Michael Peter; Azziz, Ricardo.

In: Fertility and Sterility, Vol. 106, No. 6, 13.08.2016, p. 1510-1520.e2.

Research output: Contribution to journalArticle

Lizneva, Daria ; Kirubakaran, Richard ; Mykhalchenko, Kateryna ; Suturina, Larisa ; Chernukha, Galina ; Diamond, Michael Peter ; Azziz, Ricardo. / Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations : systematic review and meta-analysis. In: Fertility and Sterility. 2016 ; Vol. 106, No. 6. pp. 1510-1520.e2.
@article{c0895dc2011d4507876cb3be7cda0d78,
title = "Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations: systematic review and meta-analysis",
abstract = "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.",
keywords = "epidemiology, meta-analysis, phenotypes, Polycystic ovary syndrome, prevalence, referral bias",
author = "Daria Lizneva and Richard Kirubakaran and Kateryna Mykhalchenko and Larisa Suturina and Galina Chernukha and Diamond, {Michael Peter} and Ricardo Azziz",
note = "Copyright {\circledC} 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.",
year = "2016",
month = "8",
day = "13",
doi = "10.1016/j.fertnstert.2016.07.1121",
language = "English (US)",
volume = "106",
pages = "1510--1520.e2",
journal = "Fertility and Sterility",
issn = "0015-0282",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations

T2 - systematic review and meta-analysis

AU - Lizneva, Daria

AU - Kirubakaran, Richard

AU - Mykhalchenko, Kateryna

AU - Suturina, Larisa

AU - Chernukha, Galina

AU - Diamond, Michael Peter

AU - Azziz, Ricardo

N1 - Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

PY - 2016/8/13

Y1 - 2016/8/13

N2 - 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.

AB - 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.

KW - epidemiology

KW - meta-analysis

KW - phenotypes

KW - Polycystic ovary syndrome

KW - prevalence

KW - referral bias

UR - http://www.scopus.com/inward/record.url?scp=84994136249&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994136249&partnerID=8YFLogxK

U2 - 10.1016/j.fertnstert.2016.07.1121

DO - 10.1016/j.fertnstert.2016.07.1121

M3 - Article

VL - 106

SP - 1510-1520.e2

JO - Fertility and Sterility

JF - Fertility and Sterility

SN - 0015-0282

IS - 6

ER -