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Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations: systematic review and meta-analysis
Open accessAbstract
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 Rotterdam 2003 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.
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“However, most relevant information has been accrued through clinical studies involving adult women in which referral bias focuses on investigation of the more severe phenotypes [7].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [7]
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Metadata
- Authors
- Lizneva, D., Kirubakaran, R., Mykhalchenko, K., Suturina, L., Chernukha, G., Diamond, M. P., & Azziz, R.
- Affiliations
- Augusta University (US)
- Christian Medical College, Vellore (IN)
- Maimonides Medical Center (US)
- Corresponding author
- Azziz, Ricardo
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 106
- Issue
- 6
- Pages
- 1510-1520.e2
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2507667443
- Cited by
- 171
- References
- 67
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 16 · 2023: 16 · 2022: 22 · 2021: 23 · 2020: 22 · 2019: 19 · 2018: 14 · 2017: 8 · 2016: 2
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Kidney Cyst Diseases
- Keywords
- polycystic ovary syndrome, PCOS phenotypes, referral bias, body mass index, obesity, hyperandrogenism, oligoanovulation, polycystic ovary morphology, Rotterdam criteria
- MeSH terms
- Female, Humans, Obesity, Ovulation, Phenotype, Polycystic Ovary Syndrome, Referral and Consultation, Selection Bias, Body Mass Index, Prevalence, Observational Studies as Topic
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