Early life adversity and polycystic ovary syndrome among North American pregnancy planners

Am J Obstet Gynecol. 2026 Jun 24:S0002-9378(26)00326-1. doi: 10.1016/j.ajog.2026.06.019. Online ahead of print.

ABSTRACT

BACKGROUND: Adverse childhood experiences (ACEs) have been associated with several long-term health outcomes, yet their relation to polycystic ovary syndrome (PCOS)-renamed as polyendocrine metabolic ovarian syndrome (PMOS) in 2026-is understudied. ACEs may influence PCOS risk via disruption of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes.

METHODS: We used cross-sectional data to evaluate the association between early life adversities and self-reported PCOS in Pregnancy Study Online (PRESTO), a North American preconception cohort of females aged 21-45 years enrolled during 2013-2025. At enrollment, participants completed a baseline questionnaire to ascertain socio-demographics, behavioral factors, and medical history. Thirty days after enrollment, participants completed a supplemental questionnaire that included the Behavioral Risk Factor Surveillance System’s 8-item ACE module and Brief Trauma Questionnaire (BTQ). Participants reported physician-diagnosed PCOS on baseline and follow-up questionnaires during preconception. We fit modified Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusting for age, race, ethnicity, childhood financial hardship, and highest level of parental education. We used inverse probability weights to account for supplemental questionnaire non-response.

RESULTS: Among 10,856 participants, 52% and 26% reported 1-3 and ≥4 ACEs, respectively; 1,169 (10.8%) reported a PCOS diagnosis. Self-reported PCOS prevalence ranged from 7.4% (no ACEs) to 14.2% (≥4 ACEs). Weighted and fully-adjusted PRs for 1-3 and ≥4 (vs. 0) ACEs were 1.33 (95% CI: 1.11-1.60) and 1.64 (95% CI: 1.33-2.01), respectively (per 1-ACE increase: PR=1.08, 95% CI: 1.05-1.11). Specific ACEs associated with the largest increase in PCOS prevalence included: sexual abuse (PR=1.82, 95% CI: 1.45-2.29, parental interpersonal violence (PR=1.68, 95% CI: 1.29-2.17), emotional abuse (PR=1.54, 95% CI: 1.28-1.86), physical abuse (PR=1.52, 95% CI: 1.21-1.90), household mental illness (PR=1.46, 95% CI: 1.21-1.77), and parental separation/divorce (PR=1.43, 95% CI: 1.15-1.77). Results based on BTQ-derived measures of childhood sexual and physical abuse were consistent with those based on ACE measures.

CONCLUSIONS: In this North American cross-sectional study, higher exposure to early life adversities was associated with a higher lifetime prevalence of self-reported physician-diagnosed PCOS. These findings add to growing evidence that childhood adversities may have lasting effects on gynecologic health and underscore the need for attention to early life stressors in understanding PCOS.

PMID:42342098 | DOI:10.1016/j.ajog.2026.06.019