Cross-sectional analysis of 10,856 North American females aged 21–45 years in the PRESTO preconception cohort (2013–2025), evaluating whether adverse childhood experiences (ACEs), measured via the 8-item BRFSS ACE module and Brief Trauma Questionnaire, were associated with self-reported, physician-diagnosed PCOS.
PCOS prevalence rose from 7.4% (no ACEs) to 14.2% (≥4 ACEs). After full adjustment, ≥4 ACEs vs. 0 carried a prevalence ratio of 1.64 (95% CI: 1.33–2.01); each additional ACE raised prevalence ~8% (PR=1.08, 95% CI: 1.05–1.11). Sexual abuse showed the strongest individual association (PR=1.82, 95% CI: 1.45–2.29).
- Cross-sectional design prevents causal inference; PCOS diagnosis preceded or followed ACE exposure cannot be confirmed. - PCOS was self-reported physician diagnosis, not verified by labs or imaging, risking misclassification. - Supplemental questionnaire non-response (addressed via inverse probability weighting) may introduce residual selection bias.
Clinicians evaluating patients with PCOS—or those at risk—should consider routinely screening for a history of childhood adversity, as cumulative ACE burden is associated with substantially higher PCOS prevalence. Attention to trauma-informed care may be warranted in the reproductive health setting.
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