Effect of maternal PCOS and PCOS-like phenotype on the offspring's health

• Pathogenesis of PCOS can be explained by the two-hit hypothesis.
• The two hits involve perinatal organizational and postnatal activational events.
• PCOS in women disrupts maternal milieu allowing vertical transmission.
• Data from women with PCOS and animal models relative to the two-hit are compared.
• Lack of human data and use of animal models relative to PCOS onset are discussed.

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder with both reproductive and metabolic abnormalities affecting women of reproductive age. While the exact origin of PCOS is unknown, observations from clinical and animal studies suggest that maternal hyperandrogenism may be a contributing factor. Because women with PCOS manifest hyperandrogenism during pregnancy, changes in the gestational endocrine milieu may play a role in the vertical transmission of this syndrome. This review discusses the potential developmental origins of PCOS, the impact of maternal PCOS on the offspring's health and contributions of the postnatal environment, capitalizing on findings from animal models that exhibit a PCOS-like phenotype. In addition, this review highlights the scarcity of data at early gestational stages in humans and the importance of animal experimentation to better understand the cellular and molecular mechanisms involved in the programming of adult diseases, therefore, helping identify therapeutic targets for preventive and treatment strategies.