Assessing new terminal body and facial hair growth during pregnancy: toward developing a simplified visual scoring system for hirsutism

Abstract

Objective: To study the distribution and progression of terminal hair growth in pregnant women and to determine the feasibility of a simplified scoring system for assessing hirsutism.

Design: Prospective follow-up observational study.

Setting: Academic hospital.

Patient(s): A total of 115 pregnant women (discovery cohort) and 1,159 women with polycystic ovary syndrome (PCOS) (validation cohort).

Intervention(s): Facial and body terminal hair growth assessed by modified Ferriman and Gallwey score system (mFG score), and total testosterone (TT) level detected by liquid chromatography with tandem mass spectrometry.

Main outcome measure(s): Degree of facial and body terminal hair growth.

Result(s): The serum TT level and mFG score increased as pregnancy progressed. Both the prospective study and receiver operating characteristics curve indicated that the body areas with the greatest contribution to hirsutism (defined as an mFG score ≥5) with new terminal hair growth were the upper lip, lower back, lower abdomen, and thigh. A simplified mFG scoring system (sFG) was developed, and a cutoff value of ≥3 was defined as hirsutism. Pregnant hirsute women were distinguished from nonhirsute women with an accuracy of 95.2%, sensitivity of 96.8%, and specificity of 94.3% for detecting hirsutism. This was further validated in the PCOS population with a sensitivity, specificity, and positive predictive value of 97.6%, 96.4%, and 96.4%, respectively.

Conclusion(s): This study suggests that the upper lip, lower back, lower abdomen, and thigh may be an effective simplified combination of the mFG system for the evaluation of excess hair growth in Chinese women.

Clinical trial registration number: ChiCTR-OCH-14005012.

Keywords: Androgen excess; hair growth; hirsutism; modified Ferriman-Gallwey score; polycystic ovary syndrome; pregnancy.