Department of Obstetrics and Gynecology, The Permanente Medical Group, San Francisco, CA 94115, USA.
Hum Reprod. 2012 Sep;27(9):2837-42. doi: 10.1093/humrep/des193. Epub 2012 Jun 14.
Pregnant women with polycystic ovarian syndrome (PCOS) experience a greater rate of adverse obstetrical outcomes compared with non-PCOS women. We examined the prevalence and incidence of cervical insufficiency (CI) in a community cohort of pregnant women with and without PCOS.
A retrospective cohort study was conducted within a large integrated health care delivery system among non-diabetic PCOS women with second or third trimester delivery during 2002-2005 (singleton or twin gestation). PCOS was defined by Rotterdam criteria. A non-PCOS comparison group matched for delivery year and hospital facility was used to estimate the background rate of CI. Women were designated as having new CI diagnosed in the index pregnancy (based on cervical dilation and/or cervical shortening) and prior CI based on prior diagnosis of CI with prophylactic cerclage placed in the subsequent pregnancy.
We identified 999 PCOS women, of whom 29 (2.9%) had CI. There were 18 patients with new CI and 11 with prior CI having prophylactic cerclage placement; four CI patients had twin gestation. In contrast, only five (0.5%) non-PCOS women had CI: two with new CI and three with prior CI. The proportion of newly diagnosed incident CI (1.8 versus 0.2%) or prevalent CI (2.9 versus 0.5%) was significantly greater for PCOS compared with non-PCOS pregnant women (both P < 0.01). Among PCOS women, CI prevalence was particularly high among South Asians (7.8%) and Blacks (17.5%) compared with Whites (1%) and significantly associated with gonadotropin use (including in vitro fertilization). Overall, the PCOS status was associated with an increased odds of prevalent CI pregnancy (adjusted odds ratio 4.8, 95% confidence interval 1.5-15.4), even after adjusting for maternal age, nulliparity, race/ethnicity, body mass index and fertility treatment.
In this large and ethnically diverse PCOS cohort, we found that CI occurred with a higher than expected frequency in PCOS women, particularly among South Asian and Black women. PCOS women with CI were also more likely to have received gonadotropin therapy. Future studies should examine whether natural and hormone-altered PCOS is a risk factor for CI, the role of race/ethnicity, fertility drugs and consideration for heightened mid-trimester surveillance in higher risk subgroups of pregnant women with PCOS.
与非多囊卵巢综合征（PCOS）女性相比，患有多囊卵巢综合征的孕妇发生不良产科结局的风险更高。我们在一个大型综合医疗保健系统中对患有和不患有 PCOS 的孕妇队列进行了回顾性队列研究，这些孕妇的妊娠处于第二或第三孕期（单胎或双胎妊娠）。多囊卵巢综合征的诊断采用鹿特丹标准。我们使用未患有 PCOS 的对照组来匹配分娩年份和医院设施，以估计宫颈机能不全（CI）的背景发生率。将在指数妊娠中诊断出新的 CI（基于宫颈扩张和/或宫颈缩短）和先前 CI（基于随后妊娠中预防性宫颈环扎术诊断的 CI）的女性指定为患有新的 CI。
我们确定了 999 名患有 PCOS 的女性，其中 29 名（2.9%）患有 CI。18 名患者新诊断出 CI，11 名患者因预防性宫颈环扎术而有先前 CI；4 名 CI 患者怀有双胞胎。相比之下，仅有 5 名（0.5%）非 PCOS 女性患有 CI：2 名新诊断出 CI，3 名有先前 CI。与非 PCOS 孕妇相比，患有新诊断出的偶发性 CI（1.8% 比 0.2%）或先前存在的 CI（2.9% 比 0.5%）的 PCOS 孕妇比例明显更高（均 P<0.01）。在患有 PCOS 的女性中，南亚人（7.8%）和黑人（17.5%）的 CI 患病率明显高于白人（1%），并且与促性腺激素的使用（包括体外受精）显著相关。总体而言，患有 PCOS 与患有先前存在的 CI 妊娠的几率增加有关（调整后的优势比 4.8，95%置信区间 1.5-15.4），即使在调整了产妇年龄、初产、种族/民族、体重指数和生育治疗后也是如此。
在这个大型且种族多样化的 PCOS 队列中，我们发现 CI 在 PCOS 女性中的发生频率高于预期，尤其是在南亚人和黑人女性中。患有 CI 的 PCOS 女性更有可能接受过促性腺激素治疗。未来的研究应探讨自然和激素改变的 PCOS 是否是 CI 的一个危险因素，种族/民族、生育药物以及是否考虑对患有 PCOS 的高危孕妇亚组进行妊娠中期加强监测。
