Department of Infertility, Institute of Reproductive Medicine, Kolkata, India.
PLoS One. 2013 May 21;8(5):e64446. doi: 10.1371/journal.pone.0064446. Print 2013.
Recurrent pregnancy loss (RPL) in polycystic ovary syndrome (PCOS), which occurs in ∼50% of total pregnancies is a frequent obstetric complication. Among the several hypotheses, insulin resistance (IR), obesity and hyperhomocysteinemia (HHcy) play significant role/s in RPL. This study was conducted to assess the link between elevated levels of homocysteine and IR in PCOS-associated women with RPL in Kolkata, India. A retrospective study was conducted of one hundred and twenty six PCOS women (<30 years) who experienced two or more spontaneous abortions during the first trimester presenting to Institute of Reproductive Medicine (IRM) in Kolkata during the period of March 2008 through February 2011. One hundred and seventeen non-PCOS subjects with matching age range were randomly chosen as controls. Incidence of HHcy and IR was 70.63% (n = 89) and 56.34% (n = 71), respectively, in RPL-affected PCOS population which was significantly higher (p<0.04; p<0.0001) when compared to the non-PCOS set (HHcy: 57.26%; IR: 6.83%). Rates of miscarriage were significantly higher (p<0.008; p<0.03) in hyperhomocysteinemia-induced miscarriage when compared to the normohomocysteinemic segment (PCOS: 70.63% vs.29.36% & non-PCOS: 57.26% vs. 42.73%) along with the insulin resistant (p<0.04; p<0.0001) population (PCOS: 70.63% vs. 56.34% & non-PCOS: 57.26% vs. 6.83%) in both groups. A probabilistic causal model evaluated HHcy as the strongest plausible factor for diagnosis of RPL. A probability percentage of 43.32% in the cases of HHcy- mediated RPL suggests its increased tendency when compared to IR mediated miscarriage (37.29%), further supported by ROC-AUC (HHcy: 0.778vs. IR: 0.601) values. Greater susceptibility towards HHcy may increase the incidence for miscarriage in women in India and highlights the need to combat the condition in RPL control programs in the subcontinent.
多囊卵巢综合征（PCOS）相关复发性妊娠丢失（RPL）在总妊娠中的发生率约为 50%，是一种常见的产科并发症。在几种假说中，胰岛素抵抗（IR）、肥胖和高同型半胱氨酸血症（HHcy）在 RPL 中起重要作用。本研究旨在评估印度加尔各答多囊卵巢综合征相关 RPL 患者血液同型半胱氨酸水平升高与 IR 之间的关系。这是一项回顾性研究，共纳入 126 名年龄在 30 岁以下的 PCOS 女性，她们在 2008 年 3 月至 2011 年 2 月期间在加尔各答生殖医学研究所（IRM）经历了两次或更多次早期自然流产。随机选择 117 名年龄匹配的非 PCOS 受试者作为对照组。RPL 相关 PCOS 人群中 HHcy 和 IR 的发生率分别为 70.63%（n=89）和 56.34%（n=71），明显高于非 PCOS 组（HHcy：57.26%；IR：6.83%）（p<0.04；p<0.0001）。与同型半胱氨酸正常组相比，高同型半胱氨酸血症诱导的流产组的流产率明显更高（p<0.008；p<0.03）（PCOS：70.63% vs.29.36%；非 PCOS：57.26% vs.42.73%），以及胰岛素抵抗组（p<0.04；p<0.0001）（PCOS：70.63% vs.56.34%；非 PCOS：57.26% vs.6.83%）。概率因果模型评估 HHcy 为诊断 RPL 的最强似然因素。HHcy 介导的 RPL 病例中概率百分比为 43.32%，表明其发生率高于 IR 介导的流产（37.29%），ROC-AUC（HHcy：0.778 vs.IR：0.601）值进一步支持这一结果。印度女性对 HHcy 的敏感性增加可能会增加其流产的发生率，并强调在该次大陆的 RPL 控制项目中需要对抗这种情况。
