多囊卵巢综合征对妊娠和后代健康的影响。

Implications of polycystic ovary syndrome for pregnancy and for the health of offspring.

机构信息

School of Women's and Infants' Health, University of Western Australia, and Fertility Specialists of Western Australia, Bethesda Hospital, Claremont, Perth, and the Women and Infants Research Foundation and the Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia.

出版信息

Obstet Gynecol. 2015 Jun;125(6):1397-1406. doi: 10.1097/AOG.0000000000000852.

DOI:10.1097/AOG.0000000000000852

PMID:26000511

Abstract

OBJECTIVE

To study the influence of polycystic ovary syndrome (PCOS) on obstetric and perinatal outcomes and on offspring in childhood.

METHODS

Using statewide data linkage systems within Western Australia, 2,566 hospitalized women with a PCOS diagnosis and at least one pregnancy at 20 weeks of gestation or greater, between 1997 and 2011, were compared with 25,660 randomly selected age-matched women not hospitalized with a PCOS diagnosis with regard to perinatal outcomes, congenital anomalies, and general health of offspring. Hospitalizations were categorized by International Classification of Diseases, 10th Revision diagnoses and rates by 10 years by Kaplan-Meier estimates. Polycystic ovary syndrome effects were summarized using adjusted odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) after controlling for maternal and perinatal characteristics, including maternal diabetes and obesity.

RESULTS

Of women with PCOS (n=1,789), 69.7% and 62.9% (n=16,139) of women without PCOS had one or more births. Hospitalizations up to 31 years were examined for 38,361 offspring. Offspring of women with PCOS were at higher risk of preterm birth (15.5% compared with 7.6% OR 1.74, 95% CI 1.53-1.98), perinatal mortality (2.3% compared with 0.7%, OR 1.49, 95% CI 1.02-2.18), more postnatal hospitalizations (14.1% compared with 7.9%, OR 1.21, 95% CI 1.05-1.40), more congenital anomalies (6.3% compared with 4.9%, OR 1.20, 95% CI 1.03-1.40), cardiovascular (1.5% compared with 1.0%, OR 1.37, 95% CI 1.01-1.87), and urogenital defects (2.0% compared with 1.4% OR 1.36, 95% CI 1.03-1.81). Maternal PCOS was associated with increased hospitalizations for their offspring, including metabolic disorder (7.9% compared with 5.3%, HR 1.43, 95% CI 1.26-1.65), disease of the nervous system (9.4% compared with 6.9%, HR 1.17, 95% CI 1.03-1.33), and asthma (6.9% compared with 4.9%, HR 1.32, 95% CI 1.13-1.54).

CONCLUSION

Controlling for increased perinatal risk, maternal PCOS was associated with a predisposition to adverse health outcomes for their offspring.

LEVEL OF EVIDENCE

II.

摘要

目的

研究多囊卵巢综合征（PCOS）对产科和围产期结局以及儿童期后代的影响。

方法

利用西澳大利亚州的全州数据链接系统，对 1997 年至 2011 年间至少有一次妊娠 20 周或以上的 2566 例患有 PCOS 住院的女性与 25660 名随机选择的年龄匹配且无 PCOS 住院诊断的女性进行比较，以了解围产期结局、先天畸形和后代的一般健康状况。住院情况按国际疾病分类第 10 版诊断进行分类，并采用 Kaplan-Meier 估计法按 10 年划分率。在控制了产妇和围产期特征（包括产妇糖尿病和肥胖症）后，采用调整后的优势比（OR）和风险比（HR）及其 95%置信区间（CI）来总结 PCOS 的影响。

结果

在患有 PCOS 的女性（n=1789）中，69.7%和 62.9%（n=16139）的无 PCOS 女性有一次或多次分娩。对 38361 名后代的 31 年随访。患有 PCOS 的女性的后代早产风险更高（15.5%比 7.6%，OR 1.74，95%CI 1.53-1.98）、围产期死亡率更高（2.3%比 0.7%，OR 1.49，95%CI 1.02-2.18）、产后住院次数更多（14.1%比 7.9%，OR 1.21，95%CI 1.05-1.40）、先天畸形更多（6.3%比 4.9%，OR 1.20，95%CI 1.03-1.40）、心血管疾病（1.5%比 1.0%，OR 1.37，95%CI 1.01-1.87）和泌尿生殖系统缺陷（2.0%比 1.4%，OR 1.36，95%CI 1.03-1.81）。母亲患有 PCOS 与后代住院次数增加有关，包括代谢紊乱（7.9%比 5.3%，HR 1.43，95%CI 1.26-1.65）、神经系统疾病（9.4%比 6.9%，HR 1.17，95%CI 1.03-1.33）和哮喘（6.9%比 4.9%，HR 1.32，95%CI 1.13-1.54）。