Koster Maria P H, de Wilde Marlieke A, Veltman-Verhulst Susanne M, Houben Michiel L, Nikkels Peter G J, van Rijn Bas B, Fauser Bart C J M
Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands
Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Hum Reprod. 2015 Dec;30(12):2829-37. doi: 10.1093/humrep/dev265. Epub 2015 Oct 25.
Are macroscopic and microscopic placental characteristics in a heterogeneous group of women diagnosed with polycystic ovary syndrome (PCOS) different from those of a low-risk general population?
Women with PCOS have significantly different microscopic placental characteristics compared with control women, independently from pregnancy complications.
Non-obese women with PCOS who conceived spontaneously have a significantly reduced placental volume and weight, with more chronic villitis and intervillositis compared with healthy controls.
STUDY DESIGN, SIZE, DURATION: A subset of a large prospective cohort study of pregnant women with PCOS was used. Healthy (low-risk) women who delivered at term after an uncomplicated pregnancy were used as the reference population. The placentas of 73 women with PCOS were analysed and compared with 209 placentas of healthy women.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Placentas were collected after delivery from women with PCOS who were followed from prior to conception until delivery. The placentas were macroscopically and microscopically analysed and compared with placentas of healthy women with either a spontaneous start of labour who delivered at term or who had an elective Caesarean section.
After adjusting for potential confounders, placentas from women with PCOS showed more chorioamnionitis (P < 0.001), funisitis (P = 0.019), villitis (P = 0.045), thrombosis (P = 0.018), infarction (P = 0.010), villous immaturity (P = 0.009) and nucleated fetal red blood cells (P < 0.001). In a subgroup analysis, among women with and without pregnancy complications within the PCOS group, only the occurrence of thrombosis was increased in pregnancies complicated by pregnancy-induced hypertension or pre-eclampsia (30%, versus 0% in gestational diabetes pregnancies and 13% in uncomplicated pregnancies; P = 0.008).
LIMITATIONS, REASONS FOR CAUTION: There might be a small proportion of women with PCOS in the reference group, since this group was not screened for PCOS. As a result, the observed difference may be an underestimation of the true difference. Placentas were stored for up to 72 h at 4°C, this is common practice but some degenerative changes cannot be ruled out absolutely. Also, there is possibility that baseline differences between the groups may in part explain some of the differences in placental pathology.
Our findings suggest that, in general, women with PCOS can have placental alterations associated with an increased hypoxic state, which seems not to be caused by the increased incidence of pregnancy complications.
在被诊断为多囊卵巢综合征（PCOS）的异质性女性群体中，胎盘的宏观和微观特征与低风险普通人群的胎盘特征是否不同？
与对照女性相比，PCOS女性具有明显不同的微观胎盘特征，且与妊娠并发症无关。
自然受孕的非肥胖PCOS女性的胎盘体积和重量显著减小，与健康对照相比，有更多的慢性绒毛炎和绒毛间炎。
研究设计、规模、持续时间：使用了一项针对PCOS孕妇的大型前瞻性队列研究的一个子集。将妊娠结局正常且足月分娩的健康（低风险）女性作为参考人群。分析了73例PCOS女性的胎盘，并与209例健康女性的胎盘进行比较。
研究对象/材料、地点、方法：从孕前至分娩一直接受随访的PCOS女性产后收集胎盘。对胎盘进行宏观和微观分析，并与足月自然分娩或择期剖宫产的健康女性的胎盘进行比较。
在对潜在混杂因素进行校正后，PCOS女性的胎盘显示出更多的绒毛膜羊膜炎（P<0.001）、脐带炎（P=0.019）、绒毛炎（P=0.045）、血栓形成（P=0.018）、梗死（P=0.010）、绒毛不成熟（P=0.009）和成核胎儿红细胞（P<0.001）。在亚组分析中，在PCOS组中有或无妊娠并发症的女性中，仅在并发妊娠高血压或子痫前期的妊娠中血栓形成的发生率增加（30%，而妊娠期糖尿病妊娠中为0%，无并发症妊娠中为13%；P=0.008）。
局限性、谨慎的原因：参考组中可能有一小部分PCOS女性，因为该组未进行PCOS筛查。因此，观察到的差异可能低估了真实差异。胎盘在4℃下保存长达72小时，这是常见做法，但不能完全排除一些退行性变化。此外，两组之间的基线差异可能部分解释了胎盘病理学上的一些差异。
我们的研究结果表明，一般来说，PCOS女性可能存在与缺氧状态增加相关的胎盘改变，这似乎不是由妊娠并发症发生率增加引起的。
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