Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
J Clin Endocrinol Metab. 2018 Nov 1;103(11):4187-4196. doi: 10.1210/jc.2018-01320.
There is increasing evidence for Müllerian-inhibiting substance (MIS)/anti-Müllerian hormone (AMH) physiologic activity in the human uterus, so it is relevant to study how MIS/AMH levels impact pregnancy.
To investigate the association of MIS/AMH levels with the risk of adverse obstetric outcomes.
Retrospective cohort study.
Academic fertility center.
Women who became pregnant through in vitro fertilization between January 2012 and October 2016. Exclusion criteria were: oocyte donation, gestational carrier, multiple gestations, miscarriage before 20 weeks, or medically indicated preterm deliveries.
None.
There were two primary outcomes, preterm birth and cesarean delivery for arrest of labor. Because MIS/AMH level is highly skewed by certain infertility diagnoses, the preterm birth analysis was stratified by polycystic ovary syndrome (PCOS) diagnosis, and the cesarean delivery for arrest of labor analysis was stratified by diminished ovarian reserve diagnosis. χ2, Mann-Whitney, and t tests were used as appropriate. A P value of <0.05 was considered statistically significant.
Among women with PCOS, those who delivered prematurely had substantially higher MIS/AMH levels (18 vs 6.4 ng/mL, P = 0.003) than did those who delivered at term. At the highest MIS/AMH values, preterm deliveries predominated; above the 90th percentile in women with PCOS, all deliveries were premature. No effect of MIS/AMH level was observed in women without PCOS. We found no association between MIS/AMH values and cesarean delivery for labor arrest.
In women with PCOS, substantially elevated MIS/AMH levels are significantly associated with preterm birth, suggesting closer follow-up and further studies to elucidate the underlying mechanisms.
越来越多的证据表明，米勒管抑制物质（MIS）/抗米勒管激素（AMH）在人类子宫中有生理活性，因此研究 MIS/AMH 水平如何影响妊娠是很有意义的。
探讨 MIS/AMH 水平与不良产科结局风险的关系。
回顾性队列研究。
学术生育中心。
2012 年 1 月至 2016 年 10 月期间通过体外受精怀孕的女性。排除标准为：赠卵、代孕、多胎妊娠、20 周前流产或医学指征的早产。
无。
主要结局为早产和因产程停止而行剖宫产术。由于某些不孕诊断会使 MIS/AMH 水平严重偏态，因此早产分析按多囊卵巢综合征（PCOS）诊断分层，因产程停止而行剖宫产术的分析按卵巢储备功能减退诊断分层。适当使用 χ2、Mann-Whitney 和 t 检验。P 值＜0.05 为差异有统计学意义。
在患有 PCOS 的女性中，早产的患者 MIS/AMH 水平明显更高（18 比 6.4ng/ml，P = 0.003），而足月分娩的患者 MIS/AMH 水平则较低。在 MIS/AMH 值最高的情况下，早产占主导地位；在患有 PCOS 的女性中，90%以上的患者均发生早产。在没有 PCOS 的女性中，MIS/AMH 水平没有影响。我们没有发现 MIS/AMH 值与因产程停止而行剖宫产术之间存在关联。
在患有 PCOS 的女性中，MIS/AMH 水平显著升高与早产显著相关，这表明需要更密切的随访和进一步的研究来阐明潜在的机制。
