Mills Ginevra, Badeghiesh Ahmad, Suarthana Eva, Baghlaf Haitham, Dahan Michael H
Department of Obstetrics and Gynecology, McGill University Health Centre, McGill University, Montreal, QC, Canada.
Hum Reprod. 2020 Aug 1;35(8):1914-1921. doi: 10.1093/humrep/deaa144.
Does polycystic ovary syndrome (PCOS) confer an independent risk for adverse delivery and neonatal outcomes, based on analysis of the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database?
After controlling for all potential confounding effects, women with PCOS are at an increased risk of experiencing preterm pre-labour rupture of membranes (PPROM), pre-term delivery (PTD), placental abruption, caesarean section (C/S) delivery, chorioamnionitis and post-partum maternal infections.
PCOS may be associated with an increased risk of adverse perinatal outcomes. However, there remain significant gaps in understanding the correlation between PCOS and important delivery and neonatal complications.
STUDY DESIGN, SIZE, DURATION: This is a retrospective population-based cohort study utilising data from the HCUP-NIS over 11 years from 2004 to 2014. A cohort of all deliveries between 2004 and 2014 inclusively was created. Within this group, all deliveries to women with PCOS were identified as part of the study group (n = 14 882), and the remaining deliveries were categorised as non-PCOS births and comprised the reference group (n = 9 081 906).
PARTICIPANTS/MATERIALS, SETTING, METHODS: The HCUP-NIS is the largest inpatient sample database in the USA and it is comprised of hospital inpatient stays throughout the entire country. It provides information relating to 7 million inpatient stays per year, includes ∼20% of admissions, and represents over 96% of the American population.
After adjustment for all potential confounders, women with PCOS were more likely to experience PPROM (aOR 1.48, 95% CI 1.20-1.83), PTD (aOR 1.37 95% CI 1.24-1.53) and placental abruption (aOR 1.63, 95% CI 1.30-2.05) and were more likely to deliver by C/S (aOR 1.50, 95% CI 1.40-1.61 (all P < 0.001). Women with PCOS more often developed chorioamnionitis (aOR 1.58, 95% CI 1.34-1.86, P < 0.001) and maternal infections (aOR 1.58, 95% CI 1.36-1.84 (both P < 0.001)). With the exception of multiple gestations (aOR 1.27, 95% CI 1.01-1.62, P = 0.04), there was no difference in the number of women who gave birth to small for gestational age (SGA) infants (aOR 0.97, 95% CI 0.82-1.15, P = 0.72) between the women with PCOS and the reference group. Intrauterine foetal deaths (IUFDs) were also comparable between the two groups (aOR 1.03, 95% CI 0.68-1.59, P = 0.88). However, congenital anomalies were more likely to occur in the offspring of women with PCOS (aOR 1.89, 95% CI 1.51-2.38, P < 0.001).
LIMITATIONS, REASONS FOR CAUTION: This is a retrospective analysis utilising an administrative database which relies on the accuracy and consistency of the individuals coding the data. There are known limitations in how accurately hospital coding is able to capture perinatal conditions and complications, making it difficult to know with certainty that such events are accurate.
Women with PCOS are more likely to experience adverse delivery and neonatal outcomes. It is important to additionally consider the risk of all other co-existing conditions frequently encountered in PCOS women, as these risks are additive and place women with PCOS at significantly increased risk of adverse pregnancy outcomes.
STUDY FUNDING/COMPETING INTEREST(S): No specific funding was obtained for this study. The authors have no conflicts of interest to disclose.
基于对医疗成本和利用项目全国住院患者样本（HCUP-NIS）数据库的分析，多囊卵巢综合征（PCOS）是否会带来不良分娩和新生儿结局的独立风险？
在控制了所有潜在的混杂效应后，患有PCOS的女性发生胎膜早破（PPROM）、早产（PTD）、胎盘早剥、剖宫产（C/S）分娩、绒毛膜羊膜炎和产后母体感染的风险增加。
PCOS可能与围产期不良结局风险增加有关。然而，在理解PCOS与重要分娩及新生儿并发症之间的相关性方面仍存在重大差距。
研究设计、规模、持续时间：这是一项基于人群的回顾性队列研究，利用了2004年至2014年11年间HCUP-NIS的数据。创建了一个2004年至2014年期间所有分娩的队列。在这个群体中，所有PCOS女性的分娩被确定为研究组的一部分（n = 14882），其余分娩被归类为非PCOS分娩，构成对照组（n = 9081906）。
参与者/材料、设置、方法：HCUP-NIS是美国最大的住院患者样本数据库，由全国各地医院的住院患者记录组成。它每年提供与700万次住院患者记录相关的信息，包括约20%的入院病例，代表了超过96%的美国人口。
在对所有潜在混杂因素进行调整后，患有PCOS的女性更有可能发生PPROM（调整后比值比[aOR] 1.48，95%置信区间[CI] 1.20 - 1.83）、PTD（aOR 1.37，95% CI 1.24 - 1.53）和胎盘早剥（aOR 1.63，95% CI 1.30 - 2.05），并且更有可能通过剖宫产分娩（aOR 1.50，95% CI 1.40 - 1.61，所有P < 0.001）。患有PCOS的女性更常发生绒毛膜羊膜炎（aOR 1.58，95% CI 1.34 - 1.86，P < 0.001）和母体感染（aOR 1.58，95% CI 1.36 - 1.84，两者P < 0.001）。除多胎妊娠外（aOR 1.27，95% CI 1.01 - 1.62，P = 0.04），PCOS女性和对照组之间分娩出小于胎龄（SGA）婴儿的女性数量没有差异（aOR 0.97，95% CI 0.82 - 1.15，P = 0.72）。两组之间的宫内胎儿死亡（IUFDs）情况也相当（aOR 1.03，95% CI 0.68 - 1.59，P = 0.88）。然而，PCOS女性的后代更有可能发生先天性异常（aOR 1.89，95% CI 1.51 - 2.38，P < 0.001）。
局限性、注意事项：这是一项利用行政数据库进行的回顾性分析，该数据库依赖于数据编码人员的准确性和一致性。医院编码在准确捕捉围产期情况和并发症方面存在已知局限性，因此难以确定此类事件是否准确。
患有PCOS的女性更有可能经历不良分娩和新生儿结局。此外，重要的是要考虑PCOS女性中经常遇到的所有其他并存疾病的风险，因为这些风险是累加的，会使患有PCOS的女性发生不良妊娠结局的风险显著增加。
研究资金/利益冲突：本研究未获得特定资金。作者没有利益冲突需要披露。
