Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark.
Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, 2400 Copenhagen NV, Denmark.
Hum Reprod. 2020 Oct 1;35(10):2348-2355. doi: 10.1093/humrep/deaa168.
Is maternal polycystic ovary syndrome (PCOS) associated with increased offspring risk of congenital heart defects?
This study does not support a strong association between PCOS and an increased risk of congenital heart defects.
In addition to affecting reproductive health, PCOS may involve insulin resistance. Maternal pregestational diabetes is associated with an increased risk of congenital heart defects and therefore PCOS may increase the risk of congenital heart defects in the offspring.
STUDY DESIGN, SIZE, DURATION: In this nationwide cohort study, we used data from Danish health registers collected from 1995 to 2018. The study included 1 302 648 offspring and their mothers.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were live singleton offspring born during the study period. Information on maternal PCOS and offspring congenital heart defects was obtained from the National Patient Register. Logistic regression analysis was used to compute prevalence (odds) ratio (PR) of the association between PCOS and offspring congenital heart defects.
Among 1 302 648 live-born singletons, 11 804 had a mother with PCOS. Of these, 143 offspring had a congenital heart defect (prevalence 121 per 10 000) as compared with 12 832 among mothers without PCOS (prevalence 99 per 10 000). The adjusted PR was 1.22, 95% CI 1.03-1.44 comparing prevalence of congenital heart defects in offspring of women with PCOS with offspring of women without. After adjusting for the potentially mediating effect of pregestational diabetes, the PR was 1.16, 95% CI 0.98-1.37.
LIMITATIONS, REASONS FOR CAUTION: PCOS may be underdetected in the National Patient Register. However, we expect that the mothers that we identified with PCOS truly had PCOS, thus, the estimated associations are not likely to be affected by this misclassification. The study does not provide evidence to rule out a moderate or weak association.
These findings provide reassurance to clinicians counselling pregnant women with PCOS that the disease does not pose a markedly increased risk of offspring congenital heart defects.
STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the Novo Nordisk Foundation. M.L. reports personal fees from Dansk Lægemiddel Information A/S outside the submitted work. The remaining authors have no conflicts of interest.
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多囊卵巢综合征（PCOS）是否会增加后代患先天性心脏病的风险？
本研究不支持 PCOS 与先天性心脏病风险增加之间存在很强的关联。
除了影响生殖健康外，PCOS 还可能涉及胰岛素抵抗。母亲孕前糖尿病与先天性心脏病风险增加有关，因此 PCOS 可能会增加后代患先天性心脏病的风险。
研究设计、规模、持续时间：在这项全国性队列研究中，我们使用了丹麦健康登记处 1995 年至 2018 年收集的数据。该研究纳入了 1302648 名活产单胎子女及其母亲。
参与者/材料、地点、方法：参与者为研究期间出生的活产单胎子女。母亲 PCOS 和子女先天性心脏病的信息来自国家患者登记处。使用逻辑回归分析计算 PCOS 与子女先天性心脏病之间关联的患病率（比值比[PR]）。
在 1302648 名活产单胎中，有 11804 名母亲患有 PCOS。其中，143 名子女患有先天性心脏病（患病率为每 10000 人 121 例），而母亲无 PCOS 的子女为 12832 名（患病率为每 10000 人 99 例）。调整后，患有 PCOS 的母亲所生子女与无 PCOS 的母亲所生子女相比，先天性心脏病的患病率 PR 为 1.22，95%CI 为 1.03-1.44。在调整了孕前糖尿病的潜在中介效应后，PR 为 1.16，95%CI 为 0.98-1.37。
局限性、谨慎的原因：国家患者登记处可能未充分检测出 PCOS。然而，我们预计我们确定患有 PCOS 的母亲确实患有 PCOS，因此，估计的关联不太可能受到这种分类错误的影响。该研究并未提供证据排除中度或轻度关联。
这些发现为向患有 PCOS 的孕妇提供咨询的临床医生提供了保证，即该疾病不会显著增加后代患先天性心脏病的风险。
研究资金/利益冲突：该研究由诺和诺德基金会资助。M.L. 从丹麦药品信息公司收取个人费用，不在提交的工作范围内。其他作者没有利益冲突。
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