Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California.
Fertil Steril. 2021 Feb;115(2):438-446. doi: 10.1016/j.fertnstert.2020.06.015. Epub 2020 Sep 1.
To determine the relationship between high antimüllerian hormone (AMH) levels and increased preterm delivery risk in populations of women with polycystic ovary syndrome (PCOS) or unexplained infertility undergoing ovulation induction.
Secondary analysis of data from two multicenter randomized clinical trials: Pregnancy in Polycystic Ovary Syndrome II (PPCOS II); and Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS).
Not applicable.
Live births at ≥24 weeks' gestation from both the PPCOS II (n = 172) and AMIGOS (n = 222) cohorts were evaluated, and those at risk for iatrogenic preterm delivery including placental conditions, fetal growth restriction, multiple gestations, hypertensive diseases of pregnancy, and pre-gestational diabetes were excluded. The final analysis included 118 women with PCOS from the PPCOS II cohort and 146 women with unexplained infertility from the AMIGOS cohort.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Spontaneous preterm delivery.
In the PCOS population, median AMH overall was 5.5 ng/dL (interquartile range 2.9-9.3 ng/dL). In all, 62% of participants who delivered preterm had AMH levels above the 75th percentile. When comparing clinical covariates between the preterm and term deliveries, women with PCOS who delivered preterm had notably higher AMH than their term counterparts (11.1 vs. 5.4 ng/mL). In the univariate logistic regression analysis, each unit increase in AMH raised the odds of preterm delivery by 14% (odds ratio 1.14, 95% confidence interval 1.02-1.26). The effect was magnified only after adjusting for age, race, body mass index, smoking status, testosterone, homeostatic model assessment for insulin resistance, and treatment randomization group (adjusted odds ratio 1.25, 95% confidence interval 1.06-1.49). Unlike in the PCOS population, the unexplained infertility cohort had no significant difference in AMH levels between those with or without preterm delivery (2.3 vs. 2.6 ng/mL).
Our findings suggest that women with PCOS and high AMH who conceived after ovulation induction represent a high-risk group for preterm delivery. These data indicate that closer monitoring in the third trimester of pregnancies in PCOS patients with early first trimester AMH levels above 9.3 ng/mL may be warranted.
NCT01044862.
确定多囊卵巢综合征（PCOS）或不明原因不孕患者接受排卵诱导后，高抗苗勒氏管激素（AMH）水平与早产风险增加之间的关系。
对两项多中心随机临床试验的数据进行二次分析：多囊卵巢综合征 II 期妊娠（PPCOS II）；以及卵巢刺激的多胎妊娠评估（AMIGOS）。
不适用。
来自 PPCOS II（n=172）和 AMIGOS（n=222）队列的≥24 周龄的活产儿进行了评估，并排除了因胎盘情况、胎儿生长受限、多胎妊娠、妊娠高血压疾病和孕前糖尿病而导致医源性早产的风险。最终分析包括来自 PPCOS II 队列的 118 名 PCOS 患者和来自 AMIGOS 队列的 146 名不明原因不孕患者。
无。
自发性早产。
在 PCOS 人群中，总体 AMH 中位数为 5.5ng/dL（四分位距 2.9-9.3ng/dL）。在所有早产的参与者中，有 62%的人 AMH 水平高于第 75 百分位。在比较早产和足月分娩的临床协变量时，早产的 PCOS 患者的 AMH 水平明显高于足月分娩的患者（11.1 vs. 5.4ng/mL）。在单变量逻辑回归分析中，AMH 每增加一个单位，早产的几率就会增加 14%（比值比 1.14，95%置信区间 1.02-1.26）。仅在调整年龄、种族、体重指数、吸烟状况、睾酮、稳态模型评估胰岛素抵抗和治疗随机分组后，这种影响才会放大（调整后的比值比 1.25，95%置信区间 1.06-1.49）。与 PCOS 人群不同的是，不明原因不孕患者中，早产与非早产患者的 AMH 水平无显著差异（2.3 vs. 2.6ng/mL）。
我们的研究结果表明，接受排卵诱导后怀孕的 PCOS 患者中，AMH 水平较高的患者早产风险较高。这些数据表明，对于 AMH 水平在妊娠早期第一 trimester 高于 9.3ng/mL 的 PCOS 患者，在妊娠晚期可能需要更密切的监测。
NCT01044862。
