Zhang Lirui, Zheng Wei, Liu Cheng, Liang Xin, Zhang Li, Tian Zhihong, Li Guanghui
Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026 China.
Diabetol Metab Syndr. 2020 Oct 8;12:88. doi: 10.1186/s13098-020-00595-3. eCollection 2020.
The influence of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on perinatal outcomes of women with polycystic ovary syndrome (PCOS) remains unclear. Therefore, we explored how the above indicators influence pregnancy outcomes in women with PCOS.
A retrospective study was conducted involving the baseline characteristics, laboratory data, and pregnancy outcomes of 722 pregnant women with PCOS. Subjects were grouped in a way to find out risks in their pregnancy outcomes. Multivariable logistic regression analysis was performed to investigate how BMI and GWG were associated with perinatal outcomes.
Among women with PCOS, underweight increased the risk of small for gestational age (SGA) (OR 12.35, 95% CI 3.56-42.82), but reduced the risk of large for gestational age (LGA). Overweight but not obese women were more susceptible to developing preeclampsia (PE) than women with normal weight. In PCOS women with BMI < 25 kg/m before pregnancy, inadequate GWG was a protective factor for gestational hypertension (GH) and postpartum hemorrhage (PPH), excessive GWG exhibited a positive correlation with LGA. But in PCOS women with BMI ≥ 25 kg/m, excessive GWG increased the probability of undergoing a cesarean section. Inadequate GWG did not reduce the likelihood of LGA in women with BMI ≥ 25 kg/m, and excessive GWG did not reduce the probability of SGA in women with BMI < 25 kg/m.
The impacts of pre-pregnancy BMI, GWG on maternal and infant outcomes among PCOS women are similar to reported results in general pregnant women. However, some unique trends were also observed in PCOS women. While the underweight factor significantly increased the risk of SGA birth, overweight but not obesity was correlated with the risk of PE. Inadequate GWG was a protective factor for GH and PPH only in women with pregestational BMI < 25 kg/m. Inadequate GWG did not reduce the probability of LGA in women with BMI ≥ 25 kg/m, and similarly, excessive GWG did not reduce the probability of SGA in women with BMI < 25 kg/m. Overall, these findings indicate that women with PCOS should begin weight management before pregnancy.
孕前体重指数（BMI）和孕期体重增加（GWG）对多囊卵巢综合征（PCOS）女性围产期结局的影响尚不清楚。因此，我们探讨了上述指标如何影响PCOS女性的妊娠结局。
进行了一项回顾性研究，纳入722例PCOS孕妇的基线特征、实验室数据和妊娠结局。对受试者进行分组以找出其妊娠结局中的风险因素。采用多变量逻辑回归分析来研究BMI和GWG与围产期结局的相关性。
在PCOS女性中，体重过轻会增加小于胎龄儿（SGA）的风险（OR 12.35，95%CI 3.56 - 42.82），但会降低大于胎龄儿（LGA）的风险。超重但非肥胖的女性比体重正常的女性更容易发生先兆子痫（PE）。在孕前BMI＜25kg/m²的PCOS女性中，GWG不足是妊娠期高血压（GH）和产后出血（PPH）的保护因素，GWG过多与LGA呈正相关。但在孕前BMI≥25kg/m²的PCOS女性中，GWG过多会增加剖宫产的概率。GWG不足并不会降低BMI≥25kg/m²女性发生LGA的可能性，GWG过多也不会降低BMI＜25kg/m²女性发生SGA的概率。
孕前BMI、GWG对PCOS女性母婴结局的影响与一般孕妇的报道结果相似。然而，在PCOS女性中也观察到了一些独特的趋势。体重过轻因素显著增加了SGA出生的风险，超重但非肥胖与PE风险相关。GWG不足仅在孕前BMI＜25kg/m²的女性中是GH和PPH的保护因素。GWG不足并不会降低BMI≥25kg/m²女性发生LGA的概率，同样，GWG过多也不会降低BMI＜25kg/m²女性发生SGA的概率。总体而言，这些发现表明PCOS女性应在孕前开始体重管理。
