多囊卵巢综合征患者首次体外受精治疗的妊娠结局：一项回顾性队列研究，共纳入 7678 例患者。
Pregnancy Outcomes of Women With Polycystic Ovary Syndrome for the First Fertilization Treatment: A Retrospective Cohort Study With 7678 Patients.
机构信息
Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.
出版信息
Front Endocrinol (Lausanne). 2020 Sep 25;11:575337. doi: 10.3389/fendo.2020.575337. eCollection 2020.
BACKGROUND
The risk of adverse pregnancy outcomes is increased by having a polycystic ovary syndrome (PCOS) diagnosis. However, the confounders in previous studies preclude firm conclusions, and further studies are warranted.
OBJECTIVES
To investigate whether PCOS affects pregnancy outcomes and complications in infertile women undergoing their first fertilization (IVF) treatment, taking into account important confounders.
METHODS
We performed a retrospective cohort study of 7,678 infertile women, including 666 women with PCOS and 7,012 controls undergoing their first IVF treatment at a private fertility center from January 2010 to December 2017. Our main outcome was the impact of PCOS on adverse pregnancy outcomes (miscarriage, preterm delivery, pregnancy-induced hypertension) and pregnancy outcomes (live birth rate, clinical pregnancy rate, implantation rate). PCOS effects were summarized by adjusted odds ratios (aORs) with 95% confidence intervals (CIs) after controlling for maternal characteristics.
RESULTS
After adjusting for differences in maternal age, BMI, infertility duration, total dose of gonadotropin, serum E and endometrial thickness on the day of hCG trigger, number of fertilized occytes, number of embryos transferred, embryo type (cleavage-stage embryo or blastocyst) and quality, women with PCOS had an increased risk of developing unfavorable pregnancy complications, including miscarriage (aOR 1.629, 95% CI 1.240-2.141), very preterm delivery (< 32 weeks) (aOR 2.072, 95% CI 1.133-3.791). For pregnancy outcomes, PCOS was associated with higher clinical pregnancy rate (aOR 1.248, 95% CI 1.038-1.501) and implantation rate (aOR 1.238, 95% CI 1.030-1.489) after adjusting for the above-mentioned confounders.
CONCLUSIONS
Women with PCOS are at increased risk of adverse pregnancy outcomes after adjusting for differences in maternal characteristics. These women may need more frequent medical consultants and management during pregnancy and parturition.
背景
多囊卵巢综合征（PCOS）诊断会增加不良妊娠结局的风险。然而，先前研究中的混杂因素使得结论难以确定，因此需要进一步的研究。
目的
探讨在考虑重要混杂因素的情况下，PCOS 是否会影响接受首次体外受精（IVF）治疗的不孕妇女的妊娠结局和并发症。
方法
我们对 2010 年 1 月至 2017 年 12 月期间在一家私立生育中心接受首次 IVF 治疗的 7678 名不孕妇女进行了回顾性队列研究，其中 666 名妇女患有 PCOS，7012 名妇女为对照组。我们的主要结局是 PCOS 对不良妊娠结局（流产、早产、妊娠高血压）和妊娠结局（活产率、临床妊娠率、着床率）的影响。在控制了母体特征后，通过调整后的优势比（aOR）及其 95%置信区间（CI）来总结 PCOS 的影响。
结果
调整了母体年龄、BMI、不孕持续时间、促性腺激素总剂量、HCG 扳机日血清 E 和子宫内膜厚度、受精卵数、移植胚胎数、胚胎类型（卵裂期胚胎或囊胚）和质量后，患有 PCOS 的妇女发生不良妊娠并发症的风险增加，包括流产（aOR 1.629，95%CI 1.240-2.141）和极早产（<32 周）（aOR 2.072，95%CI 1.133-3.791）。对于妊娠结局，在调整了上述混杂因素后，PCOS 与较高的临床妊娠率（aOR 1.248，95%CI 1.038-1.501）和着床率（aOR 1.238，95%CI 1.030-1.489）相关。
结论
调整了母体特征差异后，患有 PCOS 的妇女不良妊娠结局的风险增加。这些妇女在妊娠和分娩期间可能需要更频繁的医疗顾问和管理。
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