Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
PLoS One. 2021 Feb 4;16(2):e0246743. doi: 10.1371/journal.pone.0246743. eCollection 2021.
Women with polycystic ovary syndrome (PCOS) have increased risk of pregnancy complications, including preterm birth before 37 weeks. However, if this increased risk also includes extremely preterm births (<28 weeks) is unknown. Such information is important to identify women at risk and tailor antenatal care, since child morbidity and mortality become more prevalent with increasing prematurity.
To investigate the association between PCOS and extremely preterm birth, and whether onset of PCOS-related preterm birth is predominantly spontaneous or medically indicated.
This was a nationwide register-based cohort study in Sweden. The study population was all live singleton births registered in the Swedish Medical Birth Register 2005-2014 (n = 1 046 448). Women with and without PCOS were compared by severity of preterm birth [extremely (22+0 to 27+6 weeks), very (28+0 to 31+6 weeks) and moderately (32+0 to 36+6 weeks)] and delivery onset mode (spontaneous or medically indicated). Multinomial logistic regression was performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Adjustments were made for maternal age, parity, body mass index, smoking, country of birth and year of delivery.
During the study period, 1.3% of the women giving birth had PCOS diagnosis. They had an overall higher preterm birth rate than women without PCOS (6.7% and 4.8%, respectively). Women with PCOS had increased odds of preterm birth of all severities, with the highest odds for extremely preterm birth (aOR 2.3; 95% CI 1.7-3.0), particularly of spontaneous onset (aOR 2.7; 95% CI 2.0-3.6).
Women with PCOS had more than a two-fold increased risk of extremely preterm birth with spontaneous onset than women without such diagnosis. This can be important in antenatal risk assessment of preterm birth in women with PCOS. Future research is warranted to investigate the biological mechanisms behind preterm birth in women with PCOS.
患有多囊卵巢综合征（PCOS）的女性妊娠并发症风险增加，包括 37 周前的早产。然而，如果这种风险增加也包括极早产（<28 周）则尚不清楚。此类信息对于识别高危妇女并调整产前护理非常重要，因为随着早产的增加，儿童发病率和死亡率变得更为普遍。
调查多囊卵巢综合征与极早产之间的关系，以及多囊卵巢综合征相关的早产起始是否主要是自发性的还是医学上的指征。
这是一项在瑞典进行的全国范围内基于登记的队列研究。研究人群为 2005 年至 2014 年在瑞典医疗出生登记处登记的所有活单胎出生（n = 1 046 448）。比较了患有和不患有 PCOS 的妇女的早产严重程度[极早产（22+0 至 27+6 周）、非常早产（28+0 至 31+6 周）和中度早产（32+0 至 36+6 周）]和分娩起始方式（自发性或医学指征）。使用多项逻辑回归估计调整后的优势比（aOR）和 95%置信区间（CI）。调整了母亲年龄、产次、体重指数、吸烟、出生国和分娩年份。
在研究期间，1.3%的分娩妇女被诊断为 PCOS。与没有 PCOS 的妇女相比，她们的总体早产率更高（分别为 6.7%和 4.8%）。患有 PCOS 的妇女有所有严重程度的早产的更高的几率，极早产的几率最高（aOR 2.3；95%CI 1.7-3.0），尤其是自发性起始的（aOR 2.7；95%CI 2.0-3.6）。
与没有这种诊断的妇女相比，患有 PCOS 的妇女自发性极早产的风险增加了两倍以上。这对于 PCOS 妇女的产前早产风险评估非常重要。需要进一步研究以调查 PCOS 妇女早产的生物学机制。
