Zhang Y F, Luo H N, Shi R, Zhang Y J, Tai X M, Hu X Y, Ma J F, Wang X Y, Zhang Y S, Qu P P
Clinical College of Central Obstetrics and Gynecology, Tianjin Medical University, Institute of Obstetrics and Gynecology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300100, China.
Graduate School, Tianjin Medical University, Tianjin 300070, China.
Zhonghua Fu Chan Ke Za Zhi. 2021 Apr 25;56(4):257-263. doi: 10.3760/cma.j.cn112141-20201223-00906.
To investigate the effect of body mass index (BMI) on clinical pregnancy and neonatal outcomes in patients with polycystic ovary syndrome (PCOS) during frozen-thawed embryo transfer. A total of 650 patients with PCOS who received routine in vitro fertilization or intracytoplasmic sperm injection treatment for frozen-thawed embryo transfer from June 2014 to June 2019 in Tianjin Central Hospital of Gynecology Obstetrics were retrospectively analyzed. According to BMI, PCOS patients were divided into group A (18.5≤BMI<23 kg/m, =253), group B (23≤BMI<25 kg/m, =167), and group C (BMI≥25 kg/m, =230). The general information, clinical pregnancy outcomes, pregnancy complications, the incidence of macrosomia and low-birth-weight infants were compared in the three groups, and the influencing factors of neonatal birth weight were analyzed. The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate all showed downward trend with the increase of BMI, but the differences were not statistically significant (all >0.05). The live birth rate in group C [47.0% (108/230)] was significantly lower than those in groups A and B, with statistical significance (²7.43, =0.024). The late miscarriage rate was higher in group C [9.4% (13/139)] than in groups A and B (²7.66, =0.022). The birth rates of macrosomia in groups B [22.2% (16/72)] and group C [21.1% (16/76)] were significantly higher than that in group A, and the difference was statistically significant (²14.15, =0.001). There was no statistically significant difference in the incidence of gestational diabetes between the three groups (²3.81, =0.149). The incidence of hypertension disorders complicating pregnancy increased with the increase of BMI, and the difference was not statistically significant (>0.05). Regression analysis showed that macrosomia was significantly associated with maternal pre-pregnancy BMI and gestational weeks, and the risk of macrosomia increased by 15% (95%: 3%-28%) for every increase in maternal BMI. The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate of PCOS patients in frozen-thawed embryo transfer cycles show downward trend with the increase of BMI. Obese patients with PCOS have a significant increase in late miscarriage rate and a significant decrease in live birth rate. The incidence of hypertension disorders complicating pregnancy in PCOS patients in the obese group has an increasing trend, and the birth rate of macrosomia has increased significantly. Therefore, it is recommended that obese women with PCOS lose weight scientifically before pregnancy to improve pregnancy and neonatal outcomes.
探讨体重指数(BMI)对多囊卵巢综合征(PCOS)患者冻融胚胎移植临床妊娠及新生儿结局的影响。回顾性分析2014年6月至2019年6月在天津市中心妇产科医院接受常规体外受精或卵胞浆内单精子注射治疗进行冻融胚胎移植的650例PCOS患者。根据BMI将PCOS患者分为A组(18.5≤BMI<23kg/m²,n = 253)、B组(23≤BMI<25kg/m²,n = 167)和C组(BMI≥25kg/m²,n = 230)。比较三组患者的一般资料、临床妊娠结局、妊娠并发症、巨大儿及低体重儿发生率,并分析新生儿出生体重的影响因素。胚胎着床率、临床妊娠率及持续妊娠率均随BMI升高呈下降趋势,但差异无统计学意义(均P>0.05)。C组活产率[47.0%(108/230)]显著低于A组和B组,差异有统计学意义(χ² = 7.43,P = 0.024)。C组晚期流产率[9.4%(13/139)]高于A组和B组(χ² = 7.66,P = 0.022)。B组[22.2%(16/72)]和C组[21.1%(16/76)]巨大儿出生率显著高于A组,差异有统计学意义(χ² = 14.15,P = 0.001)。三组妊娠期糖尿病发生率差异无统计学意义(χ² = 3.81,P = 0.149)。妊娠期高血压疾病发生率随BMI升高而增加,但差异无统计学意义(P>0.05)。回归分析显示,巨大儿与孕妇孕前BMI及孕周显著相关,孕妇BMI每增加,巨大儿风险增加15%(95%CI:3% - 28%)。PCOS患者冻融胚胎移植周期中,胚胎着床率、临床妊娠率及持续妊娠率随BMI升高呈下降趋势。肥胖PCOS患者晚期流产率显著增加,活产率显著降低。肥胖组PCOS患者妊娠期高血压疾病发生率有上升趋势,巨大儿出生率显著增加。因此,建议肥胖PCOS女性孕前科学减重,以改善妊娠及新生儿结局。