Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
Int J Environ Res Public Health. 2022 Jul 26;19(15):9094. doi: 10.3390/ijerph19159094.
Polycystic ovary syndrome (PCOS) is a common metabolic problem in women of reproductive age. Evidence suggests pregnant women with PCOS may have a higher risk of the development of adverse pregnancy outcomes; however, the relationship between pre-pregnancy overweight/obesity and pregnancy outcomes in women with PCOS remains uncertain. We try to clarify the relationship between pre-pregnancy overweight/obesity and subsequent pregnancy outcomes. Therefore, we conducted this systematic review and meta-analysis. We used the databases obtained from the PubMed, Embase, Web of Science, and Cochrane databases, plus hand-searching, to examine the association between pre-pregnancy overweightness/obesity and pregnancy outcomes in women with PCOS from inception to 4 February 2022. A total of 16 cohort studies, including 14 retrospective cohort studies ( = 10,496) and another two prospective cohort studies ( = 818), contributed to a total of 11,314 women for analysis. The meta-analysis showed significantly increased odds of miscarriage rate in PCOS women whose pre-pregnancy body mass index (BMI) is above overweight (OR 1.71 [95% CI 1.38-2.11]) or obese (OR 2.00 [95% CI 1.38-2.90]) under a random effect model. The tests for subgroup difference indicated the increased risk was consistent, regardless which body mass index cut-off for overweight (24 or 25 kg/m) or obesity (28 and 30 kg/m) was used. With the same strategies, we found that pregnant women in the control group significantly increased live birth rate compared with those pregnant women with PCOS as well as pre-pregnancy overweight/obesity (OR 0.79 [95% CI 0.71-0.89], OR 0.78 [95% CI 0.67-0.91]). By contrast, we did not find any association between PCOS women with pre-pregnancy overweight/obesity and preterm birth. Based on the aforementioned findings, the main critical factor contributing to a worse pregnancy outcome may be an early fetal loss in these PCOS women with pre-pregnancy overweight/obesity. Since PCOS women with pre-pregnancy overweightness/obesity were associated with worse pregnancy outcomes, we supposed that weight reduction before attempting pregnancy in the PCOS women with pre-pregnancy overweightness/obesity may improve the subsequent pregnancy outcomes.
多囊卵巢综合征（PCOS）是育龄妇女常见的代谢问题。有证据表明，患有 PCOS 的孕妇发生不良妊娠结局的风险可能更高；然而，患有 PCOS 的孕妇孕前超重/肥胖与妊娠结局之间的关系尚不确定。我们试图阐明孕前超重/肥胖与随后妊娠结局之间的关系。因此，我们进行了这项系统评价和荟萃分析。我们使用从PubMed、Embase、Web of Science 和 Cochrane 数据库获得的数据库，加上手工搜索，从成立到 2022 年 2 月 4 日，检查了 PCOS 妇女孕前超重/肥胖与妊娠结局之间的关系。共有 16 项队列研究，包括 14 项回顾性队列研究（=10496）和另外 2 项前瞻性队列研究（=818），共有 11314 名妇女参与了分析。荟萃分析显示，在随机效应模型下，孕前体重指数（BMI）超重（OR 1.71 [95% CI 1.38-2.11]）或肥胖（OR 2.00 [95% CI 1.38-2.90]）的 PCOS 妇女流产率显著增加。亚组差异检验表明，无论超重（24 或 25 kg/m）或肥胖（28 和 30 kg/m）的 BMI 切点如何，风险增加都是一致的。采用相同的策略，我们发现与患有 PCOS 的孕妇相比，对照组孕妇的活产率显著增加，而患有 PCOS 的孕妇和孕前超重/肥胖的孕妇的活产率也显著增加（OR 0.79 [95% CI 0.71-0.89]，OR 0.78 [95% CI 0.67-0.91]）。相比之下，我们没有发现患有 PCOS 的孕妇孕前超重/肥胖与早产之间存在任何关联。基于上述发现，导致这些患有 PCOS 的孕妇孕前超重/肥胖妊娠结局较差的主要关键因素可能是早期胎儿丢失。由于患有 PCOS 的孕妇孕前超重/肥胖与不良妊娠结局相关，我们推测，患有 PCOS 的孕妇孕前超重/肥胖应在尝试怀孕前减轻体重，这可能会改善随后的妊娠结局。
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