Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, AZ, USA.
Hum Reprod. 2022 Oct 31;37(11):2690-2699. doi: 10.1093/humrep/deac210.
Do women with polycystic ovary syndrome (PCOS) have a greater risk of adverse pregnancy complications (gestational diabetes, preeclampsia, cesarean section, placental abnormalities) and neonatal outcomes (preterm birth, small for gestational age, prolonged delivery hospitalization) compared to women without a PCOS diagnosis and does this risk vary by BMI, subfertility and fertility treatment utilization?
Deliveries to women with a history of PCOS were at greater risk of complications associated with cardiometabolic function, including gestational diabetes and preeclampsia, as well as preterm birth and prolonged length of delivery hospitalization.
Prior research has suggested that women with PCOS may be at increased risk of adverse pregnancy outcomes. However, findings have been inconsistent possibly due to lack of consistent adjustment for confounding factors, small samples size and other sources of bias.
STUDY DESIGN, SIZE, DURATION: Massachusetts deliveries among women ≥18 years old during 2013-2017 from state vital records linked to hospital discharges, observational stays and emergency department visits were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) and the Massachusetts All-Payers Claims Database (APCD).
PARTICIPANTS/MATERIALS, SETTING, METHODS: PCOS was identified by ICD9 and ICD10 codes in APCD prior to index delivery. Relative risks (RRs) and 95% CI for pregnancy and delivery complications were modeled using generalized estimating equations with a log link and a Poisson distribution to take multiple cycles into account and were adjusted a priori for maternal age, BMI, race/ethnicity, education, plurality, birth year, chronic hypertension and chronic diabetes. Tests for homogeneity investigated differences between maternal pre-pregnancy BMI categories (<30, ≥30, <25 and ≥25 kg/m2) and between non-infertile deliveries and deliveries that used ART or had a history of subfertility (defined by birth certificates, SART CORS records, APCD or hospital records).
Among 91 825 deliveries, 3.9% had a history of PCOS. Women with a history of PCOS had a 51% greater risk of gestational diabetes (CI: 1.38-1.65) and a 25% greater risk of preeclampsia (CI: 1.15-1.35) compared to women without a diagnosis of PCOS. Neonates born to women with a history of PCOS were more likely to be born preterm (RR: 1.17, CI: 1.06-1.29) and more likely to have a prolonged delivery hospitalization after additionally adjusting for gestational age (RR: 1.23, CI: 1.09-1.40) compared to those of women without a diagnosis of PCOS. The risk for gestational diabetes for women with PCOS was greater among women with a pre-pregnancy BMI <30 kg/m2.
LIMITATIONS, REASONS FOR CAUTION: PCOS was defined by ICD documentation prior to delivery so there may be women with undiagnosed PCOS or PCOS diagnosed after delivery included in the unexposed group. The study population is limited to deliveries within Massachusetts among most private insurance payers and inpatient or observational hospitalization in Massachusetts during the follow-up window, therefore there may be diagnoses and or deliveries outside of the state or outside of our sample that were not captured.
In this population-based study, women with a history of PCOS were at greater risk of pregnancy complications associated with cardiometabolic function and preterm birth. Obstetricians should be aware of patients' PCOS status and closely monitor for potential pregnancy complications to improve maternal and infant perinatal health outcomes.
STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the NIH (R01HD067270). S.A.M. receives grant funding from NIH, AbbVie and the Marriot Family Foundation; payment/honoraria from the University of British Columbia, World Endometriosis Research Foundation and Huilun Shanghai; travel support for attending meetings for ESHRE 2019, IASP 2019, National Endometriosis Network UK meeting 2019; SRI 2022, ESHRE 2022; participates on the data safety monitoring board/advisory board for AbbVie, Roche, Frontiers in Reproductive Health; and has a leadership role in the Society for Women's Health Research, World Endometriosis Research Foundation, World Endometriosis Society, American Society for Reproductive Medicine and ESHRE. The other authors have no conflicts of interest.
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患有多囊卵巢综合征（PCOS）的女性与没有 PCOS 诊断的女性相比，是否更有可能出现不良妊娠并发症（妊娠糖尿病、先兆子痫、剖宫产、胎盘异常）和新生儿结局（早产、小于胎龄儿、分娩住院时间延长）？这种风险是否因 BMI、不孕和生育治疗的利用而有所不同？
有 PCOS 病史的女性分娩时，与心脏代谢功能相关的并发症（包括妊娠糖尿病和先兆子痫）以及早产和分娩住院时间延长的风险更高。
先前的研究表明，患有 PCOS 的女性可能面临不良妊娠结局的风险增加。然而，由于缺乏对混杂因素的一致调整、样本量小以及其他来源的偏倚，研究结果不一致。
研究设计、规模、持续时间：2013-2017 年期间，马萨诸塞州≥18 岁的妇女在州立生命记录中分娩，这些记录与医院出院、观察性住院和急诊就诊相关联，并与辅助生殖技术协会诊所报告系统（SART CORS）和马萨诸塞州所有支付者索赔数据库（APCD）相联系。
参与者/材料、设置、方法：在指数分娩前，通过 APCD 中的 ICD9 和 ICD10 代码识别 PCOS。使用广义估计方程（带有对数链接和泊松分布）对妊娠和分娩并发症的相对风险（RR）和 95%CI 进行建模，以考虑多个周期，并预先调整了母亲的年龄、BMI、种族/族裔、教育程度、多胎、出生年份、慢性高血压和慢性糖尿病。同质性检验用于检验母亲孕前 BMI 类别（<30、≥30、<25 和≥25kg/m2）和非不孕分娩与使用 ART 或有不孕史（通过出生证明、SART CORS 记录、APCD 或医院记录定义）之间的差异。
在 91825 次分娩中，3.9%的女性有 PCOS 病史。与没有 PCOS 诊断的女性相比，有 PCOS 病史的女性妊娠糖尿病的风险增加 51%（CI：1.38-1.65），先兆子痫的风险增加 25%（CI：1.15-1.35）。与没有 PCOS 诊断的女性相比，患有 PCOS 的女性所生的新生儿更有可能早产（RR：1.17，CI：1.06-1.29），并且在额外调整胎龄后，分娩住院时间延长的可能性更大（RR：1.23，CI：1.09-1.40）。对于 BMI<30kg/m2 的女性，患有 PCOS 的女性患妊娠糖尿病的风险更高。
局限性、谨慎的原因：PCOS 是在分娩前通过 ICD 记录定义的，因此可能有未确诊的 PCOS 或分娩后诊断为 PCOS 的女性被纳入未暴露组。研究人群仅限于马萨诸塞州大多数私人保险支付者的分娩和马萨诸塞州在随访期间的住院或观察性住院，因此可能存在州外或样本外的诊断或分娩，而这些诊断或分娩没有被捕获。
在这项基于人群的研究中，有 PCOS 病史的女性与心脏代谢功能相关的妊娠并发症和早产的风险更高。妇产科医生应该了解患者的 PCOS 状况，并密切监测潜在的妊娠并发症，以改善母婴围产期健康结局。
研究资金/利益冲突：这项工作得到了 NIH（R01HD067270）的支持。S.A.M. 从 NIH、AbbVie 和 Marriott 家族基金会获得资助；获得英属哥伦比亚大学、世界子宫内膜异位症研究基金会和惠尔伦上海的报酬/荣誉；旅行支持参加 2019 年 ESHRE、2019 年 IASP、2019 年英国国家子宫内膜异位症网络会议；SRI 2022、ESHRE 2022；参加 AbbVie、罗氏、生殖健康前沿的数据安全监测委员会/咨询委员会；并在妇女健康研究协会、世界子宫内膜异位症研究基金会、世界子宫内膜异位症协会、美国生殖医学协会和 ESHRE 中担任领导角色。其他作者没有利益冲突。
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