Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
Department of Diabetes and Vascular Medicine, Monash Health, Clayton, VIC, Australia.
Hum Reprod. 2023 Nov 2;38(11):2267-2276. doi: 10.1093/humrep/dead190.
What are the pre-existing medical conditions and lifestyle behaviours of women with and without PCOS during the preconception period?
During the preconception period, medical conditions of obesity, depression, anxiety, and a history of infertility were more highly prevalent in women with than without PCOS, and more women with than without PCOS were engaged in unhealthy lifestyle behaviours.
Women with PCOS are predisposed to infertility and pregnancy complications. Optimizing preconception medical health and lifestyle behaviours can improve maternal and pregnancy outcomes but, to the best of our knowledge, no study has examined the preconception medical conditions and lifestyle behaviours of women with PCOS.
STUDY DESIGN, SIZE DURATION: This is a cross-sectional study on 942 women with PCOS and 7024 women without PCOS, aged 24-30 years from the Australian Longitudinal Study of Women's Health, an ongoing, national survey-based prospective cohort study.
PARTICIPANTS/MATERIALS, SETTING, METHODS: The current study analysed self-reported data from Survey 6 collected in 2019 of the cohort of women born between 1989 and 1995. Explored outcomes included BMI, pre-existing medical conditions, and modifiable lifestyle behaviours, including smoking, recreational drug use, alcohol intake, and physical activity level, during the preconception period. Differences between subgroups were tested using Student's t-test, χ2 test, or Fisher's exact test as appropriate. The associations of pregnancy intention with medical conditions and lifestyle behaviours were examined using logistic regression.
Obesity, depression, anxiety, and infertility were highly prevalent in women actively planning for pregnancy. Among women with PCOS, the prevalence of obesity was 47.02%, followed by depression at 32.70%, anxiety at 39.62%, and infertility at 47.17%. Conversely among women without PCOS, the corresponding prevalence was lower, at 22.33% for obesity, 18.98% for depression, 23.93% for anxiety, and 16.42% for infertility. In women actively planning for pregnancy, only those without PCOS demonstrated a lower prevalence of unhealthy lifestyle behaviours compared to non-planning women. The prevalence of unhealthy lifestyle behaviours was similar in women with PCOS regardless of their pregnancy intentions. Multivariable logistic regression revealed that only moderate/high stress with motherhood/children (adjusted odds ratio (OR) 3.31, 95% CI 1.60-6.85) and history of infertility (adjusted OR 9.67, 95% CI 5.02-18.64) were significantly associated with active pregnancy planning in women with PCOS.
LIMITATIONS, REASONS FOR CAUTION: The findings were based on self-reported data. The cohort of women surveyed may have a higher level of education than women in the community, therefore our findings may underestimate the true prevalence of pre-existing medical conditions and lifestyle challenges faced by the broader population.
A higher proportion of women with than without PCOS had pre-existing medical conditions and engaged in potentially modifiable unhealthy lifestyle behaviours during preconception despite their risk for subfertility and pregnancy complications. Healthcare professionals play a pivotal role in guiding this high-risk group of women during this period, offering counselling, education, and support for the adoption of healthy lifestyles to improve fertility, pregnancy outcomes, and intergenerational health.
STUDY FUNDING/COMPETING INTEREST(S): C.T.T. holds a seed grant from the National Health and Medical Research Council (NHMRC) through the Centre of Research Excellence in Women's Health in Reproductive Life (CRE WHiRL) and Royal Australasian College of Physician Foundation Roger Bartop Research Establishment Fellowship. H.T. holds an NHMRC Medical Research Fellowship. C.L.H. holds an NHMRC CRE Health in Preconconception and Pregnancy Senior Postdoctoral Fellowship. A.E.J. holds a CRE WhiRL Early to Mid-career Fellowship. The authors have no conflicts of interest to declare.
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患有和不患有 PCOS 的女性在受孕前期间有哪些预先存在的医疗条件和生活方式行为？
在受孕前期间，患有 PCOS 的女性比不患有 PCOS 的女性更容易出现肥胖、抑郁、焦虑和不孕等医疗状况，而且不患有 PCOS 的女性比患有 PCOS 的女性更容易采取不健康的生活方式行为。
患有 PCOS 的女性易患不孕和妊娠并发症。优化受孕前的身体健康和生活方式行为可以改善母婴和妊娠结局，但据我们所知，尚无研究检查过患有 PCOS 的女性的受孕前医疗条件和生活方式行为。
研究设计、规模、持续时间：这是一项横断面研究，涉及 942 名患有 PCOS 的女性和 7024 名不患有 PCOS 的女性，年龄在 24-30 岁之间，来自澳大利亚妇女健康纵向研究，这是一项正在进行的、基于全国调查的前瞻性队列研究。
参与者/材料、设置、方法：本研究分析了 1989 年至 1995 年期间出生的队列中妇女在 2019 年进行的第 6 次调查的自我报告数据。探索的结果包括 BMI、受孕前的医疗状况和可改变的生活方式行为，包括吸烟、 recreational drug use、饮酒和身体活动水平。使用学生 t 检验、卡方检验或 Fisher 确切检验来测试亚组之间的差异。使用逻辑回归检查怀孕意向与医疗条件和生活方式行为之间的关联。
肥胖、抑郁、焦虑和不孕在积极计划怀孕的女性中非常普遍。在患有 PCOS 的女性中，肥胖的患病率为 47.02%，其次是抑郁为 32.70%，焦虑为 39.62%，不孕为 47.17%。相比之下，在不患有 PCOS 的女性中，相应的患病率较低，肥胖为 22.33%，抑郁为 18.98%，焦虑为 23.93%，不孕为 16.42%。在积极计划怀孕的女性中，只有不患有 PCOS 的女性表现出比不计划怀孕的女性更低的不健康生活方式行为的患病率。患有 PCOS 的女性无论怀孕意向如何，其不健康生活方式行为的患病率相似。多变量逻辑回归显示，只有母亲/孩子方面的中度/高度压力（调整后的优势比（OR）3.31，95%置信区间（CI）1.60-6.85）和不孕史（调整后的 OR 9.67，95% CI 5.02-18.64）与患有 PCOS 的女性的积极怀孕计划显著相关。
局限性、谨慎的原因：研究结果基于自我报告数据。接受调查的女性队列可能比社区中的女性具有更高的教育水平，因此我们的研究结果可能低估了更广泛人群中预先存在的医疗条件和生活方式挑战的真实流行率。
尽管患有 PCOS 的女性存在生育和妊娠并发症的风险，但与不患有 PCOS 的女性相比，患有 PCOS 的女性在受孕前期间有更高比例的预先存在的医疗条件，并从事潜在的可改变的不健康生活方式行为。医疗保健专业人员在这一时期为这一高风险群体的女性提供了关键作用，为她们提供咨询、教育和支持，以促进健康的生活方式，提高生育能力、妊娠结局和代际健康。
研究资金/利益冲突：C.T.T. 获得了澳大利亚国家健康与医学研究理事会（NHMRC）通过妇女健康生殖生活（CRE WHiRL）卓越中心和皇家澳大利亚内科医师学院基金会罗杰巴特罗研究机构奖学金获得的种子基金。H.T. 获得了 NHMRC 医学研究奖学金。C.L.H. 获得了 NHMRC CRE 受孕前和怀孕期间高级博士后研究奖学金。A.E.J. 获得了 CRE WhiRL 早期到中期职业研究员奖学金。作者没有利益冲突需要声明。
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