Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Acta Obstet Gynecol Scand. 2024 May;103(5):884-896. doi: 10.1111/aogs.14771. Epub 2024 Jan 12.
Previous studies have demonstrated that abnormal body mass index (BMI) is associated with adverse pregnancy outcomes in frozen-thawed embryo transfer cycles. However, the relationship between BMI and pregnancy and perinatal outcomes in patients with polycystic ovary syndrome (PCOS) remains unclear. Furthermore, whether a diagnosis of PCOS could result in adverse pregnancy and perinatal outcomes in women with different BMIs remains unknown.
A historical cohort study included 1667 women with PCOS and 12 256 women without PCOS after a freeze-all policy between January 2016 and December 2020. The outcomes encompassed both pregnancy and perinatal outcomes. Multivariate logistic regression analysis and restricted cubic spline models were performed to eliminate confounding factors when investigating the relationship between BMI and different outcomes.
After controlling for covariates, pregnancy outcomes were comparable between underweight women with PCOS and normal weight women with PCOS. However, overweight patients had a lower clinical pregnancy rate and an overall live birth rate. Furthermore, patients with obesity had a lower rate of multiple pregnancies but a higher rate of biochemical pregnancy than in the normal BMI group. Additionally, the restricted cubic spline models showed that as maternal BMI increased to 32 kg/m, the clinical pregnancy rate and live birth rate after blastocyst transfer decreased, but the risks of preterm birth, gestational diabetes mellitus, macrosomia, large-for-gestational age (LGA) and very LGA increased in patients with PCOS after a freeze-all strategy. Moreover, a diagnosis of PCOS resulted in a higher clinical pregnancy rate and live birth rate and a higher risk of small-for-gestational age in the normal weight group. However, women with PCOS in the overweight group exhibited higher risks of very preterm birth and gestational diabetes mellitus compared with women without PCOS.
This study showed that a higher BMI had a detrimental impact on the pregnancy and perinatal outcomes of PCOS patients undergoing a freeze-all strategy. However, it was only statistically significant in the overweight group. A diagnosis of PCOS had a higher clinical pregnancy rate and live birth rate in normal weight women but higher risks of perinatal complications in normal weight and overweight women.
先前的研究表明，异常的体重指数（BMI）与冻融胚胎移植周期的不良妊娠结局有关。然而，多囊卵巢综合征（PCOS）患者的 BMI 与妊娠和围产结局之间的关系尚不清楚。此外，不同 BMI 的 PCOS 患者的诊断是否会导致不良的妊娠和围产结局也尚不清楚。
一项历史队列研究纳入了 2016 年 1 月至 2020 年 12 月期间采用冻存所有策略的 1667 例 PCOS 患者和 12256 例非 PCOS 患者。结局包括妊娠和围产结局。采用多变量逻辑回归分析和限制性立方样条模型消除混杂因素，以研究 BMI 与不同结局之间的关系。
在控制了混杂因素后，PCOS 患者中体重不足和正常体重患者的妊娠结局相似。然而，超重患者的临床妊娠率和总活产率较低。此外，肥胖患者的多胎妊娠率较低，但生化妊娠率高于正常 BMI 组。此外，限制性立方样条模型显示，随着母体 BMI 增加到 32kg/m2，囊胚移植后的临床妊娠率和活产率下降，但在冻存所有策略后，PCOS 患者的早产、妊娠期糖尿病、巨大儿、大于胎龄儿（LGA）和非常 LGA 的风险增加。此外，PCOS 的诊断导致正常体重组的临床妊娠率和活产率较高，而小胎龄儿的风险增加。然而，超重组的 PCOS 患者与非 PCOS 患者相比，具有更高的极早产和妊娠期糖尿病风险。
本研究表明，较高的 BMI 对接受冻存所有策略的 PCOS 患者的妊娠和围产结局有不利影响。然而，这种影响仅在超重组中具有统计学意义。PCOS 的诊断在正常体重女性中具有更高的临床妊娠率和活产率，但在正常体重和超重女性中具有更高的围产期并发症风险。
