Department of Obstetrics and Gynecology, McGill University, 845 Rue Sherbrooke, O, Montreal, QC, 3HA 0G4, Canada.
The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Assist Reprod Genet. 2024 Jun;41(6):1687-1697. doi: 10.1007/s10815-024-03123-8. Epub 2024 Apr 30.
To examine the effect of bariatric surgery (BS) on obstetric and neonatal outcomes in patients with polycystic ovary syndrome (PCOS).
A retrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, including women who delivered in the third trimester or had a maternal death in the USA (2004-2014). We compared obstetric and neonatal outcomes between groups in three analyses: (1) Primary analysis-women with an ICD-9 PCOS diagnosis who underwent BS compared to pregnant PCOS patients without BS. (2) Sub-group analysis-PCOS women with BS compared to obese PCOS women (body mass index (BMI) ≥ 30 kg/m) without BS. (3) Women with and without PCOS who underwent BS.
In the primary analysis, pregnant PCOS women who underwent BS (N = 141), compared to pregnant PCOS women without BS (N = 14,741), were less likely to develop pregnancy-induced hypertension (PIH) (9.2% vs. 16.2%, respectively, aOR 0.39, 95% CI 0.21-0.72) and gestational diabetes mellitus (GDM) (9.9% vs. 18.8, aOR 0.40, 95% CI 0.23-0.70). In the sub-group analysis, PCOS women with BS, compared to obese PCOS women without BS (N = 3231), were less likely to develop gestational hypertension, preeclampsia, and preeclampsia or eclampsia superimposed on hypertension (P < 0.05). Lastly, PCOS patients with BS had a higher cesarean section rate when compared to non-PCOS patients with BS (N = 9197) (61.7% vs. 49.2%, aOR 1.48, 95% CI 1.05-2.09), with otherwise comparable obstetric and neonatal outcomes.
BS in PCOS patients was associated with reduced risks for GDM and PIH when compared to PCOS controls without BS and reduced risk for gestational hypertension, preeclampsia, and preeclampsia or eclampsia superimposed on hypertension when compared to obese PCOS controls without BS. Moreover, BS was associated with reduced inherent pregnancy risks of PCOS, almost equating them to those of non-PCOS counterparts.
探讨减重手术（BS）对多囊卵巢综合征（PCOS）患者产科和新生儿结局的影响。
这是一项利用美国医疗保健成本与利用项目全国住院患者样本数据库进行的回顾性基于人群的队列研究，包括在美国分娩的第三孕期或产妇死亡的女性（2004-2014 年）。我们在三项分析中比较了各组的产科和新生儿结局：（1）主要分析-接受 BS 的患有 ICD-9 PCOS 诊断的女性与未接受 BS 的患有 PCOS 的妊娠女性相比。（2）亚组分析-PCOS 女性接受 BS 与肥胖 PCOS 女性（BMI≥30kg/m）相比，未接受 BS。（3）接受和未接受 BS 的 PCOS 女性。
在主要分析中，与未接受 BS 的妊娠 PCOS 女性（N=14741）相比，接受 BS 的妊娠 PCOS 女性（N=141）发生妊娠高血压（PIH）的可能性较小（分别为 9.2%和 16.2%，aOR 0.39，95%CI 0.21-0.72）和妊娠糖尿病（GDM）（9.9%比 18.8，aOR 0.40，95%CI 0.23-0.70）。在亚组分析中，与肥胖的未接受 BS 的 PCOS 女性（N=3231）相比，接受 BS 的 PCOS 女性发生妊娠期高血压、子痫前期和高血压并发子痫前期或子痫的风险较低（P<0.05）。最后，与非 PCOS 患者相比，接受 BS 的 PCOS 患者的剖宫产率更高（N=9197）（61.7%比 49.2%，aOR 1.48，95%CI 1.05-2.09），但产科和新生儿结局相当。
与未接受 BS 的 PCOS 对照组相比，PCOS 患者接受 BS 与 GDM 和 PIH 风险降低相关，与未接受 BS 的肥胖 PCOS 对照组相比，PCOS 患者接受 BS 与妊娠期高血压、子痫前期和高血压并发子痫前期或子痫的风险降低相关。此外，BS 与 PCOS 妊娠的固有风险降低相关，几乎等同于非 PCOS 对应的风险。
