Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital Affiliated to Nanchang Medical College, Nanchang, China.
Jiangxi Key Laboratory of Reproductive Health, Nanchang, China.
Reprod Biol Endocrinol. 2024 Nov 21;22(1):149. doi: 10.1186/s12958-024-01313-8.
Prior research showed that elevated serum uric acid (SUA) levels in women with polycystic ovary syndrome (PCOS) before in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) treatment can lead to a lower rate of live birth and an increased risk for low birthweight. Nonetheless, it is not known whether elevated SUA results in similar reproductive outcome in women without PCOS. This study aimed to exploring the relationship between pre-pregnancy SUA levels and reproductive outcomes in non-PCOS women undergoing IVF/ICSI treatment.
This single-center, retrospective study included 13,325 women without PCOS undergoing their first IVF/ICSI fresh embryo transfer cycles from January 2014 to December 2022 at a university-affiliated reproductive medicine center in China. The trends for pregnancy, obstetric and perinatal outcomes across quartiles of SUA levels were assessed. A logistic regression analysis was applied to control for baseline and cycle characteristics. Generalized addition model was used to draw spline smoothing plot.
There was no significant decreasing or increasing trend in the clinical pregnancy rate and live birth rate with the increase in quartiles of SUA levels. For Obstetric and perinatal outcomes following a single live birth, the percentage of hypertensive disorders in pregnancy (1.6-4.1%, P<0.001), gestational diabetes mellitus (5.9-13.9%, P<0.001), premature rupture of membranes (0.6-1.5%, P=0.016), preterm birth (6.3-9.2%, P=0.009), macrosomia (2.3-5.5%, P<0.001), large for gestational age (10.8-14.9%, P=0.002) all increased significantly from the lowest quartile to the highest. Logistic regression results showed that compared with those in quartile 1, the risk of maternal and infant complications mentioned above was still significantly higher in quartile 4 after adjusting for reproductive related factors. When further confounding factors were added, including body mass index (BMI), blood pressure, fasting blood glucose, and blood lipids related indicators, only gestational diabetes mellitus and macrosomia showed a significant increase.
In women without PCOS, SUA levels before IVF/ICSI treatment do not affect the probabilities of clinical pregnancy and live birth. An elevated SUA level is associated with an increased risk for hypertensive disorders in pregnancy, gestational diabetes mellitus, premature rupture of membranes, preterm birth, macrosomia, and large for gestational age. For gestational diabetes mellitus and macrosomia, the association is independent of BMI, blood pressure, blood glucose, and blood lipid.
先前的研究表明，多囊卵巢综合征（PCOS）女性在体外受精或胞浆内单精子注射（IVF/ICSI）治疗前血清尿酸（SUA）水平升高会导致活产率降低和低出生体重风险增加。尽管如此，SUA 升高是否会导致非 PCOS 女性的生殖结局类似，目前尚不清楚。本研究旨在探讨非 PCOS 女性在接受 IVF/ICSI 治疗前 SUA 水平与生殖结局的关系。
这是一项单中心、回顾性研究，纳入了 2014 年 1 月至 2022 年 12 月在中国某大学附属医院生殖医学中心接受首次 IVF/ICSI 新鲜胚胎移植周期的 13325 名非 PCOS 女性。评估了 SUA 水平四分位数与妊娠、产科和围产期结局的趋势。应用逻辑回归分析控制基线和周期特征。应用广义加性模型绘制样条平滑图。
SUA 水平四分位数升高与临床妊娠率和活产率无显著的降低或升高趋势。对于单胎活产后的产科和围产期结局，妊娠高血压疾病的发生率（1.6%-4.1%，P<0.001）、妊娠期糖尿病（5.9%-13.9%，P<0.001）、胎膜早破（0.6%-1.5%，P=0.016）、早产（6.3%-9.2%，P=0.009）、巨大儿（2.3%-5.5%，P<0.001）、大于胎龄儿（10.8%-14.9%，P=0.002）均显著升高。与四分位 1 相比，校正与生殖相关的因素后，四分位 4 组母婴并发症的风险仍然显著更高。进一步加入混杂因素，包括体重指数（BMI）、血压、空腹血糖和血脂相关指标后，仅妊娠期糖尿病和巨大儿的发生率显著增加。
在非 PCOS 女性中，IVF/ICSI 治疗前 SUA 水平不影响临床妊娠和活产率的概率。SUA 水平升高与妊娠高血压疾病、妊娠期糖尿病、胎膜早破、早产、巨大儿和大于胎龄儿的风险增加相关。对于妊娠期糖尿病和巨大儿，这种关联独立于 BMI、血压、血糖和血脂。
