背景:多囊卵巢综合征(PCOS)被认为是育龄妇女中最常见的内分泌疾病。虽然辅助生殖技术(ART)的使用为PCOS患者的不孕症治疗带来了有利的结果,这种疾病固有的病理生理特征会在怀孕和分娩期间对母亲和后代造成并发症和后果。本研究旨在评估母体PCOS与各种妊娠并发症和接受ART的新生儿结局之间的相关性。
方法:在PubMed上进行了系统搜索,Embase,和Cochrane图书馆来确定观察性研究,调查PCOS与各种妊娠并发症和新生儿结局风险之间的关系,包括妊娠期糖尿病(GDM),妊娠期高血压(PIH),先兆子痫(PE),早产,流产,先天性畸形(CA),小于胎龄(SGA),胎龄大(LGA),低出生体重(LBW),巨大儿,新生儿重症监护病房(NICU)入院和出生体重。根据预定的纳入和排除标准选择合格的研究。荟萃分析使用ReviewManager和Stata软件进行,具有优势比(OR)或平均差(MD),置信区间(CI),和异质性(I2)正在计算。搜索一直进行到2023年3月。
结果:总共确定了33项研究,总样本量为92,810名参与者。结果表明,PCOS与GDM风险增加显著相关(OR1.51,95%CI:1.17-1.94)。PIH(OR1.72,95%CI:1.25-2.39),PE(OR2.12,95%CI:1.49-3.02),早产(OR1.29,95%CI:1.21-1.39),和LBW(OR1.29,95%CI:1.14-1.47)。在亚组分析中,新鲜胚胎移植(ET)亚组GDM(OR1.80,95%CI:1.23-2.62)和流产(OR1.41,95%CI:1.08-1.84)的风险升高,而PE(OR1.82,95%CI:1.17-2.83)和早产(OR1.31,95%CI:1.21-1.42)的风险升高在冷冻ET亚组。不管有没有高雄激素血症,PCOS患者早产风险较高(OR1.69,95%CI:1.31-2.18;OR1.24,95%CI:1.02-1.50),流产风险较高(OR1.38,95%CI:1.12-1.71;OR1.23,95%CI:1.06-1.43).
结论:我们的研究结果表明,接受ART治疗的PCOS患者发生妊娠并发症和新生儿不良结局的风险显著升高。然而,建立PCOS与妊娠相关结局之间的明确关联,有必要进行广泛的前瞻性,盲化队列研究,并有效控制混杂变量。
BACKGROUND: Polycystic ovarian syndrome (PCOS) is recognized as the most prevalent endocrine disorder among women of reproductive age. While the utilization of assisted reproductive technology (ART) has resulted in favorable outcomes for infertility treatment in PCOS patients, the inherent pathophysiological features of the condition give rise to complications and consequences during pregnancy and delivery for both the mother and offspring. This study was to assess the correlation between maternal PCOS and various pregnancy complications and neonatal outcomes undergone ART.
METHODS: A systematic search was conducted on PubMed, EmBase, and the Cochrane Library to identify observational studies that investigated the association between PCOS and the risk of various pregnancy complications and neonatal outcomes, including gestational diabetes mellitus (GDM), hypertension in pregnancy (PIH), preeclampsia (PE), preterm birth, abortion, congenital malformations (CA), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia, neonatal intensive care unit (NICU) admission and birth weight. Eligible studies were selected based on predetermined inclusion and exclusion criteria. The meta-analysis was conducted using
Review Manager and Stata software, with odds ratios (ORs) or mean difference (MD), confidence intervals (CIs), and heterogeneity (I2) being calculated. The search was conducted up to March 2023.
RESULTS: A total of 33 studies with a combined sample size of 92,810 participants were identified. The findings indicate that PCOS is significantly associated with an increased risk of GDM (OR 1.51, 95% CI:1.17-1.94), PIH (OR 1.72, 95% CI:1.25-2.39), PE (OR 2.12, 95% CI:1.49-3.02), preterm birth (OR 1.29, 95% CI:1.21-1.39), and LBW (OR 1.29, 95% CI:1.14-1.47). In subgroup analyses, the risks of GDM (OR 1.80, 95% CI:1.23-2.62) and abortion (OR 1.41, 95% CI:1.08-1.84) were elevated in fresh embryo transferred (ET) subgroup, whereas elevated risk of PE (OR 1.82, 95% CI:1.17-2.83) and preterm birth (OR 1.31, 95% CI:1.21-1.42) was identified in frozen ET subgroup. Whatever with or without hyperandrogenism, patients with PCOS had a higher risk in preterm birth (OR 1.69, 95% CI: 1.31-2.18; OR 1.24, 95% CI:1.02-1.50) and abortion (OR 1.38, 95% CI:1.12-1.71; OR 1.23, 95% CI:1.06-1.43).
CONCLUSIONS: Our findings suggest that individuals with PCOS undergone ART are at a notably elevated risk for experiencing pregnancy complications and unfavorable neonatal outcomes. Nevertheless, to establish a definitive association between PCOS and pregnancy-related outcomes, it is necessary to conduct extensive prospective, blinded cohort studies and effectively control for confounding variables.