Pregnancy complications in women with polycystic ovary syndrome
Pregnancy complications in women with polycystic ovary syndrome
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DOI：
10.1093/humupd/dmv029
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发表时间：
2015-09-01
影响因子：
13.3
通讯作者：
Fauser, Bart C. J. M.
中科院分区：
文献类型：
--
作者：
Palomba, Stefano;de Wilde, Marlieke A.;Fauser, Bart C. J. M.
背景技术背景：迄今为止，对诊断为多囊卵巢综合征（PCOS）的妇女进行的绝大多数研究都集中在诊断、月经周期异常、多毛症和不孕症上。虽然在开发实现怀孕和减少多囊卵巢综合征妇女多胎妊娠的方法方面取得了进展，但很少关注妊娠并发症和随后的儿童结局。本文旨在总结目前关于PCOS妇女妊娠和生育的临床和病理生理学特征的知识。方法：在PubMed、Medline、科克伦图书馆和Web of Science中进行文献检索，检索时间截止到2015年4月，无语言限制。首先筛选所有文章的标题和摘要，随后选择合格文章的全文。最初纳入了每个特定受试者的系统性综述和荟萃分析。最近的随机对照试验（RCT），这是不包括在系统评价，也包括在内。除了来自荟萃分析或随机对照试验的证据外，我们还使用了非随机前瞻性、非对照前瞻性、回顾性和实验性研究。当PCOS患者的具体数据缺乏，从一般人群研究的结果reported.RESULTS：PCOS妇女表现出临床显着增加妊娠并发症的风险与对照组相比。未校正BMI或其他混杂因素的数据表明，PCOS患者妊娠高血压和先兆子痫的风险增加3-4倍，妊娠期糖尿病的风险增加3倍，早产的机会增加2倍。PCOS的特征，如高雄激素血症，肥胖，胰岛素抵抗和代谢异常，可能会导致产科和新生儿并发症的风险增加。有限的可用数据表明，PCOS女性的后代未来代谢和生殖功能障碍的风险增加。妊娠并发症的潜在病理生理机制沿着其与后代健康的关系仍不确定。到目前为止，在PCOS妇女的妊娠并发症的预防和管理的策略，以及这些妇女的长期健康是否受到影响，以及在何种程度上，由妊娠和/或妊娠并发症，仍有待阐明。多囊卵巢综合征及相关共病的异质性病因因素可能都与妊娠和儿童结局受损有关。在患有PCOS的女性中，与这种复杂疾病中涉及的遗传，环境，临床和生化因素以及妊娠并发症和母亲和儿童的长期健康的可能关系仍有待确定。
BACKGROUND: The great majority of studies performed so far concerning women diagnosed with polycystic ovary syndrome (PCOS) have focused on diagnosis, menstrual cycle abnormalities, hirsutism and infertility. Although progress has been made in developing methods for achieving a pregnancy and reducing multiple gestations in women with PCOS, little attention has been paid to pregnancy complications and subsequent child outcomes. This review aims to summarize current knowledge regarding the clinical and pathophysiological features of pregnancy and children in women with PCOS.METHODS: A literature search up to April 2015 was performed in PubMed, Medline, the Cochrane Library and Web of Science without language restriction. All articles were initially screened for title and abstract and full texts of eligible articles were subsequently selected. Systematic reviews with meta-analysis were initially included for each specific subject. Recent randomised controlled trials (RCTs), which were not included in the systematic reviews, were also included. In addition to evidence from meta-analyses or RCTs, we used non-randomized prospective, uncontrolled prospective, retrospective and experimental studies. When specific data for patients with PCOS were lacking, results from general population studies were reported.RESULTS: Women with PCOS exhibit a clinically significant increased risk of pregnancy complications compared with controls. Data which were not adjusted for BMI or other confounders demonstrated in PCOS a 3-4-fold increased risk of pregnancy-induced hypertension and pre-eclampsia, a 3-fold increased risk of gestational diabetes and 2-fold higher chance for premature delivery. Features characteristic of PCOS, such as hyperandrogenism, obesity, insulin resistance and metabolic abnormalities, may contribute to the increased risk of obstetric and neonatal complications. Limited available data suggest that offspring of women with PCOS have an increased risk for future metabolic and reproductive dysfunction. Underlying pathophysiological mechanisms of pregnancy complications along with its association with health of offspring remain uncertain. To date, the strategies for prevention and management of pregnancy complications in women with PCOS, and whether long-term health of these women is influenced, and to what extent, by pregnancy and/or pregnancy complications, remain to be elucidated.CONCLUSIONS: Women with PCOS show an increased risk of pregnancy complications. Heterogeneous aetiological factors involved in PCOS and associated co-morbidities may all be involved in compromised pregnancy and child outcomes. In women with PCOS, a possible relationship with genetic, environmental, clinical and biochemical factors involved in this complex condition, as well as with pregnancy complications and long-term health for both mother and child, remains to be established.