Pregnancy Outcomes in Polycystic Ovary Syndrome

描述（由申请人提供）：多囊卵巢综合征（PCOS）是育龄妇女中最常见的内分泌疾病之一，影响到一般人群中约5- 10%的女性。多囊卵巢综合征的临床特征包括慢性无排卵、雄激素过量和多囊卵巢，其中胰岛素抵抗被认为是中心因素。在患有多囊卵巢综合征的女性中，有限的数据表明妊娠并发症的发生率可能更高，包括妊娠糖尿病和高血压疾病。然而，这些调查只在选定的人群中进行，目前还没有针对多囊卵巢综合征妇女妊娠结局的大规模人群研究，有关新生儿结局的数据也极为有限。作为美国最大的综合医疗保健服务系统之一，Kaiser Permanente北加州的会员资格提供了一个独特的机会，可以在大量多种族人群中调查诊断为多囊卵巢综合征的妇女的流行病学和妊娠相关结果。使用Kaiser Permanente PCOS Registry（包括13000名诊断为PCOS的妇女），除了自动化电子数据源和有针对性的图表回顾外，我们建议评估特定的妊娠和新生儿不良结局是否与PCOS相关，以及潜在的中介因素。我们研究的三个具体目标是：探讨PCOS对妊娠期糖尿病、妊娠期高血压、先兆子痫/子痫发生率的影响。目标2。在怀孕的多囊卵巢综合征妇女亚群中，确定预测妊娠糖尿病和先兆子痫/子痫风险增加的临床、代谢和生殖因素。目标3。评估母体PCOS状态与新生儿不良结局发生率的关系，包括巨大儿、早产和新生儿重症监护病房（NICU）入院。其次，我们将评估PCOS状态与小胎龄儿发生率和新生儿总死亡率的关系。该研究将为PCOS对妊娠相关和新生儿结局的影响提供严格的评估，并有望为更好的风险分层和制定治疗策略提供见解，旨在改善PCOS患者群体的围产期结局。

DESCRIPTION (provided by applicant): Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among reproductive-age women, affecting ~5-10 percent of women in the general population. Clinical features of PCOS include chronic anovulation, androgen excess, and polycystic ovaries, with insulin resistance considered a central factor. In women with PCOS who do get pregnant, limited data suggest there may be a higher incidence of pregnancy complications, including gestational diabetes and hypertensive disorders. However, these investigations have been conducted in only selected groups and there have been no large population-based studies of pregnancy outcomes among women with PCOS, and extremely limited data on relevant neonatal outcomes. The membership of Kaiser Permanente Northern California, one of the largest integrated health care delivery systems in the US, presents a unique opportunity to investigate the epidemiology and pregnancy-related outcomes of women with diagnosed PCOS within a large multiethnic population. Using the Kaiser Permanente PCOS Registry, which includes -13,000 women with diagnosed PCOS, in addition to automated electronic data sources and targeted chart review, we propose to evaluate whether specific gestational and neonatal adverse outcomes are associated with PCOS, and potential mediating factors. The three Specific Aims of our study are the following: AIM 1. To evaluate the effects of PCOS status on the incidence of gestational diabetes, gestational hypertension, and pre-ecclampsia/ecclampsia among pregnant women. AIM 2. Among the subset of women with PCOS who become pregnant, to identify clinical, metabolic and reproductive factors which predict an increased risk of gestational diabetes and pre-ecclampsia/ecclampsia. AIM 3. To evaluate the association of maternal PCOS status with the incidence of adverse neonatal outcomes, including macrosomia, premature delivery and neonatal intensive care unit (NICU) admission. Secondarily, we will evaluate the association of PCOS status with the incidence of small-for-gestational-age infants and overall neonatal mortality. The proposed study will provide a rigorous evaluation of the impact of PCOS on pregnancy-related and neonatal outcomes and hopefully yield insights into better risk stratification and development of therapeutic strategies designed to improve perinatal outcomes among the growing population of women with PCOS.