Pregnancy Outcomes in Polycystic Ovary Syndrome

描述(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，影响普通人群中约5%-10%的妇女。PCOS的临床特征包括慢性无排卵、雄激素过剩和多囊卵巢，胰岛素抵抗被认为是一个中心因素。在确实怀孕的多囊卵巢综合征妇女中，有限的数据表明，怀孕并发症的发生率可能更高，包括妊娠期糖尿病和高血压疾病。然而，这些调查只在选定的群体中进行，还没有对患有多囊卵巢综合征的妇女的妊娠结局进行大规模的基于人群的研究，关于相关新生儿结局的数据也极其有限。北加州Kaiser Permanente是美国最大的综合医疗保健提供系统之一，它的成员资格为在众多多种族人口中调查确诊为多囊卵巢综合征的妇女的流行病学和妊娠相关结局提供了一个独特的机会。使用Kaiser Permanente PCOS注册中心，其中包括13,000名确诊为多囊卵巢综合征的妇女，除了自动化的电子数据源和有针对性的图表审查，我们建议评估特定的妊娠和新生儿不良结果是否与多囊卵巢综合征相关，以及潜在的中介因素。本研究的三个具体目的如下：目的1.探讨PCOS状态对妊娠期糖尿病、妊娠期高血压疾病和先兆子痫/子痫发生率的影响。目的2.在怀孕的多囊卵巢综合征妇女亚组中，确定临床、代谢和生殖因素预测妊娠期糖尿病和先兆子痫/子痫的风险增加。目的3.评估母亲多囊卵巢综合征(PCOS)状况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，我们将评估多囊卵巢综合征状态与小于胎龄儿的发生率和总体新生儿死亡率的关系。这项拟议的研究将对多囊卵巢综合征对妊娠和新生儿结局的影响进行严格的评估，并有望为更好的风险分层和治疗策略的开发提供见解，旨在改善日益增长的多囊卵巢综合征妇女的围产期结局。

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.