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，影响一般人群中约5- 10%的妇女。多囊卵巢综合征的临床特征包括慢性无排卵、雄激素过多和多囊卵巢，胰岛素抵抗被认为是一个中心因素。在怀孕的PCOS妇女中，有限的数据表明可能有更高的妊娠并发症发生率，包括妊娠期糖尿病和高血压疾病。然而，这些研究仅在选定的组中进行，并且没有对PCOS妇女的妊娠结局进行大规模基于人群的研究，并且有关新生儿结局的数据非常有限。Kaiser Permanente北方加州是美国最大的综合医疗保健提供系统之一，该组织的成员资格为研究多种族人群中确诊为PCOS的女性的流行病学和妊娠相关结局提供了独特的机会。使用Kaiser Permanente PCOS登记处，其中包括约13，000名诊断为PCOS的女性，除了自动化电子数据源和有针对性的图表审查外，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，以及潜在的介导因素。我们研究的三个具体目标如下：目标1。评估PCOS状态对妊娠期糖尿病、妊娠期高血压和先兆子痫/子痫发生率的影响。AIM 2.在怀孕的PCOS女性中，确定预测妊娠期糖尿病和先兆子痫/子痫风险增加的临床、代谢和生殖因素。AIM 3.评估母亲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室（NICU）入院。其次，我们将评估PCOS状态与小于胎龄儿发生率和总体新生儿死亡率的关系。这项拟议的研究将对PCOS对妊娠相关和新生儿结局的影响进行严格的评估，并有望深入了解更好的风险分层和治疗策略的制定，旨在改善日益增长的PCOS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.