伴多囊卵巢综合征妊娠妇女的不良妊娠转归风险较高

意大利雷焦艾米利亚疾病与健康护理研究所的Stefano Palomba博士及其合作者于2014年5月29日在《临床内分泌与代谢杂志》上在线发表了一项纳入300名妊娠妇女的前瞻性研究，研究发现，多囊卵巢综合征（PCOS）患者的慢性低度炎症在妊娠期间仍持续存在，并与不良妊娠转归风险增加相关。研究结果“证实PCOS患者的慢性低度炎症标志物水平更高，”且表明“妊娠过程加强了慢性低度炎症这一典型的综合征，”（doi: 10.1210/jc.2014-1214）。

意大利卡坦扎罗"Pugliese-Ciaccio"医院的研究者在2003年2月至2012年4约间共招募了150例PCOS患者及150名年龄及体质量指数（BMI）相匹配的健康对照，所有受试者均第一次妊娠且妊娠时间均小于7周。在150例PCOS的妊娠患者中，共有83例患者使用促性腺激素或克罗米芬促进排卵而得以成功妊娠，共有118例患者同时伴有高雄激素血症。

受试者需在研究开始时、妊娠第12、20及32周时接受标准临床评估，包括超声检查、血清白细胞计数检查、C-反映蛋白水平检测和铁蛋白水平检测。每位受试者的妊娠期及围产期转归被划分为正常状态和病理状态。不良（病理）转归包括流产、妊娠糖尿病、早产、妊娠高血压、大于胎龄儿和小于胎龄儿。

研究结果显示，与无PCOS的妊娠女性相比，伴PCOS的妊娠患者具有更高的白细胞计数（风险比，1.52）、更高的C-反应蛋白水平（风险比，1.19 vs. 1.21）和铁蛋白水平（风险比，1.12），并与产科或新生儿不良转归比例较高相关（32% vs. 11.3%）。

研究未报告资金来源。作者声明无相关利益冲突。

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By: TARA HAELLE, Ob.Gyn. News Digital Network

FROM THE JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM

VITALS

Key clinical point: The low-grade chronic inflammation in polycystic ovary syndrome (PCOS) persists during pregnancy and was associated with an increased risk for adverse pregnancy outcomes.

Major finding: In pregnant women with PCOS, higher white blood cell counts (hazard ratio, 1.52), and higher levels of C-reactive protein (HR, 1.19) and ferritin (HR, 1.12), are associated with higher rates of adverse obstetric or neonatal outcomes (32%), compared with women without PCOS (11.3%).

Data source: A prospective study of 150 pregnant women with PCOS and 150 healthy pregnant controls matched by age and body mass index, recruited between February 2003 and April 2012 at the "Pugliese-Ciaccio" Hospital of Catanzaro in Italy.

Disclosures: No funding source was noted. The authors reported no disclosures.

The low-grade chronic inflammation that accompanies polycystic ovary syndrome increases during pregnancy, thereby increasing the risk of adverse pregnancy outcomes, according to a recent study of 300 women.

The results "confirmed higher markers of chronic low-grade inflammation in PCOS patients," and suggested "that pregnancy enhances the chronic low-grade inflammation typical of the syndrome," Dr. Stefano Palomba of the Istituto di Ricovero e Cura a Carattere Scientifico in Reggio Emilia, Italy, and his associates reported online May 29 in the Journal of Clinical Endocrinology & Metabolism (doi: 10.1210/jc.2014-1214).

The researchers recruited 150 women with PCOS and 150 healthy controls, matched by age and body mass index, who were pregnant for the first time and at less than 7 weeks’ gestation when they enrolled in the study between February 2003 and April 2012. Ovulation was stimulated by using gonadotropins or clomiphene citrate in 83 of the 150 women with PCOS to induce pregnancy; 118 of the PCOS patients had clinical or biochemical hyperandrogenism, or both.

At the start of the study, and then at 12, 20, and 32 weeks’ gestation, the women underwent a standard clinical assessment, received ultrasounds, and provided serum for white blood cell (WBC) counts and measurements of C-reactive protein (CRP) and ferritin. Each woman’s pregnancy and perinatal outcomes were classified as normal or pathological. Among the adverse (pathological) outcomes were miscarriages, gestational diabetes, preterm birth, pregnancy-induced hypertension, and being large or small for gestational age.

Nearly a third (32%) of the women with PCOS had adverse outcomes, compared with 11.3% of women without PCOS. The researchers identified in the PCOS patients an increased risk for adverse obstetric/neonatal outcomes for WBC (for 1 standard-deviation increase in WBC distribution, the hazard ratio was 1.52), as well as CRP and ferritin (for 1 SD increase in the distributions of CRP and ferritin, HR was 1.19 and 1.12, respectively). Yet in the women without PCOS, only an increased CRP (HR, 1.21) was associated with adverse outcomes.

No funding source was noted. The authors reported no disclosures.