Adverse Effects of Polycystic Ovarian Syndrome on Pregnancy Outcomes in Women With Frozen-Thawed Embryo Transfer: Propensity Score-Matched Study

Abstract

PurposeThis work aimed to evaluate the adverse effect of polycystic ovary syndrome (PCOS) on pregnancy outcomes of singletons after vitrification in women with frozen-thawed embryo transfer (FET).MethodsPatients with/without PCOS who underwent FET from January 2013 and December 2018 were included. Propensity score matching (PSM) was used to reduce the influence of bias. Logistic regression was applied to identify the risk factors of adverse pregnancy outcomes of singletons in women with PCOS.ResultAfter PSM, the PCOS group had shorter gestational age (P<0.001) and lower newborn birth weight than the non-PCOS group (P=0.045). Compared with the non-PCOS group, the PCOS group had an increased risk of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) (P<0.001), placenta and membrane abnormality (P<0.001), stillbirth (P<0.001), neonatal complication (P=0.014), and miscarriage rate (P<0.001). Neonatal complication was associated with parity (adjusted OR=1.202, 95% CI=1.002–1.443, P=0.048) and basal P level (adjusted OR=1.211, 95% CI=1.021–1.436, P=0.028). According to multivariable logistic regression analysis, the miscarriage rate was related to parity (adjusted OR=1.201, 95% CI=1.057–1.166, P=0.005) and basal E2 (adjusted OR=1.002, 95% CI=1.000–1.004, P=0.019) and P levels on the day of embryo transfer (adjusted OR=0.971, 95% CI=0.957–0.985, P<0.001).ConclusionsCompared with non-PCOS women, women with PCOS have a higher risk of GDM and PIH, and neonatal complications and therefore require additional care during pregnancy and parturition.

Polycystic Ovarian Syndrome (PCOS): Does the Challenge End at Conception?

“…Similarly, a systematic review and meta-analysis published in 2016 [ 77 ] that included 40 observational studies reporting on 17,816 PCOS pregnancies and 123,756 non-PCOS pregnancies, found that PCOS in pregnancy did not have an impact on the risk of fetal growth abnormalities. More recently, Zhexin et al in 2022 [ 78 ] investigated 1376 patients with PCOS and 1376 control women who had undergone invitro-fertilization/intracytoplasmic sperm injection and conceived with singleton pregnancies. PCOS patients were found to have a statistically significant lower birthweight compared with controls.…”

Gestational diabetes and other adverse pregnancy outcomes in polycystic ovary syndrome

“…As many individuals with PCOS have infertility and require ART to achieve pregnancy, and ART is itself associated with adverse outcomes, several recent studies have evaluated adverse perinatal outcomes in pregnant individuals with PCOS treated with ART [35,43 ▪ ,44,45]. In a United States-based retrospective study ( N = 80 333), Stern et al included individuals with PCOS, determined by ICD-9/10 codes, undergoing ART ( N = 4061) compared with those not requiring ART with an adverse pregnancy outcome of GDM diagnosis, obtained from birth/death certificates and hospital records [43 ▪ ].…”

“…Ni et al [45] conducted a retrospective study of individuals with PCOS undergoing IVF for infertility treatment in China. Individuals with PCOS undergoing IVF ( N = 1384), diagnosed by Rotterdam criteria, were propensity-score matched to those without PCOS undergoing IVF ( N = 14 606), and the composite outcome was GDM and HDP [45].…”

“…Ni et al [45] conducted a retrospective study of individuals with PCOS undergoing IVF for infertility treatment in China. Individuals with PCOS undergoing IVF ( N = 1384), diagnosed by Rotterdam criteria, were propensity-score matched to those without PCOS undergoing IVF ( N = 14 606), and the composite outcome was GDM and HDP [45]. Propensity score-matching was used to control for confounding in baseline characteristics and fertilization method used (IVF, ICSI, or IVF+ICSI) between the PCOS and non-PCOS groups [45].…”

Exploring the mechanism of Alisma orientale for the treatment of pregnancy induced hypertension and potential hepato-nephrotoxicity by using network pharmacology, network toxicology, molecular docking and molecular dynamics simulation

“…Currently available management consists of symptomatic treatment, including spasmolytics (magnesium sulfate), anticoagulants (aspirin), antihypertensive drugs, and termination of pregnancy as a last resort ( Zhang et al, 2022a ). Nevertheless, the clinical curative efficacy is highly heterogeneous and has been reported to cause maternal and fetal adverse effects ( Ni et al, 2022 ).…”