中国多囊卵巢综合征患者妊娠并发症发生率的Meta分析

目的：采用Meta分析的方法评价我国多囊卵巢综合征(polycystic ovary syndrome，PCOS)患者妊娠并发症 的发生现状。方法：系统检索PubMed，Web of Science，Embase，Medline，Cochrane协作网，中国知网，重庆维普及 中国生物医学文献数据库等从建库至2017年4月1日前公开发表的、报道中国PCOS患者妊娠并发症发生率的文献。 采用随机效应模型估计合并率及95%可信区间。以纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale，NOS)为标准对最终 纳入的文献进行质量评价。采用亚组分析评价孕前超重/肥胖及胰岛素抵抗对PCOS孕妇妊娠并发症发生率的影响。 结果：最终纳入文献59篇，合计PCOS孕妇13 378例，非PCOS孕妇49 395例。PCOS孕妇中各种妊娠并发症的发生率分 别为：妊娠糖尿病20.26%、妊娠高血压13.94%、剖宫产64.16%、早产13.35%、巨大儿9.84%、低出生体重儿5.88%、小 于胎龄儿5.25%、大于胎龄儿8.45%、新生儿畸形1.93%、围产儿死亡0.88%、新生儿窒息3.71%，且PCOS孕妇中妊娠糖 尿病、妊娠高血压、剖宫产、早产、巨大儿及新生儿窒息的发生率明显高于非PCOS孕妇(P<0.05)。亚组分析结果显 示：超重/肥胖的PCOS孕妇中妊娠糖尿病、巨大儿及大于胎龄儿的发生率明显高于BMI正常的PCOS孕妇(均P<0.05)； 孕前合并胰岛素抵抗的PCOS孕妇中妊娠糖尿病、早产、巨大儿的发生率明显高于未合并胰岛素抵抗的PCOS孕妇(均 P<0.05)。结论：PCOS可导致孕妇妊娠并发症的发生风险增加，是妊娠并发症发生的一个重要危险因素。

Pregnancy complications among women with polycystic ovary syndrome in China: a Meta-analysis

Objective: To estimate the status of pregnancy complications among women with polycystic ovary syndrome (PCOS) through a systematic review of published literatures. Methods: Systematic literature searches were conducted in PubMed, Web of Science, Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu and China Biology Medicine disc (CBMdisc), as well as the relevant articles published from inception to April 1st 2017, which reported the prevalence of pregnancy complications among women with PCOS. Random effective models were used to calculate pooled prevalence and 95% confidence intervals. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of those included studies. Subgroup analyses were used to evaluate the influence of overweight/obesity and insulin resistance before pregnancy on the estimates of pregnancy complications among women with PCOS. Results: Fifty-nine studies involving 13 378 PCOS women and 49 395 non-PCOS women were included. Among women with PCOS, pooled estimates were 20.26% for gestational diabetes mellitus, 13.94% for hypertensive disorder of pregnancy, 64.16% for caesarean section, 13.35% for preterm birth, 9.84% for macrosomia, 5.88% for low birth weight, 5.25% for early gestational age, 8.45% for late gestational age, 1.93% for neonatal malformations, 0.88% for perinatal mortality and 3.71% for neonatal asphyxia. And the estimates of gestational diabetes mellitus, hypertensive disorder of pregnancy, caesarean section, preterm birth, macrosomia and neonatal asphyxia among women with PCOS were significantly higher than those in women without PCOS (all P<0.05). Subgroup analysis showed the estimates of gestational diabetes mellitus, macrosomia and late gestational age among PCOS women who were overweight/obesity before pregnancy were significant higher than those among PCOS women with normal BMI (all P<0.05); and compared to PCOS women without insulin resistance prior to pregnancy, PCOS women with pre-pregnancy insulin resistance were at an increased risk for gestational diabetes mellitus, preterm birth and macrosomia (all P<0.05). Conclusion: PCOS in pregnancy is associated with high rates of pregnancy complications. It is an important risk factor for pregnancy complications.