OBJECTIVE To compare pregnancy and neonatal outcomes in women with hyperandrogenic polycystic ovarian syndrome (PCOS) phenotypes compared with nonhyperandrogenic PCOS phenotypes. METHODS We conducted a retrospective cohort study of participants in the PPCOS (Pregnancy in Polycystic Ovary Syndrome) I and II randomized controlled trials; all of the participants met the National Institutes of Health diagnostic criteria for PCOS and were then sorted into three of the four Rotterdam criteria categories based on medical interview, demographics, physical examination, and laboratory data. The two hyperandrogenic (A and B) Rotterdam categories were compared with the nonhyperandrogenic phenotype of PCOS (phenotype D). Our outcomes of interest were clinical pregnancy, pregnancy loss, live birth, obstetric complications (including preterm labor, preeclampsia, gestational diabetes, intrauterine growth restriction, and premature rupture of membranes), and neonatal outcomes (including jaundice, respiratory distress syndrome, neonatal hospitalization, and neonatal infection). RESULTS Of the 1,376 participants included in the study, 1,249 (90.8%) had hyperandrogenic PCOS phenotypes compared with 127 (9.2%) nonhyperandrogenic PCOS (nonhyperandrogenic PCOS). Compared with participants with nonhyperandrogenic PCOS, those with hyperandrogenic PCOS had higher body mass index (BMI) (35.5±8.9 vs 31.9±9.3 kg/m 2 , P <.001), fasting insulin (21.6±27.7 vs 14.7±15.0 micro-international units/mL, P <.001), and homeostatic model assessment for insulin resistance score (5.01±9.1 vs 3.4±4.1, P =.0002). Age and race were similar between groups. Months attempting pregnancy were greater in participants with hyperandrogenic PCOS compared with nonhyperandrogenic PCOS (41.8±37.3 vs 33.9±32.0). The proportion of participants who achieved pregnancy (29.9% vs 40.2%, P =.02) and live birth rates (20.1% vs 33.1%, P =.001) were lower among those with hyperandrogenic PCOS compared with nonhyperandrogenic PCOS, although pregnancy loss rates did not differ significantly (23.9% vs 32.3%, P =.06). The hyperandrogenic PCOS group had lower odds of live birth compared with the nonhyperandrogenic PCOS group (odds ratio [OR] 0.51, CI, 0.34-0.76), even after adjusting for BMI (adjusted odds ratio [aOR] 0.59, CI, 0.40-0.89). The hyperandrogenic PCOS group also had lower odds of achieving pregnancy compared with the nonhyperandrogenic PCOS group (OR 0.63, CI, 0.44-0.92); however, this association was no longer significant after adjusting for BMI (aOR 0.74, CI, 0.50-1.10). The overall low prevalence of prenatal complications and neonatal outcomes precluded a meaningful comparison between the two groups. CONCLUSION Participants with hyperandrogenic PCOS achieved lower rates of pregnancy and live birth compared with those with nonhyperandrogenic PCOS. Evaluating distinct PCOS phenotypes may allow for individualized guidance regarding the probability of pregnancy and live birth. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov , NCT00068861 and NCT00718186.

中文翻译：

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多囊卵巢综合征表型与妊娠和新生儿结局的相关性。


目的 比较高雄激素性多囊卵巢综合征 （PCOS） 表型与非高雄激素 PCOS 表型女性的妊娠和新生儿结局。方法 我们对 PPCOS（多囊卵巢综合征妊娠）I 和 II 随机对照试验的参与者进行了回顾性队列研究;所有参与者都符合美国国立卫生研究院 PCOS 诊断标准，然后根据医学访谈、人口统计学、体格检查和实验室数据被分为四个鹿特丹标准类别中的三个。将两种高雄激素 （A 和 B） 鹿特丹类别与 PCOS 的非高雄激素表型 （表型 D） 进行比较。我们感兴趣的结局是临床妊娠、流产、活产、产科并发症（包括早产、子痫前期、妊娠糖尿病、宫内生长受限和胎膜早破）和新生儿结局（包括黄疸、呼吸窘迫综合征、新生儿住院和新生儿感染）。结果在纳入研究的 1,376 名参与者中，1,249 名 （90.8%） 患有高雄激素 PCOS 表型，而 127 名 （9.2%） 患有非高雄激素 PCOS （非高雄激素 PCOS）。与非高雄激素 PCOS 参与者相比，高雄激素 PCOS 参与者的体重指数 （BMI） 较高 （35.5±8.9 vs 31.9±9.3 kg/m 2，P <.001），空腹胰岛素 （21.6±27.7 vs 14.7±15.0 微国际单位/mL，P <.001），和胰岛素抵抗评分的稳态模型评估 （5.01±9.1 vs 3.4±4.1，P =.0002）。年龄和种族在组间相似。与非高雄激素 PCOS 相比，高雄激素 PCOS 参与者尝试怀孕的月数更长 （41.8±37.3 vs 33.9±32.0）。 与非高雄激素 PCOS 相比，高雄激素 PCOS 患者怀孕 （29.9% vs 40.2%，P =.02） 和活产率 （20.1% vs 33.1%，P =.001） 的比例较低，尽管流产率没有显著差异 （23.9% vs 32.3%，P =.06）。与非高雄激素 PCOS 组相比，高雄激素 PCOS 组的活产几率较低 （比值比 [OR] 0.51，CI，0.34-0.76），即使在调整 BMI 后 （校正比值比 [aOR] 0.59，CI，0.40-0.89）。与非高雄激素 PCOS 组相比，高雄激素 PCOS 组的妊娠几率也较低 （OR 0.63，CI，0.44-0.92）;然而，在调整 BMI 后，这种关联不再显著 （aOR 0.74，CI，0.50-1.10）。产前并发症和新生儿结局的总体患病率较低，因此无法对两组进行有意义的比较。结论 与非高雄激素 PCOS 参与者相比，高雄激素 PCOS 参与者的妊娠率和活产率较低。评估不同的 PCOS 表型可能允许对妊娠和活产的可能性进行个体化指导。临床试验注册 ClinicalTrials.gov 、 NCT00068861 和 NCT00718186。