Research question

Do women with polycystic ovary syndrome (PCOS) have higher testosterone levels during pregnancy and what role does high testosterone play in the development of obstetric complications?

Design

Retrospective cohort study from Uppsala University Hospital, Sweden. The study population consisted of women with PCOS (n = 159) and a comparison group of women without PCOS matched for body mass index (n = 320). Plasma testosterone levels were measured in the early second trimester by liquid chromatography with tandem mass spectrometry, and women with PCOS were grouped into tertiles according to their testosterone levels. Possible associations with obstetric complications, maternal metabolic factors and offspring birth weight were explored by multivariable logistic and linear regression models.

Results

Compared with women who do not have PCOS, women with PCOS had higher total testosterone (median 1.94, interquartile range [IQR] 1.21–2.64 versus 1.41, IQR 0.89–1.97; P < 0.001), and free androgen index (median 0.25, IQR 0.15–0.36 versus 0.18, IQR 0.11–0.28; P < 0.001). Women with PCOS who had the highest levels of testosterone had increased risk for preeclampsia, even when adjusted for age, parity, country of birth and smoking (adjusted OR 6.16, 95% CI 1.82 to 20.91). No association was found between high testosterone in women with PCOS and other obstetric complications.

Conclusions

Women with PCOS have higher levels of total testosterone and free androgen index during pregnancy than women without PCOS matched for body mass index. Preliminary evidence shows that women with PCOS and the highest maternal testosterone levels in early second trimester had the highest risk of developing preeclampsia. This finding, however, is driven by a limited number of cases and should be interpreted with caution.

中文翻译：

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多囊卵巢综合征女性的妊娠结局与孕中期睾酮水平的关系

 研究问题

患有多囊卵巢综合症 (PCOS) 的女性在怀孕期间睾酮水平是否较高？高睾酮水平在产科并发症的发生中起什么作用？

 设计

瑞典乌普萨拉大学医院的回顾性队列研究。研究人群包括患有 PCOS 的女性 ( n = 159) 和体重指数匹配的非 PCOS 女性对照组 ( n = 320)。通过液相色谱串联质谱法测量妊娠中期早期的血浆睾酮水平，并根据睾酮水平将患有 PCOS 的女性分为三分位数。通过多变量逻辑回归和线性回归模型探讨了与产科并发症、母亲代谢因素和后代出生体重的可能关联。

 结果

与未患有 PCOS 的女性相比，患有 PCOS 的女性具有较高的总睾酮水平（中位数 1.94，四分位数间距 [IQR] 1.21–2.64 对比 1.41，IQR 0.89–1.97； P < 0.001）和游离雄激素指数（中位数 0.25， IQR 0.15–0.36 与 0.18，IQR 0.11–0.28； P < 0.001）。即使根据年龄、产次、出生国家和吸烟情况进行调整，睾酮水平最高的 PCOS 女性患先兆子痫的风险也会增加（调整后 OR 6.16，95% CI 1.82 至 20.91）。没有发现患有多囊卵巢综合症的女性的高睾酮水平与其他产科并发症之间存在关联。

 结论

患有 PCOS 的女性在怀孕期间的总睾酮和游离雄激素指数水平高于与体重指数匹配的非 PCOS 女性。初步证据表明，患有多囊卵巢综合症且在妊娠中期早期母体睾酮水平最高的女性患先兆子痫的风险最高。然而，这一发现是由有限数量的案例驱动的，应谨慎解释。