Objective: To investigate the effect of body mass index (BMI) on clinical pregnancy and neonatal outcomes in patients with polycystic ovary syndrome (PCOS) during frozen-thawed embryo transfer. Methods: A total of 650 patients with PCOS who received routine in vitro fertilization or intracytoplasmic sperm injection treatment for frozen-thawed embryo transfer from June 2014 to June 2019 in Tianjin Central Hospital of Gynecology Obstetrics were retrospectively analyzed. According to BMI, PCOS patients were divided into group A (18.5≤BMI<23 kg/m2, n=253), group B (23≤BMI<25 kg/m2, n=167), and group C (BMI≥25 kg/m2, n=230). The general information, clinical pregnancy outcomes, pregnancy complications, the incidence of macrosomia and low-birth-weight infants were compared in the three groups, and the influencing factors of neonatal birth weight were analyzed. Results: The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate all showed downward trend with the increase of BMI, but the differences were not statistically significant (all P>0.05). The live birth rate in group C [47.0% (108/230)] was significantly lower than those in groups A and B, with statistical significance (χ²=7.43, P=0.024). The late miscarriage rate was higher in group C [9.4% (13/139)] than in groups A and B (χ²=7.66, P=0.022). The birth rates of macrosomia in groups B [22.2% (16/72)] and group C [21.1% (16/76)] were significantly higher than that in group A, and the difference was statistically significant (χ²=14.15, P=0.001). There was no statistically significant difference in the incidence of gestational diabetes between the three groups (χ²=3.81, P=0.149). The incidence of hypertension disorders complicating pregnancy increased with the increase of BMI, and the difference was not statistically significant (P>0.05). Regression analysis showed that macrosomia was significantly associated with maternal pre-pregnancy BMI and gestational weeks, and the risk of macrosomia increased by 15% (95%CI: 3%-28%) for every increase in maternal BMI. Conclusions: The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate of PCOS patients in frozen-thawed embryo transfer cycles show downward trend with the increase of BMI. Obese patients with PCOS have a significant increase in late miscarriage rate and a significant decrease in live birth rate. The incidence of hypertension disorders complicating pregnancy in PCOS patients in the obese group has an increasing trend, and the birth rate of macrosomia has increased significantly. Therefore, it is recommended that obese women with PCOS lose weight scientifically before pregnancy to improve pregnancy and neonatal outcomes.
目的： 探讨冻融胚胎移植（FET）周期中体质指数（BMI）对多囊卵巢综合征（PCOS）患者辅助生殖治疗结局及新生儿出生体重的影响。 方法： 回顾性分析2014年6月至2019年6月在天津市中心妇产科医院行常规体外受精（IVF）或卵母细胞胞质内单精子注射法（ICSI）治疗、FET周期符合入组条件的PCOS患者650例，根据BMI分为正常体重组（18.5≤BMI<23 kg/m2，n=253）、超重组（23≤BMI<25 kg/m2，n=167）、肥胖组（BMI≥25 kg/m2，n=230）。分析比较3组的一般资料、临床妊娠结局、妊娠并发症发生情况及巨大儿、低出生体重儿出生率，并分析新生儿出生体重的影响因素。 结果： 3组间胚胎植入率、临床妊娠率、持续妊娠率随着3组的BMI增加均呈现下降趋势，但差异均无统计学意义（P均>0.05）。活产率肥胖组［47.0%（108/230）］显著低于正常体重组、超重组（χ²=7.43，P=0.024）。晚期流产率肥胖组［9.4%（13/139）］高于正常体重组、超重组（χ²=7.66，P=0.022）。单胎妊娠情况下，巨大儿出生率超重组［22.2%（16/72）］、肥胖组［21.1%（16/76）］显著高于正常体重组，差异有统计学意义（χ²=14.15，P=0.001）。3组之间妊娠期糖尿病发生率无明显差异（χ²=3.81，P=0.149）；妊娠期高血压疾病发生率随BMI升高呈升高趋势，但差异无统计学意义（P>0.05）。logistic回归分析显示，巨大儿出生与母亲孕前BMI及孕周显著相关（P<0.05），母亲BMI每增加1 kg/m2，巨大儿风险增加15%（95%CI为3%~28%）。 结论： FET周期PCOS患者的胚胎植入率、临床妊娠率、持续妊娠率随着BMI增加均呈现下降趋势。肥胖PCOS患者的晚期流产率显著增加，活产率显著下降。肥胖PCOS患者的妊娠期高血压疾病发生率有增加趋势，巨大儿出生率显著增加。建议肥胖PCOS妇女孕前科学减重，以改善临床妊娠结局和新生儿结局。.