title: Co-morbidity of cervical incompetence with polycystic ovarian syndrome (PCOS) negatively impacts prognosis: A retrospective analysis of 178 patients.
abstract: Cervical incompetence is an important cause of miscarriage and premature birth and polycystic ovary syndrome is a heterogeneous endocrine disorder that is the most common cause of anovulatory infertility and eugonadotrophic hypogonadism. By now, it is still debated whether women with PCOS have an increased risk of miscarriage and there have been no studies about the pregnancy outcomes of cervical incompetence patients with PCOS.
  
  
  
  The following clinical data of cervical incompetence patients with/without PCOS who were treated between September 2006 and September 2013 were retrospectively analysed: onset gestational age, termination gestational age, pregnancy outcome, co-morbid insulin resistance (IR) in PCOS patients, the influence of IR, co-morbid hyperandrogenism (HA) in PCOS patients, and the influence of HA. The independent samples t-test and chi-square trend test were used to analyse the data.
  
  
  
  A total of 178 singleton pregnancy cases with cervical incompetence were identified. The average onset gestational age was 23.9 ± 4.3 weeks, and the average termination gestational age was 32.5 ± 5.5 weeks. Of these 178 singleton pregnancy cases, 40 (22.5 %) ended in miscarriage, 82 (46.1 %) ended in preterm birth, and 56 (31.5 %) ended in term birth. Eighty cases (44.9 %) exhibited PCOS co-morbidity, and those cases had an average onset gestational age of 22.3 ± 3.8 weeks and an average termination gestational age of 31.2 ± 5.7 weeks, which were both significantly different from those of the non-PCOS group (both P < 0.001). Compared with the non-PCOS group (15.3 % miscarriage, 48.0 % preterm birth, and 36.7 % term birth), the PCOS group exhibited worse pregnancy outcomes (31.3 % miscarriage, 43.8 % preterm birth, and 25 % term birth) (P = 0.01). Among the 80 PCOS patients, 45 (56.3 %) exhibited co-morbid IR, and the IR group exhibited significantly worse pregnancy outcomes than the non-IR group (P = 0.03). Among the 80 PCOS patients, 54 cases (67.5 %) exhibited co-morbid HA, and there was no statistical difference on the pregnancy outcomes between the two groups. The multivariate logistic regression model revealed that PCOS was significantly correlated with miscarriage (OR: 3.72, 95 % CI: 1.37-10.13).
  
  
  
  The cervical incompetence patients with co-morbid PCOS exhibited earlier onset gestational ages, earlier termination gestational ages and worse pregnancy outcomes. For patients with co-morbid insulin resistance, the pregnancy outcomes were worse than expected.
authors.affiliation: Obstetrics & Gynecology Department, Peking University Third Hospital, Beijing, 100191, China.
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Obstetrics & Gynecology Department, Peking University Third Hospital, Beijing, 100191, China.
authors.forename: Xunke
authors.initials: X
authors.lastname: Gu
authors.affiliation: Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China.
authors.forename: Liyuan
authors.initials: L
authors.lastname: Tao
authors.affiliation: Obstetrics & Gynecology Department, Peking University Third Hospital, Beijing, 100191, China. yangaogi@163.com.
authors.forename: Yangyu
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005865:Gestational Age; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications / Q000453:epidemiology; D007333:Insulin Resistance; D016015:Logistic Models; D015999:Multivariate Analysis; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000453:epidemiology*
keywords: Cervical incompetence; Hyperandrogenism; Insulin resistance; Polycystic ovary syndrome; Preterm birth