Effect Of Yaz Combined With Metformin And Different Medication Cycles On The Pregnancy Outcomes Of PCOS Patients

Background and Objective:Polycystic ovary syndrome(PCOS)is one of the most common endocrine and metabolic diseases in women.Insulin resistance(IR),hyperandrogenemia(HA)and obesity are considered to be the main causes of its pathogenic process.Even when pregnant,PCOS patients are at increased risk of pregnancy complications such as miscarriage,gestational diabetes mellitus(GDM),gestational hypertensive disease(PIH),and preterm birth(PD).At present,the main treatment methods for PCOS are:Lifestyle intervention,taking compound oral contraceptives(COC)to improve menstruation and reduce androgen,using insulin sensitizers(such as metformin,etc.)to improve insulin resistance,for women with reproductive needs to carry out sexual guidance or assisted reproduction and pregnancy,under the conditions of improved lifestyle,The combination of COC and metformin can effectively improve insulin resistance and lipid metabolism in PCOS patients.However,there are few studies on the influence of the medication cycle of Yaz combined with metformin on the pregnancy outcome of PCOS patients.Therefore,this paper retrospectively analyzed the clinical data of PCOS patients treated with Yaz combined with metformin before pregnancy,and compared the influence of different medication cycles on the pregnancy outcome.In order to have a certain guidance for the follow-up clinical drug reference.Methods:A total of 177 patients with PCOS who visited the gynecological clinic of the Third Affiliated Hospital of Guangzhou Medical University from January 2020 to December 2022 were retrospectively analyzed.Group A:58 patients with PCOS who were pregnant naturally or by stimulation after no drug treatment were selected.Group B:119 patients with PCOS who were treated with Yuyousiyue combined with metformin to conceive naturally or promote excretion.The incidence of gestational hypertension,gestational diabetes and neonatal complications were analyzed.Statistical processing:SPSS 26.0 software was used for data analysis.(1)The mean of measurement data conforming to normal distribution was expressed as((?)±S);(2)F-analysis was used to compare the mean of different groups,and LSD-t test was used to compare the pairwise mean of different groups.(3)Tanmhane’s T2 test was used when variance homogeneity was not met,and the rates were compared by correctedχ~2test and Fish test.(4)Pearson Chi-square test,Phi and Klem V were used to test categorical variables.(5)Binary Logistic regression analysis was used for multivariate analysis;(6)P<0.05 was considered statistically significant.Results:1.General information:A total of 177 patients were included,including 58 in group A and 119 in group B:15 in group B1,68 in group B2,and 36 in group B3.There were no significant differences between group A and Group B in age,height,first visit weight and pre-pregnancy weight(P>0.05);There were significant differences in infertility years,BMI at first visit and pre-pregnancy BMI between the two groups(P<0.05).Average pre-pregnancy body weight and average pre-pregnancy BMI decreased in each group compared with the first visit.The weight difference between group A and group B was statistically significant(P<0.001).The body weight of B2 and B3 groups decreased significantly before and after,with statistical significance(P<0.05)2.In terms of blood drawing indexes,there were statistically significant differences in FINS and HOMA-IR between group A and group B(P<0.001),and2hPG,FINS,2hINS,3hINS and HOMA-IR in group B were significantly higher than those in group A.The comparison between group B showed a statistical difference in2hINS(P<0.05),and the 2hINS of group B2 was significantly higher than that of the other two groups.The comparison between the two groups showed that there were statistical differences in 3hINS in the B1 and B3 groups(P<0.05),and there were statistical differences in HDL-C in the B2 and B3 groups(P<0.05).There was no significant difference in delivery mode among all groups(P>0.05).3.There was no significant difference in delivery mode among all groups(P>0.05).4.In the comparison of maternal complications,the incidence of gestational diabetes in group A was higher than that in group B,and there was a statistical difference between the two groups(P<0.05).Group B was divided into three subgroups,B1,B2 and B3,according to the medication cycle.The comparison results between different subgroups showed that the number of maternal GDM symptoms decreased significantly with the increase of medication cycle(P<0.05).The number of GDM patients in group B1 was the highest,followed by B2,B3 was the least.The number of maternal symptoms of gestational hypertension(PIH)decreased between subgroups,although not statistically significant(13%vs.11%vs.0%).In terms of neonatal complications,this study investigated the prevalence of neonatal PD and the average birth weight of newborns,and there was no statistical significance among the three groups(P>0.05).5.BMI at first visit[OR=1.116,95%CI(1.003-1.242),P=0.044],pre-pregna-ncy BMI[OR=1.129,95%CI(1.001-1.274),P=0.048],FINS[OR=1.100,95%CI(1.008-1.201),P=0.033],HOMA-IR[OR=1.594,95%CI(1.076-2.361),P=0.020]were in dependent risk factors for GDM in patients with PCOS.Conclusions1.Compared with patients without preconditioning or patients with preconditioning period less than 3 cycles,the proportion of GDM in PCOS patients with preconditioning period of 3 cycles or more was significantly decreased,and the risk of PIH also showed a decreasing trend2.In PCOS patients with IR,preconditioning with Yousiyuet+metformin can reduce the risk of adverse pregnancy outcomes,but there is no significant difference in PIH,PD,low birth weight infants,macrosomia infants,and cesarean section rates.3.BMI at first visit,pre-pregnancy BMI,FINS and HOMA-IR are independent risk factors for GDM in PCOS patients.Before pregnancy,PCOS patients should be guided on lifestyle,diet and weight loss,and pretreated with personalized medication.