Neocortical pyramidal cells with axon-carrying basal dendrites: a prominent feature regulated by activity.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders among women of childbearing age, with a prevalence rate of approximately 5% to 20% []. The core characteristics of PCOS include elevated androgen levels, ovulatory disorders, and polycystic ovarian morphology, with anovulation being the primary cause of PCOS-related infertility []. In addition to infertility, women with PCOS commonly present with insulin resistance (IR), hyperinsulinemia (HI), and obesity, which elevate their risk of metabolic and cardiovascular disorders including impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) [–]. The widespread application of assisted reproductive technology (ART) has enabled an increasing number of PCOS patients to achieve pregnancy via in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). However, the inherent pathophysiological features of PCOS may increase perinatal risks for both mothers and offspring. This contributes to adverse pregnancy complications such as miscarriage, gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia (PE), preterm birth, and cesarean delivery, findings supported by numerous studies and meta-analyses [, ]. Consistently, studies focusing on PCOS patients undergoing ART have confirmed that this population faces significantly higher risks of maternal complications such as GDM, PIH, and PE. Additionally, they are also at increased risk of adverse perinatal outcomes, including preterm birth, miscarriage, low birth weight, and neonatal complications [, ]. Current evidence indicates that these adverse ART outcomes are linked not only to the underlying metabolic syndrome of PCOS but also to comorbidities including obesity, IR, and HI [–]. Notably, IR and subsequent metabolic abnormalities not only participate in the pathogenesis of PCOS but also impair reproductive function by affecting follicular development, oocyte quality, and endometrial receptivity, thereby increasing the risk of adverse pregnancy outcomes such as miscarriage [, , ]. Furthermore, the prevalence of IGT and T2DM in PCOS patients is significantly higher than in the general population. Even after weight matching, this risk remains approximately 2- to 4- fold higher [, ], which is closely associated with adverse maternal and infant outcomes. However, the adverse effects of pre-pregnancy abnormal glucose metabolism and IR on long-term pregnancy complications in PCOS patients undergoing ART remain poorly elucidated, and whether such metabolic derangements potentially influence maternal and neonatal outcomes needs further cohort exploration.