Lifestyle administration for pregnant ladies with polycystic ovary syndrome | JMDH

Introduction

Polyendocrine metabolic ovarian syndrome (PMOS),¹ previously referred to as polycystic ovary syndrome (PCOS), is a power situation pushed by genetic, epigenetic, and way of life elements,² affecting 10–13% of ladies globally.³ As the commonest endocrine dysfunction in reproductive-aged ladies, it has implications from adolescence to postmenopause.⁴ During being pregnant, ladies with PMOS face markedly elevated dangers of gestational diabetes mellitus (GDM), hypertensive issues of being pregnant, dyslipidemia, miscarriage, preterm start, and fetal development abnormalities,⁵ inflicting short- and long-term opposed results on maternal and neonatal well being. Lifestyle modification—together with dietary, bodily exercise, and behavioral interventions—is the first-line administration for PMOS, with established efficacy in decreasing weight and central weight problems, enhancing insulin sensitivity, and selling emotional well-being.⁶ The 2023 Chinese skilled consensus on PMOS administration recommends that way of life interventions start earlier than conception and proceed all through being pregnant to mitigate opposed being pregnant outcomes.⁷ Yet medical tips and skilled consensus tailor-made for pregnant ladies with PMOS stay scarce, and most worldwide PMOS tips and skilled opinions tackle preconception and basic administration fairly than pregnancy-specific interventions.^5,6,8 Recent skilled opinion nonetheless emphasizes optimizing way of life and weight administration and prioritizes analysis that develops new therapeutic methods and implements evidence-based suggestions in perinatal care.²

Traditional Chinese drugs (TCM) presents distinct benefits in regulating train, food plan, emotion, and sleep, and reveals therapeutic potential for PMOS-related gestational issues.^9–12 Standardized protocols for making use of TCM within the administration of PMOS throughout being pregnant nonetheless stay undefined. To tackle this hole, the Chinese Integrative Medicine and Traditional Chinese Medicine Branch and the Midwives Branch of the China Maternal and Child Health Association convened a multidisciplinary skilled panel—specialists in TCM, obstetrics and gynecology, nursing, endocrinology, vitamin, psychology, and evidence-based drugs to develop built-in TCM and Western drugs way of life administration suggestions for pregnant ladies with PMOS, grounded in Chinese medical observe.

Consensus Development Methodology

This consensus adopted the 5A’s mannequin of self-management assist to ship patient-centered standardized care: (1) Assess way of life behaviors routinely; (2) Advise with customized suggestions aligned with the affected person’s targets, values, and atmosphere; (3) Agree on SMART (particular, measurable, attainable, related, and well timed) targets via shared decision-making; (4) Assist via evidence-based interventions and sources, together with self-management assist; (5) Arrange patient-centered follow-up.¹³

Through on-line discussions, the drafting group recognized key points in way of life administration for pregnant ladies with PMOS. Two rounds of skilled panel session outlined 5 domains (train, food plan, psychology, sleep, and atmosphere) considering Chinese prenatal care observe and evidence-based TCM approaches to way of life modification. A complete literature search used topic headings and free-text phrases in each Chinese and English throughout PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, VIP, and Wanfang databases from inception to May 1, 2025 (Appendix 1), masking tips, skilled consensuses, randomized managed trials, systematic critiques, and meta-analyses on PMOS and way of life administration. Following an evidence-based high quality evaluation the retrieved research didn’t meet guideline formulation requirements and confirmed various dangers of bias owing to insufficient pattern sizes, methodological flaws, and disparities in efficacy standards. The first draft was due to this fact constructed from this literature along with up to date Western drugs and TCM medical observe in China.

Panel recruitment was purposeful and focused: on the advice of the affiliation secretariat, Email invites have been despatched to core influential specialists in reproductive well being in all provinces; 25 of the 31 specialists contacted agreed to participate, and 6 declined for scheduling causes. This examine pre-specified two session rounds for the modified Delphi process.¹⁴ A 1–5 Likert scale was adopted for specialists to fee the significance of every indicator, with an indicator retention standards outlined as a imply rating ≥ 3.5 and a coefficient of variation (CV) < 0.25. All consensus conferences have been held via Tencent Meeting. Experts formulated skilled suggestions primarily based on their medical and analysis expertise. Each advice was reviewed and revised over a number of rounds earlier than the ultimate consensus was reached, with all suggestions accredited by ≥ 90% of the specialists.

Scope of Application

This consensus applies to pregnant ladies beforehand identified with PMOS or assembly the diagnostic standards for PMOS earlier than being pregnant.¹⁵ According to the Chinese Guideline for PCOS Diagnosis and Management, these standards are:

1. Oligomenorrhea, amenorrhea, or irregular uterine bleeding as obligatory standards;
2. Plus one of many following: Clinical and/or biochemical hyperandrogenism or polycystic ovarian morphology on ultrasound.

Other issues inflicting hyperandrogenism or ovulatory dysfunction have to be excluded (eg, Cushing syndrome, non-classic congenital adrenal hyperplasia, androgen-secreting tumors, drug-induced hyperandrogenism, idiopathic hirsutism).

Statistical Methods

Data have been entered and sorted in Excel 2021 and analyzed with SPSS 29.0 software program. Continuous knowledge are introduced as means and normal deviations (SDs), and categorical knowledge as counts and proportions (%). CV and Kendall’s concordance coefficient (Kendall’s W) have been used to judge the consistency of skilled opinions. The skilled authority coefficient (Cr) was calculated as Cr = (Ca + Cs)/2, the place Ca is the judgment foundation coefficient of specialists and Cs is the specialists’ familiarity with the examine subject material.¹⁶ P < 0.05 was thought-about statistically important.

Results

Expert Demographics

Twenty-five multidisciplinary specialists took half in each rounds of Delphi session. The consensus framework contained 5 main, 15 secondary, and 22 tertiary indicators. The specialists have been aged 33 to 64 years, with 6 to 40 years of medical working expertise, and got here from 21 provinces and municipalities masking practically all main financial and medical areas of China. They represented TCM, obstetrics and gynecology, nursing, endocrinology, vitamin, psychology, and evidence-based drugs. Ninety-two p.c (23/25) of the specialists held main tutorial and administrative positions, reminiscent of division administrators, principal investigators of nationwide analysis tasks, and editorial board members of core tutorial journals. Demographic traits and particular person particulars are given in Table 1 and Collaborators part, respectively.

Table 1 General Information of 25 Experts in Two Rounds of Consultation

Expert Engagement Authority

Twenty-five questionnaires were collected in each round, giving a response rate of 100% in both rounds. Ten experts (40.00%) provided modification suggestions in the first round, and 3 (12.00%) put forward revision opinions in the second. Ca, Cs, and Cr were 0.93, 0.81, and 0.87, respectively.

These results reflected high expert participation, with most experts delivering constructive feedback in the initial round, and supported the stability and credibility of this Delphi procedure. The Cr value, which integrates experts’ judgment basis and their familiarity with the research theme, further verified the professional background and reliability of the expert panel.

Expert Opinion Coordination

CV and Kendall’s W were calculated to evaluate the consistency of expert scoring on all evaluation indicators. The CV indicates the individual variability of expert ratings for a specific indicator, whereas Kendall’s W indicates the collective agreement among all experts’ evaluations across all indicators.

In the first round, the mean importance scores of all 22 evaluation indicators ranged from 3.68 to 4.68, all exceeding the screening threshold of 3.5, and the CV values ranged from 0.10 to 0.24, all below the critical standard of 0.25; no indicator needed elimination for expert divergence. After the questionnaire was revised according to experts’ suggestions, the second round achieved more unified opinions: mean scores rose to 4.16–5.00 and CV values narrowed to 0.00–0.11, indicating higher recognition of the indicators and smaller scoring differences among experts.

Kendall’s W was further calculated to assess the overall coordination of expert opinions. The test covered 22 indicators with a degree of freedom of 21 for both rounds. Kendall’s W was 0.21 in the first round, with a chi-square statistic of 112.49 and P < 0.001, and rose to 0.35 in the second round, with a chi-square statistic of 184.60 and P < 0.001. Statistically significant P values in both rounds verified that the coordination of expert scoring was credible, and the higher second-round W demonstrated that expert opinions converged after targeted textual modifications.

All retained indicators obtained an expert approval rate exceeding 90% after the two‑round consultation, which supported the recognition and practicability of the final‑reached expert consensus.

Expert Consultation Feedback

First-round suggestions were systematically collated, discussed, and addressed by the research team. The detailed revisions are as follows:

1. Exercise prescription: two experts suggested removing jogging from the list of recommended sports for pregnant women; one revised inappropriate expressions related to traditional Chinese medical exercise therapy; one advised adding standardized exercise assessment tools; and four optimized the wording of the exercise assessment and exercise prescriptions and supplemented descriptive content.
2. Diet prescription: two experts revised the standardized descriptions of the oral glucose tolerance test (OGTT); three pointed out that coix seed poses potential risks to pregnant women, and this content was deleted after literature review and academic verification.
3. Psychological prescription: one expert considered the psychological intervention protocol relatively rigid and formulaic; after literature review, the original protocol was retained and supplementary explanatory notes were added. One expert revised the awkward English translation of the psychological management scheme title, and two optimized the wording of the psychological assessment and intervention modules.
4. Sleep prescription: one expert revised inappropriate statements regarding TCM sleep conditioning; another raised doubts about the recommended ambient temperature for the sleep environment, which was verified against relevant clinical literature, with supporting references supplemented.
5. Environmental prescription: two experts simplified redundant text and made the environmental intervention measures more operable.

All the above revisions were integrated into the second-round consultation questionnaire. In that round, only two experts suggested polishing the expressions of diet and psychological management, and the manuscript was finalized after corresponding adjustments. The higher average indicator scores and Kendall’s W, together with the lower CV values in the second round, indicated improved expert consensus, and all 22 tertiary indicators were retained.

Finally, the lifestyle management framework for pregnant women with PMOS included five primary, 15 secondary, and 22 tertiary indicators, as well as their associated evaluation scales (Appendix 2–7). And the finalized framework is presented in Tables 2–6, close to research.^4,13,17–65

Table 2 Exercise Prescription of Lifestyle Management for Pregnant Women with Polyendocrine Metabolic Ovarian Syndrome

Table 3 Diet Prescription of Lifestyle Management for Pregnant Women with Polyendocrine Metabolic Ovarian Syndrome

Table 4 Psychological Prescription of Lifestyle Management for Pregnant Women with Polyendocrine Metabolic Ovarian Syndrome

Table 5 Sleep Prescription of Lifestyle Management for Pregnant Women with Polyendocrine Metabolic Ovarian Syndrome

Table 6 Environmental Prescription of Lifestyle Management for Pregnant Women with Polyendocrine Metabolic Ovarian Syndrome

Discussion

PMOS exerts long-term impacts on women’s health and can lead to adverse maternal and fetal outcomes during pregnancy. Given that lifestyle modification is the first-line management for PMOS, that TCM offers unique advantages in lifestyle regulation, and that guidance tailored for pregnant women with PMOS remains scarce, we used Delphi methods to develop recommendations grounded in Chinese clinical practice that highlight both TCM and Western medicine across five core dimensions: exercise, diet, psychological, sleep, and environmental prescriptions. To the best of our knowledge, this is the first integrated TCM and Western medicine program for lifestyle management in pregnant women with PMOS, and it could serve as an alternative for future international consensus.

Exercise Prescription

Exercise is essential to health and should be maintained during pregnancy.¹⁹ In ladies with PMOS, antenatal train considerably reduces the dangers of GDM and hypertensive issues.⁷ Given the elevated dangers of miscarriage, preterm start, and cervical insufficiency on this inhabitants,^6,66,67 train regimens have to be chosen prudently, with contraindications rescreened preconception and at each prenatal check-up (Table 2).

Qigong, a conventional Chinese mind-body train, promotes bodily rehabilitation and psychological steadiness by regulating physique (Tiao Shen), respiration (Tiao Xi), and psychological state (Tiao Xin), along with inner religious focus. Its mild, moderate-intensity actions adhere to the precept of coordinated regulation of the physique and thoughts (Xingshen Tongtiao), probably benefiting the bodily and psychological standing of pregnant ladies.^20–24 Recommended qigong strategies for being pregnant: (1) Baduanjin: easy and reasonable in depth; regulates glucolipid metabolism, blood strain, temper, sleep, and cardiac operate;^24,68–81 significantly efficient in ladies with PMOS for controlling gestational hyperglycemia/hypertension,^70,72 enhancing neonatal outcomes, relieving postpartum nervousness/melancholy, and aiding postpartum weight administration and pelvic ground restoration.^68,69 (2) Taijiquan: clean, mild actions mixing bodily movement with psychological tranquility, coordinating posture and respiratory to spice up systemic qi circulation and modulate visceral operate; it reduces blood glucose, lipids ranges, and blood strain whereas enhancing temper and sleep;^82–91 and is superior to different non-pharmacological interventions for weight management in ladies with PMOS.⁸⁴

Diet Prescription

Dietary administration is vital for pregnant ladies with PMOS. Pre-pregnancy physique mass index (BMI) and gestational weight achieve are carefully related to opposed maternal-fetal outcomes.^92–94 Women with PMOS additionally face elevated dangers of consuming issues, together with bulimia nervosa, binge consuming dysfunction, anorexia nervosa, and evening consuming syndrome.⁴ Any wholesome dietary sample in step with basic dietary tips for being pregnant advantages PMOS pregnancies (Table 3); sustainable regimens needs to be tailor-made to particular person preferences and targets.⁴

TCM ideas likewise advocate contemporary, delicate, nutritious, and simply digestible diets which might be consumed moderately with out overeating and tailor-made to the stage of gestation. Such diets ought to keep away from excessively chilly, spicy, and greasy meals and are meant to tonify qi and blood, assist fetal growth, and put together the mom for supply and lactation. In early being pregnant, meals needs to be small-portioned but refined. According to TCM Five-flavor principle,^29,95 sour-flavored meals are most popular for selling fluid secretion and urge for food, and choice can observe the ladies’s preferences. Mid-pregnancy diets needs to be wealthy in protein, calcium, and phosphorus to advertise fetal muscle, bone, and mind growth. Late being pregnant prioritizes high-quality proteins with balanced animal and plant sources, limiting high-salt and alkaline meals to stop edema. Protein-rich meals embrace brown rice, legumes, aquatic merchandise, eggs, and meats; calcium sources embody egg yolks, dairy, dried shrimp, animal bones, and leafy greens; phosphorus-rich meals embrace soybeans, rooster, and mutton.^96,97

Psychological Prescription

Depression and nervousness are prevalent psychological issues amongst ladies with PMOS, but psychological interventions should not constantly built-in into their normal care.⁹⁸ Their threat of depressive and nervousness signs in being pregnant is considerably increased than that within the basic pregnant inhabitants, and way of life interventions might probably ameliorate these situations.⁴ Emerging findings counsel that mindfulness-based and cognitive-behavioral approaches, which share ideas with optimistic psychology, might profit psychological well being in ladies with PMOS.^99,100 Positive psychology interventions (PPI), outlined as interventions that pursue well-being enhancement via pathways in step with optimistic psychology principle, are broadly acknowledged to construct effectively‑being and strengths and to cut back melancholy, nervousness, and stress throughout various populations.¹⁰¹ Often utilized as adjuncts to traditional psychotherapy, PPIs can reinforce and maintain way of life interventions.¹⁰² Growing proof confirms that PPIs enhance resilience, psychological well being, and subjective well-being in pregnant ladies, giving them a central position in way of life administration in PMOS being pregnant.¹⁰³ Psychological evaluation and proof‑primarily based psychological care delivered by appropriately skilled professionals are additionally warranted (Table 4).

TCM well being preservation likewise emphasizes the significance of psychological wellness and ethical integrity for total well being,²¹ and religious cultivation which locations ethical refinement as the first process, is central to its philosophy and practices. Psychological administration might combine TCM sample differentiation with therapies reminiscent of conventional workout routines and Five-Element Music. Breath regulation (Tiao Xi), some of the generally practiced conventional strategies, promotes interdependence of spirit and breath with centered mind-body consciousness (see Exercise Prescription). Five-Element Music remedy needs to be customized to being pregnant complication dangers, following Traditional Chinese Five-Element Music: Standard Modes.^45,46

Sleep Prescription

Sleep and food plan act collectively to keep up circadian rhythm. Circadian rhythm disruption is each a significant threat issue for growing PMOS¹⁰⁴ and related to a spectrum of gestational issues much like these in PMOS.¹⁰⁵ The prevalence of sleep issues throughout being pregnant will increase with gestational age, exceeding 60% by the third trimester.¹⁰⁶ Sleep issues are carefully related to maternal and fetal issues reminiscent of gestational hyperglycemia, hypertensive issues, preterm start, low start weight, and postpartum melancholy.¹⁰⁷ Women with PMOS additionally face a considerably increased threat of sleep issues, reminiscent of sleep apnea syndrome, than wholesome populations,⁶ due to this fact extra consideration needs to be paid on the sleep administration in pregnant ladies with PMOS (Table 5).

Environmental Prescription

Tobacco publicity—energetic smoking, passive smoking, and e-cigarette use—impairs feminine fertility and is considerably related to opposed being pregnant outcomes reminiscent of miscarriage, preterm start, untimely rupture of membranes, placental abruption, stillbirth, low start weight, and congenital defects.¹⁰⁸ Any degree of alcohol consumption throughout being pregnant might trigger irregular fetal growth.¹⁰⁹ Excessive caffeine consumption could also be linked to being pregnant loss, low start weight, congenital anomalies, long-term weight problems, and neurodevelopmental abnormalities.¹¹⁰ PMOS can be related to excessive environmental pollutant publicity, which may adversely have an effect on being pregnant outcomes.^111–114 Women with PMOS ought to due to this fact keep away from tobacco publicity and alcohol consumption, restrict caffeine consumption, and decrease environmental pollution from the preconception interval onward (Table 6).^8,115

Limitations and Future Direction

This steerage directs built-in TCM and Western drugs way of life administration for pregnant ladies with a historical past of PMOS and is important for mitigating PMOS-related dangers to moms and offspring. Several limitations apply. First, sturdy medical validation is absent: this system’s conceptual foundation rests predominantly on theoretical frameworks and skilled consensus, and high-quality proof on its suitability for clinically advanced instances stays scarce. Part of the TCM content material is grounded in classical texts and small-sample Chinese-language research. Well-designed potential research, eg, randomized managed trials, are due to this fact required to verify the effectiveness of this method. Second, choice bias might have been launched throughout meeting of the skilled panel. All specialists observe in China and there’s no affected person or public involvement within the panel. Third, the Delphi technique has intrinsic drawbacks: consensus is just not proof of accuracy, might suppress minority views, and depends on subjective skilled judgment regardless of structured suggestions.

Conclusion

Based on systematic proof retrieval and the newest evidence-based drugs, this consensus assertion supplies skilled suggestions with Chinese traits for way of life interventions throughout being pregnant in ladies with PMOS throughout 5 core dimensions: train, food plan, psychology, sleep, and atmosphere. Its principal contribution is a theoretically grounded and systematically organized basis for future empirical research, which ought to prioritize pilot implementation, contextual adaptation, and rigorous appraisal of practicality, affected person acceptance, and medical efficacy.

Abbreviations

PMOS, polyendocrine metabolic ovarian syndrome; PCOS, polycystic ovary syndrome; TCM, conventional Chinese drugs; GDM, gestational diabetes mellitus; SMART, particular, measurable, attainable, related, and well timed; SD, normal deviation; CV, coefficient of variation; Cr, skilled authority coefficient; Ca, judgment foundation coefficient of specialists; Cs, specialists’ familiarity with the content material; BMI, physique mass index; OGTT, oral glucose tolerance assessments; PPI, optimistic psychology intervention.

Data Sharing Statement

All related examine knowledge can be found from the corresponding writer to any researcher who makes an inexpensive request.

Ethical Statement

This examine was accredited by the Ethics Committee of Women’s Hospital, School of Medicine, Zhejiang University (Approval No. IRB-20250451-R). All procedures carried out in research involving human members have been in accordance with the moral requirements of the institutional and/or nationwide analysis committee and with the 1964 Helsinki declaration and its later amendments or comparable moral requirements. Written knowledgeable consent was obtained from all particular person members included within the examine.

Acknowledgments

The authors want to thank Dr. Xian Zhang and Dr. Jiayu Ye for his or her help in the course of the manuscript revision.

Collaborators

Information of Panel Experts

Bianba Zhuoma, People’s Hospital of Lhasa, Xizang, China

Xiaoyong Chen, Jiangxi Maternal and Child Health Hospital, Jiangxi, China

Mali Chen, Gansu Provincial Maternity and Child Hospital (Gansu Provincial Central Hospital), Gansu, China

Hongxia Cui, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Henan, China

Longlong Fan, Aksu Maternal and Child Health Hospital, Xinjiang, China

Xiumin Jiang, Maternal and Child Health Hospital of Fujian Province, Fujian, China

Zhengqiang Jiang, Linhai Maternal and Child Health Hospital, Zhejiang, China

Furui Jin, The International Peace Maternity & Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Zhichun Jin, Maternal and Child Health Hospital of Hubei Province, Hubei, China

Yuqin Lai, Liuzhou Maternity and Child Healthcare Hospital, Guangxi, China

Yunbo Li, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China

Lidong Liang, Peking University First Hospital Ningxia Women and Children’s Hospital, Ningxia, China

Yongchun Ma, Tongde Hospital of Zhejiang Province, Zhejiang, China

Yan Ning, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China

Ziting Ouyang, Hunan Provincial Maternal and Child Health Care Hospital, Hunan, China

Huijuan Rong, Shijiazhuang Obstetrics and Gynecology Hospital, Hebei, China

Fang Wang, Women’s Hospital, School of Medicine, Zhejiang University, Zhejiang, China

Jing Wang, Shandong Maternal and Child Health Hospital, Shandong, China

Yanping Wang, Affiliated Hospital of Changchun University of Chinese Medicine, Jilin, China

Pingchun Yang, Lincang Maternal and Child Health Hospital, Yunnan, China

Xiaohong Yang, Maternal and Child Health Hospital of Qinghai Province, Qinghai, China

Chunmei Zhao, Guangdong Women and Children’s Hospital, Guangdong, China

Rui Zhao, Hainan Women and Children’s Medical Center, Hainan, China

Xiaoli Zhao, Dalian Women and Children’s Medical Group, Liaoning, China

Lin Zhou, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China

Author Contributions

All authors made important contributions to the reported work, together with its conception, examine design, execution, acquisition of knowledge, evaluation and interpretation; participated in drafting, revising, or critically reviewing the article; accredited the ultimate model of the article; agreed on the journal to which the article was submitted; and agreed to be accountable for all points of the work.

Funding

This examine was supported by Zhejiang Provincial Natural Science Foundation of China (Grant No. LZ26H270001); National Natural Science Foundation of China (Grant No. 82575119, 82274564); the Health High-Level Talent Training Project (Innovative Talents), the Health Commission of Zhejiang Province, China (Grant No.[2021] 40); and National Key R&D Program of China (Grant No.2024YFC3505800); Joint TCM Science & Technology Projects of National Demonstration Zones for Comprehensive TCM Reform (Grant No.GZY-ZJ-KJ-24034).

Disclosure

The authors report no conflicts of curiosity on this work.

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