Impact of smoking or second-hand smoke exposure on metabolic and hormonal levels in women with polycystic ovary syndrome: A systematic review and meta-analysis.
메타분석
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[BACKGROUND] Evidence on the effects of smoking or second-hand smoke (SHS) exposure on metabolic and hormonal parameters in women with Polycystic Ovary Syndrome (PCOS) remains inconsistent.
- p-value P < 0.05
APA
Yan R, He D, et al. (2026). Impact of smoking or second-hand smoke exposure on metabolic and hormonal levels in women with polycystic ovary syndrome: A systematic review and meta-analysis.. European journal of obstetrics, gynecology, and reproductive biology, 319, 114973. https://doi.org/10.1016/j.ejogrb.2026.114973
MLA
Yan R, et al.. "Impact of smoking or second-hand smoke exposure on metabolic and hormonal levels in women with polycystic ovary syndrome: A systematic review and meta-analysis.." European journal of obstetrics, gynecology, and reproductive biology, vol. 319, 2026, pp. 114973.
PMID
41616502
Abstract
[BACKGROUND] Evidence on the effects of smoking or second-hand smoke (SHS) exposure on metabolic and hormonal parameters in women with Polycystic Ovary Syndrome (PCOS) remains inconsistent. We systematically reviewed and meta-analyzed these associations.
[METHODS] Six databases (CNKI, PubMed, Web of Science, Cochrane Library, Ovid, EMBASE) were searched from inception to 24 April 2025 for observational studies reporting smoking/SHS exposure and ≥1 metabolic or hormonal outcome in PCOS patients. Study quality was assessed using the Newcastle-Ottawa and AHRQ scales. Random-effects models in Stata pooled SMD with 95% CI. Subgroup analyses evaluated SHS-only exposure; sensitivity analyses assessed robustness; publication bias was examined by funnel plots, Egger's regression, and Begg's test. Evidence certainty was graded using GRADE.
[RESULTS] Nine studies were included. Compared with non-exposed participants, smoking or SHS exposure was associated with higher Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) (SMD = 0.16, 95% CI [0.05, 0.27]), Triglyceride (TG) (SMD = 0.25, 95% CI [0.08, 0.42]), Low-Density Lipoprotein Cholesterol (LDL-C) (SMD = 0.16, 95% CI [0.003, 0.33]), Total Testosterone (TT) (SMD = 0.21, 95% CI [0.12, 0.29]) and Free Androgen Index (FAI) (SMD = 0.34, 95% CI [0.14, 0.53]), and lower High-Density Lipoprotein Cholesterol (HDL-C) (SMD = -0.15, 95% CI [-0.25, -0.05]) and Sex Hormone-Binding Globulin (SHBG) (SMD = -0.19, 95% CI [-0.34, -0.04]) (P < 0.05). No significant difference was found in Luteinizing Hormone to Follicle-Stimulating Hormone Ratio (LH/FSH). TG and TT associations persisted in SHS-only groups, whereas HOMA-IR, HDL-C, FAI, and SHBG differences were mainly driven by active smoking. Findings were robust, with no publication bias; GRADE certainty was "very low".
[CONCLUSION] Smoking or SHS exposure was significantly associated with metabolic and hormonal profiles in women with PCOS. Despite observational limitations and absent e-cigarette data, the evidence supports advising PCOS patients to avoid smoking and SHS exposure.
[REGISTRATION] CRD42025633516.
[METHODS] Six databases (CNKI, PubMed, Web of Science, Cochrane Library, Ovid, EMBASE) were searched from inception to 24 April 2025 for observational studies reporting smoking/SHS exposure and ≥1 metabolic or hormonal outcome in PCOS patients. Study quality was assessed using the Newcastle-Ottawa and AHRQ scales. Random-effects models in Stata pooled SMD with 95% CI. Subgroup analyses evaluated SHS-only exposure; sensitivity analyses assessed robustness; publication bias was examined by funnel plots, Egger's regression, and Begg's test. Evidence certainty was graded using GRADE.
[RESULTS] Nine studies were included. Compared with non-exposed participants, smoking or SHS exposure was associated with higher Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) (SMD = 0.16, 95% CI [0.05, 0.27]), Triglyceride (TG) (SMD = 0.25, 95% CI [0.08, 0.42]), Low-Density Lipoprotein Cholesterol (LDL-C) (SMD = 0.16, 95% CI [0.003, 0.33]), Total Testosterone (TT) (SMD = 0.21, 95% CI [0.12, 0.29]) and Free Androgen Index (FAI) (SMD = 0.34, 95% CI [0.14, 0.53]), and lower High-Density Lipoprotein Cholesterol (HDL-C) (SMD = -0.15, 95% CI [-0.25, -0.05]) and Sex Hormone-Binding Globulin (SHBG) (SMD = -0.19, 95% CI [-0.34, -0.04]) (P < 0.05). No significant difference was found in Luteinizing Hormone to Follicle-Stimulating Hormone Ratio (LH/FSH). TG and TT associations persisted in SHS-only groups, whereas HOMA-IR, HDL-C, FAI, and SHBG differences were mainly driven by active smoking. Findings were robust, with no publication bias; GRADE certainty was "very low".
[CONCLUSION] Smoking or SHS exposure was significantly associated with metabolic and hormonal profiles in women with PCOS. Despite observational limitations and absent e-cigarette data, the evidence supports advising PCOS patients to avoid smoking and SHS exposure.
[REGISTRATION] CRD42025633516.
MeSH Terms
Humans; Polycystic Ovary Syndrome; Female; Tobacco Smoke Pollution; Insulin Resistance; Smoking; Testosterone; Sex Hormone-Binding Globulin; Triglycerides
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