Liu L, Wang H, Zhang Y, Niu J, Li Z, Tang R. Effect of pregravid obesity on perinatal outcomes in singleton pregnancies following in vitro fertilization and the weight-loss goals to reduce the risks of poor pregnancy outcomes: A retrospective cohort study.
PLoS One 2020;
15:e0227766. [PMID:
32053669 PMCID:
PMC7027660 DOI:
10.1371/journal.pone.0227766]
[Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022] Open
Abstract
Objective
In the present study, we aimed to determine whether pregravid obesity
independently predicts increased risks of perinatal complications following
in vitro fertilization (IVF) and the weight loss goals to reduce the risk of
poor pregnancy outcomes.
Design
Retrospective cohort study.
Population
All pregnancies after first the fresh IVF cycle from January 2014 to December
2016 in the Reproductive Center affiliated to Shandong University were
reviewed. A total of 3,962 eligible singleton births were stratified into
cohorts based on the body mass index (BMI) definitions of the Working Group
on Obesity in China (WGOC).
Main outcome measures
Adverse perinatal outcomes.
Results
Pregravid overweight and obesity were associated with increased risks of
gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy
(HDP), including gestational hypertension (GH) and pre-eclampsia (PE),
polyhydramnios, preterm premature rupture of the membranes (PPROM),
placental abruption, preterm birth (PTB) <37 weeks, caesarean section
(CS), fetal macrosomia, large for gestational age (LGA) >90th percentile,
neonatal respiratory distress syndrome (NRDS), neonatal intensive care unit
(NICU) admission and congenital anomalies as compared with the normal-weight
group after adjustment of differences in age, parity, polycystic ovary
syndrome (PCOS) and type of controlled ovarian hyperstimulation (COH). The
increased risks of PPROM, NRDS and congenital anomalies were eliminated
after adjustment of GDM development, whereas the increased risk of NRDS
disappeared after adjustment of HDP. Placenta previa was not significantly
different between the obese group and reference group (REF). Moreover, the
rates of postpartum hemorrhage (PPH), PTB<32 weeks, small for gestational
age (SGA) >90th percentile and perinatal mortality were also not
significantly different between above-mentioned two groups. For obese women,
a 10%-15% reduction in prepregnancy BMI was associated with significantly
decreased risks of GH, CS and fetal macrosomia. For overweight women, just a
5% reduction in BMI could significantly reduce the risks of GDM, CS and
fetal macrosomia.
Conclusions
Pregravid obesity could independently predict a higher risk of adverse
pregnancy outcomes after adjustment of differences in maternal age, parity,
PCOS, and type of COH in IVF pregnancies. The potential mechanism that
obesity potentiated the risks of some poor perinantal outcomes might occur
through the development of GDM and HDP. A 10%-15% reduction in pregravid BMI
for obese women and a 5% reduction for overweight women were associated with
a significant reduction of poor perinatal complications.
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