Honein Margaret A, Moore Cynthia A, Watkins Margaret L
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Birth Defects Res A Clin Mol Teratol. 2003 Aug;67(8):572-7. doi: 10.1002/bdra.10077.
Maternal subfertility and high body mass index (BMI) are both associated with adverse reproductive outcomes, including some birth defects. One study reported an association between subfertility and renal anomalies (Li, 1999).
We defined subfertility as the mother's report that she sought fertility treatment from a doctor/clinic, and high BMI as a prepregnancy BMI > or = 25. We included 169 infants with renal anomalies (renal agenesis [n = 41], obstructive defects [n = 117], and duplication defects [n = 11]) and 2763 infants without defects who were born in 1968-1980 in metropolitan Atlanta, after excluding mothers who reported diabetes. Conditional logistic regression (matching variables: race, birth hospital, and birth period) was used to obtain effect estimates (adjusted for maternal age and gestational age).
Subfertility was more common among case-mothers (11.8%) than control-mothers (7.8%), high BMI was similar among case-mothers (11.2%) and control-mothers (10.9%), and joint exposure (subfertility and high BMI) was reported by 3% case-mothers and 0.7% of control-mothers. Joint exposure to subfertility and high BMI was associated with renal anomalies (odds ratio [OR] = 5.8; 95% confidence interval [CI] = 2.0-16.3). All case-mothers who reported a joint exposure had infants with obstructive renal anomalies (OR = 8.5; 95% CI = 2.9-24.7). There was no association observed for either exposure alone (subfertility and low BMI, or high BMI and no subfertility) for either all renal anomalies or obstructive defects.
Women who are overweight/obese and experience subfertility may be more likely to have an infant with an obstructive renal anomaly. Further exploration of possible biologic mechanisms is needed.
母体生育力低下和高体重指数（BMI）均与不良生殖结局相关，包括一些出生缺陷。一项研究报告了生育力低下与肾脏异常之间的关联（Li，1999年）。
我们将生育力低下定义为母亲报告她曾向医生/诊所寻求生育治疗，将高BMI定义为孕前BMI≥25。我们纳入了169例患有肾脏异常的婴儿（肾缺如[n = 41]、梗阻性缺陷[n = 117]和重复畸形[n = 11]）以及1968 - 1980年在亚特兰大大都市出生的2763例无缺陷婴儿，排除了报告患有糖尿病的母亲。采用条件逻辑回归（匹配变量：种族、出生医院和出生时期）来获得效应估计值（对母亲年龄和孕周进行了调整）。
病例组母亲中生育力低下的情况（11.8%）比对照组母亲（7.8%）更常见，病例组母亲中高BMI的情况（11.2%）与对照组母亲（10.9%）相似，3%的病例组母亲和0.7%的对照组母亲报告了联合暴露（生育力低下和高BMI）。生育力低下和高BMI的联合暴露与肾脏异常相关（优势比[OR] = 5.8；95%置信区间[CI] = 2.0 - 16.3）。所有报告联合暴露的病例组母亲所生婴儿均患有梗阻性肾脏异常（OR = 8.5；95% CI = 2.9 - 24.7）。对于所有肾脏异常或梗阻性缺陷，单独的任何一种暴露（生育力低下和低BMI，或高BMI且无生育力低下）均未观察到关联。
超重/肥胖且生育力低下的女性可能更有可能生育患有梗阻性肾脏异常的婴儿。需要进一步探索可能的生物学机制。
