Clinical Assistant Professor.
Resident Physician, Department of Obstetrics and Gynecology, University of Kansas, Kansas City, KS.
Obstet Gynecol Surv. 2014 Oct;69(10):622-8. doi: 10.1097/OGX.0000000000000115.
Obesity is associated with multiple adverse reproductive outcomes such as infertility, ovulation dysfunction, miscarriage, preeclampsia, gestational diabetes mellitus, preterm delivery, operative delivery, and fetal growth disorders. Although the prevalence of maternal obesity is increasing, it is unclear which method of weight loss is most effective before conception to improve reproductive outcomes. This article reviews the amount of weight loss needed to improve ovulation and fertility, behavioral methods for optimal weight loss, as well as medical and surgical interventions to promote weight loss with the intention of providing a tool to promote weight loss in the preconception period. Behavioral modification that includes motivational interviewing, energy intake restriction, and increased energy expenditure is first-line therapy. Behavioral therapy has been shown to improve menstrual cyclicity, ovulation, conception rates, hormone profile, and amount of weight loss. Bariatric surgery and drug therapy may be used in overweight or obese patients who fail behavioral modification. However, women who undergo bariatric surgery or drug therapy must be cautioned about safety profiles, nutritional requirements, and some adverse pregnancy outcomes such as intrauterine growth restriction. There are several areas for further investigation including amount of weight loss needed to resume ovulation by obesity class and improve reproductive outcomes, safety and efficacy of very low energy diets in the preconception period, as well as safety of obesity medications in the preconception period.
肥胖与多种不良生殖结局相关，如不孕、排卵功能障碍、流产、子痫前期、妊娠期糖尿病、早产、剖宫产和胎儿生长障碍。尽管母体肥胖的患病率在不断增加，但目前仍不清楚在受孕前采用哪种减肥方法最能有效改善生殖结局。本文综述了改善排卵和生育力所需的减肥量、最佳减肥的行为方法，以及促进减肥的医疗和手术干预措施，旨在为促进受孕前减肥提供一种工具。包括动机访谈、能量摄入限制和增加能量消耗的行为改变是一线治疗方法。行为治疗已被证明可以改善月经周期、排卵、受孕率、激素水平和减肥量。对于行为改变失败的超重或肥胖患者，可以使用减肥手术和药物治疗。但是，必须告知接受减肥手术或药物治疗的女性有关安全性、营养需求以及一些不良妊娠结局（如宫内生长受限）的问题。还有几个领域需要进一步研究，包括肥胖程度恢复排卵和改善生殖结局所需的减肥量、极低能量饮食在受孕前的安全性和有效性，以及肥胖症药物在受孕前的安全性。
