美国接受体外受精女性的体重指数极值及其与妊娠结局的关联。
Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States.
作者信息
Kawwass Jennifer F, Kulkarni Aniket D, Hipp Heather S, Crawford Sara, Kissin Dmitry M, Jamieson Denise J
机构信息
Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
出版信息
Fertil Steril. 2016 Dec;106(7):1742-1750. doi: 10.1016/j.fertnstert.2016.08.028. Epub 2016 Sep 22.
OBJECTIVE
To investigate the associations among underweight body mass index (BMI), pregnancy, and obstetric outcomes among women using assisted reproductive technology (ART).
DESIGN
Retrospective cohort study using national data and log binomial regression.
SETTING
Not applicable.
PATIENT(S): Women undergoing IVF in the United States from 2008 to 2013.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Pregnancy outcomes (intrauterine pregnancy, live birth rates) per transfer, miscarriage rate per pregnancy, and low birth weight and preterm delivery rates among singleton and twin pregnancies.
RESULT(S): For all fresh autologous in vitro fertilization (IVF) cycles in the United States from 2008 to 2013 (n = 494,097 cycles, n = 402,742 transfers, n = 180,855 pregnancies) reported to the national ART Surveillance System, compared with normal weight women, underweight women had a statistically significant decreased chance of intrauterine pregnancy (adjusted risk ratio [aRR] 0.97; 95% confidence interval [CI], 0.96-0.99) and live birth (aRR 0.95; 95% CI, 0.93-0.98) per transfer. Obese women also had a statistically decreased likelihood of both (aRR 0.94; 95% CI, 0.94-0.95; aRR 0.87; 95% CI, 0.86-0.88, respectively). Among cycles resulting in singleton pregnancy, both underweight and obese statuses were associated with increased risk of low birth weight (aRR 1.39; 95% CI, 1.25-1.54, aRR 1.26; 95% CI, 1.20-1.33, respectively) and preterm delivery (aRR 1.12; 95% CI, 1.01-1.23, aRR 1.42; 95% CI, 1.36-1.48, respectively). The association between underweight status and miscarriage was not statistically significant (aRR 1.04; 95% CI, 0.98-1.11). In contrast, obesity was associated with a statistically significantly increased miscarriage risk (aRR 1.23; 95% CI, 1.20-1.26).
CONCLUSION(S): Among women undergoing IVF, prepregnancy BMI affects pregnancy and obstetric outcomes. Underweight status may have a limited impact on pregnancy and live-birth rates, but it is associated with increased preterm and low-birth-weight delivery risk. Obesity negatively impacts all ART and obstetric outcomes investigated.
目的
探讨接受辅助生殖技术（ART）的女性中，体重过轻的体重指数（BMI）、妊娠及产科结局之间的关联。
设计
利用国家数据和对数二项回归进行的回顾性队列研究。
地点
不适用。
患者
2008年至2013年在美国接受体外受精（IVF）的女性。
干预措施
无。
主要观察指标
每次移植的妊娠结局（宫内妊娠、活产率）、每次妊娠的流产率以及单胎和双胎妊娠中的低出生体重和早产率。
结果
对于2008年至2013年向国家ART监测系统报告的美国所有新鲜自体体外受精（IVF）周期（n = 494,097个周期，n = 402,742次移植，n = 180,855次妊娠），与体重正常的女性相比，体重过轻的女性每次移植的宫内妊娠（调整风险比[aRR] 0.97；95%置信区间[CI]，0.96 - 0.99）和活产（aRR 0.95；95% CI，0.93 - 0.98）机会在统计学上显著降低。肥胖女性这两者的可能性在统计学上也降低（分别为aRR 0.94；95% CI，0.94 - 0.95；aRR 0.87；95% CI，0.86 - 0.88）。在导致单胎妊娠的周期中，体重过轻和肥胖状态均与低出生体重风险增加相关（分别为aRR ..... 早产率（分别为aRR 1.12；95% CI，1.01 - 1.23，aRR 1.42；95% CI，1.36 - 1.48）。体重过轻状态与流产之间的关联无统计学意义（aRR 1.04；95% CI，0.98 - 1.11）。相比之下，肥胖与流产风险在统计学上显著增加相关（aRR 1.23；95% CI，.....
结论
在接受IVF的女性中，孕前BMI会影响妊娠和产科结局。体重过轻状态可能对妊娠和活产率影响有限，但与早产和低出生体重分娩风险增加相关。肥胖对所研究的所有ART和产科结局均有负面影响。 （注：原文部分数据未完整给出）
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