Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.
Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
BJOG. 2019 Jun;126(7):852-862. doi: 10.1111/1471-0528.15647. Epub 2019 Mar 10.
To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m versus BMI ≥ 30 kg/m ).
Retrospective cohort study.
Multiple centres (in Australia, Ireland, New Zealand, and the UK).
Five thousand five hundred and nineteen low-risk nulliparous pregnant women.
Data on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log-normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors.
Time to pregnancy and infertility.
Of the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15-1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0-3.3 months) versus 4.1 months (3.6-4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15-2.29) or not (adjusted RR 1.73; 95% CI 1.33-2.23). Reduced high-density lipoprotein cholesterol (HDL-C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility.
Metabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification.
Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity.
确定：（1）代谢综合征（MetS）、妊娠时间（TTP）和不孕之间的关系；（2）个体和越来越多的 MetS 成分与 TTP 和不孕之间的关系；以及（3）这些关系是否因体重指数（BMI<30 kg/m 与 BMI≥30 kg/m 而有所不同。
回顾性队列研究。
多个中心（澳大利亚、爱尔兰、新西兰和英国）。
5519 名低风险初产妇。
在妊娠 14 至 16 周时，收集了回顾性报告的 TTP（受孕所需的月数）和评估代谢健康的血样数据。MetS 根据国际糖尿病联合会的标准定义。使用对数正态分布的加速失效时间模型估计时间比（TR）和 95%置信区间。使用广义线性模型（泊松分布）和稳健方差估计（相对风险，RR；95%置信区间）比较 MetS 对不孕（TTP>12 个月）的差异。所有分析（整个队列和按 BMI 分组）均控制了一系列母体和父体混杂因素。
妊娠时间和不孕。
在 5519 名女性中，12.4%（n=684）患有 MetS。与无 MetS 的女性相比，患有 MetS 的女性 TTP 较长（调整后的 TR 1.30；95%CI 1.15-1.46），肥胖和非肥胖女性的 TTP 相似。患有 MetS 的女性与无 MetS 的女性的中位 TTP 估计值分别为 3.1 个月（3.0-3.3 个月）和 4.1 个月（3.6-4.5 个月）。患有 MetS 的女性不孕风险增加 62%，且无论肥胖与否（调整后的 RR 1.62；95%CI 1.15-2.29）或不肥胖（调整后的 RR 1.73；95%CI 1.33-2.23），其不孕风险均更高。高密度脂蛋白胆固醇（HDL-C）降低和甘油三酯（TGs）升高是与不孕风险相关的主要个体成分。
代谢综合征与 TTP 延长和不孕有关，与肥胖无关。需要在怀孕前进行更多的研究，以支持我们的发现，并确定哪些代谢异常组合对延迟生育构成最大风险，或者是否可以改变个别成分。
代谢综合征与妊娠时间延长和不孕有关，与肥胖无关。
