Espinós Juan J, Solà Ivan, Valli Claudia, Polo Ana, Ziolkowska Lucja, Martínez-Zapata M José
Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain. Electronic Address:
IbCC Iberoamerican Cochrane Center, Barcelona, Spain.
Int J Fertil Steril. 2020 Apr;14(1):1-9. doi: 10.22074/ijfs.2020.5921. Epub 2020 Feb 25.
Obesity has been associated with negative effects on natural fertility and poor prognosis when assisted reproductive technologies (ART) are performed. Patients attending for fertility treatments are often advised to optimize their weights to improve the outcomes. There is lack of enough information on how weight-loss would be effective for improving fertility in women who are overweight or obese. We conducted a systematic review to evaluate whether weight-loss achieved by lifestyle program improves natural or assisted reproduction in obese infertile women. We searched CENTRAL, MEDLINE, and EMBASE up to March 2018. Two reviews were selected as randomised trials assessing a lifestyle intervention in women with obesity before receiving treatments for infertility and appraised their risk of bias. We extracted data on pregnancy, birth, and miscarriage rates as the primary outcomes and pooled effect estimates using a random effects model. The primary outcome was the live birth rate. We reported summary measures as the relative risk (RR), 95% confidence interval (CI), and percentage of heterogeneity (I). We included eight randomised trials with 1175 women. Lifestyle programmes, improved pregnancy rates (RR: 1.43, CI: 95% 1.02 to 2.01; I=60%; 8 RCTs; N=1098) but had no impact on live births (RR: 1.39, CI: 95% 0.90 to 2.14; I=64%; 7RCTs; N=1034). Our findings suggest that women participating in lifestyle interventions had an increased risk of miscarriage (RR: 1.50, CI: 95% 1.04 to 2.16; I=0; 6RCTs; N=543). We rated the quality of evidence for these outcomes as the moderate-to-low. Lifestyle interventions slightly increased the pregnancy rate, while it would be uncertain whether it can improve the live birth. Lifestyle interventions can increase the risk of miscarriage. More research is needed to further explore lifestyle interventions on reproductive outcomes in obese infertile women.
肥胖与自然生育能力的负面影响以及进行辅助生殖技术（ART）时的不良预后相关。寻求生育治疗的患者通常被建议优化体重以改善治疗结果。关于减肥如何有效改善超重或肥胖女性的生育能力，目前缺乏足够的信息。我们进行了一项系统综述，以评估通过生活方式干预实现的体重减轻是否能改善肥胖不孕女性的自然受孕或辅助生殖情况。我们检索了截至2018年3月的CENTRAL、MEDLINE和EMBASE数据库。选择了两项作为随机试验的综述，评估肥胖女性在接受不孕治疗前的生活方式干预，并评估其偏倚风险。我们提取了妊娠、分娩和流产率的数据作为主要结局，并使用随机效应模型汇总效应估计值。主要结局是活产率。我们报告的汇总指标为相对风险（RR）、95%置信区间（CI）和异质性百分比（I）。我们纳入了八项随机试验，涉及1175名女性。生活方式干预提高了妊娠率（RR：1.43，CI：95% 1.02至2.01；I = 60%；8项随机对照试验；N = 1098），但对活产没有影响（RR：1.39，CI：95% 0.90至2.14；I = 64%；7项随机对照试验；N = 1034）。我们的研究结果表明，参与生活方式干预的女性流产风险增加（RR：1.50，CI：95% 1.04至2.16；I = 0；6项随机对照试验；N = 543）。我们将这些结局的证据质量评为中低等。生活方式干预略微提高了妊娠率，但其是否能改善活产尚不确定。生活方式干预会增加流产风险。需要更多研究来进一步探索生活方式干预对肥胖不孕女性生殖结局的影响。
