Bond Rachel Talia, Nachef Alexandra, Adam Catherine, Couturier Marielle, Kadoch Isaac-Jacques, Lapensée Louise, Bleau Gilles, Godbout Ariane
Endocrinology Division, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal, Quebec, Canada.
J Reprod Infertil. 2020 Jan-Mar;21(1):34-41.
The metabolic global approach is a multidisciplinary intervention for obese women before undergoing assisted reproductive techniques, with the goal of improving fertility and decreasing adverse pregnancy outcomes. The objective of this study was to evaluate the impact of the metabolic global approach on pregnancy rate.
This retrospective cohort study included 127 women and was conducted at the Centre hospitalier de l'Université de Montréal fertility center. Eligibility included BMI at initial consultation of ≥30 . Fertility treatments were considered when a weight loss of minimum 5% and normal metabolic indices were achieved. The p<0.05 was considered statistically significant.
Median baseline and last clinical assessment BMIs were 38.2 and 35.8 respectively (p<0.001), representing a median weight loss of 5.1%. At baseline, at least one metabolic parameter was abnormal in 66% of women. Total pregnancy rate was 53%. The majority of women (63%) who achieved pregnancy did so with weight loss and metabolic stabilization alone (11%) or combined with metformin (36%) and/or oral ovulation drugs (16%). Normal vitamin D (p<0.001) and triglyceride levels (p<0.05) as well as lower BMI after weight loss (p<0.05) were associated with an increased relative risk of pregnancy.
Replete vitamin D status, weight loss of 5% and lower BMI as well as normal triglyceride level are significant and independent predictors of pregnancy in obese women presenting to our fertility center. The metabolic global approach is an effective program to detect metabolic abnormalities and improve obese women's pregnancy rate.
代谢综合疗法是一种针对肥胖女性在接受辅助生殖技术之前的多学科干预措施，旨在提高生育能力并降低不良妊娠结局。本研究的目的是评估代谢综合疗法对妊娠率的影响。
这项回顾性队列研究纳入了127名女性，在蒙特利尔大学中心医院生育中心进行。纳入标准包括初次咨询时BMI≥30。当体重减轻至少5%且代谢指标正常时考虑进行生育治疗。p<0.05被认为具有统计学意义。
基线和末次临床评估时BMI的中位数分别为38.2和35.8（p<0.001），代表体重中位数减轻了5.1%。基线时，66%的女性至少有一项代谢参数异常。总妊娠率为53%。大多数成功妊娠的女性（63%）仅通过体重减轻和代谢稳定（11%）或联合二甲双胍（36%）和/或口服促排卵药物（16%）实现。维生素D正常（p<0.001）、甘油三酯水平正常（p<0.05）以及体重减轻后BMI较低（p<0.05）与妊娠相对风险增加相关。
充足的维生素D状态、5%的体重减轻、较低的BMI以及正常的甘油三酯水平是到我们生育中心就诊的肥胖女性妊娠的重要且独立预测因素。代谢综合疗法是一种检测代谢异常并提高肥胖女性妊娠率的有效方案。
