College of Nursing, Seoul National University, Seoul 03080, Korea.
Medical Library, Seoul National University, Seoul 03080, Korea.
Int J Environ Res Public Health. 2020 Oct 13;17(20):7438. doi: 10.3390/ijerph17207438.
Obesity is a well-known risk factor for infertility, and nonpharmacological treatments are recommended as effective and safe, but evidence is still lacking on whether nonpharmacological interventions improve fertility in overweight or obese women. The aim of this study was to systematically assess the current evidence in the literature and to evaluate the impact of nonpharmacological interventions on improving pregnancy-related outcomes in overweight or obese infertile women. Seven databases were searched for randomized controlled trials (RCTs) of nonpharmacological interventions for infertile women with overweight or obesity through August 16, 2019 with no language restriction. A meta-analysis was conducted of the primary outcomes. A total of 21 RCTs were selected and systematically reviewed. Compared to the control group, nonpharmacological interventions significantly increased the pregnancy rate (relative risk (RR), 1.37; 95% CI, 1.04-1.81; = 0.03; I² = 58%; nine RCTs) and the natural conception rate (RR, 2.17, 95% CI, 1.41-3.34; = 0.0004; I² = 19%, five RCTs). However, they had no significant effect on the live birth rate (RR, 1.36, 95% CI, 0.94-1.95; =0.10, I² = 65%, eight RCTs) and increased the risk of miscarriage (RR: 1.57, 95% CI, 1.05-2.36; = 0.03; I² = 0%). Therefore, nonpharmacological interventions could have a positive effect on the pregnancy and natural conception rates, whereas it is unclear whether they improve the live birth rate. Further research is needed to demonstrate the integrated effects of nonpharmacological interventions involving psychological outcomes, as well as pregnancy-related outcomes.
肥胖是不孕的已知危险因素，推荐非药物治疗作为有效且安全的方法，但超重或肥胖的不孕妇女接受非药物干预是否能提高生育力，仍缺乏证据。本研究旨在系统评估现有文献中的证据，并评估非药物干预对改善超重或肥胖不孕妇女妊娠相关结局的影响。通过 8 月 16 日无语言限制的检索，在 7 个数据库中搜索了超重或肥胖的不孕妇女接受非药物干预的随机对照试验（RCT）。对主要结局进行了荟萃分析。共选择了 21 项 RCT 进行系统评价。与对照组相比，非药物干预显著提高了妊娠率（相对风险（RR），1.37；95%置信区间（CI），1.04-1.81； = 0.03；I² = 58%；9 项 RCT）和自然受孕率（RR，2.17，95%CI，1.41-3.34； = 0.0004；I² = 19%，5 项 RCT）。然而，它们对活产率没有显著影响（RR，1.36，95%CI，0.94-1.95； = 0.10，I² = 65%，8 项 RCT），且增加了流产风险（RR：1.57，95%CI，1.05-2.36； = 0.03；I² = 0%）。因此，非药物干预可能对妊娠率和自然受孕率有积极影响，但尚不清楚其是否能提高活产率。需要进一步研究来证明非药物干预对心理结局以及妊娠相关结局的综合影响。
