Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih-Lin District, Taipei, 111, Taiwan.
Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
BMC Pregnancy Childbirth. 2023 Apr 26;23(1):291. doi: 10.1186/s12884-023-05620-7.
Obesity is increasing globally, which affects multiple human functions, including reproductive health. Many women with overweight and obesity of child-bearing years are treated with assisted reproductive technology (ART). However, the clinical impact of body mass index (BMI) on pregnancy outcomes after ART remains to be determined. Therefore, this population-based retrospective cohort study aimed to assess whether and how higher BMI affects singleton pregnancy outcomes.
This study used the large nationally representative database of the US National Inpatient Sample (NIS), extracting data of women with singleton pregnancies who had received ART from 2005 to 2018. Diagnostic codes of the International Classification of Diseases, Ninth and Tenth edition (ICD-9 and ICD-10) were used to identify females admitted to US hospitals with delivery-related discharge diagnoses or procedures and secondary diagnostic codes for ART, including in vitro fertilization. The included women were further categorized into three groups based on BMI values < 30, 30-39, and ≥ 40 kg/m. Univariate and multivariable regression analysis were conducted to assess the associations between study variables and maternal and fetal outcomes.
Data of totally 17,048 women were included in the analysis, which represented a population of 84,851 women in the US. Number of women in the three BMI groups were 15, 878 (BMI < 30 kg/m), 653 (BMI 30-39 kg/m), and 517 (BMI ≥ 40 kg/m), respectively. The multivariable regression analysis revealed that, compared to BMI < 30 kg/m, BMI 30-39 kg/m was significantly associated with increased odds for pre-eclampsia and eclampsia (adjusted OR = 1.76, 95% CI = 1.35, 2.29), gestational diabetes (adjusted OR = 2.25, 95% CI = 1.70, 2.98), and Cesarean delivery (adjusted OR = 1.36, 95% CI = 1.15, 1.60). Further, BMI ≥ 40 kg/m was associated with greater odds for pre-eclampsia and eclampsia (adjusted OR = 2.25, 95% CI = 1.73, 2.94), gestational diabetes (adjusted OR = 3.64, 95% CI = 2.80, 4.72), disseminated intravascular coagulation (DIC) (adjusted OR = 3.79, 95% CI = 1.47, 9.78), Cesarean delivery (adjusted OR = 1.85, 95% CI = 1.54, 2.23), and hospital stay ≥ 6 days (adjusted OR = 1.60, 95% CI = 1.19, 2.14). However, higher BMI was not significantly associated with greater risk of the fetal outcomes assessed.
Among US pregnant women who received ART, having a higher BMI level independently increases the risk for adverse maternal outcomes such as pre-eclampsia and eclampsia, gestational diabetes, DIC, longer hospital stays, and higher rates of Cesarean delivery, while risk is not increased for fetal outcomes.
肥胖症在全球范围内呈上升趋势，这影响了包括生殖健康在内的多种人体功能。许多处于生育年龄的超重和肥胖女性接受辅助生殖技术（ART）治疗。然而，BMI 对 ART 后 singleton 妊娠结局的临床影响仍有待确定。因此，本基于人群的回顾性队列研究旨在评估较高的 BMI 是否以及如何影响 singleton 妊娠结局。
本研究使用了美国全国住院患者样本（NIS）的大型全国代表性数据库，提取了 2005 年至 2018 年接受 ART 的 singleton 妊娠女性的数据。国际疾病分类，第九和第十版（ICD-9 和 ICD-10）的诊断代码用于识别因分娩相关出院诊断或手术而入住美国医院的女性以及 ART 的二级诊断代码，包括体外受精。根据 BMI 值 <30、30-39 和 ≥40 kg/m，将纳入的女性进一步分为三组。进行单变量和多变量回归分析，以评估研究变量与母婴结局之间的关系。
共纳入 17048 名女性的数据，代表了美国 84851 名女性的人口。三组 BMI 女性的数量分别为 15、878 名（BMI <30 kg/m）、653 名（BMI 30-39 kg/m）和 517 名（BMI ≥40 kg/m）。多变量回归分析显示，与 BMI <30 kg/m 相比，BMI 30-39 kg/m 与子痫前期和子痫（调整后的 OR=1.76，95%CI=1.35，2.29）、妊娠期糖尿病（调整后的 OR=2.25，95%CI=1.70，2.98）和剖宫产（调整后的 OR=1.36，95%CI=1.15，1.60）的发生几率增加显著相关。此外，BMI ≥40 kg/m 与子痫前期和子痫（调整后的 OR=2.25，95%CI=1.73，2.94）、妊娠期糖尿病（调整后的 OR=3.64，95%CI=2.80，4.72）、弥散性血管内凝血（DIC）（调整后的 OR=3.79，95%CI=1.47，9.78）、剖宫产（调整后的 OR=1.85，95%CI=1.54，2.23）和住院时间≥6 天（调整后的 OR=1.60，95%CI=1.19，2.14）的几率增加显著相关。然而，较高的 BMI 与胎儿结局评估的风险增加无关。
在美国接受 ART 的孕妇中，较高的 BMI 水平独立增加了不良母婴结局的风险，如子痫前期和子痫、妊娠期糖尿病、DIC、住院时间延长和剖宫产率增加，而胎儿结局的风险没有增加。
