Division of Endocrinology Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado.
Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Fertil Steril. 2024 Aug;122(2):326-340. doi: 10.1016/j.fertnstert.2024.02.038. Epub 2024 Feb 24.
Weight loss before conception is recommended for women with overweight or obesity to improve fertility outcomes, but evidence supporting this recommendation is mixed.
To examine the effectiveness of weight loss interventions using lifestyle modification and/or medication in women with overweight or obesity on pregnancy, live birth, and miscarriage.
An electronic search of MEDLINE, Embase, Cochrane Library, including Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature was conducted through July 6, 2022, via Wiley.
Randomized controlled trials examining weight loss interventions through lifestyle and/or medication in women with overweight or obesity planning pregnancy were included. Random-effects meta-analysis was conducted, reporting the risk ratio (RR) for each outcome. Subgroup analyses were conducted by intervention type, type of control group, fertility treatment, intervention length, and body mass index (BMI).
MAIN OUTCOME(S): Clinical pregnancy, live birth, and miscarriage events.
RESULT(S): A narrative review and meta-analysis were possible for 16 studies for pregnancy (n = 3,588), 13 for live birth (n = 3,329), and 11 for miscarriage (n = 3,248). Women randomized and exposed to a weight loss intervention were more likely to become pregnant (RR = 1.24, 95% CI 1.07-1.44; I = 59%) but not to have live birth (RR = 1.19, 95% CI 0.97-1.45; I = 69%) or miscarriage (RR = 1.17, 95% CI 0.79-1.74; I = 31%) compared with women in control groups. Subgroup analyses revealed women randomized to weight loss interventions lasting 12 weeks or fewer (n = 9, RR = 1.43; 95% CI 1.13-1.83) and women with a BMI ≥ 35 kg/m (n = 7, RR = 1.54; 95% CI, 1.18-2.02) were more likely to become pregnant compared with women in the control groups. Miscarriage was higher in intervention groups who underwent fertility treatment (n = 8, RR 1.45; 95% CI 1.07-1.96).
CONCLUSION(S): Pregnancy rates were higher in women undergoing preconception weight loss interventions with no impact on live birth or miscarriage rates. Findings do not support one-size-fits-all recommendation for weight loss through lifestyle modification and/or medication in women with overweight or obesity immediately before conception to improve live birth or miscarriage outcomes.
超重或肥胖的女性在怀孕前减肥有助于改善生育结局，但支持这一建议的证据不一。
研究通过生活方式改变和/或药物干预超重或肥胖女性体重对妊娠、活产和流产的有效性。
通过 Wiley 公司于 2022 年 7 月 6 日在 MEDLINE、Embase、Cochrane 图书馆（包括 Cochrane 系统评价数据库和 Cochrane 对照试验中心注册库）和 Cumulative Index to Nursing and Allied Health Literature 中进行了电子检索。
纳入了计划妊娠的超重或肥胖女性通过生活方式和/或药物进行减肥干预的随机对照试验。进行了随机效应荟萃分析，报告了每个结局的风险比 (RR)。通过干预类型、对照组类型、生育治疗、干预时间和体重指数 (BMI) 进行了亚组分析。
临床妊娠、活产和流产事件。
对于妊娠（n = 3588）、活产（n = 3329）和流产（n = 3248），可以进行叙述性综述和荟萃分析的有 16 项研究、13 项研究和 11 项研究。与对照组相比，随机接受减肥干预并暴露于减肥干预的女性更有可能怀孕（RR = 1.24，95%CI 1.07-1.44；I = 59%），但不太可能活产（RR = 1.19，95%CI 0.97-1.45；I = 69%）或流产（RR = 1.17，95%CI 0.79-1.74；I = 31%）。亚组分析显示，随机分配至减肥干预持续 12 周或更短时间（n = 9，RR = 1.43；95%CI 1.13-1.83）和 BMI ≥ 35 kg/m （n = 7，RR = 1.54；95%CI，1.18-2.02）的女性与对照组相比，更有可能怀孕。接受生育治疗的干预组流产率较高（n = 8，RR 1.45；95%CI 1.07-1.96）。
在接受孕前减肥干预的女性中，妊娠率更高，但对活产或流产率没有影响。研究结果不支持超重或肥胖女性在怀孕前通过生活方式改变和/或药物减肥以改善活产或流产结局的一刀切建议。
