The Effect Of Female Obesity On Reproductive And Perinatal Outcomes Of First Assisted Reproductive Technology Cycles

Background and objectivesObesity is a well-documented global health problem,women of reproductive age who are obese has been rising dramatically.Rates of obesity in the developing world have tripled in the last two decades,raising major social and economic burden on our society.Body mass index(BMI)was often used to define the degree of obesity,which is measured by square of height(m)divided by weight(kg).The World Health Organization(WHO)estimates that 1.6 billion people worldwide are overweight[BMI between 25 and30 kg/m2]and 400 million are obese(BMI>30 kg/m2).It has been projected(based on current incidence figures)that by 2030 nearly 40%of the world's population will be overweight and one in five people will be obese.Now there is an increased prevalence of infertility among overweight and obese women,about one in seven couples are thought to be either directly or indirectly related to obesity,and the clinical impact of obesity on female infertilityhas been well characterized.Previous literature provides consistent evidence that female obesity is associated with ovulatory dysfunction;increased time to pregnancy;increased pregnancy loss,exerting a negative influence on female fertility.Overweight and obesity are also associated with perinatal complications and poor outcomes in spontaneous pregnancy,such as hypertension,preeclampsia,gestational diabetes,failure of labor induction,operative delivery,post-partum hemorrhage.Higher rates of operative delivery including cesarean section,wound infections and thromboembolic events also characterize the peripartum period.Children born to obese women are at increased risk of fetal macrosomia,shoulder dystocia,fetal distress,congenital and growth abnormalities,and in the long term have higher risks for childhood and adolescent obesity.These detrimental effects of maternal obesity during pregnancy and childhood development are well established.Moreover,there are many studies related to the issue of the impact on assisted conceptions and get much achievement.Many large cohort studies did demonstrate that overweight and obese women receive inferior ART outcomes,such as implantation rate,clinical pregnancy rate,pregnancy loss rate,and live birth rate,either with or without polycystic ovarian syndrome(PCOS).Several studies suggested that an increased BMI had no adverse effects on ART clinical outcomes.The obstetric and neonatal outcomes of the infertile achieve pregnancy with IVF or ICSI is less likely to be discussed.To our knowledge,no data have been reported in this area.Thus,the purpose of this study was not only to assess if increasing female BMI is related to adverse reproductive outcomes,but also perinatal outcomes such as term delivery and the health of the infant and mother..Materials and methodsThe study contains two parts:Part 1.In this analysis,We conducted a retrospective chart review of all first fresh ART(IVF/ICSI)cycle performed at hospital for reproductive medicine affiliated to Shandong University from January 1,2009,to December 31,2016,using the electronic medical record database.Women included were aged 20-40 years,having their first IVF.ICSI or IVF/ICSI cycle using fresh autologous oocytes.Patients were also excluded from the study if they had congenital or acquired uterine anomalies,endometrial polyps,intrauterine synechiae,intra-cavitary fibroids,history of pelvic tuberculosis,history of operation on cervix and cervical incompetence,abnormal results on parental karyotyping.All the selected patients underwent ovarian stimulation with a standard long GnRH agonist protocol.Women were grouped by their body mass index(BMI)Body mass index was calculated as weight in kilograms divided by the square of their height in meters(kg/m2).Weight and height was measured at the cycle start and with standardized protocols.We use the most recent World Health Organization(WHO)classification of BMI categories to divide our population into four groups:underweight(<18.5kg/m2),normal weight(18.5-24.9 kg/m2),overweight(25.0-29.9 kg/m2),or obese(>30 kg/m2,).For this material,we analysis the effect of BMI on reproductive outcomes.Part2:.A retrospective analysis of women who get term delivery was selected from Part 1.Because some of the neonatal outcomes were not followed up(we called all the patients to investigate the obstetric and neonatal outcomes,so the lost people are of no bias and the selected patients are randomized),a total of 1702 patients were included.Exclusion criteria included:? diabetes mellitus,?hypertension.Due to the low number of obese group,we put the overweight and obese as one category.ResultsThe clinical pregnancy rate decreased with increasing BMI from 63.08%in underweight patients to54.29%in the highest BMI categories,the same were to live birth rate and term delivery rate.The group of overweight[live birth(OR:0.79,95%CI:0.74-0.84),pregnancy loss(OR:1.19,95%CI:1.06-1.34),term delivery(OR:0.80,95%CI:0.75-0.85)]and the obese category[live birth(OR:0.74,95%CI:0.65-0.84),pregnancy loss(OR:1.46,95%CI:1.18-1.79),term delivery(OR:0.72,95%CI:0.63-0.82)]show a negative effect on pregnancy outcomes and progressively worsened as BMI increased.The miscarriage rate increased gradually with the increase of BMI,the obese group reached 12.08%,(OR=1.46;95%CI 1.18?1.79).Preterm delivery rate performed a increasing rate as BMI increased and the obese group(OR:1.31,95%CI:1.04-1.65)shows statistical difference.The overweight and obese resulted in a higher frequency of gestationl diabetes mellitus(GDM)(OR:2.83,95%Cl:1.65-4.86),hypertensive disorder complicating pregnancy(HDCP)(OR:1.96,95%Cl:1.20-3.19)and fetal macrosomia(OR:1.84,95%CI:1.33-2.55).All the above indicators are statistically significant between the normal weight and the high BMIs.A trend could be observed with increased ORs for c-section(OR:1.41,95%CI:0.95-2.08)and infant congenital anomalies(OR:1.45,95%CI:0.91-2.33),although there were no significant differences between group.Additional analyses assessing perinatal compications between normal weight and high BMIs,Postpartum hemorrage(OR:0.78,95%CI:0.29-2.11)and NICU admission(OR:1.04,95%CI:0.60-1.83)failed to show a negative effect.In a further analysis,patients who underwent their first fresh IVF cycle was included,the same results was observed.ConclusionsIn summary,our findings suggest that in patients undergoing their first fresh ART cycle,the overweight and obese population demonstrate poorer pregnancy outcomes.High BMI decreases the odds of live birth and term delivery rate,increases maternal and neonatal compications,which include preterm delivery rate,the odds of GDM,HDCP,caesarean section as well as fetal macrosomia.There was no difference between each group for postpartum hemorrhage and NICUadmission.