不孕女性孕前体质量指数对妊娠结局的影响  

Influence of preconception body mass index on pregnancy outcome in infertile women

作　　者：耿蔷 陈梦青 王琳琳 王丝丝 徐洁敏 曾勇 李龙飞 GENG Qiang;CHEN Mengqing;WANG Linlin;WANG Sisi;XU Jiemin;ZENG Yong;LI Longfei(Shenzhen Zhongshan Urology Hospital,Shenzhen,Guangdong 518000,China)

机构地区：[1]深圳中山泌尿外科医院,广东深圳518000

出　　处：《中国优生与遗传杂志》2023年第10期2115-2120,共6页Chinese Journal of Birth Health & Heredity

基　　金：深圳市医疗卫生三名工程项目(SZSM201502035);深圳市自然科学基金(JCYJ20210324123601004);广东省医学科学技术研究基金(B2022087)。

摘　　要：目的 本研究旨在阐明不孕女性孕前体质量指数(BMI)对首次进行IVF/ICSI新鲜周期妊娠结局的影响。方法 回顾性分析2010—2018年期间首次接受IVF-ET/ICSI新鲜胚胎移植的7656例不孕症患者的临床资料,比较不同孕前体质量指数组的妊娠结局。结果 体质量过低患者比体质量正常患者发生原发不孕症的比例更高(P<0.001),可获得优质胚胎的周期数显著低于正常体质量组(P<0.05);超重及肥胖患者不孕年限更长且排卵障碍者占比更高(P<0.01);各组的胚胎着床率、临床妊娠率、活产率及早产率无显著性差异(P>0.05);与正常组相比,超重组与肥胖组流产率显著升高(P<0.05),尤其是晚期流产率显著升高(P<0.05)。BMI升高与流产、早产、剖宫产及妊娠并发症(妊娠糖尿病、妊娠高血压)呈正相关。Logistic回归分析表明,孕前BMI升高与流产风险增加相关(aOR·1.921,95%CI:1.158~3.186,P=0.011)。结论 孕前BMI升高与女性生育潜力降低、流产风险增加及妊娠并发症发生率升高有关。Objective This study aimed to elucidate the effect of pre-pregnancy body mass index(BMI)on IVF/ICSI fresh cycle pregnancy outcomes in infertile women.Methods The clinical data of 7656 infertility patients who received fresh embryo transfer with IVF-ET/ICSI for the first time during 2010—2018 were retrospectively analyzed,and the pregnancy outcomes of different preconception body mass index groups were compared.Results Compared with normal weight group,underweight group had a higher incidence of primary infertility(P<0.001),and the number of cycles to obtain high-quality embryos was significantly reduced(P<0.05).Overweight group and obese group had longer years of infertility and a higher proportion of ovulation disorders(P<0.01).There were no significant differences in embryo implantation rate,clinical pregnancy rate,live birth rate and preterm birth rate between the groups(P>0.05).Compared with the normal group,the miscarriage rate was significantly increased in the hyperrecombinant and obese groups(P<0.05),especially in late miscarriage(P<0.05).Elevated BMI is positively associated with miscarriage,preterm birth,caesarean section,and pregnancy complications(gestational diabetes,gestational hypertension).Logistic regression analysis showed that increased preconception BMI was associated with an increased risk of miscarriage after adjusting for confounding variables for age,number of embryos transferred,and embryo quality(aOR:1.921,95%CI:1.158-3.186,P=0.011).Conclusion Elevated pre-pregnancy BMI is associated with reduced fertility potential,increased risk of abortion and increased incidence of pregnancy complications.

关 键 词：GNRH激动剂 BMI 新鲜胚胎移植 体外受精-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]