Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States

Kawwass, Jennifer F.; Kulkarni, Amita; Hipp, Heather S.; Crawford, Sara; Kissin, Dmitry M.; Jamieson, Denise J.

doi:10.1016/j.fertnstert.2016.08.028

Cited by 128 publications

(118 citation statements)

References 22 publications

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“…A large study that evaluated the influence of BMI on all autologous fresh in vitro fertilization (IVF) cycles in the United States from 2008 to 2013 ( n = 494 097 cycles, n = 402 742 transfers, n = 180 855 pregnancies) found that obese women had a statistically lower likelihood of intrauterine pregnancy (RR, 0.94; 95% CI, 0.94–0.95) and live birth (RR, 0.87; 95% CI, 0.86–0.88). Obesity has been associated with a significantly higher risk of miscarriages (RR, 1.23; 95% CI, 1.20–1.26) . These results are similar to those of other studies and meta‐analyses …”

Section: Discussionsupporting

confidence: 89%

Obesity and recurrent miscarriage: A systematic review and meta‐analysis

Cavalcante

Sarno

Peixoto

et al. 2018

J of Obstet and Gynaecol

110

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The aim of this study is to perform a systematic review and meta-analysis on the relationship between excess weight and risk of recurrent pregnancy loss (RPL) and to highlight the common immunological mechanisms of these two conditions. The PubMed and MEDLINE databases were searched for publications in English available as of November 2017. The search terms used were 'recurrent pregnancy loss', 'body mass index' (BMI), 'overweight' and 'obesity'. For calculation of the odds ratio (OR) and 95% confidence intervals (CI) for miscarriage in different BMI groups, RevMan software was used (Review Manager, Version 5.3.5 for Windows; The Cochrane Collaboration). In total, 100 publications including the search terms were identified. Six studies were included for qualitative analysis, and two studies were included for quantitative analysis (meta-analysis). The association between excess weight and RPL was significant (OR, 1.34; 95% CI, 1.05-1.70; P = 0.02). The isolated analyses of the groups of obese and overweight women revealed an association only between obesity and RPL (OR, 1.75; 95% CI, 1.24-2.47; P = 0.001). The data available in the current literature revealed that obese women with a history of RPL have a high risk of future pregnancy losses, a risk which was not found among overweight women.

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Section: Discussionsupporting

confidence: 89%

Obesity and recurrent miscarriage: A systematic review and meta‐analysis

Cavalcante

Sarno

Peixoto

et al. 2018

J of Obstet and Gynaecol

110

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“…These, in turn, are shaped by more distal processes that affect maternal nutrition, maternal exposure to biological and psychosocial stress, maternal exposure to infection, and management of chronic conditions. Pregnancy survival varies with women's body mass index (Maconochie et al 2007;Arck et al 2008;Kawwass et al 2016), consumption of folic acid (Bailey and Berry 2005), and in some studies, reports of stressful life events (Arck et al 2008).…”

Section: Parental Exposures and Pregnancy Survivalmentioning

confidence: 99%

Detecting the Effects of Early-Life Exposures: Why Fecundity Matters

Nobles,

Hamoudi

2019

Preprint

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Prenatal exposures have meaningful effects on health across the lifecourse. Innovations in causal inference have shed new light on these effects. Here, we motivate the importance of innovation in the characterization of fecundity, and prenatal selection in particular. We argue that such innovation is crucial for expanding knowledge of the fetal origins of later life health. Pregnancy loss is common, responsive to environmental factors, and closely related to maternal and fetal health outcomes. As a result, selection into live birth is driven by many of the same exposures that shape the health trajectories of survivors. Lifecourse effects that are inferred without accounting for these dynamics may be significantly distorted by survival bias. We use a set of Monte Carlo simulations with realistic parameters to examine the implications of prenatal survival bias. We find that even in conservatively specified scenarios, true fetal origin effects can be underestimated by 50% or more. In contrast, effects of exposures that reduce the probability of prenatal survival but improve the health of survivors will be overestimated. The absolute magnitude of survival bias can even exceed small effect sizes, resulting in inferences that beneficial exposures are harmful or vice-versa. We also find reason for concern that moderately sized true effects, underestimated due to failure to account for selective survival, are missing from scientific knowledge because they do not clear statistical significance filters. This bias has potential real-world costs; policy decisions about interventions to improve maternal and infant health will be affected by underestimated program impact.

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“…For obese nulliparous women the RR for very early preterm birth doubled (RR 1.99; 95% CI, 1.32–3.01). An analysis of all fresh autologous IVF cycles in the USA from 2008 to 2013 (494 097 cycles yielding 180 855 pregnancies) reported that among cycles resulting in singleton pregnancy, obesity was associated with increased risk of low birth weight (adjusted RR 1.26; 95% CI, 1.20–1.33) and preterm birth (adjusted RR 1.42; 95% CI, 1.36–1.48) …”

Section: Wellbeing Of the Childmentioning

confidence: 99%

It is ethical to recommend against assisted reproductive treatment for women with a high body mass index

Robson

Norman

2017

Aust NZ J Obst Gynaeco

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Ethical judgements in medicine in general, and assisted reproductive technology (ART) in particular, can be difficult to make. This is particularly so outside of a hospital environment where diverse skills and opinions are more difficult to obtain. The four classical principles that guide ethical judgements -respect for autonomy, beneficence, non-maleficence and justice -usually have multiple dimensions. For example, it is possible to argue that discouraging treatment of women with a high body mass index (BMI) from having ART is unethical because it contravenes the principle of justice. It may be argued that women with a high BMI have similar or, in many cases, higher chances of a live birth than women in an older age group. Thus patients in a similar position are not treated in a similar way and therefore denial of treatment is unjust.On the surface this argument seems reasonable, but the reasoning is flawed for two important reasons. First, patients' ages are not reversible -an older patient in a poorer prognosis group cannot become younger -whereas a high BMI is potentially reversible. Second, offering ART to women with a high BMI may contravene the ethical principles of beneficence (balancing the treatment risks against the desired outcome) and nonmaleficence (avoiding harm to the patient, or ensuring harm is not disproportionate) especially when the wellbeing of any child is considered. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists statement C-Gyn2 poses the question, 'Is ovarian stimulation appropriate in women with a BMI greater than 35?' and provides the opinion: It is inappropriate to recommend ovarian stimulation (including in vitro fertilization (IVF)) as part of first line therapy in the female with a BMI >35 unless there are exceptional circumstances. Ovarian stimulation in these circumstances should be deferred until appropriate weight loss by appropriate measures (eg diet, exercise, bariatric surgery, etc.) has occurred. This is expected to improve general health, may restore normal ovulatory function and enhance pregnancy outcome. 1The advice in C-Gyn2 is accompanied by an important caveat: 'This information is intended to provide general advice to practitioners, and should not be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of any patient.' It is indeed obvious that the effect of having a high BMI on the chance of having a live baby is less than that of advancing age. Whereas age is inviolable, with support and patience many women may be assisted to return to a normal weight range. RISKS TO THE WOMAN UNDERGOING ARTImportantly, women with a high BMI face greater risks procedurally and with pregnancy outcomes. 2 Oocyte retrieval procedures are more challenging in women with high BMI and obese patients may have difficult venous access. 3 Anaesthesia or sedation of oocyte retrieval can be more hazardous since response to sedation

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Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States

Cited by 128 publications

References 22 publications

Obesity and recurrent miscarriage: A systematic review and meta‐analysis

Obesity and recurrent miscarriage: A systematic review and meta‐analysis

Detecting the Effects of Early-Life Exposures: Why Fecundity Matters

It is ethical to recommend against assisted reproductive treatment for women with a high body mass index

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