Association between periconceptional weight loss and maternal and neonatal outcomes in obese infertile women

Abstract

BackgroundObesity in women of reproductive age has deleterious effects on reproductive and offspring health. In this study, we aimed to evaluate the association between the magnitude of periconceptional body-mass index (BMI) change and maternal and neonatal outcomes in obese infertile women who participated in the LIFEstyle study. The LIFEstyle study was a randomized controlled trial, evaluating if a six-month lifestyle intervention program prior to infertility treatment in obese infertile women improved birth rates, compared to prompt infertility treatment.Methods and findingsThis is an exploratory post hoc analysis of the LIFEstyle study. We recorded periconceptional BMI change in women with an ongoing pregnancy, pooling data of all women, regardless of randomization arm. Periconceptional BMI change was calculated using weight at randomization and the periconceptional weight (measured in kilograms 12 weeks before or after conception and expressed as BMI change in units BMI (kg/m2)). Subsequently, women were categorized into quartiles according to the magnitude of their periconceptional change in BMI. The odds of maternal and neonatal outcomes were calculated using logistic regression analysis, comparing women in each of the first three weight change quartiles separately, and combined, to women in the fourth quartile. The fourth quartile was chosen as reference group, since these women had the least weight loss. We adjusted for periconceptional BMI, nulliparity and smoking status. In addition, we performed a subgroup analysis for singleton pregnancies. In the LIFEstyle study, 321 obese infertile women achieved an ongoing pregnancy which was conceived within 24 months after randomization. Periconceptional BMI change was available in 244 of these women (76%). Median BMI at randomization was 35.9 kg/m2. Women in the first quartile (Q1) had a periconceptional BMI change of <-2.1 kg/m2, women in the second quartile (Q2) -2.1 to -0.9 kg/m2, women in the third quartile (Q3) -0.9 to 0.1 kg/m2 and women in the fourth quartile (Q4) gained ≥0.1 kg/m2. There were no significant differences between women in the quartiles regarding rates of excessive gestational weight gain (in term pregnancies), gestational diabetes, preterm birth, induction of labor, spontaneous vaginal birth and Caesarean section. Compared to women in Q4, the adjusted odds ratios, aOR, and 95% confidence interval for a hypertensive complication were; 0.55 (0.22–1.42) for women in Q1, 0.30 (0.12–0.78) for women in Q2, 0.39 (0.16–0.96) for women in Q3 and 0.39 (0.19–0.82) for women in Q1 to Q3 combined. In the subgroup analysis, investigating singleton pregnancies only, the statistically significant decreased rate of a hypertensive complication remained in women in Q2 (aOR 0.27, 95% CI 0.10–0.72) and Q3 (aOR 0.39, 95%CI 0.16–0.98) and when comparing women in Q1 to Q3 together to women in Q4 (aOR 0.38, 95%CI 0.18–0.80). Furthermore, there was a significantly decreased aOR (95%CI) of preterm birth in women in Q2 (0.24, 0.06–0.98) and when combining women in Q1...

Effect of a Short Message Service Intervention on Excessive Gestational Weight Gain in a Low-Income Population: A Randomized Controlled Trial

“…One study in obese women found that interpregnancy weight loss beyond returning to pre-pregnancy weight was associated with a decreased risk of gestational diabetes in a second pregnancy [24]. Preconception weight loss may be beneficial for decreasing risk of preterm birth, however, the impacts of preconception weight loss on other birth outcomes and offspring health have yet to be fully elucidated [25,26]. Depending on preconception diet quality, preconception weight loss may affect mothers' nutritional status and, therefore, birth outcomes [27].…”

Reducing intergenerational obesity and diabetes risk

“…Intervention effects on weight at conception were unreported for the 27% of women who conceived after the index cycle [49]. The LIFEstyle trial in the Netherlands did not prospectively assess weight during the 18 months of fertility treatments that followed the 6 month intervention [42] but did report that maternal weights available at 8-12 weeks' gestation for 244 women (76% of the 321 who conceived) were significantly reduced from baseline for intervention participants (−4.1 kg vs −1.0 kg for intervention vs control participants) [50]. Given the likelihood of weight regain following lifestyle interventions [51], it is important that studies of preconception interventions include frequent assessments to accurately capture maternal weight at conception.…”

Effect of Maternal Obesity and Preconceptional Weight Loss on Male and Female Offspring Metabolism and Olfactory Performance in Mice

“…When limited weight gain during pregnancy was advised to obese mothers to improve these outcomes, there were only small effects on foetal growth and metabolic outcomes [22,23]. A preconceptional weight loss (WL) is now widely recommended to obese women, improves fertility and reduces the occurrence of metabolic complications [24]. However, whereas some studies demonstrate a positive impact [25,26,27,28], other studies indicate potential deleterious effects [28,29,30].…”