scholarly journals Obesity and adverse pregnancy outcomes in older patients with decreased ovarian reserve: a retrospective single-centre study

2021 ◽  
Author(s):  
Fangxu Lin ◽  
Hao Shi ◽  
Qiongyao Shi ◽  
Yingchun Su ◽  
Shanjun Dai ◽  
...  
Keyword(s):  
Older Women ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Pregnancy Outcomes ◽  
Older Patients ◽  
Normal Weight ◽  
Adverse Pregnancy Outcomes ◽  
Live Births ◽  
Live Birth Rates ◽  
Adverse Pregnancy

Abstract BackgroundIn recent years, infertility has increased in older women with decreased ovarian reserve (DOR). Studies have shown that women with DOR have fewer oocytes, which are poorer in quality, and have an increased risk of adverse pregnancy outcomes. Pre-pregnancy BMI is significantly correlated with many adverse pregnancy outcomes. Therefore, we conducted this study to explore the correlation between body mass index (BMI) and abortion and live birth in older patients with DOR. MethodsThe clinical data of 2052 older women with infertility and DOR admitted to the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from August 2009 to May 2018 were analysed retrospectively. Patients were divided into underweight (BMI < 18.5 kg/m 2 ; n = 56), normal weight (18.5 kg/m 2 ≤ BMI < 24 kg/m 2 ; n = 1389), overweight (24 kg/m 2 ≤ BMI < 28 kg/m 2 ; n = 527) and obese (BMI ≥ 28 kg/m 2 ; n = 80). We compared the pregnancy outcomes of patients in each group. ResultsLogistic regression analysis showed that being overweight or obese were independent risk factors for miscarriage (P < 0.05) and protection factors for live births (P<0.05). Being underweight was a protective factor for live births (P < 0.05). ConclusionsThe abortion and live birth rates in older infertile women with DOR are correlated with BMI. Higher BMI was associated with higher abortion rates and lower live birth rates. Being underweight also correlated with the live birth rate. Therefore, to improve pregnancy outcomes, we suggest that older patients with DOR may benefit from maintaining a normal weight before seeking fertility treatments.

scholarly journals Association Between Menstrual Patterns and Adverse Pregnancy Outcomes in Patients With Polycystic Ovary Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Ting Yu ◽  
Di Wu ◽  
Yurong Cao ◽  
Jun Zhai
Keyword(s):  
Pregnancy Outcomes ◽  
Polycystic Ovary ◽  
Adverse Pregnancy Outcomes ◽  
Ovary Syndrome ◽  
Live Birth Rates ◽  
Menstrual Patterns ◽  
Adverse Pregnancy ◽  
Long Acting ◽  
Long Protocol

ObjectiveTo investigate the results of in vitro fertilization among polycystic ovary syndrome (PCOS) patients using the long-acting long protocol regarding the relationship between menstrual patterns and adverse pregnancy outcomes.DesignRetrospective cohort study.SettingUniversity-affiliated reproductive medical center.BackgroundThe menstrual patterns of patients with PCOS is considered related to metabolism; however, no study has analyzed the outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in patients with PCOS who have different menstrual patterns. This study aimed to observe the outcomes of IVF/ICSI in patients with PCOS with different menstrual patterns who used the long-acting long protocol.MethodsThis was a retrospective analysis in the first cycle of IVF/ICSI at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2019. In total, 1834 patients with PCOS were classified into the regular menstruation group (n=214), the oligomenorrhea group (n=1402), and the amenorrhea group (n=218).ResultsPCOS patients who used the long-acting long protocol of IVF/ICSI had similar clinical pregnancy rates and live birth rates despite having different menstrual patterns. The overall incidence of adverse pregnancy outcomes, including abortion, spontaneous preterm birth (sPTB), gestational diabetes(GDM), hypertensive disorder inpregnancy (HDP), and premature rupture of membranes(PROM, was significantly higher in the amenorrhea group than in the regular menstrual and oligomenorrhea groups (25.88% vs. 30.41% vs. 43.69%; P = 0.013). Additionally, the rates of GDM (2.35% vs. 6.10% vs. 13.79%; P=0.015) and macrosomia (5.26% vs. 10.94% vs. 18.39%; P=0.026) in the amenorrhea group were significantly higher than those in the other two groups. Correction for confounding factors showed that menstrual patterns are related to the occurrence of adverse pregnancy outcomes. Amenorrhea is an independent risk factor for adverse pregnancy outcome (OR [odds ratio]: 2.039, 95% CI [confidence interval]: 1.087-3.822), GDM (OR: 5.023, 95% CI: 1.083–23.289), and macrosomia (OR: 4.918, 95% CI: 1.516–15.954).ConclusionsIVF/ICSI can achieve similar pregnancy and live birth rates in PCOS patients with different menstrual patterns. However, the overall incidence of adverse pregnancy outcomes in PCOS patients with amenorrhea is higher than that in patients with regular menstruation or oligomenorrhea.

scholarly journals Applying growth hormone as an adjuvant to correct poor prognosis outcomes in IVF: Study 2 compares dehydroepiandrosterone

2021 ◽  
Vol 16 (3) ◽  
pp. 164-190
Author(s):  
John Lui Yovich ◽  
Shanthi Srinivasan ◽  
Mark Sillender ◽  
Shipra Gaur ◽  
Philip Rowlands ◽  
...  
Keyword(s):  
Live Birth ◽  
Ovarian Reserve ◽  
Poor Prognosis ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Utilization Rate ◽  
Recurrent Implantation Failure ◽  
Birth Rates ◽  
Live Births ◽  
Live Birth Rates

This retrospective study examines the influence of recombinant growth hormone (rGH) and dehydroepiandrosterone (DHEA) adjuvants on oocyte numbers, embryo utilization and live births arising from 3637 autologous IVF±ICSI treatment cycles undertaken on 2376 women across ten years (2011-2020) within a pioneer Australian facility. Despite using an FSH-dosing algorithm enabling maximal doses up to 450 IU for women with reduced ovarian reserve, younger women had significantly higher mean numbers of oocytes recovered than older women ranging from 11.1 for women <35 years to 9.4 for women aged 35-39 years reducing to 6.5 for women aged 40-44 years and 4.1 for those aged ≥45 years (p<0.0001). Overall, the embryo utilization rate was 48.5% and live birth productivity rate was 35.4 % across all ages and neither rGH nor DHEA showed any benefit on these rates, in fact, those women with nil adjuvants showed the highest live birth rate per initiated cycle (44.94% overall: p<0.0001, and 55.2% for the youngest group: p<0.001). Embryo utilization was increased by rGH in those women aged 40-44 years who had low ovarian reserve (p<0.0001), but this benefit did not translate into any improvement in the live birth rate, in fact those women who did not use adjuvants had the highest overall birth rate (p<0.0001). Similarly, other factors known to cause a poor prognosis, including low IGF-1 profile, recurrent implantation failure, and low oocyte numbers at OPU, showed no improvement in embryo utilization nor in live births from the adjuvants. The relevance of embryo quality was examined on 1135 women whose residual embryos after a single fresh-embryo transfer failed to develop to a suitable grade for cryopreservation. From 1727 cycles such women often displayed an improved embryo utilization rate with both rGH, and with DHEA or combined rGH+DHEA. Even so, live birth rates were not improved by either of the adjuvants excepting young women <35 years using rGH without DHEA (p<0.05). Examining poor prognosis sub-groups, indicated both rGH and DHEA or combined rGH+DHEA consistently improved embryo utilization in those women with low ovarian reserve (p<0.0001), or those with low IGF-1 levels (p<0.0001) or with recurrent implantation failure (p<0.02). All the poor-prognosis sub-groups showed low live birth rates and, notwithstanding the improvements in embryo utilization, the live birth rates were not significantly improved by the adjuvants, albeit the rates were closer to the nil adjuvant groups (not significantly different).

655: Interpregnancy weight change and risk of adverse pregnancy outcomes in normal weight women

2007 ◽  
Vol 197 (6) ◽  
pp. S188
Author(s):  
Dorothea Mostello ◽  
Sarah Betsworth ◽  
Mariah Dreisinger ◽  
Terry Leet
Keyword(s):  
Weight Change ◽  
Pregnancy Outcomes ◽  
Normal Weight ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy

scholarly journals The Influence of Maternal BMI on Adverse Pregnancy Outcomes in Older Women

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2838 ◽  
Author(s):  
Małgorzata Lewandowska ◽  
Stefan Sajdak ◽  
Barbara Więckowska ◽  
Nevena Manevska ◽  
Jan Lubiński
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Older Women ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Older Age ◽  
Odds Ratios ◽  
Age Related ◽  
Adverse Pregnancy

As mothers age, the risk of adverse pregnancy outcomes may increase, but the results so far are controversial and several issues remain unknown, such as the impact of maternal weight on the effects associated with older age. In a prospective cohort of 912 Polish women with singleton pregnancies (recruited in 2015–2016), we assessed the pregnancy outcomes depending on the mother’s age (18–24, 25–29, 30–34, 35–39, and ≥40 years). Women aged ≥35 years (vs. <35 years) were assessed in terms of body mass index (BMI). Multidimensional logistic regression was used to calculate the odds ratios (with 95% confidence intervals) of the pregnancy results. The risk profiles (using the Lowess method) were applied to determine the threshold risk. We found that both the youngest and the oldest group members displayed higher adjusted odds ratios of preeclampsia (PE), intrauterine growth restriction (IUGR), and preterm birth <37th week (U-shaped risk). In the remaining cases, the age ≥40 years, compared to the youngest age 18–24 years, was associated with a higher adjusted risk of gestational hypertension (GH) (AOR = 5.76, p = 0.034), gestational diabetes mellitus GDM-1 (AOR = 7.06, p = 0.016), cesarean section (AOR = 6.97, p <0.001), and low birth weight LBW (AOR = 15.73, p = 0.033) as well as macrosomia >4000 g (AOR = 8.95, p = 0.048). We found that older age ≥35 years (vs. <35 years) was associated with higher adjusted odds ratios of all the pregnancy outcomes investigated. In obese women, these adverse older age related results were found to be more intense in GH study, as well as (though weaker) in birth <37th week study, small-for-gestational age birth weight (SGA), LBW, large-for-gestational age birth weight (LGA), and macrosomia. In overweight women, these adverse older age related results were found to be more intense in preterm birth study, as well as (though weaker) in SGA and LBW. In underweight women, adverse pregnancy outcomes related to older age were more intense in a study of cesarean section. At the same time, underweight was associated with reversal of some negative effects of older age (we found lower odds ratios of GDM-1 diabetes). The maternal threshold age above which the risk of GH, PE, GDM, caesarean section, and preterm birth increased was 33–34 years (lower than the threshold of 35 years assumed in the literature), and the threshold risk of IUGR, LBW, SGA, LGA, and macrosomia was 36–37 years. Main conclusions: Older maternal age was associated with a higher chance of all kinds of obstetric complications. Older women should particularly avoid obesity and overweight.

scholarly journals Joint spatio-temporal modelling of adverse pregnancy outcomes sharing common risk factors at sub-county level in Kenya, 2016–2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julius Nyerere Odhiambo ◽  
Benn Sartorius
Keyword(s):  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Component Model ◽  
County Level ◽  
Neonatal Deaths ◽  
Live Births ◽  
Shared Component ◽  
Spatio Temporal ◽  
Adverse Pregnancy ◽  
Shared Risk

Abstract Background Adverse pregnancy outcomes jointly account for a high proportion of mortality and morbidity among pregnant women and their infants. Furthermore, the burden attributed to adverse pregnancy outcomes remains high and inadequately characterised due to the intricate interplay of its etiology and shared set of important risk factors. This study sought to quantify and map the underlying risk of multiple adverse pregnancy outcomes in Kenya at sub-county level using a shared component space-time modelling framework. Methods Reported sub-county level adverse pregnancy outcomes count from January 2016 – December 2019 were obtained from the Kenyan District Health Information System. A Bayesian hierarchical spatio-temporal model was used to estimate the joint burden of adverse pregnancy outcomes in space (sub-county) and time (year). To improve the precision of our estimates over time and space, information across the outcomes were combined via the shared and the outcome-specific components using a shared component model with spatio-temporal interactions. Results Overall, the total number of adverse outcomes in pregnancy increased by 14.2% (95% UI: 14.0–14.5) from 88,816 cases in 2016 to 101,455 cases in 2019. Between 2016 and 2019, the estimated low birth weight rate and the pre-term birth rate were 4.5 (95% UI: 4.4–4.7) and 2.3 (95% UI: 2.2–2.5) per 100 live births. The stillbirth and neonatal death rates were estimated to be 18.7 (95% UI: 18.0–19.4) and 6.9 (95% UI: 6.4–7.4) per 1000 live births. The magnitude of the spatio-temporal variation attributed to shared risk was high for pre-term births, low birth weight, neonatal deaths, stillbirths and neonatal deaths, respectively. The shared risk patterns were dominant in sub-counties located along the Indian ocean coastline, central and western Kenya. Conclusions This study demonstrates the usefulness of a Bayesian joint spatio-temporal shared component model in exploiting specific and shared risk of adverse pregnancy outcomes sub-nationally. By identifying sub-counties with elevated risks and data gaps, our estimates not only assert the need for bolstering maternal health programs in the identified high-risk sub-counties but also provides a baseline against which to assess the progress towards the attainment of Sustainable Development Goals.

scholarly journals Increased Adverse Pregnancy Outcomes Associated With Stage 1 Hypertension in a Low-Risk Cohort

Hypertension ◽  
2020 ◽  
Vol 75 (3) ◽  
pp. 772-780 ◽  
Author(s):  
Dan-dan Wu ◽  
Ling Gao ◽  
Ou Huang ◽  
Kamran Ullah ◽  
Meng-xi Guo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Pregnancy Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Heart Association ◽  
Normal Weight ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy ◽  
Stage 1

The recommendations for the diagnosis of stage 1 hypertension were recently revised by the American Heart Association primarily based on its impact on cardiovascular disease risks. Whether the newly diagnosed stage 1 hypertension impacts pregnancy complications remain poorly defined. We designed a retrospective cohort study to investigate the associations of stage 1 hypertension detected in early gestation (<20 weeks) with risks of adverse pregnancy outcomes stratified by prepregnancy body mass index. A total of 47 874 women with singleton live births and blood pressure (BP) <140/90 mm Hg were included, with 5781 identified as stage 1a (systolic BP, 130–134 mm Hg; diastolic BP, 80–84 mm Hg; or both) and 3267 as stage 1b hypertension (systolic BP, 135–139 mm Hg; diastolic BP, 85–90 mm Hg; or both). Slightly higher, yet significant, rates and risks of gestational diabetes mellitus, preterm delivery, and low birth weight (<2500 g) were observed in both groups compared with normotensive controls. Importantly, women with stage 1a and stage 1b hypertension had significantly increased incidences of hypertensive disorders in pregnancy compared with normotensive women (adjusted odds ratio, 2.34 [95% CI, 2.16–2.53]; 3.05 [2.78–3.34], respectively). After stratifying by body mass index, stage 1a and 1b hypertension were associated with increased hypertensive disorders in pregnancy risks in both normal weight (body mass index, 18.5–24.9; adjusted odds ratio, 2.44 [2.23–2.67]; 3.26 [2.93–3.63]) and the overweight/obese (body mass index, ≥25; adjusted odds ratio, 1.90 [1.56–2.31]; 2.36 [1.92–2.90]). Current findings suggested significantly increased adverse pregnancy outcomes associated with stage 1 hypertension based on the revised American Heart Association guidelines, especially in women with prepregnancy normal weight.

scholarly journals Investigation of optimal gestational weight gain based on the occurrence of adverse pregnancy outcomes for Chinese women: a prospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yin Sun ◽  
Zhongzhou Shen ◽  
Yongle Zhan ◽  
Yawen Wang ◽  
Shuai Ma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Pregnancy Outcomes ◽  
Chinese Women ◽  
Normal Weight ◽  
Adverse Pregnancy Outcomes ◽  
Gestational Weight ◽  
Adverse Pregnancy

Abstract Objective To investigate recommendations for appropriate gestational weight gain (GWG) of Chinese females. Methods In total of 3,172 eligible women in the first trimester were recruited into the Chinese Pregnant Women Cohort Study (CPWCS) project. Pregnancy complications and outcomes were collated using the hospital medical records system. The method of occurrence of participants with adverse pregnancy outcomes (Occurrence Method) was conducted to calculate the recommended total GWG for each participant’s pre-pregnancy BMI. Occurrence Method data were judged against the Institute of Medicine (IOM) and Japanese recommended criteria in terms of the total occurrence of adverse pregnancy outcomes of pregnant women with appropriate weight gain. Results The most frequent GWG was ≥ 14 kg and < 16 kg (19.4%), followed by ≥ 10 kg and < 12 kg (15.5%) and ≥ 12 kg and < 14 kg (15.2%). The most frequently occurring adverse pregnancy outcomes were cesarean sections for underweight (30.0%), normal weight (40.4%), overweight (53.6%) and obese (53.7%) women. A large for gestational age (LGA) accounted for 18.0% of the overweight and 20.9% of the obesity group. Gestational diabetes mellitus (GDM) occurred in 16.9% of overweight and 23.1% of obese women. The recommended total GWG in a Chinese women population is ≥ 8 and < 12 kg if underweight, ≥ 12 and < 14 kg for normal weight, ≥ 8.0 and < 10.0 kg if overweight, and < 8 kg for women with obesity. Conclusions Current Chinese recommendations provide the optimal ranges of GWG to minimize the occurrence of undesirable pregnancy outcomes for each group of pre-pregnancy BMIs in a Chinese population. Trial registration Registered with ClinicalTrials (NCT03403543).

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