The Effects of Body Mass Index on Fertility, Pregnancy and Delivery

Öz

Obesity is a worldwide public health issue, associated with many chronic health issues. There is increasing prevalence of overweight body mass index –BMI= 25.0-29.9 kg/m2 and obesity BMI ≥30.0 kg/m2 in young women, which impacts on fertility, pregnancy and delivery outcomes. Obesity and overweight also contribute to reduced male fecundity. Effects of obesity and overweight on successful in vitro fertilisation outcomes are less clear. Women with low BMI and/ or less-than-recommended gestational weight gain are at higher risk of delivering low birth weight babies. On the other hand, high BMI is linked with increased incidence of gestational hypertension, preeclampsia, induction of labour, macrosomia and caesarean delivery. This article aims to present a review of the recent scientific literature about the effects of BMI on fertility, pregnancy and delivery.

Anahtar Kelimeler

• BMI,fertility,pregnancy,delivery

Vücut Kitle İndeksinin Doğurganlık, Gebelik ve Doğum Üzerine Etkileri

Öz

Obezite, beraberindeki birçok kronik sağlık sorunuyla birlikte tüm dünyada halk sağlığı sorunu olmuştur. Doğurganlık, gebelik ve doğum üzerinde etkileri olan aşırı kilo Vücut Kitle İndeksi-VKİ=25.0-29.9 kg/m2 ve obezitenin VKİ ≥30.0 kg/m2 genç kadınlar arasındaki yaygınlığında artış görülmektedir. Obezite ve aşırı kilo aynı zamanda erkek fekunditesinin düşmesine de sebep olmaktadır. Obezite ve aşırı kiloluluğun başarılı in vitro fertilizasyon üzerindeki etkilerine dair tam anlamıyla net sonuçlar bulunmamaktadır. Düşük VKİ’ye sahip ve/veya gebelikte önerilenden daha az kilo alan kadınların düşük doğum ağırlığına sahip bebek sahibi olma riski daha yüksektir. Diğer yandan, yüksek VKİ, artmış gestasyonel hipertansiyon, pre-eklampsi, doğum indüksiyonu, makrozomi ve sezaryenle doğum insidansı ile doğrudan ilişkilidir. Bu makalede VKİ’nin doğurganlık, gebelik ve doğum üzerine etkilerini güncel literatür bilgileri ışığında değerlendirmek amaçlanmıştır.

Anahtar Kelimeler

• VKİ,fertilite,gebelik,doğum

Kaynakça

1. Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol 2006; 35:93-9.
2. Confidential Enquiry into Mother and Child Health (CEMACH). Why mo- thers die 2000-2002: The Sixth Report of the Confidential Enquiries into Maternal Death in the United Kingdom. London, UK: RCOG Press; 2004.
3. World Health Organisation (WHO). Fact sheet 113: Obesity and overwe- ight. Geneva, Switzerland: WHO Press; [updated 2015 Jan]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/
4. Dallongeville J, Bringer J, Bruckert E, Charbonnel B, Dievart F, Komajda M et al. Abdominal obesity is associated with ineffective control of car- diovascular risk factors in primary care in France. Diabetes Metab 2008; 34:606-11.
5. Phillips LK, Prins JB. The link between abdominal obesity and the meta- bolic syndrome. Curr Hypertension Res; 10:156-64.
6. Zalesin KC, Franklin BA, Miller WM, Peterson ED, McCullough PA. Impa- ct of obesity on cardiovascular disease. Endocrin Metab Clin North Am 2008; 37:663-84.
7. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414:782-7.
8. Calle EE, Thun MJ. Obesity and cancer. Oncogene 2004; 23:6365-78.

9. Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C. Knee os- teoarthritis and obesity. Int J Obes Relat Metab Disord 2001; 25:622-7.
10. Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obes Rev 2001; 2:219-29.
11. Li Z, Bowerman S, Heber D. Health ramifications of the obesity epidemic. Surg Clin North Am 2005; 85:681-701.
12. Suk Sh, Sacco Rl, Boden-Albala B, Cheun Jf, Pittman Jg, Elkind MS et al. Abdominal obesity and risk of ischemic stroke: the Northern Manhattan stroke study. Stroke 2003; 34:1586-92.
13. World Health Organisation (WHO). Physical status: the use and interp- retation of anthropometry: report of a WHO expert committee. Geneva, Switzerland: WHO Press; 1995.
14. National Institutes of Health (NIH). Clinical guidelines on the identifica- tion, evaluation, and treatment of overweight and obesity in adults. The evidence report. NIH publication No. 98-4083. Bethesda US: NIH; 1998
15. National Institutes of Health (NIH). The practical guide. Identification, evaluation and treatment of overweight and obesity in adults. Bethesda US: NIH; 2000.
16. Strohacker K, Wing RR, Mc Caffery JM. Contributions of body mass index and exercise habits on inflammatory markers: a cohort study of middle-aged adults living in the USA. BMJ Open 2013; 3:002623.
17. Stejskal D, Karpisek M. Adipocyte fatty acid binding protein in a Cauca- sian population:a new marker of metabolic syndrome? Eur J Clin Invest 2006;36:621-5.
18. Wass P, Waldenström U, Rössner S, Hellberg D. An android body fat distribution in females impairs the pregnancy rate of in-vitro fertilizati- on-embryo transfer. Human Reprod 1997; 12:2057-60.
19. Ramlau-Hansen CH, Thulstrup AM, Nohr EA, Bonde JP, Sİrensen TIA, Olsen J. Subfecundity in overweight and obese couples. Human Reprod 2007; 22:1634-7.
20. Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A. Obesity and reproductive disorders in women. Hum Reprod Update 2003; 9:359-72.
21. Eisenberg ML, Kim S, Chen Z, Sundaram R, Schisterman EF, Buck Louis GM. The relationship between male BMI and waist circumference on se- men quality: data from the LIFE study. Hum Reprod 2014; 29:193-200.
22. Thomsen L, Humaidan P, Bungum L, Bungum M. The impact of male overweight on semen quality and outcome of assisted reproduction. Asi- an J Androl 2014;16:749-54.
23. Bolşmar F, Olsen J, Rebagliato M, Sáez-Lloret I, Bisanti L. Body mass index and delayed conception: a European Multicenter Study on Infertility and Subfecundity. AM J Epidemiol 2000; 151:1072-9.
24. Rato L, Alves MG, Cavaco JE, Oliveira PF. High-energy diets: a threat for male fertility? Obesity Rev 2014; 15:996-1007.
25. Boots C, Stephenson MD. Does obesity increase the risk of miscarria- ge in spontaneous conception:a systematic review. Semin Reprod Med 2011; 29:507-13.
26. Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA. Maternal obesity and risk for birth defects. Pediatrics 2003; 11:1152-8.
27. Rode L, Nilas L, Wİjdemann K, Tabor A. Obesity-related complicati- ons in Danish single cephalic term pregnancies. Obstet Gynecol 2005; 105:537-42.
28. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Ma- ternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25:1175-82.
29. Smith GC, Shah I, Pell JP, Crossley JA, Dobbie R. Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: a retrospective cohort study. Obstet Gynecol Surv 2007; 62:299-300.
30. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999; 282:1523-9.
31. Jensen TK, Andersson AM, Jİrgensen N, Andersen AG, Carlsen E, Peter- sen J et al. Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men. Fertil Steril 2004; 82:863-70.
32. Balen AH, Anderson RA. Policy & Practice Committee of the BFS. Impact of obesity on female reproductive health: British Fertility Society, Policy and Practice Guidelines. Hum Fertil (Camb) 2007; 10:195-206.
33. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnan- cy outcome. Obstet Gynecol 2004; 103:219-24.
34. Jokela M, Elovainio M, Kivimäki M. Lower fertility associated with obesity and underweight: the US National Longitudinal Survey of Youth. Am J Clin Nutr 2008; 88:886-93.
35. Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ. Preα pregnancy weight and the risk of stillbirth and neonatal death. BJOG: Int J Obstet Gynaecol 2005; 112:403-8.
36. Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later (the Rancho Bernardo Study). Am J Cardiol 2005; 96:3-7.
37. Leary C, Leese HJ, Sturmey RG. Human embryos from overweight and obese women display phenotypic and metabolic abnormalities. Hum Reprod 2015; 30:122-32.
38. NATCEN Social Research, UCL. Health Survey for England 2013. Leeds UK: Health And Social Care Information Centre (HSCIC); 2014.
39. Sharpe R M, Franks S. Environment, lifestyle and infertility--an inter-ge- nerational issue. Nat Cell Biol 2002; 4:33-40.
40. Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, et al. The impact of maternal BMI status on pregnancy outcomes with imme- diate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008; 9:635-83.
41. Law DCG, Maclehose RF, Longnecker MP. Obesity and Time to Pregnan- cy. Hum Reprod 2007; 22:414-20.
42. Wise LA, Rothman KJ, Mikkelsen EM, Sİrensen HT, Riis A, Hatch EE. An internet-based prospective study of body size and time-to-pregnancy. Hum Reprod 2010; 25:253-64.
43. Nohr EA, Vaeth M, Rasmussen S, Ramlau-Hansen CH, Olsen J. Waiting time to pregnancy according to maternal birthweight and prepregnancy BMI. Hum Reprod 2009; 24:226-32.
44. Farquhar CM, Gillett WR. Prioritising for fertility treatments—should a high BMI exclude treatment? BJOG: Int J Obstet Gynaecol 2006; 113:1107-9.
45. Callaway LK, Prins JB, Chang AM, McIntyre HD. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006; 184: 56.
46. Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S. Effect of Body Mass Index on pregnancy outcomes in nulliparous women delive- ring singleton babies. BMC Public Health 2007; 7:168.
47. Gillett WR, Putt T, Farquhar CM. Prioritising for fertility treatments--the effect of excluding women with a high body mass index. BJOG 2006; 113:1218-21.
48. Legge A, Bouzayen R, Hamilton L, Young D. The impact of maternal body mass index on in vitro fertilization outcomes. JOGC 2014; 36:613-9.
49. Schliep KC, Mumford SL, Ahrens KA, Hotaling JM, Carrell DT, Link M, et al. Effect of male and female body mass index on pregnancy and live birth success after in vitro fertilization. Fertil Steril 2015;103: 388-95.
50. Kirschner MA, Samojlik E, Drejka M, Szmal E, Schneider G, Ertel N. Androgen-estrogen metabolism in women with upper body versus lower body obesity. J Clin Endocrinol Metab 1990; 70:473-9.
51. De Pergola G, Tartagni M, d’Angelo F, Centoducati C, Guida P, Giorgino R. Abdominal fat accumulation, and not insulin resistance, is associated to oligomenorrhea in non-hyperandrogenic overweight/obese women. J Endocrinol Invest 2009; 32:98-101.
52. Zaadstra BM, Seidell JC, Van Noord PA, te Velde ER, Habbema JD, Vrieswijk B et al. Fat and female fecundity: prospective study of effect of body fat distribution on conception rates. BMJ 1993; 306:484-7.
53. Merhi Z, Mcgee EA, Buyuk E. Role of advanced glycation end-products in obesity-related ovarian dysfunction. Minerva Endocrinol 2014; 39:167- 74.
54. Seli E, Babayev E, Collins SC, Nemeth G, Horvath TL. Minireview: Meta- bolism of female reproduction: regulatory mechanisms and clinical imp- lications. Mol Endocrinol 2014; 28:790-804.
55. Dale PO, Tanbo T, Vaaler S, Abyholm T. Body weight, hyperinsulinemia, and gonadotropin levels in the polycystic ovarian syndrome: evidence of two distinct populations. Fertil Steril 1992; 58:487-91.
56. Sallmén M, Sandler DP, Hoppin JA, Blair A, Baird DD. Reduced fertility among overweight and obese men. Epidemiology 2006; 17:520-3.
57. Sermondade N, Faure C, Fezeu L, Shayeb AG, Bonde JP, Jensen TK, et al. BMI in relation to sperm count: an updated systematic review and collaborative meta-analysis. Hum Reprod Update 2013; 19:221-31.
58. Olsen J, Ramlau-Hansen CH. Epidemiologic methods for investigating male fecundity. Asian J Androl 2014; 16:17-22.
59. Håkonsen LB, Thulstrup AM, Aggerholm AS, Olsen J, Bonde JP, Ander- sen CY, et al. Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men. Reprod Health 2011; 8:24.
60. Schieve LA, Cogswell ME, Scanlon KS. Maternal weight gain and preterm delivery: differential effects by body mass index. Epidemiol 1999;10:141-7.
61. Rössner S. Pregnancy, weight cycling and weight gain in obesity. Int J Obes Relat Metab Disord 1992; 16:145-7.
62. Vikanes Å, Grjibovski A M, Vangen S, Gunnes N, Samuelsen S O, Magnus P. Maternal body composition, smoking, and hyperemesis gravidarum. Ann Intern Med 2010; 20:592-8.
63. Swank ML, Marshall NE, Caughey AB, Main EK, Gilbert WM, Melsop KA, et al. Pregnancy outcomes in the super obese, stratified by weight gain above and below institute of medicine guidelines. Obstet Gynecol 2014; 124:1105-10.
64. National Institute for Health and Clinical Excellence (NICE). Public health guidance 27. Weight management before, during and after pregnancy. London, UK: NICE; 2010.
65. Roberts JM, Bodnar LM, Patrick TE, Powers RW. The Role of Obesity in Preeclampsia. Pregnancy Hypertens 2011; 1:6-16.
66. Seely EW, Solomon CG. Insulin resistance and its potential role in preg- nancy-induced hypertension. J Clin Endocrinol Metab 2003; 88:2393-8.
67. Tuuri AL, Jauhiainen MS, Tikkanen MJ, Kaaja RJ. Systolic blood pressure and fatty acid-binding protein 4 predict pregnancy-induced hypertension in overweight nulliparous women. Placenta 2014; 35:797-801.
68. Kaul P, Savu A, Nerenberg KA, Donovan LE, Chik CL, Ryan EA, et al. Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: a population-level analysis. Diabetic Med 2015; 32:164-73.
69. Maftei O, Whitrow MJ, Davies MJ, Giles LC, Owens JA, Moore VM. Ma- ternal body size prior to pregnancy, gestational diabetes and weight gain: associations with insulin resistance in children at 9-10 years. Diabetic Med 2015; 32:174-80.
70. De Frène V, Vansteelandt S, T’Sjoen G, Gerris J, Somers S, Vercruysse L, et al. A retrospective study of the pregnancy, delivery and neonatal out- come in overweight versus normal weight women with polycystic ovary syndrome. Hum Reprod 2014; 29:2333-8.
71. Bailey AP, Hawkins LK, Missmer SA, Correia KF, Yanushpolsky EH. Effect of body mass index on in vitro fertilization outcomes in women with polycystic ovary syndrome. Obstet Gynecol 2014; 211:163.
72. Crosignani PG, Ragni G, Parazzini F, Wyssling H, Lombroso G, Perotti L. Anthropometric indicators and response to gonadotrophin for ovulation induction. Human Reprod. 1994; 9:420-3.
73. Carrell DT, Jones KP, Peterson CM, Aoki V, Emery BR, Campbell BR. Body mass index is inversely related to intra-follicular HCG concentrations, embryo quality and IVF outcome. Reprod Biomed Online 2001; 3:109- 11.
74. Bellver J, Pellicer A. Impact of obesity on spontaneous abortion. Am J Obstet Gynecol 2004; 190:293-4.
75. Garbaciak Jr JA, Richter M, Miller S, Barton JJ. Maternal weight and pregnancy complications. Am J Obstet Gynecol 1985; 152:238-45.
76. Wegrzyniak LJ, Repke JT, Ural SH. Treatment of hyperemesis gravida- rum. Rev Obstet Gynecol 2012; 5: 78-84.
77. Yu CKH, Teoh TG, Robinson S. Review article: obesity in pregnancy. BJOG 2006; 113:1117-25.
78. Vikanes AV, Stoer NC, Gunnes N, Grjibovski AM, Samuelsen SO, Magnus P, et al. Helicobacter pylori infection and severe hyperemesis gravidarum among immigrant women in Norway: a case-control study. Eur J Obstet Gynecol Reprod Biol 2013; 167: 41-46.
79. Schieve LA, Cogswell ME, Scanlon KS, Perry G, Ferre C, Blackmo- re-Prince C, NMIHS Collaborative Working Group. Prepregnancy body mass index and pregnancy weight gain: associations with preterm deli- very. Obstet Gynecol 2000; 96:194-200.
80. Kenyon S, Ullman R, Mori R, Whittle M. Guidelines: Care of healthy wo- men and their babies during childbirth: summary of NICE guidance. BMJ 2007; 335:667.
81. Veleva Z, Tiitinen A, Vilska S, Hydén-Granskog C, Tomás C, Martikainen H, et al. High and low BMI increase the risk of miscarriage after IVF/ICSI and FET. Human Reprod 2008; 23:878-84.
82. Roman H, Goffinet F, Hulsey T F, Newman R, Yves Robillard P, Hulsey T C. Maternal body mass index at delivery and risk of caesarean due to dystocia in low risk pregnancies. Acta Obstet Gynecol Scand 2008; 87:163-70.
83. Vrouenraets F, Roumen F, Dehing C, van den Akker E, Aarts M, Scheve E. Bishop Score and Risk of Cesarean Delivery after Induction of Labor in Nulliparous Women. Obstet Gynecol 2005; 105:690-7.
84. Pevzner L, Powers BL, Rayburn WF, Rumney P, Wing DA. Effects of ma- ternal obesity on duration and outcomes of prostaglandin cervical ripe- ning and labor induction. Obstet Gynecol 2009; 114:1315-21.