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Abstract：
BACKGROUND: With the increasing incidence of obesity and the childbearing-age delay among women, a debate over obesity\'s impacts on pregnancy and neonatal outcomes becomes hot. The potential negative effects of obesity and aging on fertility lead to an idea, whether an obese female pursuing IVF treatment can benefit from an ideal BMI achieved over a long-time weight loss process at the cost of aging? We aimed to assess the association between body mass index (BMI) and clinical or neonatal outcomes in patients undergoing in vitro fertilization (IVF) treatment, for answering whether it is necessary to lose weight first for obese patients, particularly those at advanced age.
METHODS: A retrospective cohort study was performed using multicentered data from China. The women were stratified into 5 groups in terms of pre-gravid BMI (kg/m2) with the WHO obesity standard (group 1: BMI < 18.5; group 2: 18.5 ≤ BMI < 23.0; group 3: 23.0 ≤ BMI < 25.0; group 4: 25.0 ≤ BMI < 30.0; group 5: BMI ≥ 30.0). The primary outcome was cumulative live birth rate (CLBR), and other clinical and neonatal outcomes were weighed as secondary outcomes. Multivariate logistic regression analyses were carried to evaluate the association between BMI and the CLBR, or between BMI and some neonatal outcomes. Furthermore, we implemented a machine-learning algorithm to predict the CLBR based on age and BMI.
RESULTS: A total of 115,287 women who underwent first IVF cycles with autologous oocytes from January 2013 to December 2017 were included in our study. The difference in the CLBR among the five groups was statistically significant (P < 0.001). The multivariate logistic regression analysis showed that BMI had no significant impact on the CLBR, while women\'s age associated with the CLBR negatively. Further, the calculation of the CLBR in different age stratifications among the five groups revealed that the CLBR lowered with age increasing, quantitatively, it decreased by approximately 2% for each one-year increment after 35 years old, while little difference observed in the CLBR corresponding to the five groups at the same age stratification. The machine-learning algorithm derived model showed that BMI\'s effect on the CLBR in each age stratification was negligible, but age\'s impact on the CLBR was overwhelming. The multivariate logistic regression analysis showed that BMI did not affect preterm birth, low birth weight infant, small for gestational age (SGA) and large for gestational age (LGA), while BMI was an independent risk factor for fetal macrosomia, which was positively associated with BMI.
CONCLUSIONS: Maternal pre-gravid BMI had no association with the CLBR and neonatal outcomes, except for fetal macrosomia. While the CLBR was lowered with age increasing. For the IVF-pursuing women with obesity plus advanced age, rather than losing weight first, the sooner the treatment starts, the better. A multicentered prospective study with a large size of samples is needed to confirm this conclusion in the future.
METHODS: A retrospective cohort study was performed using multicentered data from China. The women were stratified into 5 groups in terms of pre-gravid BMI (kg/m2) with the WHO obesity standard (group 1: BMI < 18.5; group 2: 18.5 ≤ BMI < 23.0; group 3: 23.0 ≤ BMI < 25.0; group 4: 25.0 ≤ BMI < 30.0; group 5: BMI ≥ 30.0). The primary outcome was cumulative live birth rate (CLBR), and other clinical and neonatal outcomes were weighed as secondary outcomes. Multivariate logistic regression analyses were carried to evaluate the association between BMI and the CLBR, or between BMI and some neonatal outcomes. Furthermore, we implemented a machine-learning algorithm to predict the CLBR based on age and BMI.
RESULTS: A total of 115,287 women who underwent first IVF cycles with autologous oocytes from January 2013 to December 2017 were included in our study. The difference in the CLBR among the five groups was statistically significant (P < 0.001). The multivariate logistic regression analysis showed that BMI had no significant impact on the CLBR, while women\'s age associated with the CLBR negatively. Further, the calculation of the CLBR in different age stratifications among the five groups revealed that the CLBR lowered with age increasing, quantitatively, it decreased by approximately 2% for each one-year increment after 35 years old, while little difference observed in the CLBR corresponding to the five groups at the same age stratification. The machine-learning algorithm derived model showed that BMI\'s effect on the CLBR in each age stratification was negligible, but age\'s impact on the CLBR was overwhelming. The multivariate logistic regression analysis showed that BMI did not affect preterm birth, low birth weight infant, small for gestational age (SGA) and large for gestational age (LGA), while BMI was an independent risk factor for fetal macrosomia, which was positively associated with BMI.
CONCLUSIONS: Maternal pre-gravid BMI had no association with the CLBR and neonatal outcomes, except for fetal macrosomia. While the CLBR was lowered with age increasing. For the IVF-pursuing women with obesity plus advanced age, rather than losing weight first, the sooner the treatment starts, the better. A multicentered prospective study with a large size of samples is needed to confirm this conclusion in the future.
摘要：
背景：随着女性肥胖发病率的增加和生育年龄的延迟，关于肥胖对妊娠和新生儿结局的影响的争论变得热烈起来。肥胖和衰老对生育能力的潜在负面影响导致了一个想法，追求IVF治疗的肥胖女性是否可以从以衰老为代价的长期减肥过程中获得的理想BMI中受益？我们旨在评估接受体外受精（IVF）治疗的患者的体重指数（BMI）与临床或新生儿结局之间的关系，为了回答肥胖患者是否有必要首先减肥，尤其是那些年迈的人。
方法：使用来自中国的多中心数据进行回顾性队列研究。根据WHO肥胖标准，根据妊娠前BMI（kg/m2）将妇女分为5组（第1组：BMI<18.5；第2组：18.5≤BMI<23.0；第3组：23.0≤BMI<25.0；第4组：25.0≤BMI<30.0；第5组：BMI≥30.0）。主要结果是累积活产率（CLBR），其他临床和新生儿结局作为次要结局进行称重.进行多因素logistic回归分析以评估BMI与CLBR之间的关系。或BMI和一些新生儿结局之间。此外，我们实施了一种基于年龄和BMI的机器学习算法来预测CLBR.
结果：从2013年1月至2017年12月，共有115,287名妇女接受了自体卵母细胞的首次IVF周期。五组间CLBR差异有统计学意义(P<0.001)。多因素logistic回归分析显示BMI对CLBR无显著影响,而女性的年龄与CLBR呈负相关。Further,五组不同年龄分层的CLBR的计算表明，CLBR随着年龄的增加而降低，定量，35岁后，每增加一年就减少约2%，而在相同年龄分层的五组对应的CLBR中观察到的差异不大。机器学习算法推导的模型表明，在每个年龄分层中，BMI对CLBR的影响可以忽略不计，但是年龄对CLBR的影响是压倒性的。多因素logistic回归分析显示,BMI不影响早产,低出生体重婴儿，胎龄小（SGA）和胎龄大（LGA），而BMI是巨大胎儿的独立危险因素,与BMI呈正相关。
结论：孕前BMI与CLBR和新生儿结局无关，除了巨大胎儿.而CLBR随着年龄的增加而降低。对于追求试管婴儿的肥胖加上高龄的女性来说，而不是先减肥，治疗越早开始,越好。未来需要一个大样本的多中心前瞻性研究来证实这一结论。
方法：使用来自中国的多中心数据进行回顾性队列研究。根据WHO肥胖标准，根据妊娠前BMI（kg/m2）将妇女分为5组（第1组：BMI<18.5；第2组：18.5≤BMI<23.0；第3组：23.0≤BMI<25.0；第4组：25.0≤BMI<30.0；第5组：BMI≥30.0）。主要结果是累积活产率（CLBR），其他临床和新生儿结局作为次要结局进行称重.进行多因素logistic回归分析以评估BMI与CLBR之间的关系。或BMI和一些新生儿结局之间。此外，我们实施了一种基于年龄和BMI的机器学习算法来预测CLBR.
结果：从2013年1月至2017年12月，共有115,287名妇女接受了自体卵母细胞的首次IVF周期。五组间CLBR差异有统计学意义(P<0.001)。多因素logistic回归分析显示BMI对CLBR无显著影响,而女性的年龄与CLBR呈负相关。Further,五组不同年龄分层的CLBR的计算表明，CLBR随着年龄的增加而降低，定量，35岁后，每增加一年就减少约2%，而在相同年龄分层的五组对应的CLBR中观察到的差异不大。机器学习算法推导的模型表明，在每个年龄分层中，BMI对CLBR的影响可以忽略不计，但是年龄对CLBR的影响是压倒性的。多因素logistic回归分析显示,BMI不影响早产,低出生体重婴儿，胎龄小（SGA）和胎龄大（LGA），而BMI是巨大胎儿的独立危险因素,与BMI呈正相关。
结论：孕前BMI与CLBR和新生儿结局无关，除了巨大胎儿.而CLBR随着年龄的增加而降低。对于追求试管婴儿的肥胖加上高龄的女性来说，而不是先减肥，治疗越早开始,越好。未来需要一个大样本的多中心前瞻性研究来证实这一结论。
