The Risk of Recurrent Pregnancy Loss in Patients with a High Body Mass Index: An Evidence-Based Case Report
Authors
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Tofan Widya Utami
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
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Lowilius Wiyono
- Nathalia Isabella Muskitta Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
- Nadine Herdwita Putri Soerojo Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
- Karel Handito Syafi Sumarsudi Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
- Ingrid Felicia Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
DOI:
https://doi.org/10.3923/pjn.2020.460.467Keywords:
Body mass index, obesity, prenatal care, recurrent pregnancy loss, reproductive diseasesAbstract
Background and Objective: A high body mass index (BMI) has many negative health consequences. Recurrent pregnancy loss (RPL) has become an important issue in pregnancy outcomes. An increasing frequency of RPL not only in undernourished women but also in women with high BMIs suggested that there is an association between these variables. Lack of evidence urged the authors to determine the association between RPL and high BMI to understand the correlation between RPL in women with high BMI so that BMI can be considered in the prevention of RPL with nutritional approaches. Materials and Methods: This evidence-based case report used the population, intervention, control, outcome (PICO) method in the literature search. A literature search was performed by hand searches and database searches in Cochrane Library, Science Direct and PubMed. The included articles were appraised for their results and quality assessment using the Center for Evidence Based Medicine (CEBM) Oxford Appraisal Tools. Results: We found 308 articles; however, only one meta-analysis was included in the qualitative analysis. The article concluded that there was a significant correlation between a high BMI and RPL (OR = 1.34 [95% CI, 1.05-1.70]; p = 0.02), especially in obese patients (OR = 1.75 [95% CI, 1.24-2.46]; p = 0.001). These results were in line with those of several studies and reviews. While remaining unclear, various factors are considered to cause RPL in obesity, such as abnormalities in the hormonal axis, oocyte quality, embryo development, endometrial receptivity and inflammation markers. Conclusion: A high BMI in pregnant women is significantly correlated with a higher incidence of recurrent pregnancy loss. Thus, comprehensive management of prenatal care including a nutritional approach is required to prevent RPL.
References
WHO, 2019. Obesity and Overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Purnell, J.Q., 2018. Definitions, Classification, and Epidemiology of Obesity. In: Endotext, Feingold K.R., B. Anawalt and A. Boyce et al., (Eds.)., MDText.com, Inc, Maryland.
Harbuwono, D.S., L.A. Pramono, E. Yunir and I. Subekti, 2018. Obesity and central obesity in Indonesia: evidence from a national health survey. Med. J. Indonesia, 27: 114-120.
Oddo, V.M., M. Maehara and J.H. Rah, 2019. Overweight in Indonesia: an observational study of trends and risk factors among adults and children. BMJ Open, Vol. 9, No. 9.
Djalalinia, S., M. Qorbani, N. Peykari and R. Kelishadi, 2015. Health impacts of obesity. Pak. J. Med. Sci., 31: 239-242.
Kyrou, I., H.S. Randeva, C. Tsigos, G. Kaltsas and M.O. Weickert, 2018. Clinical Problems Caused by Obesity. In: Endotext [Internet], Feingold, K.R., B. Anawalt, A. Boyce, G. Chrousos and K. Dungan et al. (Eds.). MDText.com, Inc., South Dartmouth, MA., USA.
Lorem, G.F., H. Schirmer and N. Emaus, 2017. What is the impact of underweight on self-reported health trajectories and mortality rates: a cohort study. Health Qual. Life Outcomes, Vol. 15, No. 191.
WHO., 2016. Prevalence of underweight among adults, BMI < 18.5, crude estimates by WHO region. https://apps.who.int/gho/data/view.main.NCDBMILT18CREGv
Park, D., J.H. Lee and S. Han, 2017. Underweight: another risk factor for cardiovascular disease? Medicine, Vol. 96, No. 48.
Noh, J.W., Y.D. Kwon, J. Park and J. Kim, 2015. Body mass index and depressive symptoms in middle aged and older adults. BMC Public Health, Vol. 15, No. 310.
Pan, Y., S. Zhang, Q. Wang, H. Shen, Y. Zhang et al., 2016. Investigating the association between prepregnancy body mass index and adverse pregnancy outcomes: a large cohort study of 536 098 Chinese pregnant women in rural China. BMJ Open, Vol. 6, No. 7.
Triunfo, S. and A. Lanzone, 2015. Impact of maternal under nutrition on obstetric outcomes. J. Endocrinological Invest., 38: 31-38.
Silvestris, E., G.d. Pergola, R. Rosania and G. Loverro, 2018. Obesity as disruptor of the female fertility. Reprod. Biol. Endocrinol., Vol. 16, No. 22.
Mahutte, N., C. Kamga-Ngande, A. Sharma and C. Sylvestre, 2018. Obesity and reproduction. Obstetrics Gynaecology Canada, 40: 950-966.
Hachem, H.E., V. Crepaux, P. May-Panloup, P. Descamps, G. Legendre and P.E. Bouet, 2017. Recurrent pregnancy loss: current perspectives. Int. J. Women's Health, 2017: 331-345.
ASRM, 2016. What is Recurrent Pregnancy Loss (RPL)? American Society for Reproductive Medicine.
Stubert, J., F. Reister, S. Hartmann and W. Janni, 2018. The risks associated with obesity in pregnancy. Dtsch Arztebl Int., 115: 276-283.
CEBM Oxford, 2019. Systematic Reviews Critical Appraisal Sheet. cebm.net/wp-content/uploads/2019/01/Systematic-Review.pdf
Cavalcante, M.B., M. Sarno, A.B. Peixoto, E.A. Júnior and R. Barini, 2019. Obesity and recurrent miscarriage: A systematic review and metaâ€analysis. J. Obstetrics Gynaecology Res., 45: 30-38.
Lashen, H., K. Fear and D.W. Sturdee, 2004. Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case–control study. Hum. Reprod., 19: 1644-1646.
Metwally, M., S.H. Saravelos, W.L. Ledger and T.C. Li, 2010. Body mass index and risk of miscarriage in women with recurrent miscarriage. Fertil. Sterility, 94: 290-295.
Lo, W., R. Rai, A. Hameed, S.R. Brailsford, A.A. Al-Ghamdi and L. Regan, 2012. The effect of body mass index on the outcome of pregnancy in women with recurrent miscarriage. J. Family Community Med., 19: 167-171.
Boots, C.E., L.A. Bernardi and M.D. Stephenson, 2014. Frequency of euploid miscarriage is increased in obese women with recurrent early pregnancy loss. Fertil. Sterility, 102: 455-459.
Bhandari, H.M., B.K. Tan and S. Quenby, 2020. Superfertility is more prevalent in obese women with recurrent early pregnancy miscarriage. Int. J. Obstetrics Gynecology, 127: 217-222.
Zhang, B.Y., Y.S. Wei, J.M. Niu, Y. Li, Z.L. Miao and Z.N. Wang, 2010. Risk factors for unexplained recurrent spontaneous abortion in a population from southern China. Int. J. Gynecology Obstetrics, 108: 135-138.
Metwally, M., K.J. Ong, W.L. Ledger and T.C. Li, 2008. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil. Steril., 90: 714-726.
Talmor, A. and B. Dunphy, 2015. Female obesity and infertility. Best Pract. Res. Clin. Obstetrics Gynaecology, 29: 498-506.
Boots, C. and M.D. Stephenson, 2011. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin. Reprod. Med., 29: 507-513.
Metwally, M., E.M. Tuckerman, S.M. Laird, W.L. Ledger and T.C. Li, 2007. Impact of high body mass index on endometrial morphology and function in the peri-implantation period in women with recurrent miscarriage. Reprod. BioMed. Online, 14: 328-334.
Arendas, K., Q.Qiu and A. Gruslin, 2008. Obesity in pregnancy: pre-conceptional to postpartum consequences. J. Obstetrics and Gynaecology Canada, 30: 477-488.
Dadi, A.F., H.D. Desyibelew, 2019. Undernutrition and its associated factors among pregnant mothers in Gondar town, Northwest Ethiopia. PLoS ONE, Vol. 14, No. 4.
Lopes, K.d.S., E. Ota, P. Shakya, A. Dagvadorj and O.O. Balogun et al., 2017. Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews. BMJ Glob. Health, Vol. 2, No. 3.
ACOG, 2020. Nutrition During Pregnancy. https://www.acog.org/patient-resources/faqs/pregnancy/nutrition-during-pregnancy
Sugiura-Ogasawara, M., 2015. Recurrent pregnancy loss and obesity. Best Pract. Res. Clin. Obstetrics Gynaecology, 29: 489-497.
Atik, R.B., O.B. Christiansen, J. Elson, A.M. Kolte and S. Lewis et al., 2018. ESHRE guideline: recurrent pregnancy loss. Hum. Reprod. Open, Vol. 2015, No. 2.
Pearson, A.C. and T.A. Mahmood, 2020. Obesity and Recurrent Miscarriage. In: Obesity and Gynecology. Mahmood, T.A., S. Arulkumaran and F.A. Chervenak (Eds.). Elsevier, Netherlands pp: 91-96.
Bahadur, A. and J. Chaturvedi, 2018. Obesity and Its Association with Recurrent Pregnancy Loss. In: Recurrent Pregnancy Loss. Mehta, S. and B. Gupta (Eds.). Springer, Singapore pp: 363-369.
Vahid, F., N. Shivappa, A. Hekmatdoost, J.R. Hebert, S.H. Davoodi and M. Sadeghi, 2017. Association between maternal dietary inflammatory index (DII) and abortion in Iranian women and validation of DII with serum concentration of inflammatory factors: case-control study. Applied Physiol., Nutr. and Metab., 42: 511-516.
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