İnfertil Obez Kadınlarda Obezitenin Yönetiminde Kullanılan Yöntemlerin Obstetrik Sonuçlara Etkisi: Sistematik Derleme ve Meta-Analiz

Amaç: Bu çalışma, infertil obez kadınlarda obezitenin yönetiminde kullanılan yöntemlerin obstetrik sonuçlara etkisinin belirlemesi amacı ile yapılmıştır. Yöntem: Çalışma sistematik derlemede ve meta-analiz deseninde yapılmıştır. Taramalar Şubat-Mart 2021 tarihleri arasında, obesity* AND infertility* AND weight control*AND weight reduction* kelime grupları ile PubMed, Ulusal Tez Merkezi, DergiPark, MEDLINE, the Cochrane Library ve EBSCO arama motorlarından yapılmıştır. Araştırmaların metodolojik kalitesi Joanna Briggs Institute tarafından geliştirilen deneysel, yarı deneysel ve kesitsel çalışmalar için Kritik Değerlendirme Kontrol Listeleri ile değerlendirilmiştir. Veriler meta-analiz yöntemleri ile sentez edilmiştir. Bulgular: Çalışmaya 2010–2021 yıllarında yayımlanmış 19 araştırma dâhil edilmiştir. Araştırmaların toplam örneklem hacmi 3253’tür. Meta-analiz sonuçlarında, müdahale grubunda gebelik oluşumunun 2.12 (OR: 2.12, p= 0.002), spontan gebeliğin 2.19 (OR: 2.19, p<0.001), canlı doğum oranının 1,5 (OR: 1.50, p=0.04) ve abortus gelişme olasılığının 1.58 (OR: 1.58, p=0.01) kat daha fazla olduğu bulunmuştur. Çalışmaların birleştirilmiş sonuçları, kullanılan yöntemlerin, beden kitle indeksi (p=0.0003), kadın başına düşen obstetrik maliyet (p=0.0007) ve doğum ağırlığında (p=0.04) istatistiksel olarak anlamlı azalmaya neden olduğunu ve yardımlı gebelik, çoğul gebelik, ektopik gebelik, sezaryen doğum, preterm doğum, laserasyon, doğum sonu kanama, preeklemsi, gestasyonel diyabet, gestasyonel hipertansiyon, HELLP sendromu, APGAR<7 ve konjenital anomali üzerine etkili olmadığını göstermiştir. Sonuç: Bu çalışmada, obez infertil kadınlarda kilo yönetiminde kullanılan yöntemlerin, kilo kaybı, gebelik oluşumu, canlı doğum, spontan gebelik ve abortus oranını arttırdığı, obstetrik komplikasyonlar, kadın ve bebek sağlığı ile ilgili sonuçları etkilemediği, obstetrik maliyeti düşürdüğü sonuçları açığa çıkarılmıştır.

Anahtar Kelimeler:

obezite, infertilite, gebelik, diyet, egzersiz, kilo kaybı

The Effect of Methods Used in the Management of Obesity in Infertile Obese Women on Obstetric Outcomes: A Systematic Review and Meta-Analysis

Aim: This study was conducted to determine the effects of the methods used in the management of obesity in infertile obese women on obstetric outcomes.Method: The study was conducted in a systematic review and meta-analysis design. Searches were made between February and March 2021, using the word groups obesity* AND infertility* AND weight control*AND weight reduction* from PubMed, National Thesis Centre, DergiPark, MEDLINE, the Cochrane Library and, EBSCO search engines. The methodological quality of the studies was evaluated with the Critical Evaluation Checklists developed by the Joanna Briggs Institute. Data were synthesized by meta-analysis methods.Results: For this study, the results of 19 studies published in 2010-2021 were compiled. The total sample size of the studies is 3253. In the meta-analysis results, pregnancy occurs in the intervention group was 2.12 (OR: 2.12, p= 0.002), spontaneous pregnancy was 2.19 (OR: 2.19, p<0.001), live birth rate was 1.5 (OR: 1.50, p=0.04), and the probability of developing abortion was 1.58 (OR: 1.58, p=0.01) times higher. The combined results of the studies showed that the methods used resulted in a statistically significant reduction in body mass index (p=0.0003), obstetric cost per woman (p=0.0007) and, birth weight (p=0.04). In addition don’t affect the results of obstetric complications. Conclusion: In this study, it was revealed that the methods used in weight management in obese infertile women increase the rate of pregnancy formation, live birth, spontaneous pregnancy, and abortion, do not affect the results of obstetric complications, women and infant health.

Keywords:

Obesity, Infertility, Pregnancy, Diet, Exercise, Weight loss,

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1. WHO [Internet]. Obesity and overweight. (2020). [cited by 01.01.2021] Available from: https://www.who.int/news-room/fact-sh ee ts / de ta il /obesity-and-overweight.
2. Türkiye Nüfus ve Sağlık Araştırması, ‘’Çocukların ve Kadınların Beslenme Durumu’’, TNSA, Ankara, 2018,159-68.
3. WHO[Internet]. İnfertility. (2020). [cited by 01.01.2021] Available from: https://www.who.int/news-room/fact-sheets/detail/infertility.
4. Küçükdurmaz F, Taşkıran M. İnfertil kadınlarda cinsel fonksiyonlar (tanı ve tedavi aşamalarında). Türkiye Klinikleri J Urology 2015;8(3):52-7.
5. Cara DD, Kominiarek MA. Pregnancy in women with obesity. Obstetrics and Gynecology Clinics of North America 2018;45(2):217-32.
6. CDC [Internet]. Infertility and Public Health. Reproductive Health. (2020). [cited by 01.01.2021] Available from: https://www.cdc.gov/reproductivehealth/infertility /publ ichealth.htm.
7. Khaskheli MN, Baloch S, Baloch AS. Infertility and weight reduction: Influence and Outcome. JCPSP 2013;23 (11):798-801.
8. Best D, Avenell A, Bhattacharya S. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence. Hum Reprod Update 2017;23(6):681-705.
9. Seneviratne NS, et al. Antenatal exercise in overweight and obese women and its effects on offspring and maternal health: Design and rationale of the IM. BMC Pregnancy and Childbirth 2014;14:148-156.
10. Moher D, et al. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):1000097.
11. Munn Z, et al. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. International Journal of Health Policy and Management 2014;3(3):123-28.
12. JBI [Internet]. Manual for evidence synthesis, jbi data extraction form for experimental /observational studies. (2020). [cited by 05.12.2020] Available from: https:// wiki.jbi. global/ display /MANUAL /3.2.8+Data + extraction.
13. Becker FG, Passos EP, Moulin CC. Short-term effects of a hypocaloric diet with low glycemic index. Am J Clin Nutr 2015;102:1365-72.
14. Duval K, at al. The Obesity-fertility protocol: a randomized controlled trial assessing clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women. BMC Obes 2015;2:47.
15. Einarsson S, at al. Weight reduction intervention for obese infertile women prior to IVF: a randomized controlled trial. Hum Reprod 2017;32(8): 1621-30
16. Einarsson S, at al. No effect of weight intervention on perinatal outcomes in obese women scheduled for in vitro fertilization treatment. AOGS 2019;98:708-14.
17. Espinós JJ, et al. Weight decrease improves live birth rates in obese women undergoing IVF: a pilot study. Reproductive Bio Medicine Online [Internet] 2017; Oct [cited;35(4):417-424.]. Available from: https:// pubmed. ncbi. nlm. nih. gov/ 2 8 739335/.
18. Goldman RH, et al. Reproductive outcomes differ following roux-en-Y gastric bypass and adjustable gastric band compared with those of an obese non-surgical group. Obes Surg 2016;26(11):2581-89.
19. Grzegorczyk-Martin V, et al. IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study. Hum Reprod 2020; 35(12):2755–62.
20. Kaya Y, et al. The effect of health-promoting lifestyle education on the treatment of unexplained female infertility. EJOG 2016; 9667:1-6.
21. Kiel IA, et al. Women undergoing assisted fertilisation and high-intensity interval training: a pilot randomised controlled trial. BMJ Open Sport Exerc Med 2018;4(1):000387.
22. Milone M, et al. Does bariatric surgery improve assisted reproductive technology outcomes in obese infertile women? Obes Surg 2017;27(8):2106-12.
23. Moran L, et al. Diet and IVF pilot study: Short-term weight loss improves pregnancy rates in overweight⁄obese women undertaking IVF. ANZJOG 2011;51(5):455-9.
24. Musella M, et al. The potential role of intragastric balloon in the treatment of obese-related infertility: Personal experience. Obes Surg 2011;21(4):426-30.
25. Musella M, et al. Effect of bariatric surgery on obesity-related infertility. Surg Obes Relat Dis 2012;8(4):445-9.
26. Mutsaerts MAQ, et al. Randomized trial of a lifestyle program in obese infertile women. N Engl J Med 2016; 374(20):1942-1953.
27. Oers AM, et al. Effectiveness of lifestyle intervention in subgroups of obese infertile women: a subgroup analysis of a RCT. Hum Reprod 2016;31(12):2704-13.
28. Oers AM, et al. Cost-effectiveness analysis of lifestyle intervention in obese infertile women. Human Reproduction 2017;32(7):1418-26.
29. Palomba S, et al. Physical activity before IVF and ICSI cycles in infertile obese women: an observational cohort study. Reproductive BioMedicine Online [Internet] 2014;Oct [cited;29:72-9.]. Available from: https://www.rbmojournal.com/action/ showPdf?pii=S1472-6483%2814%2900137-0.
30. Rothberg A, et al. The Feasibility of a Brief, Intensive Weight Loss Intervention to Improve Reproductive Outcomes in Obese, Subfertile Women: A Pilot Study. Fertil Steril 2016;106(5):1212-20.
31. Sim KA, et al. Weight loss improves reproductive outcomes in obese women undergoing fertility treatment: a randomized controlled trial. Clin Obes 2014;4:61–8.
32. Adamo KB, et al. The Maternal Obesity Management (MOM) Trial Protocol: a lifestyle intervention during pregnancy to minimize downstream obesity. Contemp Clin Trials 2013;35(1):87-96.
33. Amiri M, Tehrani FR. Potential Adverse Effects of Female and Male Obesity on Fertility: A Narrative Review. Int J Endocrinol Metab 2020;18(3):101776.
34. Güler AE, et al. Spontan ve Yardımcı Üreme Tekniği ile Oluşan İkiz Gebeliklerin Perinatal Sonuçları. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi 2016;8(4):256-62.
35. Price S, et al. Health consequences for mother and baby of substantial pre-conception weight loss in obese women: study protocol for a randomized controlled trial. Trials 2018;19(1):248-61.
36. Jul Yi X, et al. A meta-analysis of maternal and fetal outcomes of pregnancy after bariatric surgery. Int J Gynaecol Obstet 2015;130(1):3-9.
37. Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric ve risks, a systematic review and meta-analysis: do the benefits outweigh the benefits outweigh the risks? Am J Obstet Gynecol 2018;218(6):573-80.
38. Espinós JJ, et al. The Effect of Lifestyle Intervention on Pregnancy and Birth Outcomes on Obese Infertile Women: A Systematic Review and Meta-Analysis. Int J Fertil Steril 2020;14(1):1-9.
39. Lisonkova S, et al. Maternal Risk Factors and adverse birth Outcomes Associated with HELLP syndrome: a population-based study. BJOG 2020;127(10):1189-1198.
40. Zhu T, et al. Association between maternal obesity and Offspring APGAR score or cord pH: systemstic review and meta-analysis. Scientific Reports 2015;5:183-86.