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Authors
Abstract(s)
Introdução:
A obesidade e o excesso de peso estão relacionados com efeitos deletérios ao nível do sistema reprodutivo que podem levar a infertilidade e complicações da gravidez, bem como a diminuição do sucesso das tecnologias de reprodução assistida (TRA). Em 2016, segundo a Organização Mundial da Saúde, existiam 1.9 mil milhões de adultos com excesso de peso e 650 milhões de adultos obesos em todo o mundo, pelo que é previsível que os problemas de fertilidade ganhem cada vez mais proporção.
A obesidade causa diversas condições metabólicas como diabetes mellitus e síndrome do ovário poliquístico (SOP). Contribui para irregularidades menstruais, anovulação, aborto espontâneo, menor taxa de conceção e complicações da gravidez, tais como diabetes gestacional, doença hipertensiva da gravidez, alterações do crescimento intrauterino e parto pré-termo.
Objetivo:
Investigar os efeitos do excesso de peso e da obesidade na infertilidade feminina, nas tecnologias de reprodução assistida e nas complicações da gravidez.
Metodologia:
Estudo retrospetivo e observacional, com uma amostra constituída por 137 mulheres com IMC =18.5 kg/m2, com idades compreendidas entre os 18 e os 40 anos e com uma média de idades de aproximadamente 33 anos (32.85±3.99), submetidas a tratamentos de fertilidade na Unidade de Medicina Reprodutiva do Centro Hospitalar Cova da Beira, entre 2011 e 2017. O IMC tem uma média de 24 kg/m2 (24.13±3.92). As mulheres com peso normal (18.5=IMC=24.99 kg/m2) correspondem a 65% dos casos, enquanto 35% das mulheres apresentam excesso de peso ou obesidade (IMC =25 kg/m2).
Resultados:
Verificou-se a existência de uma relação significativa (p<0.05) entre o IMC e os fatores de infertilidade, a SOP e o ciclo menstrual. Entre as mulheres que têm ciclo menstrual irregular, SOP ou fator ovárico/SOP, a maioria tem excesso de peso ou obesidade. Para as restantes variáveis em estudo, incluindo os resultados dos diferentes ciclos de tratamentos de fertilidade, não se verificou a existência de relação significativa com o IMC. No entanto, na IIU há uma ligeira diminuição não significativa da taxa de gravidez clínica nas mulheres com IMC elevado. As complicações da gravidez são superiores em mulheres com IMC =25 kg/m2, com predominância da diabetes gestacional, embora tal não seja estatisticamente significativo. Obteve-se ainda o modelo de regressão logística binária que demonstrou que as mulheres com SOP têm 4.5 vezes maior probabilidade de ter IMC =25 kg/m2.
Conclusões:
Há uma associação significativa entre o IMC e os fatores de infertilidade, a SOP e o ciclo menstrual. A maioria das mulheres com fator ovárico/SOP apresenta excesso de peso ou obesidade. No entanto, não se verificou influência estatisticamente significativa do IMC nas taxas de sucesso das TRA, nem nas complicações da gravidez após TRA. Este estudo alerta para a necessidade da elaboração de investigações mais abrangentes, com uma amostra substancialmente superior, por forma a averiguar as implicações do excesso de peso e da obesidade nas TRA e nas complicações da gravidez, bem como para avaliar o impacto da perda de peso prévia à realização das TRA. Não obstante, a obesidade comporta efeitos negativos a nível da saúde global, pelo que é pertinente consciencializar a população acerca dos benefícios dos estilos de vida saudáveis.
Introduction: Obesity and overweight are related to deleterious effects on the reproductive system that can lead to infertility and pregnancy complications, as well as decreased success of assisted reproduction technologies (ART). By 2016, according to WHO, there were 1.9 billion overweight adults and 650 million obese adults worldwide, therefore it is expected that fertility problems are going to increase in proportion. Obesity causes several metabolic conditions such as diabetes mellitus and polycystic ovarian syndrome (PCOS). It contributes to menstrual irregularities, anovulation, spontaneous abortion, lower conception rate, and pregnancy complications, such as gestational diabetes, hypertensive pregnancy, changes in intrauterine growth and preterm delivery. Goal: To investigate the effects of overweight and obesity on female infertility, assisted reproductive technologies and complications of pregnancy. Methodology: Retrospective and observational study with a sample of 137 women with a BMI =18.5 kg/m2, aged 18-40 years and with a mean age of approximately 33 years (32.85±3.99), submitted to fertility treatments at the Reproductive Medicine Unit of Cova da Beira Hospital Center between 2011 and 2017. The BMI has an average of 24 kg/m2 (24.13±3.92). Women with normal weight (18.5=IMC=24.99 kg/m2) correspond to 65% of the cases, while 35% of the women are overweight or obese (BMI =25 kg/m2). Results: There was a significant (p<0.05) association between BMI and infertility factors, PCOS and the menstrual cycle. Among women who have irregular menstrual cycles, PCOS or ovarian factor/PCOS, most are overweight or obese. For the remaining variables under study, including the results of the different cycles of fertility treatments, there was no significant association with BMI. However, in IUI there is a slight non-significant decrease in the clinical pregnancy rate in women with a high BMI. Pregnancy complications are higher in women with BMI =25 kg/m2, with predominance of gestational diabetes, although this is not statistically significant. It was also obtained a binary logistic regression model that showed that women with PCOS are 4.5 times more likely to have a BMI =25 kg/m2. Conclusions: There is a significant association between BMI and infertility factors, PCOS and menstrual cycle. Most women with ovarian/PCOS are overweight or obese. However, there was no statistically significant influence of BMI on the success rates of ART, nor on pregnancy complications after ART. This study points to the need to elaborate more extensive investigations with a substantially higher sample, to ascertain the implications of overweight and obesity in ART and pregnancy complications, as well as to evaluate the impact of the weight loss prior to ART. Nevertheless, obesity has negative effects on global health, so it is important to raise awareness of the benefits of healthy lifestyles.
Introduction: Obesity and overweight are related to deleterious effects on the reproductive system that can lead to infertility and pregnancy complications, as well as decreased success of assisted reproduction technologies (ART). By 2016, according to WHO, there were 1.9 billion overweight adults and 650 million obese adults worldwide, therefore it is expected that fertility problems are going to increase in proportion. Obesity causes several metabolic conditions such as diabetes mellitus and polycystic ovarian syndrome (PCOS). It contributes to menstrual irregularities, anovulation, spontaneous abortion, lower conception rate, and pregnancy complications, such as gestational diabetes, hypertensive pregnancy, changes in intrauterine growth and preterm delivery. Goal: To investigate the effects of overweight and obesity on female infertility, assisted reproductive technologies and complications of pregnancy. Methodology: Retrospective and observational study with a sample of 137 women with a BMI =18.5 kg/m2, aged 18-40 years and with a mean age of approximately 33 years (32.85±3.99), submitted to fertility treatments at the Reproductive Medicine Unit of Cova da Beira Hospital Center between 2011 and 2017. The BMI has an average of 24 kg/m2 (24.13±3.92). Women with normal weight (18.5=IMC=24.99 kg/m2) correspond to 65% of the cases, while 35% of the women are overweight or obese (BMI =25 kg/m2). Results: There was a significant (p<0.05) association between BMI and infertility factors, PCOS and the menstrual cycle. Among women who have irregular menstrual cycles, PCOS or ovarian factor/PCOS, most are overweight or obese. For the remaining variables under study, including the results of the different cycles of fertility treatments, there was no significant association with BMI. However, in IUI there is a slight non-significant decrease in the clinical pregnancy rate in women with a high BMI. Pregnancy complications are higher in women with BMI =25 kg/m2, with predominance of gestational diabetes, although this is not statistically significant. It was also obtained a binary logistic regression model that showed that women with PCOS are 4.5 times more likely to have a BMI =25 kg/m2. Conclusions: There is a significant association between BMI and infertility factors, PCOS and menstrual cycle. Most women with ovarian/PCOS are overweight or obese. However, there was no statistically significant influence of BMI on the success rates of ART, nor on pregnancy complications after ART. This study points to the need to elaborate more extensive investigations with a substantially higher sample, to ascertain the implications of overweight and obesity in ART and pregnancy complications, as well as to evaluate the impact of the weight loss prior to ART. Nevertheless, obesity has negative effects on global health, so it is important to raise awareness of the benefits of healthy lifestyles.
Description
Keywords
Complicações da Gravidez Imc Infertilidade Obesidade Tecnologias de Reprodução Assistida