Begin at the beginning: some reflections on future periconceptional and obstetric care and research in the Netherlands

Bariatric surgery influences the number and quality of oocytes in patients submitted to assisted reproduction techniques

OBJECTIVE

To determine differences in follicle stimulation, oocyte retrieval, maturation, and fertilization among patients who underwent bariatric surgery, obese patients, and patients with 18 < BMI < 30 kg/m² submitted to assisted reproduction techniques and check that these patients may have some impairment in ovarian response.

METHODS

The study comprised three groups: GI: 29 patients who had undergone restrictive and/or malabsorptive bariatric surgery; GII: 57 obese patients (BMI > 30 kg/m²); and GIII: 94 patients (18 < BMI < 30 kg/m²) with infertility due to a male factor. BMI, weight loss until oocyte retrieval, vitamin supplementation, and anemia were evaluated. Data were compared with the number of follicles observed, the number of oocytes retrieved, and the maturation status of these oocytes. Results were analyzed statistically.

RESULTS

A statistically significant difference in the number of follicles observed by ultrasound (P < 0.01), the number of oocytes retrieved (P = 0.013), and the number of metaphase II oocytes (P < 0.01) between the patients with prior bariatric surgery and both GII and GIII group was found.

CONCLUSIONS

The weight loss resulting from bariatric surgery can be very beneficial to the overall health of the woman, but the reproductive process can be impaired. Bariatric surgery appears to have an important impact on the formation of follicles and oocytes.

Periconceptional multivitamin use and infant birth weight disparities

PURPOSE

In the United States, African American women deliver preterm and low birth weight infants two to three times more frequently than their white counterparts. Our objective was to determine whether maternal periconceptional multivitamin (MVI) use is associated with this disparity.

METHODS

As a secondary analysis of previously collected data from mothers of non-malformed infants from the Slone Epidemiology Center Birth Defects Study, we conducted a retrospective cohort study of 2331 non-Hispanic white and 133 non-Hispanic black mother/infant pairs from 1998 through 2007. To estimate the effect of MVI use on birth outcomes, linear regression models were used.

RESULTS

In white subjects, MVI use was not associated with birth weight, gestational age, or weight-for-gestational-age. However, in black subjects, MVI use was associated with a 536-gram increased birth weight (p=0.001). Black MVI users also had longer gestations (although not statistically significant). When birth weights were adjusted for gestational age using z scores, MVI use was associated with increased fetal growth in black infants (+0.86 z score units, 95% confidence interval: 0.35-1.36).

CONCLUSIONS

The present findings suggest MVI use may improve fetal growth and possibly gestational age in the offspring of African American women.