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Burden SJ, Alshehri R, Lamata P, Poston L, Taylor PD. Maternal obesity and offspring cardiovascular remodelling - the effect of preconception and antenatal lifestyle interventions: a systematic review. Int J Obes (Lond) 2024; 48:1045-1064. [PMID: 38898228 PMCID: PMC11281905 DOI: 10.1038/s41366-024-01536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/02/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Preconception or antenatal lifestyle interventions in women with obesity may prevent adverse cardiovascular outcomes in the child, including cardiac remodelling. We undertook a systematic review of the existing data to examine the impact of randomised controlled trials of lifestyle interventions in pregnant women with obesity on offspring cardiac remodelling and related parameters of cardiovascular health. METHODS This review was registered with PROSPERO (CRD42023454762) and aligns with PRISMA guidelines. PubMed, Embase, and previous reviews were systematically searched. Follow-up studies from randomised trials of lifestyle interventions in pregnant women with obesity, which included offspring cardiac remodelling or related cardiovascular parameters as outcome measures, were included based on pre-defined inclusion criteria. RESULTS Eight studies from five randomised controlled trials were included after screening 3252 articles. Interventions included antenatal exercise (n = 2), diet and physical activity (n = 2), and preconception diet and physical activity (n = 1). Children were <2-months to 3-7-years-old, with sample sizes ranging between n = 18-404. Reduced cardiac remodelling, with reduced interventricular septal wall thickness, was consistently reported. Some studies identified improved systolic and diastolic function and a reduced resting heart rate. Risk of bias analyses rated all studies as 'fair' (some risk of bias). A high loss-to-follow-up was a common limitation. CONCLUSION Although there is some evidence to suggest that lifestyle interventions in women with obesity may limit offspring cardiac remodelling, further high-quality longitudinal studies with larger sample sizes are required to confirm these observations and to determine whether these changes persist to adulthood. Child offspring cardiovascular health benefits of preconception and antenatal lifestyle interventions in women with obesity.
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Affiliation(s)
- Samuel J Burden
- Department of Women and Children's Health, School of Life Course & Population Sciences, King's College London, London, UK.
| | - Rahaf Alshehri
- Cardiovascular Medicine and Science Research, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
| | - Pablo Lamata
- Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course & Population Sciences, King's College London, London, UK
| | - Paul D Taylor
- Department of Women and Children's Health, School of Life Course & Population Sciences, King's College London, London, UK
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Wang Z, Van Faassen M, Groen H, Cantineau AEP, Van Oers A, Van der Veen A, Hawley JM, Keevil BG, Kema IP, Hoek A. Resumption of ovulation in anovulatory women with PCOS and obesity is associated with reduction of 11β-hydroxyandrostenedione concentrations. Hum Reprod 2024; 39:1078-1088. [PMID: 38503490 PMCID: PMC11063562 DOI: 10.1093/humrep/deae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 02/02/2024] [Indexed: 03/21/2024] Open
Abstract
STUDY QUESTION Is resumption of ovulation after a 6-month lifestyle intervention in women with PCOS and obesity associated with differential changes in endocrine and metabolic parameters (weight, insulin resistance, anti-Müllerian hormone (AMH), and androgens) compared to women with PCOS who remained anovulatory? SUMMARY ANSWER Resumption of ovulation after a 6-month lifestyle intervention in women with PCOS and obesity is associated with changes in serum 11β-hydroxyandrostenedione (11OHA4) concentrations. WHAT IS KNOWN ALREADY Lifestyle interventions have been shown to reduce clinical and biochemical hyperandrogenism in women with PCOS. Weight loss of 5-10% may reverse anovulatory status, thereby increasing natural conception rates. However, the mechanisms underlying why some women with PCOS remain anovulatory and others resume ovulation after weight loss are unclear. Reproductive characteristics at baseline and a greater degree of change in endocrine and metabolic features with lifestyle intervention may be crucial for ovulatory response. STUDY DESIGN, SIZE, DURATION We used data and samples originating from an earlier randomized controlled trial (RCT), which examined the efficacy of a 6-month lifestyle intervention prior to infertility treatment compared to prompt infertility treatment on live birth rate in women with obesity. A total of 577 women with obesity (BMI > 29 kg/m2) were randomized between 2009 and 2012. Anovulatory women with PCOS who were allocated to the intervention arm of the original RCT (n = 95) were included in the current analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS We defined women as having resumed ovulation (RO+) based on the following criteria: spontaneous pregnancy; or assignment to expectant management; or IUI in natural cycles as the treatment strategy after lifestyle intervention. Steroid hormones were measured using liquid chromatography tandem mass spectrometry. Generalized estimating equations with adjustment for baseline measures and interaction between group and time was used to examine differences in changes of endocrine and metabolic parameters between RO+ (n = 34) and persistently anovulatory women (RO-, n = 61) at 3 and 6 months after intervention. MAIN RESULTS AND THE ROLE OF CHANCE At baseline, the mean ± SD age was 27.5 ± 3.6 years in the RO+ group and 27.9 ± 4.1 years in the RO- group (P = 0.65), and the mean ± SD weights were 101.2 ± 9.5 kg and 105.0 ± 14.6 kg, respectively (P = 0.13). Baseline AMH concentrations showed significant differences between RO+ and RO- women (median and interquartile range [IQR] 4.7 [3.2; 8.3] versus 7.2 [5.3; 10.8] ng/ml, respectively). Baseline androgen concentrations did not differ between the two groups. During and after lifestyle intervention, both groups showed weight loss; changes in 11OHA4 were significantly different between the RO+ and RO groups (P-value for interaction = 0.03). There was a similar trend for SHBG (interaction P-value = 0.07), and DHEA-S (interaction P-value = 0.06), with the most pronounced differences observed in the first 3 months. Other parameters, such as AMH and FAI, decreased over time but with no difference between the groups. LIMITATIONS, REASONS FOR CAUTION No high-resolution transvaginal ultrasonography was used to confirm ovulatory status at the end of the lifestyle program. The small sample size may limit the robustness of the results. WIDER IMPLICATIONS OF THE FINDINGS Reduction of androgen concentrations during and after lifestyle intervention is associated with recovery of ovulatory cycles. If our results are confirmed in other studies, androgen concentrations could be monitored during lifestyle intervention to provide individualized recommendations on the timing of resumption of ovulation in anovulatory women with PCOS and obesity. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a grant from ZonMw, the Dutch Organization for Health Research and Development (50-50110-96-518). The Department of Obstetrics and Gynecology of the UMCG received an unrestricted educational grant from Ferring Pharmaceuticals BV, The Netherlands. A.H. reports consultancy for the development and implementation of a lifestyle App MyFertiCoach developed by Ferring Pharmaceutical Company. All other authors have no conflicts to declare. TRIAL REGISTRATION NUMBER The LIFEstyle RCT was registered at the Dutch trial registry (NTR 1530).
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Affiliation(s)
- Z Wang
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Van Faassen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A E P Cantineau
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Van Oers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Van der Veen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J M Hawley
- Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, UK
| | - B G Keevil
- Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, UK
| | - I P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Wang Z, Van Faassen M, Groen H, Cantineau AEP, Van Oers A, Van der Veen A, Hawley JM, Keevil BG, Kema IP, Hoek A. Discriminatory Value of Steroid Hormones on Polycystic Ovary Syndrome and Clustering of Hyperandrogenism and Metabolic Factors. Endocr Pract 2024; 30:348-355. [PMID: 38244859 DOI: 10.1016/j.eprac.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE We determined (1) if 11-oxygenated androgens better identify polycystic ovary syndrome (PCOS) diagnosis in women with obesity compared to total or free testosterone (T) and free androgen index; (2) how biochemical hyperandrogenism and metabolic factors cluster in a cohort of women with infertility and obesity. METHODS Women with obesity and PCOS comprised the study group (N = 132). Ovulatory women with obesity and idiopathic, tubal or male factor infertility were the control group (N = 83). Steroid hormones were measured by means of liquid chromatography tandem mass spectrometry. Receiver operating characteristic curves and principal component analysis were used. RESULTS Women with obesity and PCOS had higher 11-ketotestosterone (11 KT) (1.22 nmol/L [0.84; 1.65] vs 1.05 [0.78; 1.35], P = .04) compared to controls, but not 11β-hydroxyandrostenedione 4.30 [2.87; 5.92] vs 4.06 [3.22; 5.73], P = .44). 11-ketotestosterone (area under the curve: 0.59) did not better discriminate PCOS in women with obesity compared to: total T (0.84), free T (0.91), and free androgen index (0.85). We identified 4 principal components (PCs) in the PCOS group (72.1% explained variance): (1) insulin resistance status; (2) blood pressure; (3) obesity; (4) androgen status and 4 PCs in the control group (68.7% explained variance) with variables representing metabolism being dispersed in component 2, 3, and 4. CONCLUSIONS Eleven-oxygenated androgens do not aid in the diagnosis of PCOS in women with obesity. Insulin resistance is the strongest PC in the PCOS group. There is no major dominant characteristic that defines obese non-PCOS women.
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Affiliation(s)
- Zheng Wang
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn Van Faassen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Astrid E P Cantineau
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne Van Oers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna Van der Veen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - James M Hawley
- Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, UK
| | - Brian G Keevil
- Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, UK
| | - Ido P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
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Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
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Developing a lifestyle intervention program for overweight or obese preconception, pregnant and postpartum women using qualitative methods. Sci Rep 2022; 12:2511. [PMID: 35169236 PMCID: PMC8847557 DOI: 10.1038/s41598-022-06564-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 02/02/2022] [Indexed: 11/18/2022] Open
Abstract
The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors to improve the metabolic health of mothers and their offspring. However, the success of a lifestyle intervention is dependent on uptake and continued compliance. To identify enablers and barriers towards engagement with a lifestyle intervention, thematic analysis of 15 in-depth interviews with overweight or obese women in the preconception, pregnancy or postpartum periods was undertaken, using the integrated-Promoting Action on Research Implementation in Health Services framework as a guide to systematically chart factors influencing adoption of a novel lifestyle intervention. Barrier factors include time constraints, poor baseline knowledge, family culture, food accessibility, and lack of relevant data sources. Enabling factors were motivation to be healthy for themselves and their offspring, family and social support, a holistic delivery platform providing desired information delivered at appropriate times, regular feedback, goal setting, and nudges. From the findings of this study, we propose components of an idealized lifestyle intervention including (i) taking a holistic life-course approach to education, (ii) using mobile health platforms to reduce barriers, provide personalized feedback and promote goal-setting, and (iii) health nudges to cultivate sustained lifestyle habits.
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Karsten MDA, Wekker V, Groen H, Painter RC, Mol BWJ, Laan ETM, Roseboom TJ, Hoek A. The role of PCOS in mental health and sexual function in women with obesity and a history of infertility. Hum Reprod Open 2021; 2021:hoab038. [PMID: 34877412 PMCID: PMC8643501 DOI: 10.1093/hropen/hoab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/27/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Do mental health and sexual function differ between women with or without polycystic ovary syndrome (PCOS) with comparable BMI and fertility characteristics? SUMMARY ANSWER Women with PCOS have a poorer mental quality of life than women without PCOS, but there were no differences in symptoms of depression, anxiety, physical quality of life or sexual function. WHAT IS KNOWN ALREADY Various studies suggest that women with PCOS have poorer mental health, such as higher symptoms of anxiety and depression with a lower quality of life, and have an impaired sexual function compared to women without PCOS. However, in most studies, BMI and infertility status differ between women with and without PCOS, which may hamper comparability. STUDY DESIGN SIZE DURATION This study is a cross-sectional analysis of a 5-year follow-up of a randomized controlled trial (RCT) among women with obesity and a history of infertility. PARTICIPANTS/MATERIALS SETTING METHODS Participants in this follow-up study of an RCT were women with obesity and infertility randomized to a lifestyle intervention followed by infertility treatment or prompt infertility treatment (control), stratified by ovulatory status and trial centre. In total, 173 (30.0%) women of the 577 women randomized in the initial trial participated in this follow-up study, with a mean follow-up of 5.5 years (range 3.7-7.0 years); of these women 73 had been diagnosed with PCOS and 100 did not have PCOS. Participants completed questionnaires on symptoms of anxiety and depression (Hospital Anxiety and Depression scale (HADS)), quality of life (36-item Short Form Health Survey (SF-36)) and sexual function (McCoy Female Sexuality Questionnaire (MFSQ)). We also compared quality of life subscale scores in women with and without PCOS and compared them to an age-matched Dutch reference population with average BMI. Effect sizes were calculated to assess the differences. MAIN RESULTS AND THE ROLE OF CHANCE Symptoms of anxiety and depression, physical quality of life and sexual function did not differ significantly between obese women with and without PCOS. However, women with PCOS had a worse mental quality of life summary component score (-3.60 [95% CI -6.72 to -0.56]), mainly due to a lower score on the subscale 'role limitations due to emotional problems' (-12.41 [95% CI -22.78 to -2.28]), compared to women without PCOS. However, compared to an age-matched Dutch reference population, the obese infertile women with and without PCOS both scored lower on almost all physical and mental quality of life subscales. LIMITATIONS REASONS FOR CAUTION These are secondary analyses of the follow-up study of the RCT. No power analysis was performed for the outcomes included in this analysis and, as our study had a relatively small sample size, the null findings could be based on insufficient power to detect small differences between the groups. Our study population had a high mean BMI (average total group 34.5 [SD ± 5.1]); therefore, our results may only be generalizable to women with obesity. WIDER IMPLICATIONS OF THE FINDINGS Our results indicate that PCOS status is associated with impaired mental quality of life. Anxiety and depression, physical quality of life and sexual function in obese infertile women with PCOS seem more related to the obesity than the PCOS status. STUDY FUNDING/COMPETING INTERESTS The initial study and follow-up were supported by grants from: ZonMw (50-50110-96-518), the Dutch Heart Foundation (2013T085) and the European Commission (633595). The Department of Obstetrics and Gynaecology of the UMCG received an unrestricted educational grant from Ferring pharmaceuticals BV, The Netherlands, outside the submitted work. A.H. reports consultancy for Ferring pharmaceuticals. B.W.J.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). B.W.J.M. reports consultancy for ObsEva, Merck Merck KGaA, iGenomix and Guerbet. All other authors declare no competing interests. TRIAL REGISTRATION NUMBER The initial trial was registered on 16 November 2008 in the Dutch trial register; clinical trial registry number NTR1530.
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Affiliation(s)
- M D A Karsten
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - V Wekker
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - R C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, VIC, Australia
| | - E T M Laan
- Department of Sexology and Psychosomatic Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Wang Z, Nagy RA, Groen H, Cantineau AEP, van Oers AM, van Dammen L, Wekker V, Roseboom TJ, Mol BWJ, Tietge UJF, Hoek A. Preconception insulin resistance and neonatal birth weight in women with obesity: role of bile acids. Reprod Biomed Online 2021; 43:931-939. [PMID: 34627684 DOI: 10.1016/j.rbmo.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022]
Abstract
RESEARCH QUESTION Does maternal preconception insulin resistance affect neonatal birth weight among women with obesity? Is insulin resistance associated with circulating bile acids? Do bile acids influence the association between maternal preconception insulin resistance and neonatal birth weight? DESIGN An exploratory post-hoc analysis of the LIFEstyle randomized controlled trial comparing lifestyle intervention with conventional infertility treatment in women with a BMI of ≥29 kg/m2. Fasting blood samples were collected at randomization and after 3 and 6 months in 469 women. Insulin resistance was quantified using the homeostasis model assessment of insulin resistance (HOMA-IR). Bile acid sub-species were determined by liquid chromatography with tandem mass spectrometry. Singletons were included (n = 238). Birth weight Z-scores were adjusted for age, offspring gender and parity. Multilevel analysis and linear regressions were used. RESULTS A total of 913 pairs of simultaneous preconception HOMA-IR (median [Q25; Q75]: 2.96 [2.07; 4.16]) and total bile acid measurements (1.79 [1.10; 2.94]) µmol/l were taken. Preconception HOMA-IR was positively associated with total bile acids (adjusted B 0.15; 95% CI 0.09 to 0.22; P < 0.001) and all bile acid sub-species. At the last measurement before pregnancy, HOMA-IR (2.71 [1.91; 3.74]) was positively related to birth weight Z-score (mean ± SD 0.4 ± 1.1; adjusted B 0.08; 95% CI 0.01 to 0.14; P = 0.03). None of the preconception bile acids measured were associated with birth weight. CONCLUSION Maternal preconception insulin resistance is an important determinant of neonatal birth weight in women with obesity, whereas preconception bile acids are not.
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Affiliation(s)
- Zheng Wang
- University of Groningen, University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Ruxandra A Nagy
- University of Groningen, University Medical Centre Groningen, Department of Clinical Genetics, Groningen, The Netherlands
| | - Henk Groen
- University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Astrid E P Cantineau
- University of Groningen, University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Anne M van Oers
- University of Groningen, University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Lotte van Dammen
- University of Groningen, University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands; Iowa State University, Department of Human Development and Family Studies, Ames Iowa, USA
| | - Vincent Wekker
- Academic Medical Centre, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Academic Medical Centre, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, the Netherlands
| | - Tessa J Roseboom
- Academic Medical Centre, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Academic Medical Centre, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, the Netherlands.
| | - Ben W J Mol
- Monash University, Department of Obstetrics and Gynecology, Clayton, Australia
| | - Uwe J F Tietge
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Annemieke Hoek
- University of Groningen, University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
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Dietary Intake, Eating Behavior, Physical Activity, and Quality of Life in Infertile Women with PCOS and Obesity Compared with Non-PCOS Obese Controls. Nutrients 2021; 13:nu13103526. [PMID: 34684528 PMCID: PMC8538395 DOI: 10.3390/nu13103526] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/16/2022] Open
Abstract
To personalize lifestyle advice for women with polycystic ovary syndrome (PCOS) and obesity, detailed information regarding dietary intake, eating behavior, physical activity levels, and quality of life (QoL) may be useful. We aimed to investigate in a post-hoc cross-sectional analysis within a large multicenter randomized controlled trial in women with infertility whether there are significant differences in dietary intake (vegetables, fruits, sugary drinks, alcoholic beverages, savory snacks, and sweet snacks); eating behavior (emotional eating, external eating, and restricted eating); physical activity; and QoL between women with PCOS and obesity and non-PCOS obese controls. Participants were asked to complete the food frequency questionnaire (FFQ), the Dutch Eating Behavior Questionnaire (DEBQ), the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH), and the 36-item Short Form Health Survey (SF-36) at study entry (PCOS: n = 170; non-PCOS: n = 321, mean BMI: 36). Linear and binary (multinomial) logistic regressions were used, and the analyses were adjusted for age, waist-hip circumference ratio, and homeostasis model assessment of insulin resistance (HOMA-IR). No statistically significant differences in dietary intake or physical activity were observed between the two groups. The overall score of emotional eating was 34.6 ± 11.2 in the PCOS group and 34.1 ± 11.3 in the non-PCOS group (p = 0.11). QoL scores (physical and mental) did not differ between PCOS and non-PCOS women. These findings suggest that infertile women with PCOS and obesity and infertile non-PCOS obese controls do not have different dietary habits and have similar mental and physical QoL.
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Wang Z, Groen H, Cantineau AEP, van Elten TM, Karsten MDA, van Oers AM, Mol BWJ, Roseboom TJ, Hoek A. Effectiveness of a 6-Month Lifestyle Intervention on Diet, Physical Activity, Quality of Life, and Markers of Cardiometabolic Health in Women with PCOS and Obesity and Non-PCOS Obese Controls: One Size Fits All? Nutrients 2021; 13:nu13103425. [PMID: 34684438 PMCID: PMC8538637 DOI: 10.3390/nu13103425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022] Open
Abstract
Little is known about the difference in effectiveness of lifestyle intervention between women with PCOS and non-PCOS women. In a post hoc longitudinal analysis of a randomized, controlled trial, we aimed to investigate whether infertile women with PCOS and obesity (N = 87) responded differently to a 6-month lifestyle intervention program than infertile non-PCOS obese controls (N = 172). We evaluated several aspects of the intervention such as changes in diet, physical activity, and dropout rate, as well as the effect on weight, quality of life (QoL), and cardiometabolic outcomes. Multilevel analyses were used, and analyses were adjusted for baseline characteristics such as age, education, and smoking. Although BMI in both groups significantly decreased at 3 months and 6 months, there were no significant differences between the groups at 3 months (adjusted B: −0.3, 95% CI: −0.9 to 0.3, p = 0.35) and 6 months (adjusted B: 0.5, 95% CI: −0.4 to 1.4, p = 0.29). Women with PCOS and non-PCOS women had similar compliance with the lifestyle intervention in terms of actual change in diet and physical activity. Mental QoL scores were not different at either 3 or 6 months. Physical QoL scores were lower in women with PCOS compared with non-PCOS women at 3 months (adjusted B: −2.4, 95% CI: −4.8 to −0.06, p = 0.045) but not at 6 months. Cardiometabolic parameters did not differ between the groups. Our results showed that infertile women with PCOS and obesity and non-PCOS obese controls responded largely similarly to our lifestyle intervention and achieved the same level of improvement in markers of cardiometabolic health.
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Affiliation(s)
- Zheng Wang
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands; (Z.W.); (A.E.P.C.); (A.M.v.O.)
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands;
| | - Astrid E. P. Cantineau
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands; (Z.W.); (A.E.P.C.); (A.M.v.O.)
| | - Tessa M. van Elten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1105 AZ Amsterdam, The Netherlands;
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.D.A.K.); (T.J.R.)
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands
| | - Matty D. A. Karsten
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.D.A.K.); (T.J.R.)
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands
| | - Anne M. van Oers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands; (Z.W.); (A.E.P.C.); (A.M.v.O.)
| | - Ben W. J. Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne 3800, Australia;
| | - Tessa J. Roseboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.D.A.K.); (T.J.R.)
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands; (Z.W.); (A.E.P.C.); (A.M.v.O.)
- Correspondence:
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Wang Z, Groen H, Van Zomeren KC, Cantineau AEP, Van Oers A, Van Montfoort APA, Kuchenbecker WKH, Pelinck MJ, Broekmans FJM, Klijn NF, Kaaijk EM, Mol BWJ, Hoek A, Van Echten-Arends J. Lifestyle intervention prior to IVF does not improve embryo utilization rate and cumulative live birth rate in women with obesity: a nested cohort study. Hum Reprod Open 2021; 2021:hoab032. [PMID: 34557597 PMCID: PMC8452483 DOI: 10.1093/hropen/hoab032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/13/2021] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION Does lifestyle intervention consisting of an energy-restricted diet, enhancement of physical activity and motivational counseling prior to IVF improve embryo utilization rate (EUR) and cumulative live birth rate (CLBR) in women with obesity? SUMMARY ANSWER A 6-month lifestyle intervention preceding IVF improved neither EUR nor CLBR in women with obesity in the first IVF treatment cycle where at least one oocyte was retrieved. WHAT IS KNOWN ALREADY A randomized controlled trial (RCT) evaluating the efficacy of a low caloric liquid formula diet (LCD) preceding IVF in women with obesity was unable to demonstrate an effect of LCD on embryo quality and live birth rate: in this study, only one fresh embryo transfer (ET) or, in case of freeze-all strategy, the first transfer with frozen-thawed embryos was reported. We hypothesized that any effect on embryo quality of a lifestyle intervention in women with obesity undergoing IVF treatment is better revealed by EUR and CLBR after transfer of all fresh and frozen-thawed embryos. STUDY DESIGN, SIZE, DURATION This is a nested cohort study within an RCT, the LIFEstyle study. The original study examined whether a 6-month lifestyle intervention prior to infertility treatment in women with obesity improved live birth rate, compared to prompt infertility treatment within 24 months after randomization. In the original study between 2009 and 2012, 577 (three women withdrew informed consent) women with obesity and infertility were assigned to a lifestyle intervention followed by infertility treatment (n = 289) or to prompt infertility treatment (n = 285). PARTICIPANTS/MATERIALS, SETTING, METHODS Only participants from the LIFEstyle study who received IVF treatment were eligible for the current analysis. In total, 137 participants (n = 58 in the intervention group and n = 79 in the control group) started the first cycle. In 25 participants, the first cycle was cancelled prior to oocyte retrieval mostly due to poor response. Sixteen participants started a second or third consecutive cycle. The first cycle with successful oocyte retrieval was used for this analysis, resulting in analysis of 51 participants in the intervention group and 72 participants in the control group. Considering differences in embryo scoring methods and ET day strategy between IVF centers, we used EUR as a proxy for embryo quality. EUR was defined as the proportion of inseminated/injected oocytes per cycle that was transferred or cryopreserved as an embryo. Analysis was performed per cycle and per oocyte/embryo. CLBR was defined as the percentage of participants with at least one live birth from the first fresh and subsequent frozen-thawed ET(s). In addition, we calculated the Z-score for singleton neonatal birthweight and compared these outcomes between the two groups. MAIN RESULTS AND THE ROLE OF CHANCE The overall mean age was 31.6 years and the mean BMI was 35.4 ± 3.2 kg/m2 in the intervention group, and 34.9 ± 2.9 kg/m2 in the control group. The weight change at 6 months was in favor of the intervention group (mean difference in kg vs the control group: −3.14, 95% CI: −5.73 to −0.56). The median (Q25; Q75) number of oocytes retrieved was 4.00 (2.00; 8.00) in the intervention group versus 6.00 (4.00; 9.75) in the control group, and was not significantly different, as was the number of oocytes inseminated/injected (4.00 [2.00; 8.00] vs 6.00 [3.00; 8.75]), normal fertilized embryos (2.00 [0.50; 5.00] vs 3.00 [1.00; 5.00]) and the number of cryopreserved embryos (2.00 [1.25; 4.75] vs 2.00 [1.00; 4.00]). The median (Q25; Q75) EUR was 33.3% (12.5%; 60.0%) in the intervention group and 33.3% (16.7%; 50.0%) in the control group in the per cycle analysis (adjusted B: 2.7%, 95% CI: −8.6% to 14.0%). In the per oocyte/embryo analysis, in total, 280 oocytes were injected or inseminated in the intervention group, 113 were utilized (transferred or cryopreserved, EUR = 40.4%); in the control group, EUR was 30.8% (142/461). The lifestyle intervention did not significantly improve EUR (adjusted odds ratio [OR]: 1.36, 95% CI: 0.94–1.98) in the per oocyte/embryo analysis, taking into account the interdependency of the oocytes per participant. CLBR was not significantly different between the intervention group and the control group after adjusting for type of infertility (male factor and unexplained) and smoking (27.5% vs 22.2%, adjusted OR: 1.03, 95% CI: 0.43–2.47). Singleton neonatal birthweight and Z-score were not significantly different between the two groups. LIMITATIONS, REASONS FOR CAUTION This study is a nested cohort study within an RCT, and no power calculation was performed. The randomization was not stratified for indicated treatment, and although we corrected our analyses for baseline differences, there may be residual confounding. The limited absolute weight loss and the short duration of the lifestyle intervention might be insufficient to affect EUR and CLBR. WIDER IMPLICATIONS OF THE FINDINGS Our data do not support the hypothesis of a beneficial short-term effect of lifestyle intervention on EUR and CLBR after IVF in women with obesity, although more studies are needed as there may be a potential clinically relevant effect on EUR. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a grant from ZonMw, the Dutch Organization for Health Research and Development (50-50110-96-518). A.H. has received an unrestricted educational grant from Ferring pharmaceuticals BV, The Netherlands. B.W.J.M. is supported by an NHMRC Investigator grant (GNT1176437). B.W.J.M. reports consultancy for Guerbet, has been a member of the ObsEva advisory board and holds Stock options for ObsEva. B.W.J.M. has received research funding from Guerbet, Ferring and Merck. F.J.M.B. reports personal fees from membership of the external advisory board for Merck Serono and a research support grant from Merck Serono, outside the submitted work. TRIAL REGISTRATION NUMBER The LIFEstyle RCT was registered at the Dutch trial registry (NTR 1530). https://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1530.
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Affiliation(s)
- Zheng Wang
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Koen C Van Zomeren
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Astrid E P Cantineau
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anne Van Oers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Aafke P A Van Montfoort
- Department of Obstetrics and Gynecology, GROW School for Oncology and Development Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marie J Pelinck
- Department of Obstetrics and Gynecology, Treant Zorggroep, Emmen, The Netherlands
| | - Frank J M Broekmans
- Division Women and Baby, Department of Reproductive Medicine and Gynecology, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicole F Klijn
- Department of Gynecology and Reproductive Medicine, University of Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Eugenie M Kaaijk
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Ben W J Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jannie Van Echten-Arends
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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The Effect of Lifestyle Intervention on Systemic Oxidative Stress in Women with Obesity and Infertility: A Post-Hoc Analysis of a Randomized Controlled Trial. J Clin Med 2021; 10:jcm10184243. [PMID: 34575354 PMCID: PMC8467169 DOI: 10.3390/jcm10184243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022] Open
Abstract
We aimed to study whether lifestyle intervention could reduce systemic oxidative stress (OS) and the association between OS and cardiometabolic outcomes in women with obesity and infertility. From 2009 to 2012, infertile women with a BMI ≥ 29 kg/m2 were randomly assigned to a six-month lifestyle intervention followed by infertility treatment (N = 289) or to prompt infertility treatment (N = 285). Fasting serum free thiols (FT) concentrations were determined by colorimetry at baseline, at three and six months after randomization. Generalized estimating equations and restricted cubic spline regressions were used to estimate mean differences in serum FT levels between groups and to explore associations between serum FT levels and cardiometabolic outcomes. Baseline serum FT levels did not differ between the two groups (N = 203 in the intervention group vs N = 226 in the control group, 222.1 ± 48.0 µM vs 229.9 ± 47.8 µM, p = 0.09). Body weight decreased by 3.70 kg in the intervention group compared with the control group at six months (95% confidence interval [CI]: −7.61 to 0.21, p = 0.06). No differences in serum FT levels were observed between groups at either three months (N = 142 vs N = 150, mean differences: −1.03 µM, 95% CI: −8.37 to 6.32, p = 0.78) or six months (N = 104 vs N = 96, mean differences: 2.19 µM, 95% CI: −5.90 to 10.28, p = 0.60). In a pooled analysis of all available measurements, triglycerides (crude B: 5.29, 95% CI: 1.08 to 9.50, p = 0.01), insulin (crude B: 0.62, 95% CI: 0.26 to 0.98, p = 0.001), and homeostasis model assessment of insulin resistance (crude B: 2.50, 95% CI: 1.16 to 3.38, p < 0.001) were positively associated with serum FT levels. High-sensitivity C-reactive protein (hs-CRP) was negatively associated with serum FT levels (crude B: −0.60, 95% CI: −1.11 to −0.10, p = 0.02). The change in hs-CRP during the lifestyle intervention was strongly and inversely associated with serum FT levels (crude B: −0.41, 95% CI: −0.70 to −0.13, p = 0.005). No significant deviations from linear associations were observed between serum FT and hs-CRP. We do not observe an improvement in systemic OS in women with obesity and infertility with modest weight loss. There were potential associations between OS and biomarkers of cardiometabolic health. Trial registration: This trial was registered on 16 November 2008 at the Dutch trial register (NTR1530).
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Boedt T, Vanhove AC, Vercoe MA, Matthys C, Dancet E, Lie Fong S. Preconception lifestyle advice for people with infertility. Cochrane Database Syst Rev 2021; 4:CD008189. [PMID: 33914901 PMCID: PMC8092458 DOI: 10.1002/14651858.cd008189.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infertility is a prevalent problem that has significant consequences for individuals, families, and the community. Modifiable lifestyle factors may affect the chance of people with infertility having a baby. However, no guideline is available about what preconception advice should be offered. It is important to determine what preconception advice should be given to people with infertility and to evaluate whether this advice helps them make positive behavioural changes to improve their lifestyle and their chances of conceiving. OBJECTIVES To assess the safety and effectiveness of preconception lifestyle advice on fertility outcomes and lifestyle behavioural changes for people with infertility. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, trial registers, Google Scholar, and Epistemonikos in January 2021; we checked references and contacted field experts to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), randomised cross-over studies, and cluster-randomised studies that compared at least one form of preconception lifestyle advice with routine care or attention control for people with infertility. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Primary effectiveness outcomes were live birth and ongoing pregnancy. Primary safety outcomes were adverse events and miscarriage. Secondary outcomes included reported behavioural changes in lifestyle, birth weight, gestational age, clinical pregnancy, time to pregnancy, quality of life, and male factor infertility outcomes. We assessed the overall quality of evidence using GRADE criteria. MAIN RESULTS We included in the review seven RCTs involving 2130 participants. Only one RCT included male partners. Three studies compared preconception lifestyle advice on a combination of topics with routine care or attention control. Four studies compared preconception lifestyle advice on one topic (weight, alcohol intake, or smoking) with routine care for women with infertility and specific lifestyle characteristics. The evidence was of low to very low-quality. The main limitations of the included studies were serious risk of bias due to lack of blinding, serious imprecision, and poor reporting of outcome measures. Preconception lifestyle advice on a combination of topics versus routine care or attention control Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.79 to 1.10; 1 RCT, 626 participants), but the quality of evidence was low. No studies reported on adverse events or miscarriage. Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice on a combination of topics affects lifestyle behavioural changes: body mass index (BMI) (mean difference (MD) -1.06 kg/m², 95% CI -2.33 to 0.21; 1 RCT, 180 participants), vegetable intake (MD 12.50 grams/d, 95% CI -8.43 to 33.43; 1 RCT, 264 participants), alcohol abstinence in men (RR 1.08, 95% CI 0.74 to 1.58; 1 RCT, 210 participants), or smoking cessation in men (RR 1.01, 95% CI 0.91 to 1.12; 1 RCT, 212 participants). Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of women with adequate folic acid supplement use (RR 0.98, 95% CI 0.95 to 1.01; 2 RCTs, 850 participants; I² = 4%), alcohol abstinence (RR 1.07, 95% CI 0.99 to 1.17; 1 RCT, 607 participants), and smoking cessation (RR 1.01, 95% CI 0.98 to 1.04; 1 RCT, 606 participants), on low quality evidence. No studies reported on other behavioural changes. Preconception lifestyle advice on weight versus routine care Studies on preconception lifestyle advice on weight were identified only in women with infertility and obesity. Compared to routine care, we are uncertain whether preconception lifestyle advice on weight affects the number of live births (RR 0.94, 95% CI 0.62 to 1.43; 2 RCTs, 707 participants; I² = 68%; very low-quality evidence), adverse events including gestational diabetes (RR 0.78, 95% CI 0.48 to 1.26; 1 RCT, 317 participants; very low-quality evidence), hypertension (RR 1.07, 95% CI 0.66 to 1.75; 1 RCT, 317 participants; very low-quality evidence), or miscarriage (RR 1.50, 95% CI 0.95 to 2.37; 1 RCT, 577 participants; very low-quality evidence). Regarding lifestyle behavioural changes for women with infertility and obesity, preconception lifestyle advice on weight may slightly reduce BMI (MD -1.30 kg/m², 95% CI -1.58 to -1.02; 1 RCT, 574 participants; low-quality evidence). Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice affects the percentage of weight loss, vegetable and fruit intake, alcohol abstinence, or physical activity. No studies reported on other behavioural changes. Preconception lifestyle advice on alcohol intake versus routine care Studies on preconception lifestyle advice on alcohol intake were identified only in at-risk drinking women with infertility. We are uncertain whether preconception lifestyle advice on alcohol intake affects the number of live births (RR 1.15, 95% CI 0.53 to 2.50; 1 RCT, 37 participants; very low-quality evidence) or miscarriages (RR 1.31, 95% CI 0.21 to 8.34; 1 RCT, 37 participants; very low-quality evidence). One study reported on behavioural changes for alcohol consumption but not as defined in the review methods. No studies reported on adverse events or other behavioural changes. Preconception lifestyle advice on smoking versus routine care Studies on preconception lifestyle advice on smoking were identified only in smoking women with infertility. No studies reported on live birth, ongoing pregnancy, adverse events, or miscarriage. One study reported on behavioural changes for smoking but not as defined in the review methods. AUTHORS' CONCLUSIONS Low-quality evidence suggests that preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births. Evidence was insufficient to allow conclusions on the effects of preconception lifestyle advice on adverse events and miscarriage and on safety, as no studies were found that looked at these outcomes, or the studies were of very low quality. This review does not provide clear guidance for clinical practice in this area. However, it does highlight the need for high-quality RCTs to investigate preconception lifestyle advice on a combination of topics and to assess relevant effectiveness and safety outcomes in men and women with infertility.
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Affiliation(s)
- Tessy Boedt
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Anne-Catherine Vanhove
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium, Leuven, Belgium
| | - Melissa A Vercoe
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Christophe Matthys
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Eline Dancet
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Sharon Lie Fong
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium
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van Dammen L, Bush NR, de Rooij S, Mol BW, Mutsaerts M, van Oers A, Groen H, Hoek A, Roseboom T. A lifestyle intervention randomized controlled trial in obese women with infertility improved body composition among those who experienced childhood adversity. Stress Health 2021; 37:93-102. [PMID: 32761731 PMCID: PMC7983922 DOI: 10.1002/smi.2976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/20/2020] [Accepted: 07/28/2020] [Indexed: 01/06/2023]
Abstract
Previous research indicates that tailoring lifestyle interventions to participant characteristics optimizes intervention effectiveness. Our objective was to assess whether the effects of a preconception lifestyle intervention in obese infertile women depended on women's exposure to adversity in childhood. A follow-up of a preconception lifestyle intervention randomized controlled trial (the LIFEstyle study) was conducted in the Netherlands among 577 infertile women (age 18-39 years) with a body mass index (BMI) ≥29 kg/m2 at time of randomization; N = 110 (19%) consented to the follow-up assessment, 6 years later. A 6-month preconception lifestyle intervention aimed weight loss through improving diet and increasing physical activity. The control group received care as usual. Outcome measures included weight, BMI, waist and hip circumference, body fat percentage, blood pressure and metabolic syndrome. The potential moderator, childhood adversity, was assessed with the Life Events Checklist-5 questionnaire. Among the 110 women in our follow-up study, n = 65 (59%) reported no childhood adverse events, n = 28 (25.5%) reported 1 type of childhood adverse events and n = 17 (15.5%) reported ≥2 types of childhood adverse events. Regression models showed significant interactions between childhood adversity and effects of lifestyle intervention at the 6-year follow-up. Among women who experienced childhood adversity, the intervention significantly reduced weight (-10.0 [95% CI -18.5 to -1.5] kg, p = 0.02), BMI (-3.2 [-6.1 to -0.2] kg/m2 , p = 0.04) and body fat percentage (-4.5 [95% CI -7.2 to -1.9] p < 0.01). Among women without childhood adversity, the intervention did not affect these outcomes (2.7 [-3.9 to 9.4] kg, p = 0.42), (0.9 [-1.4 to 3.3] kg/m2 , p = 0.42) and (1.7 [95% CI -0.3 to 3.7] p = 0.10), respectively. Having a history of childhood adversity modified the effect of a preconception lifestyle intervention on women's body composition. If replicated, it may be important to consider childhood adversity as a determinant of lifestyle intervention effectiveness.
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Affiliation(s)
- Lotte van Dammen
- Department of Human Development & Family StudiesIowa State UniversityAmesIowaUSA,Department of Obstetrics and GynaecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Nicole R. Bush
- Departments of Psychiatry and PediatricsCenter for Health and CommunityDivision of Developmental MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Susanne de Rooij
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAmsterdam UMCLocation AMCAmsterdamThe Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
| | - Meike Mutsaerts
- Department of Obstetrics and GynaecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Anne van Oers
- Department of Obstetrics and GynaecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Department of Obstetrics and GynaecologyMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Henk Groen
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and GynaecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Tessa Roseboom
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAmsterdam UMCLocation AMCAmsterdamThe Netherlands,Department of Obstetrics and GynaecologyAmsterdam UMC at the University of AmsterdamAmsterdamThe Netherlands
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Chronopoulou E, Seifalian A, Stephenson J, Serhal P, Saab W, Seshadri S. Preconceptual care for couples seeking fertility treatment, an evidence-based approach. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.xfnr.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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15
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Karsten MDA, Wekker V, Bakker A, Groen H, Olff M, Hoek A, Laan ETM, Roseboom TJ. Sexual function and pelvic floor activity in women: the role of traumatic events and PTSD symptoms. Eur J Psychotraumatol 2020; 11:1764246. [PMID: 33029306 PMCID: PMC7473031 DOI: 10.1080/20008198.2020.1764246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Traumatic sexual experiences can negatively affect sexual functioning and increase pelvic floor activity in women, especially when post-traumatic stress disorder (PTSD) is developed. However, little is known about the effect of other types of interpersonal and non-interpersonal, traumatic experiences on sexual function and pelvic floor overactivity. OBJECTIVE The aim of this study was to examine the effects of lifetime traumatic experiences and subsequent PTSD symptoms on sexual function and pelvic floor activity and to investigate whether the effects differ for interpersonal and non-interpersonal trauma. METHODS Women (N=82) with obesity and a history of infertility, participating in a follow-up study of an RCT investigating a lifestyle intervention programme, completed questionnaires on lifetime exposure to traumatic events (LEC-5), PTSD symptoms (PC-PTSD-5), sexual function (MFSQ) and pelvic floor activity (AOPFS-SV). RESULTS A large majority of women (85%) reported exposure to at least one traumatic event during their lifetime. Sexual function and pelvic floor activity did not differ between women who experienced non-interpersonal or interpersonal (including sexual) trauma and those who did not experience traumatic events during their lifetime. Women who had developed PTSD symptoms, however, did have higher pelvic floor activity, but sexual function was not affected. Women with a positive screen for PTSD had the highest pelvic floor activity score, and individual PTSD symptoms nightmares and hypervigilance were associated with significantly higher pelvic floor activity scores. CONCLUSION Trauma exposure is associated with pelvic floor overactivity in women with a positive screen for PTSD, such that pelvic floor overactivity is more severe with greater PTSD severity. These findings suggest that the development of PTSD after interpersonal trauma is pivotal in this association. Sexual function was unrelated to trauma exposure and pelvic floor function, perhaps related to the fact that the interpersonal trauma events reported in this study were mainly non-sexual.
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Affiliation(s)
- Matty D A Karsten
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Vincent Wekker
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anne Bakker
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Miranda Olff
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands.,Amsterdam Neuroscience Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Gynaecology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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16
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Menting MD, van de Beek C, Rono K, Hoek A, Groen H, Painter RC, Girchenko P, Lahti‐Pulkkinen M, Koivusalo SB, Räikkönen K, Eriksson JG, Roseboom TJ, Heinonen K. Effects of maternal lifestyle interventions on child neurobehavioral development: Follow-up of randomized controlled trials. Scand J Psychol 2019; 60:548-558. [PMID: 31498898 PMCID: PMC6899471 DOI: 10.1111/sjop.12575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Obesity is a major public health problem. Children of women who were obese before or during pregnancy are at increased risk for neurobehavioral developmental problems. Whether a maternal lifestyle intervention conducted before and during pregnancy in obese women affects child neurobehavioral development is unknown. This study reports on the follow-up of a subsample of two randomized controlled trials, the Finnish RADIEL (n = 216) and Dutch LIFEstyle (n = 305) trial. Women with a pre-pregnancy BMI ≥29 kg/m2 wishing to conceive or who were already pregnant (<20 weeks) were allocated to a lifestyle intervention or to care as usual. Child neurodevelopment was measured with the Ages and Stages Questionnaire and child behavioral problems were measured with the Childhood Behavior Checklist (RADIEL) or the Strengths and Difficulties Questionnaire (LIFEstyle) at age 3-6 years. We used linear and binary logistic regression analyses to assess the effects of the lifestyle interventions on children's neurobehavioral developmental scores. Follow-up data was available from 161(38%) RADIEL and 96(32%) LIFEstyle children. Child neurodevelopmental scores did not differ significantly between children in the intervention and the control group (RADIEL:median = 275 vs. 280; LIFEstyle:median = 270 vs 267). Child behavioral problem scores did not differ significantly between children in the intervention and the control group (RADIEL:median = 22 vs. 21; LIFEstyle:median = 8 vs. 8). We did not observe considerable effects of the lifestyle interventions before or during pregnancy in obese women on child neurobehavioral development. With our sample sizes, we were not able to detect subtle differences in neurobehavioral development however.
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Affiliation(s)
- Malou D. Menting
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdam UMCAmsterdamthe Netherlands
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Public Health Research InstituteAmsterdam UMCAmsterdamthe Netherlands
| | - Cornelieke van de Beek
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdam UMCAmsterdamthe Netherlands
| | - Kristiina Rono
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Annemieke Hoek
- University of GroningenUniversity Medical Centre GroningenDepartment of Obstetrics and GynecologyGroningenthe Netherlands
| | - Henk Groen
- University of GroningenUniversity Medical Centre GroningenDepartment of EpidemiologyGroningenthe Netherlands
| | - Rebecca C. Painter
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdam UMCAmsterdamthe Netherlands
| | - Polina Girchenko
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Marius Lahti‐Pulkkinen
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
- University/British Heart Foundation Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of EdinburghUK
| | - Saila B. Koivusalo
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Katri Räikkönen
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Johan G. Eriksson
- Department of General Practice and Primary Health CareUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Folkhälsan Research CenterHelsinkiFinland
| | - Tessa J. Roseboom
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdam UMCAmsterdamthe Netherlands
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Public Health Research InstituteAmsterdam UMCAmsterdamthe Netherlands
| | - Kati Heinonen
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
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17
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van Elten TM, van de Beek C, Geelen A, Gemke RJBJ, Groen H, Hoek A, Mol BW, van Poppel MNM, Roseboom TJ. Preconception Lifestyle and Cardiovascular Health in the Offspring of Overweight and Obese Women. Nutrients 2019; 11:nu11102446. [PMID: 31615021 PMCID: PMC6835651 DOI: 10.3390/nu11102446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 01/21/2023] Open
Abstract
Women’s lifestyle has important implications for the development and health of their offspring. Yet little is known about the association between women’s preconception dietary intake and physical activity with cardiovascular health of the offspring. We therefore examined this association in a group of Dutch women with overweight or obesity (BMI ≥ 29 kg/m2) and infertility, who participated in a 6-month randomized preconception lifestyle intervention trial, and their offspring (n = 46). Preconception dietary intake and physical activity were assessed during the 6-month intervention using a food frequency questionnaire and the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH), respectively. Offspring cardiovascular health (i.e., BMI, waist:height ratio, systolic and diastolic blood pressure, fat and fat free mass, and pulse wave velocity) was measured at age 3–6 years. Multivariable linear regression analyses were used to examine the associations between preconception lifestyle and offspring cardiovascular health. Higher preconception vegetable intake (per 10 g/day) was associated with lower offspring diastolic blood pressure (Z-score: −0.05 (−0.08; −0.01); p = 0.007) and higher preconception fruit intake (per 10 g/day) was associated with lower offspring pulse wave velocity (−0.05 m/s (−0.10; −0.01); p = 0.03). Against our expectations, higher preconception intake of sugary drinks was associated with a higher offspring fat free mass (0.54 kg (0.01; 1.07); p = 0.045). To conclude, preconception dietary intake is associated with offspring health.
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Affiliation(s)
- Tessa M van Elten
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam UMC, Department of Clinical Epidemiology, University of Amsterdam, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam UMC, Department of Obstetrics and Gynecology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands.
| | - Cornelieke van de Beek
- Amsterdam UMC, Department of Obstetrics and Gynecology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands.
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University & Research, 6700 AA Wageningen, The Netherlands.
| | - Reinoud J B J Gemke
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, the Netherlands.
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre, Groningen, 9700 RB Groningen, the Netherlands.
| | - Ben Willem Mol
- Department of Obstetrics and Gynecology, Monash University, 3800 Melbourne, Australia.
| | - Mireille N M van Poppel
- Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands.
- Institute of Sport Science, University of Graz, 8010 Graz, Austria.
| | - Tessa J Roseboom
- Amsterdam UMC, Department of Clinical Epidemiology, University of Amsterdam, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam UMC, Department of Obstetrics and Gynecology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands.
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18
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Karsten MDA, van Oers AM, Groen H, Mutsaerts MAQ, van Poppel MNM, Geelen A, van de Beek C, Painter RC, Mol BWJ, Roseboom TJ, Hoek A. Determinants of successful lifestyle change during a 6-month preconception lifestyle intervention in women with obesity and infertility. Eur J Nutr 2019; 58:2463-2475. [PMID: 30076459 PMCID: PMC6689274 DOI: 10.1007/s00394-018-1798-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/26/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE To identify demographic, (bio)physical, behavioral, and psychological determinants of successful lifestyle change and program completion by performing a secondary analysis of the intervention arm of a randomized-controlled trial, investigating a preconception lifestyle intervention. METHODS The 6-month lifestyle intervention consisted of dietary counseling, physical activity, and behavioral modification, and was aimed at 5-10% weight loss. We operationalized successful lifestyle change as successful weight loss (≥ 5% weight/BMI ≤ 29 kg/m2), weight loss in kilograms, a reduction in energy intake, and an increase in physical activity during the intervention program. We performed logistic and mixed-effect regression analyses to identify baseline factors that were associated with successful change or program completion. RESULTS Women with higher external eating behavior scores had higher odds of successful weight loss (OR 1.10, 95% CI 1.05-1.16). Women with the previous dietetic support lost 0.94 kg less during the intervention period (95% CI 0.01-1.87 kg). Women with higher self-efficacy reduced energy intake more than women with lower self-efficacy (p < 0.01). Women with an older partner had an increased energy intake (6 kcal/year older, 95% CI 3-13). A high stage of change towards physical activity was associated with a higher number of daily steps (p = 0.03). A high stage of change towards weight loss was associated with completion of the intervention (p = 0.04). CONCLUSIONS Determinants of lifestyle change and program completion were: higher external eating behavior, not having received previous dietetic support, high stage of change. This knowledge can be used to identify women likely to benefit from lifestyle interventions and develop new interventions for women requiring alternative support. TRIAL REGISTRATION The LIFEstyle study was registered at the Dutch trial registry (NTR 1530; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1530 ).
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Affiliation(s)
- Matty D A Karsten
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Anne M van Oers
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Meike A Q Mutsaerts
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University and Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Cornelieke van de Beek
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ben W J Mol
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, School of Medicine, Monash University, Clayton Road, Melbourne, Australia
| | - Tessa J Roseboom
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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19
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Wekker V, Huvinen E, van Dammen L, Rono K, Painter RC, Zwinderman AH, van de Beek C, Sarkola T, Mol BWJ, Groen H, Hoek A, Koivusalo SB, Roseboom TJ, Eriksson JG. Long-term effects of a preconception lifestyle intervention on cardiometabolic health of overweight and obese women. Eur J Public Health 2019; 29:308-314. [PMID: 30380017 PMCID: PMC6427693 DOI: 10.1093/eurpub/cky222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The global prevalence of obesity in women keeps increasing. The preconception period may be a window of opportunity to improve lifestyle, reduce obesity and improve cardiometabolic health. This study assessed the effect of a preconception lifestyle intervention on long-term cardiometabolic health in two randomized controlled trials (RCTs). Methods Participants of the LIFEstyle and RADIEL preconception lifestyle intervention studies with a baseline body mass index (BMI) ≥29 kg/m2 were eligible for this follow-up study. Both studies randomized between a lifestyle intervention targeting physical activity, diet and behaviour modification or usual care. We assessed cardiometabolic health 6 years after randomization. Results In the LIFEstyle study (n = 111) and RADIEL study (n = 39), no statistically significant differences between the intervention and control groups were found for body composition, blood pressure, arterial stiffness, fasting glucose, homeostasis model assessment of insulin resistance, HbA1c, lipids and high sensitive C-reactive protein levels 6 years after randomization. Participants of the LIFEstyle study who successfully lost ≥5% bodyweight or reached a BMI <29 kg/m2 during the intervention (n = 22, [44%]) had lower weight (−8.1 kg; 99% CI [−16.6 to −0.9]), BMI (−3.3 kg/m2; [−6.5 to −0.8]), waist circumference (−8.2 cm; [−15.3 to −1.3]), fasting glucose (−0.5 mmol/L; [−1.1 to −0.0]), HbA1c (−4.1 mmol/mol; [−9.1 to −0.8]), and higher HDL-C (0.3 mmol/L; [0.1–0.5]) compared with controls. Conclusion We found no evidence of improved cardiometabolic health 6 years after a preconception lifestyle intervention among overweight and obese women in two RCTs. Women who successfully lost weight during the intervention had better cardiometabolic health 6 years later, emphasizing the potential of successful preconception lifestyle improvement.
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Affiliation(s)
- Vincent Wekker
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Emilia Huvinen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Lotte van Dammen
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kristiina Rono
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cornelieke van de Beek
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Taisto Sarkola
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Clayton, Australia
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Saila B Koivusalo
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Johan G Eriksson
- Unit of General Practice and Primary Health Care, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, FInland
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20
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The effects of a pre-conception lifestyle intervention in women with obesity and infertility on perceived stress, mood symptoms, sleep and quality of life. PLoS One 2019; 14:e0212914. [PMID: 30802271 PMCID: PMC6388912 DOI: 10.1371/journal.pone.0212914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/11/2019] [Indexed: 12/31/2022] Open
Abstract
Background Obesity is an increasing problem worldwide and is associated with serious health risks. Obesity not only reduces physical health, but can also negatively affect levels of perceived stress, mood symptoms, sleep quality and quality of life (QoL), which may lead to further weight gain. We have previously shown that a pre-conception lifestyle intervention reduced weight and improved physical QoL in the short term. In the current study, we assessed the effects of this intervention in women with obesity and infertility on perceived stress, mood symptoms, sleep quality and QoL five years after randomization. Methods and findings We followed women who participated in the LIFEstyle study. This is a multi-center randomized controlled trial comparing a six-month lifestyle intervention to improve diet and increase physical activity followed by infertility treatment, versus prompt infertility treatment. Participants were 577 women with infertility between 18 and 39 years of age with a body mass index (BMI) ≥ 29 kg/m2. For the current study we measured perceived stress, mood symptoms, sleep quality and QoL in 178 women five years after randomization. T-tests and linear regression models were used to assess differences between the intervention and control groups. Five years after randomization, no differences were observed for perceived stress, mood symptoms, sleep quality and QoL between the intervention (n = 84) and control groups (n = 94). There was selective participation: women who did not participate in the follow-up had lower baseline mental QoL, and benefitted more from the intervention in terms of improved physical QoL during the original LIFEstyle intervention. Conclusions We found no evidence that a pre-conception lifestyle intervention improved female well-being five years after randomization.
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21
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van Elten TM, Karsten MDA, Geelen A, Gemke RJBJ, Groen H, Hoek A, van Poppel MNM, Roseboom TJ. Preconception lifestyle intervention reduces long term energy intake in women with obesity and infertility: a randomised controlled trial. Int J Behav Nutr Phys Act 2019; 16:3. [PMID: 30621789 PMCID: PMC6325811 DOI: 10.1186/s12966-018-0761-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background The preconceptional period may be an optimal window of opportunity to improve lifestyle. We previously showed that a 6 month preconception lifestyle intervention among women with obesity and infertility was successful in decreasing the intake of high caloric snacks and beverages, increasing physical activity and in reducing weight in the short term. We now report the effects of the preconception lifestyle intervention on diet, physical activity and body mass index (BMI) at 5.5 years (range = 3.7–7.0 years) after the intervention. Methods We followed women who participated in the LIFEstyle study, a multicentre RCT in which women with obesity and infertility were assigned to a six-month lifestyle intervention program or prompt infertility treatment (N = 577). Diet and physical activity 5.5 years later were assessed with an 173-item food frequency questionnaire (N = 175) and Actigraph triaxial accelerometers (N = 155), respectively. BMI was calculated from self-reported weight and previously measured height (N = 179). Dietary intake, physical activity, and BMI in the intervention and control group were compared using multivariate regression models. Additionally, dietary intake, physical activity and BMI of women allocated to the intervention arm with successful weight loss during the intervention (i.e. BMI < 29 kg/m2 or ≥ 5% weight loss), unsuccessful weight loss and the control group were compared with ANCOVA. Results Although BMI did not differ between the intervention and control group 5.5 years after the intervention (− 0.5 kg/m2 [− 2.0;1.1]; P = 0.56), the intervention group did report a lower energy intake (− 216 kcal/day [− 417;-16]; P = 0.04). Women in the intervention arm who successfully lost weight during the intervention had a significantly lower BMI at follow-up compared to women in the intervention arm who did not lose weight successfully (− 3.4 kg/m2 [− 6.3;-0.6]; P = 0.01), and they reported a significantly lower energy intake compared to the control group (− 301 kcal [− 589;-14]; P = 0.04). Macronutrient intake, diet quality, and physical activity did not differ between the intervention and control group, irrespective of successful weight loss during the intervention. Conclusions In our study population, a preconception lifestyle intervention led to reduced energy intake 5.5 years later. Additionally, women allocated to the intervention group who were successful in losing weight during the intervention also had a lower BMI at follow-up. This shows the potential sustainable effect of a preconception lifestyle intervention. Trial registration This trial was registered on 16 November 2008 in the Dutch trial register; clinical trial registry number NTR1530. Electronic supplementary material The online version of this article (10.1186/s12966-018-0761-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T M van Elten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical centre, de Boelelaan 1117, Amsterdam, The Netherlands. .,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - M D A Karsten
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - A Geelen
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - R J B J Gemke
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Department of Paediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical centre, de Boelelaan 1117, Amsterdam, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - M N M van Poppel
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical centre, de Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,University of Graz, Institute of Sport Science, Graz, Austria
| | - T J Roseboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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22
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Van Elten TM, Van Poppel MNM, Gemke RJBJ, Groen H, Hoek A, Mol BW, Roseboom TJ. Cardiometabolic Health in Relation to Lifestyle and Body Weight Changes 3⁻8 Years Earlier. Nutrients 2018; 10:E1953. [PMID: 30544716 PMCID: PMC6315733 DOI: 10.3390/nu10121953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/09/2018] [Accepted: 11/26/2018] [Indexed: 01/28/2023] Open
Abstract
The degree to which individuals change their lifestyle in response to interventions differs and this variation could affect cardiometabolic health. We examined if changes in dietary intake, physical activity and weight of obese infertile women during the first six months of the LIFEstyle trial were associated with cardiometabolic health 3⁻8 years later (N = 50⁻78). Lifestyle was assessed using questionnaires and weight was measured at baseline, 3 and 6 months after randomization. BMI, blood pressure, body composition, pulse wave velocity, glycemic parameters and lipid profile were assessed 3⁻8 years after randomization. Decreases in savory and sweet snack intake were associated with lower HOMA-IR 3⁻8 years later, but these associations disappeared after adjustment for current lifestyle. No other associations between changes in lifestyle or body weight during the first six months after randomization with cardiovascular health 3⁻8 years later were observed. In conclusion, reductions in snack intake were associated with reduced insulin resistance 3⁻8 years later, but adjustment for current lifestyle reduced these associations. This indicates that changing lifestyle is an important first step, but maintaining this change is needed for improving cardiometabolic health in the long-term.
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Affiliation(s)
- Tessa M Van Elten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands.
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Department of Obstetrics and Gynecology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands.
| | - Mireille N M Van Poppel
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands.
- Institute of Sport Science, University of Graz, 8010 Graz, Austria.
| | - Reinoud J B J Gemke
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands.
- Department of Pediatrics, Emma Childrens Hospital, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands.
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands.
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre, Groningen, 9700 RB Groningen, The Netherlands.
| | - Ben W Mol
- School of Medicine, The Robinson Institute, University of Adelaide, 5006 Adelaide, Australia.
- Department of Obstetrics and Gynecology, Monash University, 3800 Melbourne, Australia.
| | - Tessa J Roseboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Department of Obstetrics and Gynecology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, 1105 AZ Amsterdam, The Netherlands.
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23
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van Elten TM, Karsten MDA, Geelen A, van Oers AM, van Poppel MNM, Groen H, Gemke RJBJ, Mol BW, Mutsaerts MAQ, Roseboom TJ, Hoek A. Effects of a preconception lifestyle intervention in obese infertile women on diet and physical activity; A secondary analysis of a randomized controlled trial. PLoS One 2018; 13:e0206888. [PMID: 30403756 PMCID: PMC6221548 DOI: 10.1371/journal.pone.0206888] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lifestyle changes are notoriously difficult. Since women who intend to become pregnant are more susceptible to lifestyle advice, interventions during this time window might be more effective than interventions during any other period in life. We here report the effects of the first large preconception lifestyle intervention RCT on diet and physical activity in obese infertile women. METHODS In total, 577 women were randomized between a six-month lifestyle intervention program (intervention group; N = 290) or prompt infertility treatment (control group; N = 287). Self-reported dietary behaviors and physical activity were assessed at baseline, three, six and twelve months after randomization. Mixed models were used to analyze differences between groups. RESULTS Compared to the control group, the intervention group reduced their intake of sugary drinks at three months (-0.5 glasses/day [95% C.I. = -0.9;-0.2]), of savory snacks at three (-2.4 handful/week [-3.4;-1.4]) and at six months (-1.4 handful/week [-2.6;-0.2]), and of sweet snacks at three (-2.2 portion/week [-3.3;-1.0]) and twelve months after randomization (-1.9 portion/week [-3.5;-0.4]). Also, the intervention group was more moderate to vigorous physically active at three months after randomization compared to the control group (169.0 minutes/week [6.0; 332.1]). CONCLUSION Our study showed that obese infertile women who followed a six-month preconception lifestyle intervention program decreased their intake of high caloric snacks and beverages, and increased their physical activity. These changes in lifestyle may not only improve women's health but their offspring's health too.
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Affiliation(s)
- Tessa M. van Elten
- Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical center, Department of Public and Occupational Health, de Boelelaan, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynecology, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- * E-mail:
| | - Matty D. A. Karsten
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynecology, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
| | - Anouk Geelen
- Wageningen University & Research, Division of Human Nutrition, Wageningen, The Netherlands
| | - Anne M. van Oers
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
| | - Mireille N. M. van Poppel
- Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical center, Department of Public and Occupational Health, de Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- University of Graz, Institute of Sport Science, Graz, Austria
| | - Henk Groen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Reinoud J. B. J. Gemke
- Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical center, Department of Public and Occupational Health, de Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Emma Childrens Hospital, Department of Pediatrics, Amsterdam, The Netherlands
| | - Ben Willem Mol
- Monash University, Department of Obstetrics and Gynecology, Melbourne, Australia
| | - Meike A. Q. Mutsaerts
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
| | - Tessa J. Roseboom
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynecology, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Annemieke Hoek
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
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Wekker V, Karsten MDA, Painter RC, van de Beek C, Groen H, Mol BWJ, Hoek A, Laan E, Roseboom TJ. A lifestyle intervention improves sexual function of women with obesity and infertility: A 5 year follow-up of a RCT. PLoS One 2018; 13:e0205934. [PMID: 30352059 PMCID: PMC6198949 DOI: 10.1371/journal.pone.0205934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/02/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Obesity and infertility are associated with poorer sexual function. We have previously shown that a lifestyle intervention in women with obesity and infertility reduced weight and improved cardiometabolic health and quality of life, which may positively affect sexual function. We now report on sexual function 5 years after randomization. METHODS AND FINDINGS In total 577 women, between 18-39 years of age, with infertility and a BMI ≥29 kg/m2 were randomized to a six-month lifestyle intervention targeting physical activity, diet and behavior modification or prompt infertility care as usual. Intercourse frequency and sexual function were assessed with the McCoy Female Sexuality Questionnaire (MFSQ), 5.4±0.8 years after randomization. 550 women could be approached for the follow-up study, of whom 84 women in the intervention and 93 in the control group completed the MFSQ. Results were adjusted for duration of infertility, polycystic ovary syndrome and whether women were attempting to conceive. The intervention group more often reported having had intercourse in the past 4 weeks compared to the control group (aOR: 2.3 95% CI 0.96 to 5.72). Among women reporting intercourse in the past 4 weeks, the intervention group (n = 75) had intercourse more frequently (6.6±5.8 vs. 4.9±4.0 times; 95% CI 0.10 to 3.40) and had higher scores for vaginal lubrication (16.5±3.0 vs. 15.4±3.5; 95% CI 0.15 to 2.32) and total 'sexual function' score (96.5±14.2 vs. 91.4±12.8; 95% CI 0.84 to 9.35) compared to the control group (n = 72). Sexual interest, satisfaction, orgasm and sex partner scores did not differ statistically between the groups. The intervention effect on sexual function was for 21% mediated by the change in moderate to vigorous physical activity. CONCLUSION A six-month lifestyle intervention in women with obesity and infertility led to more frequent intercourse, better vaginal lubrication and overall sexual function 5 years after the intervention. (Trial Registration: NTR1530).
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Affiliation(s)
- Vincent Wekker
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Matty D. A. Karsten
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rebecca C. Painter
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cornelieke van de Beek
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ben Willem J. Mol
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Monash Medical Centre, Monash University, Clayton, Australia
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ellen Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa J. Roseboom
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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25
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van Oers AM, Mutsaerts MAQ, Burggraaff JM, Kuchenbecker WKH, Perquin DAM, Koks CAM, van Golde R, Kaaijk EM, Schierbeek JM, Klijn NF, van Kasteren YM, Land JA, Mol BWJ, Hoek A, Groen H. Cost-effectiveness analysis of lifestyle intervention in obese infertile women. Hum Reprod 2018; 32:1418-1426. [PMID: 28486704 DOI: 10.1093/humrep/dex092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/27/2017] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the cost-effectiveness of lifestyle intervention preceding infertility treatment in obese infertile women? SUMMARY ANSWER Lifestyle intervention preceding infertility treatment as compared to prompt infertility treatment in obese infertile women is not a cost-effective strategy in terms of healthy live birth rate within 24 months after randomization, but is more likely to be cost-effective using a longer follow-up period and live birth rate as endpoint. WHAT IS KNOWN ALREADY In infertile couples, obesity decreases conception chances. We previously showed that lifestyle intervention prior to infertility treatment in obese infertile women did not increase the healthy singleton vaginal live birth rate at term, but increased natural conceptions, especially in anovulatory women. Cost-effectiveness analyses could provide relevant additional information to guide decisions regarding offering a lifestyle intervention to obese infertile women. STUDY DESIGN, SIZE, DURATION The cost-effectiveness of lifestyle intervention preceding infertility treatment compared to prompt infertility treatment was evaluated based on data of a previous RCT, the LIFEstyle study. The primary outcome for effectiveness was the vaginal birth of a healthy singleton at term within 24 months after randomization (the healthy live birth rate). The economic evaluation was performed from a hospital perspective and included direct medical costs of the lifestyle intervention, infertility treatments, medication and pregnancy in the intervention and control group. In addition, we performed exploratory cost-effectiveness analyses of scenarios with additional effectiveness outcomes (overall live birth within 24 months and overall live birth conceived within 24 months) and of subgroups, i.e. of ovulatory and anovulatory women, women <36 years and ≥36 years of age and of completers of the lifestyle intervention. Bootstrap analyses were performed to assess the uncertainty surrounding cost-effectiveness. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Infertile women with a BMI of ≥29 kg/m2 (no upper limit) were allocated to a 6-month lifestyle intervention programme preceding infertility treatment (intervention group, n = 290) or to prompt infertility treatment (control group, n = 287). After excluding women who withdrew informed consent or who were lost to follow-up we included 280 women in the intervention group and 284 women in the control group in the analysis. MAIN RESULTS AND THE ROLE OF CHANCE Total mean costs per woman in the intervention group within 24 months after randomization were €4324 (SD €4276) versus €5603 (SD €4632) in the control group (cost difference of -€1278, P < 0.05). Healthy live birth rates were 27 and 35% in the intervention group and the control group, respectively (effect difference of -8.1%, P < 0.05), resulting in an incremental cost-effectiveness ratio of €15 845 per additional percentage increase of the healthy live birth rate. Mean costs per healthy live birth event were €15 932 in the intervention group and €15 912 in the control group. Exploratory scenario analyses showed that after changing the effectiveness outcome to all live births conceived within 24 months, irrespective of delivery within or after 24 months, cost-effectiveness of the lifestyle intervention improved. Using this effectiveness outcome, the probability that lifestyle intervention preceding infertility treatment was cost-effective in anovulatory women was 40%, in completers of the lifestyle intervention 39%, and in women ≥36 years 29%. LIMITATIONS, REASONS FOR CAUTION In contrast to the study protocol, we were not able to perform the analysis from a societal perspective. Besides the primary outcome of the LIFEstyle study, we performed exploratory analyses using outcomes observed at longer follow-up times and we evaluated subgroups of women; the trial was not powered on these additional outcomes or subgroup analyses. WIDER IMPLICATIONS OF THE FINDINGS Cost-effectiveness of a lifestyle intervention is more likely for longer follow-up times, and with live births conceived within 24 months as the effectiveness outcome. This effect was most profound in anovulatory women, in completers of the lifestyle intervention and in women ≥36 years old. This result indicates that the follow-up period of lifestyle interventions in obese infertile women is important. The scenario analyses performed in this study suggest that offering and reimbursing lifestyle intervention programmes in certain patient categories may be cost-effective and it provides directions for future research in this field. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a grant from ZonMw, the Dutch Organization for Health Research and Development (50-50110-96-518). The department of obstetrics and gynaecology of the UMCG received an unrestricted educational grant from Ferring pharmaceuticals BV, The Netherlands. B.W.J.M. is a consultant for ObsEva, Geneva. TRIAL REGISTRATION NUMBER The LIFEstyle RCT was registered at the Dutch trial registry (NTR 1530). http://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 1530.
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Affiliation(s)
- A M van Oers
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - M A Q Mutsaerts
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands.,Department of General Practice, University of Utrecht, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands
| | - J M Burggraaff
- Department of Obstetrics and Gynaecology, Scheper Hospital, 7800RA Emmen, The Netherlands
| | - W K H Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Clinics, 8000 GK Zwolle, The Netherlands
| | - D A M Perquin
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, 8901BR Leeuwarden, The Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Maxima Medical Center, 5500MB Veldhoven, The Netherlands
| | - R van Golde
- Department of Obstetrics and Gynaecology, University of Maastricht, Maastricht University Medical Center, 6202AZ Maastricht, The Netherlands
| | - E M Kaaijk
- Department of Obstetrics and Gynaecology, OLVG, 1090HM Amsterdam, The Netherlands
| | - J M Schierbeek
- Department of Obstetrics and Gynaecology, Deventer Hospital, 7400GC Deventer, The Netherlands
| | - N F Klijn
- Department of Gynaecology and Reproductive Medicine, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - Y M van Kasteren
- Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, 1815 JD Alkmaar, The Netherlands
| | - J A Land
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - B W J Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, 5000SA Adelaide, Australia
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
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Lan L, Harrison CL, Misso M, Hill B, Teede HJ, Mol BW, Moran LJ. Systematic review and meta-analysis of the impact of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric and metabolic outcomes in men and women. Hum Reprod 2018; 32:1925-1940. [PMID: 28854715 DOI: 10.1093/humrep/dex241] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/21/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the impact of preconception lifestyle interventions on live birth, birth weight and pregnancy rate? SUMMARY ANSWER Lifestyle interventions showed benefits for weight loss and increased natural pregnancy rate, but not for live birth or birth weight. WHAT IS KNOWN ALREADY Evidence on the practice and content of preconception counseling and interventions is variable and limited. STUDY DESIGN, SIZE, DURATION Systematic review and meta-analysis (MA). Main search terms were those related to preconception lifestyle. Database searched were Ovid MEDLINE(R), EBM Reviews, PsycINFO, EMBASE and CINAHL Plus. No language restriction was placed on the published articles. The final search was performed on 10 January 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were non-pregnant women of childbearing age intent on conceiving or their male partners. Exclusion criteria include participants with BMI < 18 kg/m2, animal trials, hereditary disorder in one or both partners and trials focusing solely on alcohol or smoking cessation/reduction, micronutrient supplementation, or diabetes control. Anthropometric, fertility, obstetric and fetal outcomes were assessed. Bias and quality assessments were performed. MAIN RESULTS AND THE ROLE OF CHANCE The search returned 1802 articles and eight studies were included for analysis. Populations targeted were primarily overweight or obese subfertile women seeking reproductive assistance, with few community-based studies and none including men. MA showed greater reduction in weight (n = 3, P < 0.00001, mean difference: -3.48 kg, 95% CI: -4.29, -2.67, I2 = 0%) and BMI (n = 2, P < 0.00001, mean difference: -1.40 kg/m2, 95% CI: -1.95, -0.84, I2 = 24%) with intervention. The only significant fertility outcome was an increased natural pregnancy rate (n = 2, P = 0.003, odds ratio: 1.87, CI: 1.24, 2.81, I2 = 0%). No differences were observed for ART adverse events, clinical pregnancy, pregnancy complications, delivery complications, live birth, premature birth, birth weight, neonatal mortality or anxiety. Risk of bias were high for three studies, moderate for three studies and low for two studies, Attrition bias was moderate or high in majority of studies. LIMITATIONS, REASONS FOR CAUTION Results were limited to subfertile or infertile women who were overweight or obese undergoing ART with no studies in men. The heterogeneous nature of the interventions in terms of duration and regimen means no conclusions could be made regarding the method or components of optimal lifestyle intervention. Attrition bias itself is an important factor that could affect efficacy of interventions. WIDER IMPLICATIONS OF THE FINDINGS Existing preconception lifestyle interventions primarily targeted overweight and obese subfertile women undergoing ART with a focus on weight loss. It is important to note that natural conception increased with lifestyle intervention. This emphasizes the need for further research exploring optimal components of preconception lifestyle interventions in the broader population and on the optimal nature, intensity and timing of interventions. STUDY FUNDING/COMPETING INTEREST(S) No conflict of interest declared. C.L.H. is a National Heart Foundation Postdoctoral Research Fellow. B.H. is funded by an Alfred Deakin Postdoctoral Research Fellowship. H.J.T. and B.W.M. hold NHMRC Practitioner fellowships. L.J.M. is supported by a SACVRDP Fellowship; a program collaboratively funded by the NHF, the South Australian Department of Health and the South Australian Health and Medical Research Institute. PROSPERO REGISTRATION NUMBER CRD42015023952.
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Affiliation(s)
- L Lan
- Monash Diabetes, Monash Health, 246 Clayton Road, Clayton VIC 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Locked Bag 29, Clayton VIC 3168, Australia
| | - C L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Locked Bag 29, ClaytonVIC 3168, Australia
| | - M Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Locked Bag 29, ClaytonVIC 3168, Australia
| | - B Hill
- School of Psychology, Deakin University, Geelong, Locked Bag 20000VIC, 3220, Australia
| | - H J Teede
- Monash Diabetes, Monash Health, 246 Clayton Road, Clayton VIC 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Locked Bag 29, Clayton VIC 3168, Australia
| | - B W Mol
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Street, North Adelaide SA 5006, Australia, Locked Bag 29, ClaytonVIC 3168, Australia
| | - L J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Locked Bag 29, Clayton VIC 3168, Australia.,Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Street, North Adelaide SA 5006, Australia, Locked Bag 29, Clayton VIC 3168, Australia
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27
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Association between periconceptional weight loss and maternal and neonatal outcomes in obese infertile women. PLoS One 2018; 13:e0192670. [PMID: 29590118 PMCID: PMC5873932 DOI: 10.1371/journal.pone.0192670] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 01/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Obesity in women of reproductive age has deleterious effects on reproductive and offspring health. In this study, we aimed to evaluate the association between the magnitude of periconceptional body-mass index (BMI) change and maternal and neonatal outcomes in obese infertile women who participated in the LIFEstyle study. The LIFEstyle study was a randomized controlled trial, evaluating if a six-month lifestyle intervention program prior to infertility treatment in obese infertile women improved birth rates, compared to prompt infertility treatment. Methods and findings This is an exploratory post hoc analysis of the LIFEstyle study. We recorded periconceptional BMI change in women with an ongoing pregnancy, pooling data of all women, regardless of randomization arm. Periconceptional BMI change was calculated using weight at randomization and the periconceptional weight (measured in kilograms 12 weeks before or after conception and expressed as BMI change in units BMI (kg/m2)). Subsequently, women were categorized into quartiles according to the magnitude of their periconceptional change in BMI. The odds of maternal and neonatal outcomes were calculated using logistic regression analysis, comparing women in each of the first three weight change quartiles separately, and combined, to women in the fourth quartile. The fourth quartile was chosen as reference group, since these women had the least weight loss. We adjusted for periconceptional BMI, nulliparity and smoking status. In addition, we performed a subgroup analysis for singleton pregnancies. In the LIFEstyle study, 321 obese infertile women achieved an ongoing pregnancy which was conceived within 24 months after randomization. Periconceptional BMI change was available in 244 of these women (76%). Median BMI at randomization was 35.9 kg/m2. Women in the first quartile (Q1) had a periconceptional BMI change of <-2.1 kg/m2, women in the second quartile (Q2) -2.1 to -0.9 kg/m2, women in the third quartile (Q3) -0.9 to 0.1 kg/m2 and women in the fourth quartile (Q4) gained ≥0.1 kg/m2. There were no significant differences between women in the quartiles regarding rates of excessive gestational weight gain (in term pregnancies), gestational diabetes, preterm birth, induction of labor, spontaneous vaginal birth and Caesarean section. Compared to women in Q4, the adjusted odds ratios, aOR, and 95% confidence interval for a hypertensive complication were; 0.55 (0.22–1.42) for women in Q1, 0.30 (0.12–0.78) for women in Q2, 0.39 (0.16–0.96) for women in Q3 and 0.39 (0.19–0.82) for women in Q1 to Q3 combined. In the subgroup analysis, investigating singleton pregnancies only, the statistically significant decreased rate of a hypertensive complication remained in women in Q2 (aOR 0.27, 95% CI 0.10–0.72) and Q3 (aOR 0.39, 95%CI 0.16–0.98) and when comparing women in Q1 to Q3 together to women in Q4 (aOR 0.38, 95%CI 0.18–0.80). Furthermore, there was a significantly decreased aOR (95%CI) of preterm birth in women in Q2 (0.24, 0.06–0.98) and when combining women in Q1 to Q3 (0.37, 0.14–0.97) compared to women in Q4. Conclusions These results suggest that a periconceptional decrease in BMI in obese infertile women could lead to a decrease of the rates of hypertensive pregnancy complications and preterm birth. The results are limited by the exploratory nature of the analyses and further evidence is necessary to provide more definitive conclusions.
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van de Beek C, Hoek A, Painter RC, Gemke RJBJ, van Poppel MNM, Geelen A, Groen H, Willem Mol B, Roseboom TJ. Women, their Offspring and iMproving lifestyle for Better cardiovascular health of both (WOMB project): a protocol of the follow-up of a multicentre randomised controlled trial. BMJ Open 2018; 8:e016579. [PMID: 29371262 PMCID: PMC5786127 DOI: 10.1136/bmjopen-2017-016579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Women, their Offspring and iMproving lifestyle for Better cardiovascular health of both (WOMB) project is the follow-up of the LIFEstyle study, a randomised controlled trial in obese infertile women, and investigates the effects of a preconception lifestyle intervention on later health of women (WOMB women) and their children (WOMB kids). METHODS AND ANALYSIS Obese infertile women, aged between 18 and 39 years, were recruited in 23 Dutch fertility clinics between June 2009 and June 2012. The 284 women allocated to the intervention group received a 6-month structured lifestyle programme. The 280 women in the control group received infertility care as usual. 4 to 7 years after inclusion in the trial, all women (n=564) and children conceived during the trial (24 months after randomisation) (n=305 singletons and age 3-5 years) will be approached to participate in this follow-up study (starting in 2015). The main focus of outcome will be cardiovascular health, but the dataset comprises a wide range of physical and mental health measures, diet and physical activity measures, child growth and development measures, biological samples and genetic and epigenetic information. The follow-up assessment consists of three stages that take place between 2016 and 2018, and includes (online) questionnaires, accelerometry and physical and behavioural measurements in a mobile research vehicle. A subsample of 100 women and 100 children are planned for cardiac ultrasound measurements. ETHICS AND DISSEMINATION The protocol of this follow-up study is approved by the local medical ethics committee (University Medical Centre Groningen). Study findings of the WOMB project will be widely disseminated to the scientific community, healthcare professionals, policy makers, future parents and general public. TRIAL REGISTRATION NUMBER The original LIFEstyle study is registered at The Netherlands Trial Registry (number 1530).
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Affiliation(s)
- Cornelieke van de Beek
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Reinoud J B J Gemke
- Department of Paediatrics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Department Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Institute of Sport Science, University of Graz, Graz, Austria
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, The Robinson Institute, School of Medicine, University of Adelaide, Adelaide, Australia
- Division of women and babies, The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
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van Dammen L, Wekker V, van Oers AM, Mutsaerts MAQ, Painter RC, Zwinderman AH, Groen H, van de Beek C, Muller Kobold AC, Kuchenbecker WKH, van Golde R, Oosterhuis GJE, Vogel NEA, Mol BWJ, Roseboom TJ, Hoek A. Effect of a lifestyle intervention in obese infertile women on cardiometabolic health and quality of life: A randomized controlled trial. PLoS One 2018; 13:e0190662. [PMID: 29324776 PMCID: PMC5764284 DOI: 10.1371/journal.pone.0190662] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/13/2017] [Indexed: 01/26/2023] Open
Abstract
Background The prevalence of obesity, an important cardiometabolic risk factor, is rising in women. Lifestyle improvements are the first step in treatment of obesity, but the success depends on factors like timing and motivation. Women are especially receptive to advice about lifestyle before and during pregnancy. Therefore, we hypothesize that the pre-pregnancy period provides the perfect window of opportunity to improve cardiometabolic health and quality of life of obese infertile women, by means of a lifestyle intervention. Methods and findings Between 2009–2012, 577 infertile women between 18 and 39 years of age, with a Body Mass Index of ≥ 29 kg/m2, were randomized to a six month lifestyle intervention preceding infertility treatment, or to direct infertility treatment. The goal of the intervention was 5–10% weight loss or a BMI < 29 kg/m2. Cardiometabolic outcomes included weight, waist- and hip circumference, body mass index, systolic and diastolic blood pressure, fasting glucose and insulin, HOMA-IR, hs-CRP, lipids and metabolic syndrome. All outcomes were measured by research nurses at randomization, 3 and 6 months. Self-reported quality of life was also measured at 12 months. Three participants withdrew their informed consent, and 63 participants discontinued the intervention program. Intention to treat analysis was conducted. Mixed effects regression models analyses were performed. Results are displayed as estimated mean differences between intervention and control group. Weight (-3.1 kg 95% CI: -4.0 to -2.2 kg; P < .001), waist circumference (-2.4 cm 95% CI: -3.6 to -1.1 cm; P < .001), hip circumference (-3.0 95% CI: -4.2 to -1.9 cm; P < .001), BMI (-1.2 kg/m2 95% CI: -1.5 to -0.8 kg/m2; P < .001), systolic blood pressure (-2.8 mmHg 95% CI: -5.0 to -0.7 mmHg; P = .01) and HOMA-IR (-0.5 95% CI: -0.8 to -0.1; P = .01) were lower in the intervention group compared to controls. Hs-CRP and lipids did not differ between groups. The odds ratio for metabolic syndrome in the intervention group was 0.53 (95% CI: 0.33 to 0.85; P < .01) compared to controls. Physical QoL scores were higher in the lifestyle intervention group (2.2 95% CI: 0.9 to 3.5; P = .001) while mental QoL scores did not differ. Conclusions In obese infertile women, a lifestyle intervention prior to infertility treatment improves cardiometabolic health and self-reported physical quality of life (LIFEstyle study: Netherlands Trial Register: NTR1530).
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Affiliation(s)
- Lotte van Dammen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Vincent Wekker
- Department of Obstetrics and Gynecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health research institute, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Anne M. van Oers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Meike A. Q. Mutsaerts
- Department of General Practice, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Rebecca C. Painter
- Department of Obstetrics and Gynecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health research institute, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Cornelieke van de Beek
- Department of Obstetrics and Gynecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Anneke C. Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | | | - Ron van Golde
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
| | | | - Niels E. A. Vogel
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands
| | - Ben Willem J. Mol
- Department of Obstetrics and Gynecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health research institute, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Department of General Practice, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
- Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands
- School of Medicine, Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Tessa J. Roseboom
- Department of Obstetrics and Gynecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health research institute, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Adipositas und kontrollierte ovarielle Stimulation (COH). GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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O'brien CM, Poprzeczny A, Dodd JM. Implications of maternal obesity on fetal growth and the role of ultrasound. Expert Rev Endocrinol Metab 2017; 12:45-58. [PMID: 30058877 DOI: 10.1080/17446651.2017.1271707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over fifty percent of women entering pregnancy are overweight or obese. This has a significant impact on short and long term maternal and infant health outcomes, and the intergenerational effects of obesity are now a major public health problem globally. Areas covered: There are two major pathways contributing to fetal growth. Glucose and insulin directly affect growth, while other substrates such as leptin, adiponectin and insulin-like growth factors indirectly influence growth through structural and morphological effects on the placenta, uteroplacental blood flow, and regulation of placental transporters. Advances in ultrasonography over the past decade have led to interest in the prediction of the fetus at risk of overgrowth and adiposity utilizing both standard ultrasound biometry and fetal body composition measurements. However, to date there is no consensus regarding the definition of fetal overgrowth, its reporting, and clinical management. Expert commentary: Maternal dietary intervention targeting the antenatal period appear to be too late to sufficiently affect fetal growth. The peri-conceptual period and early pregnancy are being evaluated to determine if the intergenerational effects of maternal obesity can be altered to improve newborn, infant and child health.
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Affiliation(s)
- Cecelia M O'brien
- a School of Paediatrics and Reproductive Health, and Robinson Research Institute , University of Adelaide , Adelaide , Australia
- b Maternal Fetal Medicine Unit , John Hunter Hospital , Newcastle , Australia
| | - Amanda Poprzeczny
- a School of Paediatrics and Reproductive Health, and Robinson Research Institute , University of Adelaide , Adelaide , Australia
- c Department of Obstetrics and Gynaecology , Lyell McEwin Hospital , Adelaide , Australia
| | - Jodie M Dodd
- a School of Paediatrics and Reproductive Health, and Robinson Research Institute , University of Adelaide , Adelaide , Australia
- d Department of Perinatal Medicine, Women's and Babies Division , Women's and Children's Hospital , Adelaide , Australia
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Mariona FG. Perspectives in obesity and pregnancy. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:523-532. [PMID: 29334009 PMCID: PMC5373261 DOI: 10.1177/1745505716686101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/17/2016] [Accepted: 12/02/2016] [Indexed: 02/06/2023]
Abstract
Obesity is currently recognized as a health epidemic worldwide. Its prevalence has doubled in the last three decades. Obesity is a complex clinical picture associated with physical, physiologic, hormonal, genetic, cultural, socioeconomic and environmental factors. The rate of obesity is also increasing in the pregnant women population. Maternal obesity is associated with less than optimal obstetrical, fetal and neonatal outcomes. It is also associated with significant adverse long-term effects on both obese parturients and the infants born from obese women. A number of guidelines have been published to educate health care workers and the general population in an attempt to develop effective interventions on a large scale to prevent obesity. These guidelines are multiple, confusing and inconsistent. There are no standard recommendations regarding gestational weight gaining goals, nutrients and additional elements necessary for certain obese women who have been treated with bariatric surgical procedures, screening for metabolic diseases such as diabetes, additional preventive health care services indicated for obese women in the pregnancy planning stages, during prenatal care, in the immediate post-partum period and as a long-term approach for health preservation. In 2013, the American Medical Association supported by several US national medical specialty organizations published Resolution 420 (A-13) recognizing obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to improve its prevention and treatment. The goal of this decision was to encourage a broader spectrum of health care benefits insurance coverage for the prevention and treatment of obesity. There are a number of myths and misconceptions associated with obesity. These perspectives present our views and clinical experience with a partial review of recent bibliography addressing the associations between obese reproductive age women and their risks during pregnancy.
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Affiliation(s)
- Federico G. Mariona
- Division of Maternal-Fetal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
- Michigan Perinatal Associates, Dearborn, MI, USA
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van Oers AM, Groen H, Mutsaerts MAQ, Burggraaff JM, Kuchenbecker WKH, Perquin DAM, Koks CAM, van Golde R, Kaaijk EM, Schierbeek JM, Oosterhuis GJE, Broekmans FJ, Vogel NEA, Land JA, Mol BWJ, Hoek A. Effectiveness of lifestyle intervention in subgroups of obese infertile women: a subgroup analysis of a RCT. Hum Reprod 2016; 31:2704-2713. [PMID: 27798042 DOI: 10.1093/humrep/dew252] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do age, ovulatory status, severity of obesity and body fat distribution affect the effectiveness of lifestyle intervention in obese infertile women? SUMMARY ANSWER We did not identify a subgroup in which lifestyle intervention increased the healthy live birth rate however it did increase the natural conception rate in anovulatory obese infertile women. WHAT IS KNOWN ALREADY Obese women are at increased risk of infertility and are less likely to conceive after infertility treatment. We previously demonstrated that a 6-month lifestyle intervention preceding infertility treatment did not increase the rate of healthy live births (vaginal live birth of a healthy singleton at term) within 24 months of follow-up as compared to prompt infertility treatment in obese infertile women. Natural conceptions occurred more frequently in women who received a 6-month lifestyle intervention preceding infertility treatment. STUDY DESIGN, SIZE, DURATION This is a secondary analysis of a multicentre RCT (randomized controlled trial), the LIFEstyle study. Between 2009 and 2012, 577 obese infertile women were randomly assigned to a 6-month lifestyle intervention followed by infertility treatment (intervention group) or to prompt infertility treatment (control group). Subgroups were predefined in the study protocol, based on frequently used cut-off values in the literature: age (≥36 or <36 years), ovulatory status (anovulatory or ovulatory), BMI (≥35 or <35 kg/m2) and waist-hip (WH) ratio (≥0.8 or <0.8). PARTICIPANTS/MATERIALS, SETTING, METHODS Data of 564 (98%) randomized women who completed follow-up were analyzed. We studied the effect of the intervention program in various subgroups on healthy live birth rate within 24 months, as well as the rate of overall live births (live births independent of gestational age, mode of delivery and health) and natural conceptions within 24 months. Live birth rates included pregnancies resulting from both treatment dependent and natural conceptions. Logistic regression models with randomization group, subgroup and the interaction between randomization group and subgroup were used. Significant interaction was defined as a P-value <0.1. MAIN RESULTS AND THE ROLE OF CHANCE Neither maternal age, ovulatory status nor BMI had an impact on the healthy live birth rate within 24 months, nor did they influence the overall live birth rate within 24 months after randomization. WH ratio showed a significant interaction with the effect of lifestyle intervention on healthy live birth rate (P = 0.05), resulting in a lower healthy live birth rate in women with a WH ratio <0.8. WH ratio had no interaction regarding overall live birth rate (P = 0.27) or natural conception rate (P = 0.38). In anovulatory women, the effect of lifestyle intervention resulted in more natural conceptions compared to ovulatory women (P-value for interaction = 0.02). There was no interaction between other subgroups and the effect of the intervention on the rate of natural conception. LIMITATIONS, REASONS FOR CAUTION Since this was a subgroup analysis of a RCT and sample size determination of the trial was based on the primary outcome of the study, the study was not powered for analyses of all subgroups. WIDER IMPLICATIONS OF THE FINDINGS Our finding that lifestyle intervention leads to increased natural conception in anovulatory obese women could be used in the counselling of these women, but requires further research using an appropriately powered study in order to confirm this result. STUDY FUNDING/COMPETING INTERESTS The study was supported by a grant from ZonMw, the Dutch Organisation for Health Research and Development (50-50110-96-518). The Department of Obstetrics and Gynaecology of the UMCG received an unrestricted educational grant from Ferring pharmaceuticals BV, The Netherlands. Ben Mol is a consultant for ObsEva, Geneva. Annemieke Hoek received a speaker's fee for a postgraduate education from MSD pharmaceutical company, outside the submitted work. TRIAL REGISTRATION NUMBER The LIFEstyle study was registered at the Dutch trial registry (NTR 1530).
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Affiliation(s)
- A M van Oers
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - M A Q Mutsaerts
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands.,Department of General Practice, University of Utrecht, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands
| | - J M Burggraaff
- Department of Obstetrics and Gynaecology, Scheper Hospital, 7800RA Emmen, The Netherlands
| | - W K H Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Clinics, 8000GK Zwolle, The Netherlands
| | - D A M Perquin
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, 8901BR Leeuwarden, The Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Maxima Medical Center, 5500MB Veldhoven, The Netherlands
| | - R van Golde
- Department of Obstetrics and Gynaecology, University of Maastricht, Maastricht University Medical Center, 6202AZ Maastricht, The Netherlands
| | - E M Kaaijk
- Department of Obstetrics and Gynaecology, OLVG, 1090HM Amsterdam, The Netherlands
| | - J M Schierbeek
- Department of Obstetrics and Gynaecology, Deventer Hospital, 7400GC Deventer, The Netherlands
| | - G J E Oosterhuis
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, 3430EM Nieuwegein, The Netherlands
| | - F J Broekmans
- Department for Reproductive Medicine, Division Female and Baby, University of Utrecht, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands
| | - N E A Vogel
- Department of Obstetrics and Gynaecology, Martini Hospital, 9700RM Groningen, The Netherlands
| | - J A Land
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - B W J Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, 5000SA Adelaide, Australia
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
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Mutsaerts MAQ, van Oers AM, Groen H, Burggraaff JM, Kuchenbecker WKH, Perquin DAM, Koks CAM, van Golde R, Kaaijk EM, Schierbeek JM, Oosterhuis GJE, Broekmans FJ, Bemelmans WJE, Lambalk CB, Verberg MFG, van der Veen F, Klijn NF, Mercelina PEAM, van Kasteren YM, Nap AW, Brinkhuis EA, Vogel NEA, Mulder RJAB, Gondrie ETCM, de Bruin JP, Sikkema JM, de Greef MHG, ter Bogt NCW, Land JA, Mol BWJ, Hoek A. Randomized Trial of a Lifestyle Program in Obese Infertile Women. N Engl J Med 2016; 374:1942-53. [PMID: 27192672 DOI: 10.1056/nejmoa1505297] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Small lifestyle-intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcomes, but large randomized, controlled trials are lacking. METHODS We randomly assigned infertile women with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 29 or higher to a 6-month lifestyle intervention preceding treatment for infertility or to prompt treatment for infertility. The primary outcome was the vaginal birth of a healthy singleton at term within 24 months after randomization. RESULTS We assigned women who did not conceive naturally to one of two treatment strategies: 290 women were assigned to a 6-month lifestyle-intervention program preceding 18 months of infertility treatment (intervention group) and 287 were assigned to prompt infertility treatment for 24 months (control group). A total of 3 women withdrew consent, so 289 women in the intervention group and 285 women in the control group were included in the analysis. The discontinuation rate in the intervention group was 21.8%. In intention-to-treat analyses, the mean weight loss was 4.4 kg in the intervention group and 1.1 kg in the control group (P<0.001). The primary outcome occurred in 27.1% of the women in the intervention group and 35.2% of those in the control group (rate ratio in the intervention group, 0.77; 95% confidence interval, 0.60 to 0.99). CONCLUSIONS In obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization. (Funded by the Netherlands Organization for Health Research and Development; Netherlands Trial Register number, NTR1530.).
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Affiliation(s)
- Meike A Q Mutsaerts
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Anne M van Oers
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Henk Groen
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Jan M Burggraaff
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Walter K H Kuchenbecker
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Denise A M Perquin
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Carolien A M Koks
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Ron van Golde
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Eugenie M Kaaijk
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Jaap M Schierbeek
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Gerrit J E Oosterhuis
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Frank J Broekmans
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Wanda J E Bemelmans
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Cornelis B Lambalk
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Marieke F G Verberg
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Fulco van der Veen
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Nicole F Klijn
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Patricia E A M Mercelina
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Yvonne M van Kasteren
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Annemiek W Nap
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Egbert A Brinkhuis
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Niels E A Vogel
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Robert J A B Mulder
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Ed T C M Gondrie
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Jan P de Bruin
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - J Marko Sikkema
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Mathieu H G de Greef
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Nancy C W ter Bogt
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Jolande A Land
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Ben W J Mol
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
| | - Annemieke Hoek
- From the Departments of Obstetrics and Gynecology (M.A.Q.M., A.M.O., J.A.L., A.H.), General Practice (M.A.Q.M.), and Epidemiology (H.G.), and the Institute of Human Movement Sciences (M.H.G.G.), University Medical Center Groningen, University of Groningen, the Department of Obstetrics and Gynecology, Martini Hospital (N.E.A.V.), and the Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences (M.H.G.G.), Groningen, the Department of Obstetrics and Gynecology, Scheper Hospital, Emmen (J.M.B.), the Department of Obstetrics and Gynecology, Isala Clinics, Zwolle (W.K.H.K.), the Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden (D.A.M.P.), the Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven (C.A.M.K.), the Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht University, Maastricht (R.G.), the Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis (E.M.K.), the Department of Obstetrics and Gynecology, VU University Medical Center (C.B.L.), and the Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam (F.V.), Amsterdam, the Department of Obstetrics and Gynecology, Deventer Hospital, Deventer (J.M. Schierbeek), the Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein (G.J.E.O.), the Department of Reproductive Medicine, Division Female and Baby, University Medical Center Utrecht, Utrecht University, Utrecht (F.J.B.), the Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven (W.J.E.B.), the Department of Obstetrics and Gynecology, Medical Spectrum Twente, Enschede (M.F.G.V.), the Department of Gynecology and Reproductive Medicine, Leiden University Medical Center, University of Leiden, Leiden (N.F.K.), the Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen (P.E.A.M.M.), the Department of Obstetrics a
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Palomba S, de Wilde MA, Falbo A, Koster MP, La Sala GB, Fauser BC. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update 2015; 21:575-592. [DOI: 10.1093/humupd/dmv029] [Citation(s) in RCA: 373] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Polotsky AJ, Allshouse AA, Casson PR, Coutifaris C, Diamond MP, Christman GM, Schlaff WD, Alvero R, Trussell JC, Krawetz SA, Santoro N, Eisenberg E, Zhang H, Legro RS. Impact of Male and Female Weight, Smoking, and Intercourse Frequency on Live Birth in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2015; 100:2405-12. [PMID: 25856211 PMCID: PMC4454812 DOI: 10.1210/jc.2015-1178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Obese men with normal semen parameters exhibit reduced fertility but few prospective data are available. OBJECTIVE This study aimed to determine the effect of male factors and body mass among the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) participants. METHODS This is a secondary analysis of the PPCOS II trial. A total of 750 infertile women with polycystic ovary syndrome (PCOS) were randomly assigned to up to receive five cycles of letrozole or clomiphene citrate. Females were 18-39-years-old and had a male partner with sperm concentration of at least 14 million/mL who consented to regular intercourse. Analysis was limited to couples with complete male partner information (n = 710). RESULTS Male body mass index (BMI) was higher in couples who failed to conceive (29.5 kg/m(2) vs 28.2 kg/m(2); P = .039) as well as those who did not achieve a live birth (29.5 kg/m(2) vs 28.1 kg/m(2); P = .047). At least one partner was obese in 548 couples (77.1%). A total of 261 couples were concordant for obesity (36.8%). After adjustment for female BMI, the association of male BMI with live birth was no longer significant (odds ratio [OR] = 0.85; 95 % confidence interval [CI], 0.68-1.05; P = .13). Couples in which both partners smoked had a lower chance of live birth vs nonsmokers (OR = 0.20; 95 % CI, 0.08-0.52; P = .02), whereas there was not a significant effect of female or male smoking alone. Live birth was more likely in couples with at least three sexual intercourse attempts over the previous 4 weeks (reported at baseline) as opposed to couples with lesser frequency (OR = 4.39; 95 % CI, 1.52-12. 4; P < .01). CONCLUSIONS In this large cohort of obese women with PCOS, effect of male obesity was explained by female BMI. Lower chance of success was seen among couples where both partners smoked. Obesity and smoking are common among women with PCOS and their partners and contribute to a decrease in fertility treatment success.
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Affiliation(s)
- Alex J Polotsky
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Amanda A Allshouse
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Peter R Casson
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Michael P Diamond
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Gregory M Christman
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - William D Schlaff
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Ruben Alvero
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - J C Trussell
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Nanette Santoro
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Esther Eisenberg
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Heping Zhang
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
| | - Richard S Legro
- Department of Obstetrics and Gynecology (A.J.P., A.A.A., R.A., N.S.), University of Colorado Denver, Aurora, Colorado 80045; Department of Biostatistics and Informatics (A.A.A.), School of Public Health, University of Colorado Denver, Aurora, Colorado 80045; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont 05405; Department of Obstetrics and Gynecology (C.C.), Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Obstetrics and Gynecology (M.P.D.), GA Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (G.M.C.), University of Florida Health System, Gainesville, Florida 32610; Department of Obstetrics and Gynecology (W.D.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107; Department of Urology (J.C.T.), State University of New York Upstate Medical University, Syracuse, New York 13202; Department of Obstetrics and Gynecology (S.A.K.), Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan 48201; Eunice Kennedy Shriver National Institute of Child Health and Human Development (E.E.), Bethesda, Maryland 20892; Department of Biostatistics (H.Z.), Yale University School of Public Health, New Haven, Connecticut 06520; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033
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Desoye G, van Poppel M. The Feto-placental Dialogue and Diabesity. Best Pract Res Clin Obstet Gynaecol 2015; 29:15-23. [DOI: 10.1016/j.bpobgyn.2014.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 01/20/2023]
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Dietary Interventions, Lifestyle Changes, and Dietary Supplements in Preventing Gestational Diabetes Mellitus. Obstet Gynecol Surv 2014; 69:669-80. [DOI: 10.1097/ogx.0000000000000121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Sim KA, Partridge SR, Sainsbury A. Does weight loss in overweight or obese women improve fertility treatment outcomes? A systematic review. Obes Rev 2014; 15:839-50. [PMID: 25132280 DOI: 10.1111/obr.12217] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/26/2014] [Accepted: 06/23/2014] [Indexed: 11/29/2022]
Abstract
This systematic review assessed the effect of weight loss in overweight and/or obese women undergoing assisted reproductive technology (ART) on their subsequent pregnancy outcome. Weight losses achieved by diet and lifestyle changes, very-low-energy diets, non-surgical medical interventions and bariatric surgery translated into significantly increased pregnancy rates and/or live birth in overweight and/or obese women undergoing ART in 8 of the 11 studies reviewed. In addition, regularization of the menstrual pattern, a decrease in cancellation rates, an increase in the number of embryos available for transfer, a reduction in the number of ART cycles required to achieve pregnancy and a decrease in miscarriage rates were reported. There were also a number of natural conceptions in five of the six studies that reported this outcome. Non-surgical medical weight loss procedures and bariatric surgery induced the greatest weight losses, but their use, as well as that of very-low-energy diets, for weight loss prior to ART requires careful consideration. While the overall quality of the studies included in this review was poor, these results support the clinical recommendation of advising overweight and/or obese women to lose weight prior to ART. Prospective randomized controlled trials are required to establish efficacious evidence-based guidelines for weight loss interventions in overweight and/or obese women prior to ART treatment.
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Affiliation(s)
- K A Sim
- The Boden Institute for Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, NSW, Australia
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Seli E, Babayev E, Collins SC, Nemeth G, Horvath TL. Minireview: Metabolism of female reproduction: regulatory mechanisms and clinical implications. Mol Endocrinol 2014; 28:790-804. [PMID: 24678733 DOI: 10.1210/me.2013-1413] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Female fertility is highly dependent on successful regulation of energy metabolism. Central processes in the hypothalamus monitor the metabolic state of the organism and, together with metabolic hormones, drive the peripheral availability of energy for cellular functions. In the ovary, the oocyte and neighboring somatic cells of the follicle work in unison to achieve successful metabolism of carbohydrates, amino acids, and lipids. Metabolic disturbances such as anorexia nervosa, obesity, and diabetes mellitus have clinically important consequences on human reproduction. In this article, we review the metabolic determinants of female reproduction and their role in infertility.
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Affiliation(s)
- Emre Seli
- Department of Obstetrics, Gynecology, and Reproductive Sciences (E.S., E.B., S.C., T.L.H.), Yale School of Medicine, New Haven, Connecticut 06520; Department of Obstetrics and Gynecology (G.N., T.L.H.), University of Szeged, Faculty of Medicine, Szeged, Hungary 6701; Department of Comparative Medicine (T.L.H.), Yale School of Medicine, New Haven, Connecticut 06520; and the Department of Neurobiology (T.L.H.), Yale School of Medicine, New Haven, Connecticut 06520
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Santangelo C, Varì R, Scazzocchio B, Filesi C, Masella R. Management of reproduction and pregnancy complications in maternal obesity: which role for dietary polyphenols? Biofactors 2014; 40:79-102. [PMID: 23983164 DOI: 10.1002/biof.1126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/28/2013] [Accepted: 07/02/2013] [Indexed: 02/06/2023]
Abstract
Obesity is a global and dramatic public health problem; maternal obesity represents one of the main risk factors of infertility and pregnancy complications as it is associated with adverse maternal and offspring outcomes. In the last few years, adipose tissue dysfunction associated with altered adipocytokine secretion has been suggested to play a critical role in all the phases of reproductive process. Obesity is a nutrition-related disorder. In this regard, dietary intervention strategies, such as high intake of fruit and vegetables, have shown significant effects in both preserving health and counteracting obesity-associated diseases. Evidence has been provided that polyphenols, important constituents of plant-derived food, can influence developmental program of oocyte and embryo, as well as pregnancy progression by modulating several cellular pathways. This review will examine the controversial results so far obtained on adipocytokine involvement in fertility impairment and pregnancy complications. Furthermore, the different effects exerted by polyphenols on oocyte, embryo, and pregnancy development will be also taken in account.
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Affiliation(s)
- Carmela Santangelo
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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Natürliche Fertilität eines Paares und epidemiologische Aspekte der Subfertilität. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:1633-41. [DOI: 10.1007/s00103-013-1852-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pinborg A, Petersen GL, Schmidt L. Recent insights into the influence of female bodyweight on assisted reproductive technology outcomes. ACTA ACUST UNITED AC 2013; 9:1-4. [PMID: 23241149 DOI: 10.2217/whe.12.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Obesity is associated with multiple adverse reproductive outcomes, but the mechanisms involved are largely unknown. Obesity has been referred to as a "complex system," defined as a system of heterogeneous parts interacting in nonlinear ways to influence the behavior of the parts as a whole. Human reproduction is also a complex system; hence the difficulty in identifying the mechanisms linking obesity and adverse reproductive function. This review discusses the adverse reproductive outcomes associated with obesity and the mechanisms involved and concludes with a discussion of public health policy with respect to the treatment of infertility in obese women.
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Affiliation(s)
- Emily S Jungheim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO 63108, USA.
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Forsum E, Brantsæter AL, Olafsdottir AS, Olsen SF, Thorsdottir I. Weight loss before conception: A systematic literature review. Food Nutr Res 2013; 57:20522. [PMID: 23503117 PMCID: PMC3597776 DOI: 10.3402/fnr.v57i0.20522] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 01/07/2013] [Accepted: 01/30/2013] [Indexed: 11/14/2022] Open
Abstract
The prevalence of overweight and obesity in women has increased during the last decades. This is a serious concern since a high BMI before conception is an independent risk factor for many adverse outcomes of pregnancy. Therefore, dietary counseling, intended to stimulate weight loss in overweight and obese women prior to conception has recently been recommended. However, dieting with the purpose to lose weight may involve health risks for mother and offspring. We conducted a systematic literature review to identify papers investigating the effects of weight loss due to dietary interventions before conception. The objective of this study is to assess the effect of weight loss prior to conception in overweight or obese women on a number of health-related outcomes in mother and offspring using studies published between January 2000 and December 2011. Our first literature search produced 486 citations and, based on predefined eligibility criteria, 58 were selected and ordered in full text. Two group members read each paper. Fifteen studies were selected for quality assessment and two of them were considered appropriate for inclusion in evidence tables. A complementary search identified 168 citations with four papers being ordered in full text. The two selected studies provided data for overweight and obese women. One showed a positive effect of weight loss before pregnancy on the risk of gestational diabetes and one demonstrated a reduced risk for large-for-gestational-age infants in women with a BMI above 25 who lost weight before pregnancy. No study investigated the effect of weight loss due to a dietary intervention before conception. There is a lack of studies on overweight and obese women investigating the effect of dietary-induced weight loss prior to conception on health-related variables in mother and offspring. Such studies are probably lacking since they are difficult to conduct. Therefore, alternative strategies to control the body weight of girls and women of reproductive age are needed.
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Affiliation(s)
- Elisabet Forsum
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Kim JH, Shin HS, Park BK, Yang KM, Lee YH, Ryu HM. [Impact of prepregnancy body mass index on pregnancy outcome in women with a singleton conceived by assisted reproductive technology and spontaneously conceived pregnancy: a case-control study]. J Korean Acad Nurs 2012; 42:517-24. [PMID: 22972212 DOI: 10.4040/jkan.2012.42.4.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE To compare and confirm the impact of prepregnancy body mass index on pregnancy outcome in women with a singleton conceived by assisted reproductive technology and spontaneously conceived pregnancy. METHODS A sample of 165 and 247 pregnant women with and without assisted reproductive technology were retrospectively recruited from electronic medical charts of C hospital. RESULTS There were significant differences between the two groups for maternal age, paternal age, length of marriage, prepregnancy body mass index, parity, spontaneous abortion experience, and preterm delivery. A prepregnancy body mass index of ≥25 was associated with higher risk for maternal and neonatal complication in the assisted reproductive technology group. CONCLUSION The results indicate that a higher prepregnancy body mass index is associated with increased risks for adverse pregnancy outcomes for women using assisted reproductive technology. So these women need appropriate care to compensate for the risk.
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Affiliation(s)
- Ju Hee Kim
- College of Nursing Science, Kyung Hee University, Seoul, Korea
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Homan G, Litt J, Norman RJ. The FAST study: Fertility ASsessment and advice Targeting lifestyle choices and behaviours: a pilot study. Hum Reprod 2012; 27:2396-404. [DOI: 10.1093/humrep/des176] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Baird DD, Steiner AZ. Anti-Müllerian hormone: a potential new tool in epidemiologic studies of female fecundability. Am J Epidemiol 2012; 175:245-9. [PMID: 22247047 DOI: 10.1093/aje/kwr439] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of the present commentary is to suggest that epidemiologists explore the use of anti-Müllerian hormone (AMH) as a new measurement tool in fecundability studies. The authors briefly summarize the advantages and limitations of the 3 current approaches to studies of fecundability. All 3 approaches involve the collection of time-to-pregnancy or attempt-time data, and most are limited to participants who plan their pregnancies. AMH is produced by ovarian follicles during their early growth stages and is measured clinically to assess ovarian reserve (the number of remaining oocytes). Unlike time to pregnancy, serum AMH level can be assessed regardless of pregnancy-attempt status. Measurements are not significantly affected by phase of the menstrual cycle, oral contraceptive use, or early pregnancy. The authors suggest that AMH measurement can be a valuable addition to traditionally designed fecundability studies. In addition, this hormone should be investigated as an independent measure of fecundability in studies that focus on exposures hypothesized to target the ovary.
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Affiliation(s)
- Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA.
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Koning AMH, Mutsaerts MAQ, Kuchenbecker WKH, Kuchenbecher WKH, Broekmans FJ, Land JA, Mol BW, Hoek A. Complications and outcome of assisted reproduction technologies in overweight and obese women. Hum Reprod 2011; 27:457-67. [PMID: 22144420 DOI: 10.1093/humrep/der416] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Based on a presumed negative impact of overweight and obesity on reproductive capacity and pregnancy outcome, some national guidelines and clinicians have argued that there should be an upper limit for a woman's BMI to access assisted reproductive technologies (ART). However, evidence on the risk of complications or expected success rate of ART in obese women is scarce. We therefore performed a systematic review on the subject. METHODS We searched the literature for studies reporting on complications or success rates in overweight and obese women undergoing ART. Articles were scored on methodological quality. We calculated pooled odds ratios (ORs) to express the association between overweight and obesity on the one hand, and complications and success rates of ART on the other hand. We only pooled results if data were available per woman instead of per cycle or embryo transfer. RESULTS We detected 14 studies that reported on the association between overweight and complications during or after ART, of which 6 reported on ovarian hyperstimulation syndrome (OHSS), 7 on multiple pregnancies and 6 on ectopic pregnancies. None of the individual studies found a positive association between overweight and ART complications. The pooled ORs for overweight versus normal weight for OHSS, multiple pregnancy and ectopic pregnancy were 1.0 [95% confidence interval (CI) 0.77-1.3], 0.97 (95% CI 0.91-1.04) and 0.96 (95% CI 0.54-1.7), respectively. In 27 studies that reported on BMI and the success of ART, the pooled ORs for overweight versus normal weight on live birth, ongoing and clinical pregnancy following ART were OR 0.90 (95% CI 0.82-1.0), 1.01 (95% CI 0.75-1.4) and OR 0.94 (95% CI 0.69-1.3), respectively. CONCLUSIONS Data on complications following ART are scarce and therefore a registration system should be implemented in order to gain more insight into this subject. In the available literature, there is no evidence of overweight or obesity increasing the risk of complications following ART. Furthermore, they only marginally reduce the success rates. Based on the currently available data, overweight and obesity in itself should not be a reason to withhold ART.
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Affiliation(s)
- A M H Koning
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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