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Obesity, inflammation and early pregnancy loss
Symposium Abstracts / Journal of Reproductive Immunology 90 (2011) 131–163
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S17
Recurrent pregnancy loss in obese women-is it an independent risk factor?
Obesity, inflammation and early pregnancy loss
M. Metwally Ninewells Hospital and the University of Dundee, Dundee, United Kingdom Introduction: There is significant evidence from the literature to suggest an increased risk of miscarriage in obese women. The mechanism for this relationship is still largely unknown but may be a result of an adverse effect on the embryo, endometrium or both. Materials and methods: In this presentation we explore the findings of several studies from our group as well as others that have attempted to explore this complex association. Results: Firstly we explore the epidemiological relationship between obesity and miscarriage by evidence from two studies. The first was a meta-analysis of the current literature that showed obesity to be associated with a small but significant risk of miscarriage both in the general population and in women undergoing assisted conception. The second was a retrospective study of 844 pregnancies from women suffering from recurrent miscarriage. The results again demonstrated that obesity causes a small but significant increased risk of miscarriage in the subsequent pregnancy. We then go on to explore the possible mechanisms behind this increased miscarriage risk. Findings from a retrospective study of endometrial function in the peri-implantation period demonstrated a significant negative correlation between endometrial glandular leukaemia inhibitory factor (LIF) concentrations and BMI. Yet another study describing the protein profile in the perimplantation endometrium showed that obesity was associated with a positive effect on haptoglobin expression. Both LIF and haptoglobin are inflammatory markers and point to a possible local inflammatory endometrial condition in obese women. Our final study examined the effect of obesity on embryo quality in women undergoing in Vitro Fertilisation and showed that obesity is associated with poorer embryo quality in patients less than 35 years of age. Conclusions: Findings from these studies as well as from other groups demonstrate that obesity increases the risk of miscarriage as a result of an adverse effect on both the endometrium and developing embryo. More studies are needed to examine the exact nature of these defects but preliminary evidence points to a possible inflammatory condition. doi:10.1016/j.jri.2011.06.018
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F.C. Denison MRC Centre for Reproductive Health, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom Maternal obesity is the commonest co-morbidity in pregnancy and currently affects one in five of the antenatal population. In early pregnancy, maternal obesity is associated with an increased risk of miscarriage, and congenital anomalies in the offspring. Later in pregnancy, maternal obesity is associated with increased risk of gestational diabetes, pre-eclampsia, peripartum complications, stillbirth and fetal macrosomia. However, the mechanisms that link poor obstetric outcome to pre-pregnancy obesity are not well understood. This paper will review the evidence base for maternal and fetal factors, which have been suggested as mediating adverse pregnancy outcome. These will include systemic inflammation, endothelial dysfunction, maternal metabolism, oocyte and embryo quality and the endometrial receptivity. doi:10.1016/j.jri.2011.06.019 S18 Maternal obesity and risk of spontaneous abortion A. Aghamohammadi ∗ , A. Zafari, A. Rajabi Islamic Azad University, Sari Branch, Iran Introduction: Because of the increasing epidemic of obesity and the fact that obesity is linked with several known disorders, there has been concern that obesity may have effects on pregnancy. The purpose of this study was to determine whether obesity increases the risk of spontaneous abortion. Material and methods: In this cohort study, nulliparous pregnant women who presented to perinatal care center Imam Khomeyni hospital Sari Iran were included in this study. Weight and height in all women were measured. The omission measures of the sample was included these cases: all the woman under 20 years and beyond 35, smoking and addicted women, pregnancy with the fertility aid methods, multigravida in present pregnancy, suffering from known physical and mental diseases, uterine pathology or clinical history of antiphospholipid antibodies or recurrent abortion. Spontaneous abortion rates were compared among the four BMI groups: normal weight, overweight, obese and morbidly obese. Chi-Square and Odds-Ratio were used in this study. Results: There were significant differences in abortion rates between the morbidly obese (42.1%), the obese (25.3%), and the normal (12.3%) and overweight (14.7%) groups. Compared with the normal weight group, the obese and morbidly obese had a significant increase in the risk of spontaneous abortion. Conclusions: Our findings showed that obesity is a risk factor for spontaneous abortion. Therefore, obese patients
S16
S17
Recurrent pregnancy loss in obese women-is it an independent risk factor?
Obesity, inflammation and early pregnancy loss
M. Metwally Ninewells Hospital and the University of Dundee, Dundee, United Kingdom Introduction: There is significant evidence from the literature to suggest an increased risk of miscarriage in obese women. The mechanism for this relationship is still largely unknown but may be a result of an adverse effect on the embryo, endometrium or both. Materials and methods: In this presentation we explore the findings of several studies from our group as well as others that have attempted to explore this complex association. Results: Firstly we explore the epidemiological relationship between obesity and miscarriage by evidence from two studies. The first was a meta-analysis of the current literature that showed obesity to be associated with a small but significant risk of miscarriage both in the general population and in women undergoing assisted conception. The second was a retrospective study of 844 pregnancies from women suffering from recurrent miscarriage. The results again demonstrated that obesity causes a small but significant increased risk of miscarriage in the subsequent pregnancy. We then go on to explore the possible mechanisms behind this increased miscarriage risk. Findings from a retrospective study of endometrial function in the peri-implantation period demonstrated a significant negative correlation between endometrial glandular leukaemia inhibitory factor (LIF) concentrations and BMI. Yet another study describing the protein profile in the perimplantation endometrium showed that obesity was associated with a positive effect on haptoglobin expression. Both LIF and haptoglobin are inflammatory markers and point to a possible local inflammatory endometrial condition in obese women. Our final study examined the effect of obesity on embryo quality in women undergoing in Vitro Fertilisation and showed that obesity is associated with poorer embryo quality in patients less than 35 years of age. Conclusions: Findings from these studies as well as from other groups demonstrate that obesity increases the risk of miscarriage as a result of an adverse effect on both the endometrium and developing embryo. More studies are needed to examine the exact nature of these defects but preliminary evidence points to a possible inflammatory condition. doi:10.1016/j.jri.2011.06.018
139
F.C. Denison MRC Centre for Reproductive Health, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom Maternal obesity is the commonest co-morbidity in pregnancy and currently affects one in five of the antenatal population. In early pregnancy, maternal obesity is associated with an increased risk of miscarriage, and congenital anomalies in the offspring. Later in pregnancy, maternal obesity is associated with increased risk of gestational diabetes, pre-eclampsia, peripartum complications, stillbirth and fetal macrosomia. However, the mechanisms that link poor obstetric outcome to pre-pregnancy obesity are not well understood. This paper will review the evidence base for maternal and fetal factors, which have been suggested as mediating adverse pregnancy outcome. These will include systemic inflammation, endothelial dysfunction, maternal metabolism, oocyte and embryo quality and the endometrial receptivity. doi:10.1016/j.jri.2011.06.019 S18 Maternal obesity and risk of spontaneous abortion A. Aghamohammadi ∗ , A. Zafari, A. Rajabi Islamic Azad University, Sari Branch, Iran Introduction: Because of the increasing epidemic of obesity and the fact that obesity is linked with several known disorders, there has been concern that obesity may have effects on pregnancy. The purpose of this study was to determine whether obesity increases the risk of spontaneous abortion. Material and methods: In this cohort study, nulliparous pregnant women who presented to perinatal care center Imam Khomeyni hospital Sari Iran were included in this study. Weight and height in all women were measured. The omission measures of the sample was included these cases: all the woman under 20 years and beyond 35, smoking and addicted women, pregnancy with the fertility aid methods, multigravida in present pregnancy, suffering from known physical and mental diseases, uterine pathology or clinical history of antiphospholipid antibodies or recurrent abortion. Spontaneous abortion rates were compared among the four BMI groups: normal weight, overweight, obese and morbidly obese. Chi-Square and Odds-Ratio were used in this study. Results: There were significant differences in abortion rates between the morbidly obese (42.1%), the obese (25.3%), and the normal (12.3%) and overweight (14.7%) groups. Compared with the normal weight group, the obese and morbidly obese had a significant increase in the risk of spontaneous abortion. Conclusions: Our findings showed that obesity is a risk factor for spontaneous abortion. Therefore, obese patients