生活方式综合管理超重肥胖多囊卵巢综合征患者体质量下降与成功妊娠的关系

目的综合管理不孕超重肥胖多囊卵巢综合征(PCOS)女性,以期更有效地控制体质量(BW)、改善胰岛素抵抗(IR)及不孕,并明确体质量下降程度与妊娠的关系。方法健康管理中心开设体质量管理门诊,针对不孕超重肥胖的PCOS女性进行生活方式综合管理,观察干预后妊娠率,并分析体质量下降程度与成功妊娠的关系。结果52例不孕不育超重肥胖PCOS女性随访管理时长平均8个月,其中30例妊娠(4例自然受孕,26例该院生殖中心辅助受孕;在总人群中自然受孕率为7.69%)。基线时两组BW、体质指数(BMI)、内脏脂肪面积(VFA)及三酰甘油(TG)差异无统计学意义(P>0.05)。干预后两组BW、BMI、VFA、体脂肪(BF)及稳态模型评估胰岛素抵抗指数(HOMA-IR)、TG均明显下降(P<0.05);干预后未妊娠组TG及HOMA-IR显著高于妊娠组(P<0.05);干预前后妊娠组体质量下降百分比(△BW%)高于未妊娠组(P=0.019);能够成功受孕的△BW%临界值为10.45%。结论对于超重肥胖不孕PCOS患者生活方式综合管理后,体质量、BMI、BF及HOMA-IR、血脂均取得良好改善;为成功妊娠,体质量下降需达原始体质量的10.45%。

Relationship between weight loss and successful pregnancy in patients with overweight,obesity,and polycystic ovary syndrome through integrated lifestyle management

Objective To comprehensively manage infertile women with overweight,obesity,and polycystic ovary syndrome(PCOS),effectively control body weight(BW),improve insulin resistance(IR)and infertility,explore the relationship between the degree of weight loss and pregnancy.Methods Health Management Center opened a weight management clinic to conduct comprehensive lifestyle management for PCOS women with infertility,overweight,and obesity,observe the pregnancy rate after intervention,and analyze the relationship between the degree of weight loss and successful pregnancy.Results The follow-up management duration of 52 infertile,overweight,and obese PCOS women was 8 months,including 30 cases of pregnancy(4 cases were natural conception,26 cases were assisted by reproductive center;the natural conception rate was 7.69%in general population).There was no statistically significant difference in BW,body mass index(BMI),visceral fat area(VFA),and triglyceride(TG)between the two groups at baseline(P>0.05).After intervention,the levels of BW,BMI,VFA,body fat(BF),HOMA-IR,and TG in the two groups decreased significantly(P<0.05),the levels of TG and HOMA-IR in non-pregnancy group were statistically significantly higher than those in pregnancy group(P<0.05).Before and after intervention,the percentage of body weight loss(△BW%)in pregnancy group was statistically significantly higher than that in non-pregnancy group(P=0.019).The critical value of△BW%for successful pregnancy was 10.45%.Conclusion After comprehensive management,BW,BMI,BF,HOMA-IR,and blood lipids in infertile,overweight,and obese PCOS patients are improved;in order to achieve successful pregnancy,weight loss needs to reach 10.45%of the original weight.