女性体质量指数对宫腔内人工授精妊娠结局的影响:一项单中心大样本队列研究

Impact of female body mass index on clinical outcomes in patients treated with intrauterine insemination: a single-center cohort study

目的探讨在宫腔内人工授精(intrauterine insemination,IUI)助孕技术过程中,女性体质量指数(bodymass index,BMI)对妊娠结局的影响。方法回顾性队列研究分析2010年1月至2021年12月期间于郑州大学第一附属医院生殖医学中心就诊,并首次进行IUI助孕的21137例患者,包括夫精人工授精(artificial insemination byhusband,AIH)和供精人工授精(artificial inseminationby donor,AID)周期。根据临床妊娠与否,分成妊娠组和非妊娠组。首先比较临床妊娠组和非临床妊娠组的基线资料,然后根据女性BMI,将患者分为4组,A组:BMI≤18.5kg/m^(2)(偏度),B组:18.6~23.9kg/m^(2)(正常体质量),C组:24.0~27.9kg/m^(2)(超重),D组:BMI>28kg/m^(2)(肥胖),比较组间基本资料和妊娠结局;采用多因素logistic回归分析BMI对临床妊娠率和早期流产率的影响。结果在所有IUI助孕周期中,妊娠组患者的BMI[(24.58±3.52)kg/m^(2)]和非妊娠组[(23.35±4.20)kg/m^(2)]差异有统计学意义(P<0.001)。在AIH助孕周期中,C组和D组患者的临床妊娠率[18.21%(877/4815),17.12%(222/1297)]和早期流产率[17.10%(150/877),21.62%(48/222)]高于A组[11.24%(130/1157),10.77%(14/130)]和B组[13.40%(1229/9174),15.30%(188/1229)],4组间比较差异均有统计学意义(P=0.012,P=0.003)。经过多因素logistic回归分析,BMI高低对临床妊娠率无显著影响,但肥胖显著增加早期流产的风险(0R=1.63,95%CI:1.25~1.95,P=0.003)。在AID助孕周期中,不同BMI人群的妊娠结局差异无统计学意义,肥胖是早期流产的危险因素(0R=1.58,95%CI:1.14~1.87,P=0.016)。结论女性BMI并不影响AIH和AID周期的临床妊娠率,但肥胖显著增加早期流产的风险。

Objective To explore the impact of female body mass index(BMI)on clinical outcomes in patients treated with intrauterine insemination(IUI).Methods This study was a retrospective cohort study.A total of 21137 patients who visited the Reproductive Medical Center,the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2021 were recruited.The patients underwent the first IUI cycles,including artificial insemination by husband(AIH)and artificial insemination by donor(AID).According to clinical pregnancy or not,it is divided into pregnancy group and non-pregnancy group.The basic parameters between clinical pregnancy group and non-clinical pregnancy group were compared.According to the BMI,patients were divided into 4 groups,group A:BMI≤18.5 kg/m2,group B:18.6-23.9 kg/m2,group C:24.0-27.9 kg/m2and group D:BMI≥28.0 kg/m2.Patients'basic parameters and clinical outcomes were compared among the four groups.Multivariate logistic regression analysis was used to explore the impact of BMI on pregnancy outcomes.Results In all IUI cycles,BMI was significantly different between pregnant patients and non-pregnant patients[(24.58±3.52)kg/m2vs.(23.35±4.20)kg/m2,P<0.001].In AIH cycles,clinical pregnancy rate[18.21%(877/4815),17.12%(222/1297)]and early spontaneous miscarriage rate[17.10%(150/877),21.62%(48/222)]were significantly higher in patients of group C and group D than in group A[11.24%(130/1157),10.77%(14/130)]and group B[13.40%(1229/9174),15.30%(188/1229)].The differences among the 4 groups were statistically significant(P=0.012,P=0.003).However,BMI was not associated with clinical pregnancy rate in multivariate logistic analysis,but obesity was a predictor for early spontaneous miscarriage(OR=1.63,95%CI:1.25-1.95,P=0.003).In AID cycles,pregnancy outcomes were comparable among the four BMI groups.Obesity significantly increased early spontaneous miscarriage rate(OR=1.58,95%CI:1.14-1.87,P=0.016).Conclusion Female BMI is not associated with clinical outcomes in IUI cycles.Obesity is a predictor for early spontaneous miscarriage in both AIH and AID cycles.