The Impact of High BMI on Pregnancy Outcomes and Complications in Women with PCOS Undergoing IVF-A Systematic Review and Meta-Analysis

Salih Atalah Alenezi; Raheela Khan; Saad Amer

doi:10.3390/jcm13061578

The Impact of High BMI on Pregnancy Outcomes and Complications in Women with PCOS Undergoing IVF-A Systematic Review and Meta-Analysis

J Clin Med. 2024 Mar 10;13(6):1578. doi: 10.3390/jcm13061578.

Authors

Salih Atalah Alenezi^{1

2}, Raheela Khan¹, Saad Amer¹

Affiliations

¹ Translational Medical Sciences, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby DE22 3DT, UK.
² Prince Mohammed Bin Abdulaziz Medical City, Ministry of Health, Al-Jouf 14214, Saudi Arabia.

Abstract

(1) Background: Current evidence indicates that women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization (IVF) have an increased likelihood of adverse pregnancy outcomes. The objective of this systematic review was to clarify the role of a PCOS-related high body mass index (BMI) in these unfavourable pregnancy outcomes. (2) Methods: A comprehensive search of electronic databases was conducted to identify studies investigating the impact of high BMI on pregnancy outcomes in women with PCOS undergoing IVF. RevMan software (v5.4) was used to calculate the odds ratio (OR) and 95% confidence interval (CI). (3) Results: Nineteen eligible studies (n = 7680) were identified, including 16 retrospective cohort studies (n = 6934), two prospective cohort studies (n = 525), and one cross-sectional study (n = 221). Pooled analysis showed significantly higher odds of clinical pregnancy (OR, 1.16 [95% CI, 1.04-1.29]; z = 2.73; p = 0.006; I² = 30%) and livebirths (OR, 1.88 [95% CI, 1.56-2.27]; z = 6.54; p < 0.0001; I² = 55%) in women with PCOS with a normal versus a high BMI. Meta-analysis showed significantly increased odds of miscarriages in women with PCOS with a high versus a normal BMI (OR, 0.76 [95% CI, 0.60-0.95]; z = 2.42; p = 0.02; I² = 53%). Pooled analysis of three studies (n = 993) showed significantly higher ORs of gestational diabetes mellitus (OR 3.96 [95% CI 1.62-9.68]; z = 3.01; p = 0.003; I² = 58%) and gestational hypertension (OR 2.16 [95% CI 1.32-3.54]; z = 3.05; p = 0.002; I² = 68%) in women with PCOS with a high versus a normal BMI. Meta-analysis of three studies reported significantly greater odds of a caesarean section for women with PCOS with a high versus a normal BMI (OR 0.45 [95% CI 0.29-0.69]; z = 3.66; p = 0.0003; I² = 0%). (4) Conclusions: The increased likelihood of adverse pregnancy outcomes observed in women with PCOS undergoing IVF seems to be attributable to a PCOS-related high BMI.

Keywords: IVF; assisted reproductive technology; obesity; polycystic ovarian syndrome; pregnancy complications.

Publication types

Review

Grants and funding

This research was funded by the Saudi Arabia Cultural Bureau in London.