肥胖与整倍体冻胚移植后早期妊娠丢失风险增加相关
在校正混杂因素后，肥胖患者妊娠丢失风险增加19%（aRR 1.19，95%CI 1.14-1.24），且风险随BMI类别升高而递增。
要点
- 肥胖患者整倍体冻胚移植后妊娠丢失风险较非肥胖者增加19%。
- BMI I、II、III级肥胖妊娠丢失风险分别增加13%、20%、42%。
- 肥胖患者临床妊娠、持续妊娠和活产率均低于非肥胖者。
核心结论
- 在仅移植整倍体胚胎以控制胚胎非整倍体因素后，肥胖患者早期妊娠丢失风险仍较非肥胖患者增加19%，且风险随BMI升高而递增。
主要发现
- 校正后肥胖患者妊娠丢失风险增加19%（aRR 1.19，95%CI 1.14-1.24）。
- BMI I级、II级、III级肥胖妊娠丢失风险分别增加13%、20%、42%。
- 妊娠丢失预测概率在BMI 25.3 kg/m2时最低。
- 肥胖患者临床妊娠（aRR 0.96，95%CI 0.94-0.99）、持续妊娠（aRR 0.94，95%CI 0.92-0.96）和活产（aRR 0.92，95%CI 0.91-0.94）概率较低。
- 已产肥胖患者妊娠丢失风险减弱（aRR 0.90，95%CI 0.79-1.02）。
关键数值与推荐
- 肥胖定义为BMI≥30.0 kg/m2，非肥胖为BMI<30.0 kg/m2。
- BMI分类：I级30.0-34.9 kg/m2，II级35.0-39.9 kg/m2，III级≥40.0 kg/m2。
- 低体重（BMI<18.0 kg/m2）和超重（BMI 25.0-29.9 kg/m2）组妊娠丢失风险与正常体重组（BMI 18.5-24.9 kg/m2）相似。
临床怎么用
- 对接受整倍体冻胚移植的肥胖患者，应告知其早期妊娠丢失风险增加，并建议按BMI分层进行风险咨询。
- 已产肥胖患者风险相对较低，咨询时可考虑这一因素。
局限性
- 原文未报告研究局限性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To determine whether obesity is associated with an increased risk of pregnancy loss in patients undergoing autologous euploid frozen embryo transfer (FET). DESIGN: Retrospective cohort study. SUBJECTS: Patients with recorded body mass index (BMI) from nine clinical sites during January 2019 to December 2024, undergoing their first, autologous, single, euploid FET were included. Other preimplantation genetic testing indications were excluded. EXPOSURE: Patients were stratified into two groups: patients with obesity (BMI ≥30.0 kg/m2) and nonobese patients (BMI <30.0 kg/m2). MAIN OUTCOME MEASURES: Primary outcome was biochemical pregnancy loss (beta human chorionic gonadotropin [β-hCG] >5 mIU/mL without ultrasound evidence of pregnancy until β-hCG <5 mIU/mL) or clinical pregnancy loss (ultrasound evidence of at least an intrauterine gestational sac, which did not progress to live birth). Secondary outcomes included implantation, ectopic, clinical and ongoing pregnancy (8-9 weeks gestational age with cardiac activity), and live birth (neonate >24 weeks gestational age). RESULTS: A total of 14,990 patients were included: 11,179 nonobese and 3,811 with obesity. Compared with nonobese, patients with obesity were older. Parity, antimüllerian hormone (AMH) levels, and blastulation day were similar between groups. After adjustment, patients with obesity had a 19% increased risk of pregnancy loss (adjusted relative risk [aRR]: 1.19, 95% confidence interval [CI] 1.14-1.24) compared with nonobese. When stratified by BMI categories, class I (BMI 30.0-34.9 kg/m2), II (BMI 35.0-39.9 kg/m2), and III (BMI ≥40.0 kg/m2) obesities had 13%, 20%, and 42% increased risk of pregnancy loss, respectively, whereas the underweight (BMI <18.0 kg/m2) and overweight (BMI 25.0-29.9 kg/m2) groups performed similarly to the normal-weight group (BMI 18.5-24.9 kg/m2). The predicted probability of pregnancy loss was lowest at a BMI of 25.3 kg/m2. Although there was no difference in implantation (aRR: 0.98, 95% CI 0.86-1.37), patients with obesity had lower chances of clinical (aRR: 0.96, 95% CI 0.94-0.99) and ongoing pregnancy (aRR: 0.94, 95% CI 0.92-0.96) and live birth (aRR: 0.92, 95% CI 0.91-0.94). Risk of pregnancy loss was attenuated in parous patients with obesity (aRR: 0.90, 95% CI 0.79-1.02). CONCLUSION: When accounting for embryonic aneuploidy in the setting of euploid-only transfers, patients with obesity had a 19% increased risk of early pregnancy loss compared with nonobese patients, with risk rising across BMIs and BMI categories.
引用
- Whitehead C, Lefebvre K, Seli E, et al. Obesity is associated with an increased risk of early pregnancy loss after euploid frozen embryo transfer. Fertil Steril. 2026. PMID: 42069113. doi:10.1016/j.fertnstert.2026.04.016
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。