Metabolic syndrome and time to pregnancy: a retrospective study of nulliparous women
Objective To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 k...
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| Published in: | BJOG : an international journal of obstetrics and gynaecology Vol. 126; no. 7; pp. 852 - 862 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Wiley Subscription Services, Inc
01.06.2019
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| ISSN: | 1470-0328, 1471-0528, 1471-0528 |
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| Abstract | Objective
To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m2 versus BMI ≥ 30 kg/m2).
Design
Retrospective cohort study.
Setting
Multiple centres (in Australia, Ireland, New Zealand, and the UK).
Population
Five thousand five hundred and nineteen low‐risk nulliparous pregnant women.
Methods
Data on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log‐normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors.
Main outcome measures
Time to pregnancy and infertility.
Results
Of the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15–1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0–3.3 months) versus 4.1 months (3.6–4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15–2.29) or not (adjusted RR 1.73; 95% CI 1.33–2.23). Reduced high‐density lipoprotein cholesterol (HDL‐C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility.
Conclusion
Metabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification.
Tweetable
Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity.
Tweetable
Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity. |
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| AbstractList | To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m2 versus BMI ≥ 30 kg/m2 ).OBJECTIVETo determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m2 versus BMI ≥ 30 kg/m2 ).Retrospective cohort study.DESIGNRetrospective cohort study.Multiple centres (in Australia, Ireland, New Zealand, and the UK).SETTINGMultiple centres (in Australia, Ireland, New Zealand, and the UK).Five thousand five hundred and nineteen low-risk nulliparous pregnant women.POPULATIONFive thousand five hundred and nineteen low-risk nulliparous pregnant women.Data on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log-normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors.METHODSData on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log-normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors.Time to pregnancy and infertility.MAIN OUTCOME MEASURESTime to pregnancy and infertility.Of the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15-1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0-3.3 months) versus 4.1 months (3.6-4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15-2.29) or not (adjusted RR 1.73; 95% CI 1.33-2.23). Reduced high-density lipoprotein cholesterol (HDL-C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility.RESULTSOf the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15-1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0-3.3 months) versus 4.1 months (3.6-4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15-2.29) or not (adjusted RR 1.73; 95% CI 1.33-2.23). Reduced high-density lipoprotein cholesterol (HDL-C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility.Metabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification.CONCLUSIONMetabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification.Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity.TWEETABLE ABSTRACTMetabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity. To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m versus BMI ≥ 30 kg/m ). Retrospective cohort study. Multiple centres (in Australia, Ireland, New Zealand, and the UK). Five thousand five hundred and nineteen low-risk nulliparous pregnant women. Data on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log-normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors. Time to pregnancy and infertility. Of the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15-1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0-3.3 months) versus 4.1 months (3.6-4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15-2.29) or not (adjusted RR 1.73; 95% CI 1.33-2.23). Reduced high-density lipoprotein cholesterol (HDL-C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility. Metabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification. Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity. Tweetable abstract Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity. ObjectiveTo determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m2 versus BMI ≥ 30 kg/m2).DesignRetrospective cohort study.SettingMultiple centres (in Australia, Ireland, New Zealand, and the UK).PopulationFive thousand five hundred and nineteen low‐risk nulliparous pregnant women.MethodsData on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log‐normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors.Main outcome measuresTime to pregnancy and infertility.ResultsOf the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15–1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0–3.3 months) versus 4.1 months (3.6–4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15–2.29) or not (adjusted RR 1.73; 95% CI 1.33–2.23). Reduced high‐density lipoprotein cholesterol (HDL‐C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility.ConclusionMetabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification.Tweetable abstractMetabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity. Objective To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m2 versus BMI ≥ 30 kg/m2). Design Retrospective cohort study. Setting Multiple centres (in Australia, Ireland, New Zealand, and the UK). Population Five thousand five hundred and nineteen low‐risk nulliparous pregnant women. Methods Data on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log‐normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors. Main outcome measures Time to pregnancy and infertility. Results Of the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15–1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0–3.3 months) versus 4.1 months (3.6–4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15–2.29) or not (adjusted RR 1.73; 95% CI 1.33–2.23). Reduced high‐density lipoprotein cholesterol (HDL‐C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility. Conclusion Metabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification. Tweetable Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity. Tweetable Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity. |
| Author | Andraweera, P Bianco‐Miotto, T Smithers, LG Kenny, LC Poston, L Grzeskowiak, LE Dekker, GA Roberts, CT Norman, RJ Grieger, JA Leemaqz, SY Walker, JJ McCowan, LM Myers, J |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30734474$$D View this record in MEDLINE/PubMed |
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| Issue | 7 |
| Keywords | metabolic syndrome time to pregnancy lipids pregnancy infertility Fecundity retrospective study |
| Language | English |
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| Notes | https://doi.org/10.1111/1471-0528.15669 Linked article This article is commented on by R Homburg, p. 863 in this issue. To view this article visit . ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
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| PublicationSubtitle | An International Journal of Obstetrics and Gynaecology |
| PublicationTitle | BJOG : an international journal of obstetrics and gynaecology |
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| PublicationYear | 2019 |
| Publisher | Wiley Subscription Services, Inc |
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| References | 1993; 60 2017; 44 2013; 168 2008; 4 2008; 31 2013; 8 2009; 114 2012; 97 2012; 71 2013; 13 2009; 170 2009; 94 2017; 32 2006; 26 2017; 34 2002; 106 2006; 29 2008; 23 2008; 24 2012; 27 2006; 127 2018; 33 2014; 99 2017; 129 2007; 167 2014; 90 1991; 133 2015; 126 2005; 112 2009 1997 2008; 15 1996 2011; 34 2008; 168 2009; 338 2007; 53 2015; 7 2009; 26 2007; 15 2016; 11 2018; 111 2005; 162 2015; 27 2015 2014; 30 2016; 27 2016; 8 2018; 15 2014; 148 2017; 107 e_1_2_6_51_1 e_1_2_6_53_1 e_1_2_6_32_1 e_1_2_6_30_1 e_1_2_6_19_1 e_1_2_6_13_1 e_1_2_6_36_1 e_1_2_6_11_1 e_1_2_6_17_1 e_1_2_6_55_1 e_1_2_6_15_1 e_1_2_6_38_1 e_1_2_6_57_1 e_1_2_6_43_1 e_1_2_6_20_1 e_1_2_6_41_1 e_1_2_6_9_1 e_1_2_6_5_1 e_1_2_6_7_1 Davis P (e_1_2_6_23_1) 1997 e_1_2_6_49_1 e_1_2_6_3_1 e_1_2_6_22_1 e_1_2_6_28_1 e_1_2_6_45_1 e_1_2_6_26_1 e_1_2_6_47_1 e_1_2_6_52_1 e_1_2_6_54_1 Galbraith C (e_1_2_6_24_1) 1996 e_1_2_6_10_1 e_1_2_6_31_1 e_1_2_6_50_1 e_1_2_6_14_1 e_1_2_6_35_1 e_1_2_6_12_1 e_1_2_6_33_1 e_1_2_6_18_1 e_1_2_6_39_1 e_1_2_6_56_1 e_1_2_6_16_1 e_1_2_6_37_1 Lippi G (e_1_2_6_34_1) 2007; 53 e_1_2_6_42_1 e_1_2_6_21_1 e_1_2_6_40_1 e_1_2_6_8_1 e_1_2_6_4_1 e_1_2_6_6_1 e_1_2_6_25_1 e_1_2_6_48_1 e_1_2_6_2_1 e_1_2_6_29_1 e_1_2_6_44_1 e_1_2_6_27_1 e_1_2_6_46_1 30811837 - BJOG. 2019 Jun;126(7):863. doi: 10.1111/1471-0528.15669. |
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To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual... Tweetable abstract Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity. To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an... ObjectiveTo determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and... |
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| SubjectTerms | Adult Australia - epidemiology Body Mass Index Cholesterol Diabetes mellitus Fecundity Female Gestation High density lipoprotein Humans Infertility Infertility, Female - epidemiology Ireland - epidemiology lipids Metabolic syndrome Metabolic Syndrome - epidemiology New Zealand - epidemiology Obesity Parity - physiology Pregnancy Retrospective Studies retrospective study Risk assessment time to pregnancy Time-to-Pregnancy - physiology Triglycerides United Kingdom - epidemiology Womens health |
| Title | Metabolic syndrome and time to pregnancy: a retrospective study of nulliparous women |
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