Ju Hee Kim; Hye Sook Shin; Bo Kyung Park; Kwang Moon Yang; Young Ho Lee; Hyun Mee Ryu

doi:10.4040/jkan.2012.42.4.517

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Original Article
Impact of Prepregnancy Body Mass Index on Pregnancy Outcome in Women with a Singleton Conceived by Assisted Reproductive Technology and Spontaneously Conceived Pregnancy: A Case-Control Study: Ju Hee Kim¹, Hye Sook Shin², Bo Kyung Park³, Kwang Moon Yang⁴, Young Ho Lee⁵, Hyun Mee Ryu⁶; Journal of Korean Academy of Nursing 2012;42(4):517-524.
DOI: https://doi.org/10.4040/jkan.2012.42.4.517
Published online: August 12, 2012

¹College of Nursing Science, Kyung Hee University, Seoul, Korea

²College of Nursing Science, Kyung Hee University, Seoul, Korea

³Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea

⁴Infertility, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea

⁵Radiology, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea

⁶Maternal Fetal Medicine, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea

¹College of Nursing Science, Kyung Hee University, Seoul, Korea

²College of Nursing Science, Kyung Hee University, Seoul, Korea

³Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea

⁴Infertility, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea

⁵Radiology, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea

⁶Maternal Fetal Medicine, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea

Address reprint requests to : Shin, Hye Sook College of Nursing Science, Kyung Hee University, 26 Kyunghee-daero, Dongdaemon-gu, Seoul 130-701, Korea Tel: +82-2-961-9143 Fax: +82-2-961-9398 E-mail: suksh@khu.ac.kr

• Received: February 18, 2012 • Revised: March 6, 2012 • Accepted: July 19, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
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Abstract

Purpose
To compare and confirm the impact of prepregnancy body mass index on pregnancy outcome in women with a singleton conceived by assisted reproductive technology and spontaneously conceived pregnancy.
Methods
A sample of 165 and 247 pregnant women with and without assisted reproductive technology were retrospectively recruited from electronic medical charts of C hospital.
Results
There were significant differences between the two groups for maternal age, paternal age, length of marriage, prepregnancy body mass index, parity, spontaneous abortion experience, and preterm delivery. A prepregnancy body mass index of ≥25 was associated with higher risk for maternal and neonatal complication in the assisted reproductive technology group.
Conclusion
The results indicate that a higher prepregnancy body mass index is associated with increased risks for adverse pregnancy outcomes for women using assisted reproductive technology. So these women need appropriate care to compensate for the risk.
Keywords: Body mass index; Weight gain; Pregnancy outcome; Assisted reproductive technology

Table 1.

Characteristics and Pregnancy Outcomes of Pregnant Women with and without ART (N =412)

Variables	Characteristics	Categories	ART group (n=165)	Natural group (n=247)	χ²	p
Variables	Characteristics	Categories	n (%)	n (%)	χ²	p
General and obstetric characteristics	Age (yr)	< 35	67 (40.6)	141 (57.1)	10.75	.001
		≥35	98 (59.4)	106 (42.9)
	Husbands' age (yr)	< 35	40 (24.2)	92 (37.2)	7.68	.007
		≥35	125 (75.8)	155 (62.8)
	Employment	Yes	66 (40.7)	110 (44.7)	0.63	.475
		No	96 (59.3)	136 (55.3)
	Length of marriage (yr)	< 3	32 (19.4)	95 (38.5)	16.87	< .001
		≥3	133 (80.6)	152 (61.5)
	PBMI	< 25	132 (80.0)	223 (90.3)	8.78	.004
		≥25	33 (20.0)	24 (9.7)
	GWG (kg)	Normal range	95 (57.6)	129 (52.2)	1.14	.167
		Abnormal range	70 (42.4)	118 (47.8)
	Parity	Primipara	85 (51.5)	66 (26.7)	26.19	< .001
		Multipara	80 (48.5)	181 (73.3)
	Spontaneous abortion	Yes	44 (26.7)	124 (50.2)	22.69	< .001
	experience	No	121 (73.3)	123 (49.8)
	Artificial abortion	Yes	34 (20.4)	49 (19.8)	0.04	.900
	experience	No	131 (79.4)	198 (80.2)
Maternal outcomes	Maternal complication	Yes	24 (14.5)	28 (11.3)	0.92	.365
		No	141 (85.5)	219 (88.7)
	Preterm delivery	Yes	24 (14.5)	13 (5.3)	10.43	.001
		No	141 (85.5)	234 (94.7)
	Delivery method	NSVD	78 (47.3)	140 (56.7)	3.51	.070
		C/S	87 (52.7)	107 (43.3)
Neonatal outcomes	Neonatal birth weight (g)	Abnormal	19 (11.5)	23 (9.3)	0.53	.508
		Normal	146 (88.5)	224 (90.7)
	Neonatal complication	Yes	9 (5.5)	5 (2.0)	3.55	.093
		No	156 (94.5)	242 (98.0)

ART=Artificial reproduction technology; PBMI=Prepregnancy body mass index; GWG=Gestational weight gain; NSVD=Nomal spontaneous vaginal delivery.

Table 2.

Characteristics and Pregnancy Outcomes of Pregnant Women with and without ART according to PBMI

Variables	Characteristics	Categories	PBMI in ART group		χ²	p	PBMI in natural group		χ²	p
			< 25 (n=132)	≥25 (n=33)			< 25 (n=223)	≥25 (n=24)
			n (%)	n (%)			n (%)	n (%)
General and obstetric characteristics	Age (yr)	< 35	53 (40.2)	14 (42.4)	0.06	.845	132 (59.2)	9 (37.5)	4.16	.035
		≥35	79 (59.8)	19 (57.6)			91 (40.8)	15 (62.5)
	Employment	Yes	77 (58.3)	22 (66.7)	0.76	.431	122 (55.0)	14 (58.3)	0.10	.831
		No	55 (41.7)	11 (33.3)			100 (45.0)	10 (41.7)
	GWG (kg)	Normal	81 (61.4)	14 (42.4)	3.88	.039	115 (51.6)	14 (58.3)	0.40	.668
		Abnormal	51 (38.6)	19 (57.6)			108 (48.4)	10 (41.7)
	Parity	Primipara^*	69 (52.3)	16 (48.5)	0.15	.703	65 (29.1)	1 (1.5)	6.91	.007
		Multipara	63 (47.7)	17 (51.5)			158 (70.9)	23 (95.8)
	Spontaneous abortion	Yes	33 (25.0)	11 (33.3)	0.94	.380	108 (48.4)	16 (66.7)	2.88	.131
	experience	No	99 (75.0)	22 (66.7)			115 (51.6)	8 (33.3)
	Artificial abortion	Yes	25 (18.9)	9 (27.3)	1.12	.336	41 (18.4)	8 (33.3)	3.04	.104
	experience	No	107 (81.1)	24 (72.7)			182 (81.6)	16 (66.7)
Maternal outcomes	Maternal complication	Yes^*	14 (10.6)	10 (30.3)	8.24	.010	25 (11.2)	3 (12.5)	0.04	.742
		No	118 (89.4)	23 (69.7)			198 (88.8)	21 (87.5)
	Preterm delivery	Yes^*	20 (15.2)	4 (12.1)	0.20	.788	10 (4.5)	3 (12.5)	2.79	.120
		No	112 (84.8)	29 (87.9)			213 (95.5)	21 (87.5)
	Delivery method	NSVD	64 (48.5)	14 (42.4)	0.39	.564	127 (57.0)	13 (54.2)	0.07	.832
		C/S	68 (51.5)	19 (57.6)			96 (43.0)	11 (45.8)
Neonatal outcomes	Neonatal complication	Yes^*	5 (3.8)	4 (12.1)	3.56	.080	4 (1.8)	1 (4.2)	0.62	.403
		No	127 (96.2)	29 (87.9)			219 (98.2)	23 (95.8)
	Neonatal birth weight	Abnormal^*	16 (12.1)	3 (9.1)	0.24	.768	19 (8.5)	4 (16.7)	1.70	.255
		Normal	116 (87.9)	30 (90.9)			204 (91.5)	20 (83.3)

ART=Artificial reproduction technology; PBMI=Prepregnancy body mass index; GWG=Gestational weight gain; NSVD=Nomal spontaneous vaginal delivery.

^*Fisher's exact test.

Table 3.

Odds Ratio for Associations between PBMI and Pregnancy Outcomes

Variable	PBMI in ART group						PBMI in natural group
Variable	Crude OR	95% CI	p	Adjusted OR	95% CI	p	Crude OR	95% CI	p	Adjusted OR	95% CI	p
Maternal complication	4.72	1.65-13.50	.004	4.29	1.47-12.57	.008	1.05	0.28-3.94	.945	0.95	0.24-3.80	.942
Preterm delivery	0.31	0.06-1.45	.137	0.34	0.07-1.69	.188	2.53	0.54-11.82	.238	3.53	0.64-19.45	.147
Cesarean section	1.39	0.62-3.13	.426	0.75	0.32-1.74	.499	1.01	0.43-2.42	.977	1.13	0.46-2.78	.786
Neonatal complication	4.60	0.94-22.50	.059	5.40	1.04-28.17	.045	2.46	0.25-24.28	.441	2.02	0.19-21.70	.561
Abnormal birth weight	1.70	0.37-7.89	.499	2.19	0.41-11.79	.360	0.65	0.17-2.51	.534	0.65	0.15-2.84	.568

OR=Odds ratio; CI=Confidence interval; PBMI=Prepregnancy body mass index; Pregnancy BMI< 25 served as the reference group. Adjusted for age, GWG, parity, and spontaneous abortion experience.

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Impact of Prepregnancy Body Mass Index on Pregnancy Outcome in Women with a Singleton Conceived by Assisted Reproductive Technology and Spontaneously Conceived Pregnancy: A Case-Control Study

J Korean Acad Nurs. 2012;42(4):517-524. Published online August 12, 2012

DOI: https://doi.org/10.4040/jkan.2012.42.4.517

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Impact of Prepregnancy Body Mass Index on Pregnancy Outcome in Women with a Singleton Conceived by Assisted Reproductive Technology and Spontaneously Conceived Pregnancy: A Case-Control Study

Variables	Characteristics	Categories	ART group (n=165)	Natural group (n=247)	χ²	p
Variables	Characteristics	Categories	n (%)	n (%)	χ²	p
General and obstetric characteristics	Age (yr)	< 35	67 (40.6)	141 (57.1)	10.75	.001
		≥35	98 (59.4)	106 (42.9)
	Husbands' age (yr)	< 35	40 (24.2)	92 (37.2)	7.68	.007
		≥35	125 (75.8)	155 (62.8)
	Employment	Yes	66 (40.7)	110 (44.7)	0.63	.475
		No	96 (59.3)	136 (55.3)
	Length of marriage (yr)	< 3	32 (19.4)	95 (38.5)	16.87	< .001
		≥3	133 (80.6)	152 (61.5)
	PBMI	< 25	132 (80.0)	223 (90.3)	8.78	.004
		≥25	33 (20.0)	24 (9.7)
	GWG (kg)	Normal range	95 (57.6)	129 (52.2)	1.14	.167
		Abnormal range	70 (42.4)	118 (47.8)
	Parity	Primipara	85 (51.5)	66 (26.7)	26.19	< .001
		Multipara	80 (48.5)	181 (73.3)
	Spontaneous abortion	Yes	44 (26.7)	124 (50.2)	22.69	< .001
	experience	No	121 (73.3)	123 (49.8)
	Artificial abortion	Yes	34 (20.4)	49 (19.8)	0.04	.900
	experience	No	131 (79.4)	198 (80.2)
Maternal outcomes	Maternal complication	Yes	24 (14.5)	28 (11.3)	0.92	.365
		No	141 (85.5)	219 (88.7)
	Preterm delivery	Yes	24 (14.5)	13 (5.3)	10.43	.001
		No	141 (85.5)	234 (94.7)
	Delivery method	NSVD	78 (47.3)	140 (56.7)	3.51	.070
		C/S	87 (52.7)	107 (43.3)
Neonatal outcomes	Neonatal birth weight (g)	Abnormal	19 (11.5)	23 (9.3)	0.53	.508
		Normal	146 (88.5)	224 (90.7)
	Neonatal complication	Yes	9 (5.5)	5 (2.0)	3.55	.093
		No	156 (94.5)	242 (98.0)

Variables	Characteristics	Categories	PBMI in ART group		χ²	p	PBMI in natural group		χ²	p
			< 25 (n=132)	≥25 (n=33)			< 25 (n=223)	≥25 (n=24)
			n (%)	n (%)			n (%)	n (%)
General and obstetric characteristics	Age (yr)	< 35	53 (40.2)	14 (42.4)	0.06	.845	132 (59.2)	9 (37.5)	4.16	.035
		≥35	79 (59.8)	19 (57.6)			91 (40.8)	15 (62.5)
	Employment	Yes	77 (58.3)	22 (66.7)	0.76	.431	122 (55.0)	14 (58.3)	0.10	.831
		No	55 (41.7)	11 (33.3)			100 (45.0)	10 (41.7)
	GWG (kg)	Normal	81 (61.4)	14 (42.4)	3.88	.039	115 (51.6)	14 (58.3)	0.40	.668
		Abnormal	51 (38.6)	19 (57.6)			108 (48.4)	10 (41.7)
	Parity	Primipara^*	69 (52.3)	16 (48.5)	0.15	.703	65 (29.1)	1 (1.5)	6.91	.007
		Multipara	63 (47.7)	17 (51.5)			158 (70.9)	23 (95.8)
	Spontaneous abortion	Yes	33 (25.0)	11 (33.3)	0.94	.380	108 (48.4)	16 (66.7)	2.88	.131
	experience	No	99 (75.0)	22 (66.7)			115 (51.6)	8 (33.3)
	Artificial abortion	Yes	25 (18.9)	9 (27.3)	1.12	.336	41 (18.4)	8 (33.3)	3.04	.104
	experience	No	107 (81.1)	24 (72.7)			182 (81.6)	16 (66.7)
Maternal outcomes	Maternal complication	Yes^*	14 (10.6)	10 (30.3)	8.24	.010	25 (11.2)	3 (12.5)	0.04	.742
		No	118 (89.4)	23 (69.7)			198 (88.8)	21 (87.5)
	Preterm delivery	Yes^*	20 (15.2)	4 (12.1)	0.20	.788	10 (4.5)	3 (12.5)	2.79	.120
		No	112 (84.8)	29 (87.9)			213 (95.5)	21 (87.5)
	Delivery method	NSVD	64 (48.5)	14 (42.4)	0.39	.564	127 (57.0)	13 (54.2)	0.07	.832
		C/S	68 (51.5)	19 (57.6)			96 (43.0)	11 (45.8)
Neonatal outcomes	Neonatal complication	Yes^*	5 (3.8)	4 (12.1)	3.56	.080	4 (1.8)	1 (4.2)	0.62	.403
		No	127 (96.2)	29 (87.9)			219 (98.2)	23 (95.8)
	Neonatal birth weight	Abnormal^*	16 (12.1)	3 (9.1)	0.24	.768	19 (8.5)	4 (16.7)	1.70	.255
		Normal	116 (87.9)	30 (90.9)			204 (91.5)	20 (83.3)

Variable	PBMI in ART group						PBMI in natural group
Variable	Crude OR	95% CI	p	Adjusted OR	95% CI	p	Crude OR	95% CI	p	Adjusted OR	95% CI	p
Maternal complication	4.72	1.65-13.50	.004	4.29	1.47-12.57	.008	1.05	0.28-3.94	.945	0.95	0.24-3.80	.942
Preterm delivery	0.31	0.06-1.45	.137	0.34	0.07-1.69	.188	2.53	0.54-11.82	.238	3.53	0.64-19.45	.147
Cesarean section	1.39	0.62-3.13	.426	0.75	0.32-1.74	.499	1.01	0.43-2.42	.977	1.13	0.46-2.78	.786
Neonatal complication	4.60	0.94-22.50	.059	5.40	1.04-28.17	.045	2.46	0.25-24.28	.441	2.02	0.19-21.70	.561
Abnormal birth weight	1.70	0.37-7.89	.499	2.19	0.41-11.79	.360	0.65	0.17-2.51	.534	0.65	0.15-2.84	.568

Table 1. Characteristics and Pregnancy Outcomes of Pregnant Women with and without ART (N =412)

ART=Artificial reproduction technology; PBMI=Prepregnancy body mass index; GWG=Gestational weight gain; NSVD=Nomal spontaneous vaginal delivery.

Table 2. Characteristics and Pregnancy Outcomes of Pregnant Women with and without ART according to PBMI

ART=Artificial reproduction technology; PBMI=Prepregnancy body mass index; GWG=Gestational weight gain; NSVD=Nomal spontaneous vaginal delivery.

Fisher's exact test.

Table 3. Odds Ratio for Associations between PBMI and Pregnancy Outcomes

OR=Odds ratio; CI=Confidence interval; PBMI=Prepregnancy body mass index; Pregnancy BMI< 25 served as the reference group. Adjusted for age, GWG, parity, and spontaneous abortion experience.