Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/111600
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Type: Journal article
Title: Systematic review and meta-analysis of the impact of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric and metabolic outcomes in men and women
Author: Lan, L.
Harrison, C.
Misso, M.
Hill, B.
Teede, H.
Mol, B.
Moran, L.
Citation: Human Reproduction, 2017; 32(9):1925-1940
Publisher: Oxford University Press
Issue Date: 2017
ISSN: 0268-1161
1460-2350
Statement of
Responsibility: 
L. Lan, C.L. Harrison, M. Misso, B. Hill, H.J. Teede, B.W. Mol and L.J. Moran
Abstract: Study Question: What is the impact of preconception lifestyle interventions on live birth, birth weight and pregnancy rate? Summary Answer: Lifestyle interventions showed benefits for weight loss and increased natural pregnancy rate, but not for live birth or birth weight. What is Known Already: Evidence on the practice and content of preconception counseling and interventions is variable and limited. Study Design, Size, Duration: Systematic review and meta-analysis (MA). Main search terms were those related to preconception lifestyle. Database searched were Ovid MEDLINE(R), EBM Reviews, PsycINFO, EMBASE and CINAHL Plus. No language restriction was placed on the published articles. The final search was performed on 10 January 2017. Participants/Materials, Setting, Methods: Participants were non-pregnant women of childbearing age intent on conceiving or their male partners. Exclusion criteria include participants with BMI < 18 kg/m2, animal trials, hereditary disorder in one or both partners and trials focusing solely on alcohol or smoking cessation/reduction, micronutrient supplementation, or diabetes control. Anthropometric, fertility, obstetric and fetal outcomes were assessed. Bias and quality assessments were performed. Main Results and the Role of Chance: The search returned 1802 articles and eight studies were included for analysis. Populations targeted were primarily overweight or obese subfertile women seeking reproductive assistance, with few community-based studies and none including men. MA showed greater reduction in weight (n = 3, P < 0.00001, mean difference: -3.48 kg, 95% CI: -4.29, -2.67, I2 = 0%) and BMI (n = 2, P < 0.00001, mean difference: -1.40 kg/m2, 95% CI: -1.95, -0.84, I2 = 24%) with intervention. The only significant fertility outcome was an increased natural pregnancy rate (n = 2, P = 0.003, odds ratio: 1.87, CI: 1.24, 2.81, I2 = 0%). No differences were observed for ART adverse events, clinical pregnancy, pregnancy complications, delivery complications, live birth, premature birth, birth weight, neonatal mortality or anxiety. Risk of bias were high for three studies, moderate for three studies and low for two studies, Attrition bias was moderate or high in majority of studies. Limitations, Reasons for Caution: Results were limited to subfertile or infertile women who were overweight or obese undergoing ART with no studies in men. The heterogeneous nature of the interventions in terms of duration and regimen means no conclusions could be made regarding the method or components of optimal lifestyle intervention. Attrition bias itself is an important factor that could affect efficacy of interventions. Wider Implications of the Finding: Existing preconception lifestyle interventions primarily targeted overweight and obese subfertile women undergoing ART with a focus on weight loss. It is important to note that natural conception increased with lifestyle intervention. This emphasizes the need for further research exploring optimal components of preconception lifestyle interventions in the broader population and on the optimal nature, intensity and timing of interventions.
Keywords: Preconception; lifestyle intervention; systematic review; meta-analysis; fertility; birth weight; pregnancy
Rights: © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com
RMID: 0030075145
DOI: 10.1093/humrep/dex241
Appears in Collections:Medicine publications

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