Women with complications like obesity and poor lifestyle choices are often counseled before their conception or infertility journey. They are often advised to lose weight before starting their conception journey to enhance pregnancy rates and a safer birth outcome.
Despite the differences in the approach with the preconception lifestyle interventions before pregnancy or fertility treatments, a recently conducted study led by Penn State College of Medicine didn’t find any significant differences in the incidence of the live births in both the control groups in the trial.
When compared, the intensive group had a significant weight loss of 5.4% compared to the standard group, where only 3.2% lost their weight.
The FIT-PLESE randomized controlled trial examined whether the preconception lifestyle interventions with weight loss were a better approach than the weight neutral intervention for not just the conception but also for the healthy birth outcome.
The study was conducted with a group of 379 women with obesity and BMI over BMI ≥ 30 kg/m2, who were on a journey to conceive a baby naturally and ensure a successful and healthy pregnancy term. The outcomes of the pregnancies were then tracked in both the assigned groups.
Amidst the 191 women who were part of the standard lifestyle group, around 40 women dropped out of the trial before the successful conception. Similarly, out of the 188 women under the intensive randomized group, around 31 backed out of the trial before conception.
However, besides the lacking difference in the live birth rate, the study found that indulging in the preconception lifestyle interventions, especially in the intensive group, resulted in improved metabolic health reduced incidence of metabolic syndrome, which is common in obese patients.
Besides the good, the study recorded that the women under the intensive group experienced gastrointestinal side effects due to the sudden alterations in the food and lifestyle habits. There was also 33.3% first-trimester pregnancy loss in the intensive group, compared to 23.7% in the controlled standard group.
So, the researchers, from the results, concluded that the preconception lifestyle interventions in obese and overweight patients didn’t have any “positive” or significant impacts as opposed to a standard exercise-based intervention that wasn’t targeting weight loss. Yes, there were significant improvements to the overall metabolic health, but that doesn’t significantly or directly correlate to the improved fertility or incidence of a successful and safe pregnancy term.
The study was conducted as an open-labeled and randomized control trial where the subjects were randomly assigned to a 1:1 ratio to two control groups. The study was conducted over 16 weeks, and the final follow-up was done in July 2018.
The study was conducted across nine academic health centers in the U.S. Under that, the first group (intensive group) underwent changes to their diet and lifestyle with meal replacements and medication (Orlistat) to reflect significantly on their weight loss. The second group (standard group) underwent increased physical activity with no end intent for weight loss.
Following these lifestyle interventions, both the groups received around three cycles of the standard infertility treatments. The results didn’t defer much than normal.
The researchers finally concluded that there needs to be further research to investigate and ascertain the impacts of weight loss and if weight loss interventions can eventually help with the successful conception and safer live birth. The current study faced limitations and couldn’t reach statistical significance.
1- Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial Richard S. Legro et al., https://doi.org/10.1371/journal.pmed.1003883