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High preconception leptin level may decrease probability of pregnancy
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Among women with a history of prior pregnancy loss, higher levels of preconception leptin are associated with decreased fecundability and reduced likelihood of pregnancy and live birth, according to findings published in the Journal of the Endocrine Society.
“There is biological plausibility to support a link between preconception leptin and fecundability,” Torie C. Plowden, MD, of the program in reproductive and adult endocrinology at the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the NIH, and colleagues wrote. “It has been shown that leptin is associated with some changes in reproductive hormones over the menstrual cycle and could potentially be associated with ovulation. Thus, leptin concentrations may affect ovulation through these mechanisms, which could subsequently influence timing of pregnancy. Elevated leptin concentrations also appear to negatively affect oocyte development, which could provide another potential explanation of our findings of decreased fecundability. Elevated leptin concentrations have also been shown to be strongly associated with obesity in different populations.”
In a secondary analysis of the Effects of Aspirin in Gestation and Reproduction trial, Plowden and colleagues analyzed data from 1,053 women aged 18 to 40 years with one or two documented prior pregnancy losses and self-reported regular menstrual cycles (21-42 days in length) who were attempting pregnancy without the use of a fertility treatment. Participants completed questionnaires on demographics, lifestyle factors, and medical and reproductive history at a baseline, and provided preconception serum samples during days 2 to 4 of the menstrual cycle for analysis of serum leptin. Waist-to-hip ratio and sum of skinfolds were calculated at the baseline. Participants were followed for up to six menstrual cycles or throughout pregnancy for those who became pregnant. Primary outcomes were time to pregnancy (number of cycles until a positive pregnancy test over up to six consecutive cycles), pregnancy and live birth. Researchers used Cox proportional hazards regression models to evaluate the association between leptin concentrations and time to pregnancy.
Within the cohort, 767 women (72.8%) achieved pregnancy and 572 (54.9%) had a live birth.
The researchers found that, compared with women in the lowest leptin tertile, women in the highest leptin tertile had decreased fecundability (OR = 0.72; 95% CI, 0.58-0.9), reduced risk for pregnancy (RR = 0.87; 95% CI, 0.78-0.96) and reduced risk for live birth (RR = 0.76; 95% CI, 0.65-0.89). However, results were attenuated when the model was adjusted for BMI in lieu of waist-to-hip ratio (OR = 0.94; 95% CI, 0.69-1.28).
Researchers also found that, when evaluating other markers of adiposity, leptin was most strongly correlated with BMI and least correlated with waist-to-hip ratio. Additionally, the upper tertile of leptin concentrations were not associated with fecundability or a longer time to pregnancy after adjusting for age, physical activity, treatment arm and waist circumference, hip circumference, sum of skin folds or weight. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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