1
|
Reimer CJ, Willis MD, Wesselink AK, Hystad P, Campbell EJ, Hatch EE, Kirwa K, Gradus JL, Vinceti M, Wise LA, Jimenez MP. Exposure to residential greenness, perceived stress, and depressive symptoms in a North American preconception cohort. ENVIRONMENTAL RESEARCH 2024; 260:119438. [PMID: 38901815 DOI: 10.1016/j.envres.2024.119438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Studies suggest that greater exposure to natural vegetation (i.e., greenness) is associated with better mental health. However, there is limited research on greenness and mental health in the preconception period, a critical window of exposure in the life course. We investigated the associations of residential greenness with perceived stress and depressive symptoms using cross-sectional data from a cohort of pregnancy planners. METHODS From 2013 to 2019, we enrolled female-identified participants aged 21-45 years who were trying to conceive without the use of fertility treatment into a North American preconception cohort study (Pregnancy Study Online [PRESTO]). On the baseline questionnaire, participants completed the 10-item Perceived Stress Scale (PSS) and the Major Depression Inventory (MDI). Using geocoded addresses, we estimated residential greenness exposure via satellite imagery (Normalized Difference Vegetation Index [NDVI]) in a 100m buffer. We estimated mean differences and 95% confidence intervals for the association of greenness with perceived stress and depression scores using linear regression models, adjusting for individual and neighborhood sociodemographic characteristics. We also evaluated the extent to which associations were modified by urbanicity and neighborhood socioeconomic status (SES). RESULTS Among 9718 participants, mean age was 29.9 years, 81.5% identified as non-Hispanic White, 25% had household incomes <$50,000, and mean neighborhood income was $61,932. In adjusted models, higher greenness was associated with lower stress and depression scores (mean difference per interquartile range in greenness: -0.20, 95% CI: -0.39, -0.01; and -0.19, 95% CI: -0.48, 0.10, respectively). The association was stronger among residents of lower SES neighborhoods in urban areas (PSS: -0.57, 95% CI: -1.00, -0.15; MDI: -0.72, 95% CI: -1.40, -0.04). CONCLUSIONS Higher greenness exposure was associated with lower stress and depressive symptoms among pregnancy planners, particularly in lower-SES neighborhoods.
Collapse
Affiliation(s)
- Cameron J Reimer
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Perry Hystad
- School of Nutrition and Public Health, College of Health, Oregon State University, Corvallis, OR, USA
| | - Erin J Campbell
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kipruto Kirwa
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Marco Vinceti
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Biomedical, Metabolic and Neural Sciences, Medical School, University of Modena and Reggio Emilia, Modena, Italy
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | |
Collapse
|
2
|
Willis MD, Campbell EJ, Selbe S, Koenig MR, Gradus JL, Nillni YI, Casey JA, Deziel NC, Hatch EE, Wesselink AK, Wise LA. Residential Proximity to Oil and Gas Development and Mental Health in a North American Preconception Cohort Study: 2013-2023. Am J Public Health 2024; 114:923-934. [PMID: 38991173 PMCID: PMC11306607 DOI: 10.2105/ajph.2024.307730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 07/13/2024]
Abstract
Objectives. To evaluate associations between oil and gas development (OGD) and mental health using cross-sectional data from a preconception cohort study, Pregnancy Study Online. Methods. We analyzed baseline data from a prospective cohort of US and Canadian women aged 21 to 45 years who were attempting conception without fertility treatment (2013-2023). We developed residential proximity measures for active OGD during preconception, including distance from nearest site. At baseline, participants completed validated scales for perceived stress (10-item Perceived Stress Scale, PSS) and depressive symptoms (Major Depression Inventory, MDI) and reported psychotropic medication use. We used log-binomial regression and restricted cubic splines to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results. Among 5725 participants across 37 states and provinces, residence at 2 km versus 20 to 50 km of active OGD was associated with moderate to high perceived stress (PSS ≥ 20 vs < 20: PR = 1.08; 95% CI = 0.98, 1.18), moderate to severe depressive symptoms (MDI ≥ 20 vs < 20: PR = 1.27; 95% CI = 1.11, 1.45), and psychotropic medication use (PR = 1.11; 95% CI = 0.97, 1.28). Conclusions. Among North American pregnancy planners, closer proximity to OGD was associated with adverse preconception mental health symptomatology. (Am J Public Health. 2024;114(9):923-934. https://doi.org/10.2105/AJPH.2024.307730).
Collapse
Affiliation(s)
- Mary D Willis
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Erin J Campbell
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Sophie Selbe
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Martha R Koenig
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Jaimie L Gradus
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Yael I Nillni
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Joan A Casey
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Nicole C Deziel
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Elizabeth E Hatch
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Amelia K Wesselink
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Lauren A Wise
- Mary D. Willis, Erin J. Campbell, Sophie Selbe, Martha R. Koenig, Jaimie L. Gradus, Elizabeth Hatch, Amelia K. Wesselink, and Lauren A. Wise are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Yael I. Nillni is with the Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston. Joan A. Casey is with the Department of Environmental Health and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Nicole C. Deziel is with the Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| |
Collapse
|
3
|
Sabbath EL, Willis MD, Wesselink AK, Wang TR, McKinnon CJ, Hatch EE, Wise LA. Association between job control and time to pregnancy in a preconception cohort. Fertil Steril 2024; 121:497-505. [PMID: 38036244 PMCID: PMC10923004 DOI: 10.1016/j.fertnstert.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To evaluate associations between low job control (operationalized as job independence and freedom to make decisions) and time to pregnancy. Low job control, a form of workplace stress, is associated with adverse health outcomes ranging from cardiovascular disease to premature mortality; few studies have specifically examined its association with reproductive outcomes. DESIGN We used data from Pregnancy Study Online, an internet-based preconception cohort study of couples trying to conceive in the United States and Canada. We estimated fecundability ratios (FRs) and 95% confidence intervals (CIs) via proportional probability regression models, adjusting for sociodemographic and behavioral characteristics. SETTING Not applicable (Web-based study). PATIENTS Participants self-identified as female, were aged 21-45 years, and reported ≤6 cycles of pregnancy attempt time at enrollment (2018-2022). EXPOSURE We assessed job control by matching participants' baseline self-reported occupation and industry with standardized occupation codes from the National Institute for Occupational Safety and Health's Industry and Occupation Computerized Coding System, then linking codes to O∗NET job exposure scores for job independence and freedom to make decisions. MAIN OUTCOME MEASURE Our main outcome measure was fecundability. Participants completed self-administered questionnaires at baseline and every 8 weeks for up to 12 months or until reported pregnancy, whichever occurred first. RESULTS Among 3,110 participants, lower job independence was associated with reduced fecundability. Compared with the fourth (highest) quartile, corresponding to the most job independence, FRs (95% CI) for first (lowest), second, and third quartiles were 0.92 (0.82-1.04), 0.84 (0.74-0.95), and 0.99 (0.88, 1.11), respectively. Lower freedom to make decisions was associated with slightly reduced fecundability (first vs. fourth quartile: FR = 0.92; 95% CI: 0.80-1.05). CONCLUSION Lower job control, a work-related stressor, may adversely influence time to pregnancy. Because job control is a condition of work (i.e., not modifiable by individuals), these findings may strengthen arguments for improving working conditions as a means of improving worker health, including fertility.
Collapse
Affiliation(s)
- Erika L Sabbath
- Boston College School of Social Work, Chestnut Hill, Massachusetts.
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Craig J McKinnon
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| |
Collapse
|
4
|
Wesselink AK, Hystad P, Kirwa K, Kaufman JD, Willis MD, Wang TR, Szpiro AA, Levy JI, Savitz DA, Rothman KJ, Hatch EE, Wise LA. Air pollution and fecundability in a North American preconception cohort study. ENVIRONMENT INTERNATIONAL 2023; 181:108249. [PMID: 37862861 PMCID: PMC10841991 DOI: 10.1016/j.envint.2023.108249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Animal and epidemiologic studies indicate that air pollution may adversely affect fertility. However, the level of evidence is limited and specific pollutants driving the association are inconsistent across studies. METHODS We used data from a web-based preconception cohort study of pregnancy planners enrolled during 2013-2019 (Pregnancy Study Online; PRESTO). Eligible participants self-identified as female, were aged 21-45 years, resided in the United States (U.S.) or Canada, and were trying to conceive without fertility treatments. Participants completed a baseline questionnaire and bi-monthly follow-up questionnaires until conception or 12 months. We analyzed data from 8,747 participants (U.S.: 7,304; Canada: 1,443) who had been trying to conceive for < 12 cycles at enrollment. We estimated residential ambient concentrations of particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) using validated spatiotemporal models specific to each country. We fit country-specific proportional probabilities regression models to estimate the association between annual average, menstrual cycle-specific, and preconception average pollutant concentrations with fecundability, the per-cycle probability of conception. We calculated fecundability ratios (FRs) and 95% confidence intervals (CIs) and adjusted for individual- and neighborhood-level confounders. RESULTS In the U.S., the FRs for a 5-µg/m3 increase in annual average, cycle-specific, and preconception average PM2.5 concentrations were 0.94 (95% CI: 0.83, 1.08), 1.00 (95% CI: 0.93, 1.07), and 1.00 (95% CI: 0.93, 1.09), respectively. In Canada, the corresponding FRs were 0.92 (95% CI: 0.74, 1.16), 0.97 (95% CI: 0.87, 1.09), and 0.94 (95% CI: 0.80, 1.09), respectively. Likewise, NO2 and O3 concentrations were not strongly associated with fecundability in either country. CONCLUSIONS Neither annual average, menstrual cycle-specific, nor preconception average exposure to ambient PM2.5, NO2, and O3 were appreciably associated with reduced fecundability in this cohort of pregnancy planners.
Collapse
Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States.
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Kipruto Kirwa
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States; School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, United States
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, MA, United States
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| |
Collapse
|
5
|
Li QL, Wang C, Cao KX, Zhang L, Xu YS, Chang L, Liu ZH, Yang AJ, Xue YX. Sleep characteristics before assisted reproductive technology treatment predict reproductive outcomes: a prospective cohort study of Chinese infertile women. Front Endocrinol (Lausanne) 2023; 14:1178396. [PMID: 37908752 PMCID: PMC10614022 DOI: 10.3389/fendo.2023.1178396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/06/2023] [Indexed: 11/02/2023] Open
Abstract
Sleep disorders affect mental and physical health. Infertile women undergoing assisted reproductive technology (ART) treatment are prone to sleep disorders. Sleep condition, its influencing factors, and the association between sleep condition and ART treatment outcomes before treatment have not been explored within a population with a large sample size. Therefore, we investigated the sleep characteristics of 1002 Chinese infertile women before ovulation induction and investigated the influencing factors (negative and positive psychological factors, demographics, and fertility characteristics). We also examined whether sleep conditions before treatment predicted reproductive outcomes. We found that 24.1% of participants reported poor sleep quality. Women with primary infertility reported poorer sleep than women with secondary infertility. Negative psychological factors, including depression, anxiety, and perceived stress were associated with poor sleep, whereas positive affect was linked with good sleep. Adverse sleep characteristics, including poor subjective sleep quality, sleep disturbances, and poor sleep efficiency, decreased the quantity and quality of oocytes retrieved, fertilization rates, and clinical pregnancy rates. This study indicates that before ART treatment, a large number of females with infertility suffer from sleep problems, which are affected by psychological factors and infertility type, and unhealthy sleep characteristics may impair treatment outcomes. Our findings highlight the importance of screening and treatment for sleep disorders before the enrollment of ART treatment in infertile women.
Collapse
Affiliation(s)
- Qian-Ling Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Chao Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, China
| | - Ke-Xin Cao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Lin Zhang
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yun-Shuai Xu
- Department of Psychiatry, Shandong Daizhuang Hospital, Jining, China
| | - Liang Chang
- Henan Key Laboratory of Medical Tissue Regeneration, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Zhen-Hui Liu
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ai-Jun Yang
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, China
| |
Collapse
|
6
|
Harper T, Kuohung W, Sayres L, Willis MD, Wise LA. Optimizing preconception care and interventions for improved population health. Fertil Steril 2023; 120:438-448. [PMID: 36516911 DOI: 10.1016/j.fertnstert.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/18/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
There is growing literature indicating that optimal preconception health is associated with improved reproductive, perinatal, and pediatric outcomes. Given that preconception care is recommended for all individuals planning a pregnancy, medical providers and public health practitioners have a unique opportunity to optimize care and improve health outcomes for reproductive-aged individuals. Knowledge of the determinants of preconception health is important for all types of health professionals, including policy makers. Although some evidence-based recommendations have already been implemented, additional research is needed to identify factors associated with favorable health outcomes and to ensure that effective interventions are made in a timely fashion. Given the largely clinical readership of this journal, this piece is primarily focused on clinical care. However, we acknowledge that optimizing preconception health for the entire population at risk of pregnancy requires broadening our strategies to include population-health interventions that consider the larger social systems, structures, and policies that shape individual health outcomes.
Collapse
Affiliation(s)
- Teresa Harper
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Wendy Kuohung
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | - Lauren Sayres
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| |
Collapse
|
7
|
Willis MD, Wesselink AK, Hystad P, Pescador Jimenez M, Coleman CM, Kirwa K, Hatch EE, Wise LA. Associations between Residential Greenspace and Fecundability in a North American Preconception Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:47012. [PMID: 37098782 PMCID: PMC10132140 DOI: 10.1289/ehp10648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Residential green space can have positive physiological effects on human health through various mechanisms, including reducing stress and/or depression or facilitating physical activity. Although green space has been consistently associated with improved birth outcomes in several studies, there has been limited study of its effect on other reproductive outcomes, including fertility. OBJECTIVE We examined associations between residential green space and fecundability, the per-cycle probability of conception. METHODS We analyzed data from 8,563 female participants enrolled between 2013 and 2019 in Pregnancy Study Online (PRESTO), a prospective preconception cohort study of North American couples attempting conception. Participants completed a baseline questionnaire on sociodemographic, behavioral, and reproductive factors, and bimonthly follow-up questionnaires for up to 12 months to ascertain pregnancies. Using geocoded addresses, we calculated residential green space exposure using the Normalized Difference Vegetation Index (NDVI) within 50-, 100-, 250-, and 500 -m buffers across multiple temporal scales: annual maximum, seasonal maximum, and seasonal mean. We used proportional probabilities regression models to estimate fecundability ratios (FRs), adjusting for sociodemographic, behavioral, and neighborhood characteristics. We also evaluated the extent to which associations were mediated by reductions in perceived stress or depressive symptoms and increased physical activity. RESULTS When comparing the highest (≥ 0.8 ) with the lowest (< 0.2 ) NDVI exposures within 50 m , we observed positive associations in the annual maximum NDVI [FR: 1.33; 95% confidence interval (CI): 1.06, 1.67] and seasonal maximum NDVI (FR: 1.19; 95% CI: 1.00, 1.41) models, but little association in the seasonal mean NDVI models (FR: 0.98; 95% CI: 0.73, 1.30). Restricted cubic splines showed evidence of nonlinearity in this association. Results were similar across buffer distances. Perceived stress, depressive symptoms, and physical activity explained ≤ 5 : 0 % of mediation across all NDVI metrics. DISCUSSION In this cohort, greater residential green space was associated with a modest increase in fecundability. https://doi.org/10.1289/EHP10648.
Collapse
Affiliation(s)
- Mary D. Willis
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Amelia K. Wesselink
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Marcia Pescador Jimenez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Chad M. Coleman
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Kipruto Kirwa
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Elizabeth E. Hatch
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Lauren A. Wise
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Carter T, Schoenaker D, Adams J, Steel A. Paternal preconception modifiable risk factors for adverse pregnancy and offspring outcomes: a review of contemporary evidence from observational studies. BMC Public Health 2023; 23:509. [PMID: 36927694 PMCID: PMC10022288 DOI: 10.1186/s12889-023-15335-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The preconception period represents transgenerational opportunities to optimize modifiable risk factors associated with both short and long-term adverse health outcomes for women, men, and children. As such, preconception care is recommended to couples during this time to enable them to optimise their health in preparation for pregnancy. Historically, preconception research predominately focuses on maternal modifiable risks and health behaviours associated with pregnancy and offspring outcomes; limited attention has been given to inform paternal preconception health risks and outcomes. This systematic review aims to advance paternal preconception research by synthesising the current evidence on modifiable paternal preconception health behaviours and risk factors to identify associations with pregnancy and/or offspring outcomes. METHODS Medline, Embase, Maternity and Infant care, CINAHL, PsycINFO, Scopus, and ISI Proceedings were searched on the 5th of January 2023, a date limit was set [2012-2023] in each database. A Google Scholar search was also conducted identifying all other relevant papers. Studies were included if they were observational, reporting associations of modifiable risk factors in the preconception period among males (e.g., identified as reproductive partners of pregnant women and/or fathers of offspring for which outcomes were reported) with adverse pregnancy and offspring outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Exposure and outcome heterogeneity precluded meta-analysis, and results were summarised in tables. RESULTS This review identified 56 cohort and nine case control studies. Studies reported on a range of risk factors and/or health behaviours including paternal body composition (n = 25), alcohol intake (n = 6), cannabis use (n = 5), physical activity (n = 2), smoking (n = 20), stress (n = 3) and nutrition (n = 13). Outcomes included fecundability, IVF/ISCI live birth, offspring weight, body composition/BMI, asthma, lung function, leukemia, preterm birth, and behavioural issues. Despite the limited number of studies and substantial heterogeneity in reporting, results of studies assessed as good quality showed that paternal smoking may increase the risk of birth defects and higher paternal BMI was associated with higher offspring birthweight. CONCLUSION The current evidence demonstrates a role of paternal preconception health in influencing outcomes related to pregnancy success and offspring health. The evidence is however limited and heterogenous, and further high-quality research is needed to inform clinical preconception care guidelines to support men and couples to prepare for a health pregnancy and child.
Collapse
Affiliation(s)
- Tristan Carter
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, 2006, Australia.
| | - Danielle Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, 2006, Australia
| | - Amie Steel
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, 2006, Australia
| |
Collapse
|
9
|
Nillni YI, Crowe HM, Yland JJ, Wesselink AK, Wise LA. The association between time-to-pregnancy and postpartum depressive symptoms in a North American prospective cohort study. Ann Epidemiol 2022; 74:51-57. [PMID: 35902064 PMCID: PMC9743161 DOI: 10.1016/j.annepidem.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively examine the association between time-to-pregnancy (TTP) and postpartum depression (PPD) and determine whether perceived stress during early pregnancy mediated this association. METHODS In Pregnancy Study Online, an internet-based preconception cohort study of pregnancy planners, participants completed questionnaires every 8 weeks for up to 12 months or conception, during pregnancy, and at postpartum. A total of 2643 women provided information on sociodemographic factors, reproductive history, and stress (i.e., Perceived Stress Scale [PSS]) during preconception and early pregnancy (completed at ∼4-12 weeks' gestation) and on postpartum depressive symptoms (i.e., Edinburgh Postnatal Depression Scale [EPDS]) at ∼6 months postpartum. We used multivariable modified Poisson regression models to estimate risk ratios and 95% confidence intervals (CIs) for the association between TTP (<3, 3-5, 6-11, ≥12 menstrual cycles) and PPD (EPDS score ≥13). Causal mediation analyses assessed the mediating role of early pregnancy PSS scores. RESULTS 10.6% of women had EPDS scores indicating possible PPD (≥13). Compared with women who took less than 3 cycles to conceive, risk ratios for those who took 3-5, 6-11, and greater than or equal to 12 were 1.06 (95% CI: 0.77, 1.45), 1.24 (95% CI: 0.90, 1.70), and 1.31 (95% CI: 0.87, 1.99), respectively. Approximately 30% of the association between infertility (TTP ≥ 12) and PPD was mediated by early pregnancy PSS. CONCLUSIONS There was a modest positive dose-response association between delayed conception and PPD. Perceived stress in early pregnancy explained a small proportion of this association. However, given the width of the CIs, chance cannot be ruled out as an explanation for the observed association.
Collapse
Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA.
| | - Holly M Crowe
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| |
Collapse
|
10
|
Kim SM, Um YH, Kim TW, Seo HJ, Jeong JH, Hong SC. Mediation Effect of the Coping Strategies on the Relation Between Stress and Sleep Quality. Psychiatry Investig 2022; 19:580-587. [PMID: 35903060 PMCID: PMC9334809 DOI: 10.30773/pi.2022.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Recently data has been accumulated regarding the role of coping strategies in the relationship between stress and sleep quality. Therefore, we set out to identify the mediating effects of coping strategies between stress and sleep quality. METHODS A online-based cross-sectional study was performed using the Perceived Stress Scale-10, the Pittsburgh Sleep Quality Index, and a simplification of the 60-item Coping Orientation to Problems Experienced (Brief COPE) inventory in the nonclinical adult sample. The 24 items of Brief COPE were categorized into four factors (social support, problem solving, avoidance, positive thinking). Then, we used the PROCESS macro to conduct the multiple mediation analysis for the four coping styles as potential mediators in the relationship between stress and sleep quality, and an additional subgroup analysis was examined to identify a gender difference for the mediation effect. RESULTS As a group, four coping styles mediated significantly the association between perceived stress and poor sleep quality. And avoidance has maintained its significance thought all regression analyses. Finally, this results remained as same in the females. CONCLUSION The effect of perceived stress on poor sleep quality was mediated by coping strategies, especially by avoidance. Thus, further research should consider the coping styles of individuals to reduce the influence of stress on sleep quality.
Collapse
Affiliation(s)
- Sung Min Kim
- Department of Psychiatry, H Plus Yangji Hospital, Seoul, Republic of Korea
| | - Yoo Hyun Um
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Tae Won Kim
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Ho-Jun Seo
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Seung-Chul Hong
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| |
Collapse
|
11
|
Willis MD, Orta OR, Ncube C, Wesselink AK, Ðoàn LN, Kirwa K, Boynton-Jarrett R, Hatch EE, Wise LA. Association Between Neighborhood Disadvantage and Fertility Among Pregnancy Planners in the US. JAMA Netw Open 2022; 5:e2218738. [PMID: 35771576 PMCID: PMC9247730 DOI: 10.1001/jamanetworkopen.2022.18738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
IMPORTANCE Decades of inequitable policies in the US have yielded disparities in neighborhood quality, and some studies show that living in a socioeconomically disadvantaged neighborhood is associated with worse health outcomes, including reproductive health outcomes. However, no US studies to date have directly examined the association between residence in disadvantaged neighborhoods and fertility. OBJECTIVE To examine the association between residence in disadvantaged neighborhoods and fecundability, a sensitive marker of fertility with many health implications. DESIGN, SETTING, AND PARTICIPANTS This prospective preconception cohort study used the Pregnancy Study Online, for which baseline data were collected from June 19, 2013, through April 12, 2019. The study included 6356 participants who identified as female, were 21 to 45 years of age, were attempting conception without fertility treatment, and provided a valid residential address in the contiguous US at enrollment. EXPOSURES A standardized area deprivation index (ADI) derived at the census block group level applied to each residential address. MAIN OUTCOMES AND MEASURES Fecundability, the per-cycle probability of conception, via questionnaires that were completed every 8 weeks for 12 months, until conception or a censoring event. Proportional probabilities models were used to estimate fecundability ratios and 95% CIs for associations between ADI and fecundability. Restricted cubic splines were also implemented to examine nonlinearity. Models were adjusted for demographic characteristics and factors associated with fertility. The study's a priori hypothesis was that higher levels of neighborhood disadvantage would be associated with decreased fecundability. RESULTS Among 6356 participants, 3725 pregnancies were observed for 27 427 menstrual cycles of follow-up. The mean (SD) baseline age was 30.0 (4.1) years, and most participants were non-Hispanic White (5297 [83.3%]) and nulliparous (4179 [65.7%]). Comparing the top and bottom deciles of disadvantaged neighborhood status, adjusted fecundability ratios were 0.79 (95% CI, 0.66-0.96) for national-level ADI rankings and 0.77 (95% CI, 0.65-0.92) for within-state ADI rankings. Restricted cubic splines showed some evidence of nonlinearity in the association. Associations were slightly stronger among participants with lower annual incomes (<$50 000). CONCLUSIONS AND RELEVANCE In this cohort study, residence in a socioeconomically disadvantaged neighborhood was associated with moderately decreased fecundability. If confirmed in other studies, these results suggest that investments to reduce disadvantaged neighborhood status may yield positive cobenefits for fertility.
Collapse
Affiliation(s)
- Mary D Willis
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Olivia R Orta
- John Jay College of Criminal Justice, City University of New York, New York, New York
| | - Collette Ncube
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Amelia K Wesselink
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Lan N Ðoàn
- Department of Population Health, Section for Health Equity, Grossman School of Medicine, New York University, New York
| | - Kipruto Kirwa
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts
| | - Renée Boynton-Jarrett
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Elizabeth E Hatch
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Lauren A Wise
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| |
Collapse
|
12
|
Yland JJ, Wang T, Zad Z, Willis SK, Wang TR, Wesselink AK, Jiang T, Hatch EE, Wise LA, Paschalidis IC. Predictive models of pregnancy based on data from a preconception cohort study. Hum Reprod 2022; 37:565-576. [PMID: 35024824 PMCID: PMC8888990 DOI: 10.1093/humrep/deab280] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/30/2021] [Indexed: 01/16/2023] Open
Abstract
STUDY QUESTION Can we derive adequate models to predict the probability of conception among couples actively trying to conceive? SUMMARY ANSWER Leveraging data collected from female participants in a North American preconception cohort study, we developed models to predict pregnancy with performance of ∼70% in the area under the receiver operating characteristic curve (AUC). WHAT IS KNOWN ALREADY Earlier work has focused primarily on identifying individual risk factors for infertility. Several predictive models have been developed in subfertile populations, with relatively low discrimination (AUC: 59-64%). STUDY DESIGN, SIZE, DURATION Study participants were female, aged 21-45 years, residents of the USA or Canada, not using fertility treatment, and actively trying to conceive at enrollment (2013-2019). Participants completed a baseline questionnaire at enrollment and follow-up questionnaires every 2 months for up to 12 months or until conception. We used data from 4133 participants with no more than one menstrual cycle of pregnancy attempt at study entry. PARTICIPANTS/MATERIALS, SETTING, METHODS On the baseline questionnaire, participants reported data on sociodemographic factors, lifestyle and behavioral factors, diet quality, medical history and selected male partner characteristics. A total of 163 predictors were considered in this study. We implemented regularized logistic regression, support vector machines, neural networks and gradient boosted decision trees to derive models predicting the probability of pregnancy: (i) within fewer than 12 menstrual cycles of pregnancy attempt time (Model I), and (ii) within 6 menstrual cycles of pregnancy attempt time (Model II). Cox models were used to predict the probability of pregnancy within each menstrual cycle for up to 12 cycles of follow-up (Model III). We assessed model performance using the AUC and the weighted-F1 score for Models I and II, and the concordance index for Model III. MAIN RESULTS AND THE ROLE OF CHANCE Model I and II AUCs were 70% and 66%, respectively, in parsimonious models, and the concordance index for Model III was 63%. The predictors that were positively associated with pregnancy in all models were: having previously breastfed an infant and using multivitamins or folic acid supplements. The predictors that were inversely associated with pregnancy in all models were: female age, female BMI and history of infertility. Among nulligravid women with no history of infertility, the most important predictors were: female age, female BMI, male BMI, use of a fertility app, attempt time at study entry and perceived stress. LIMITATIONS, REASONS FOR CAUTION Reliance on self-reported predictor data could have introduced misclassification, which would likely be non-differential with respect to the pregnancy outcome given the prospective design. In addition, we cannot be certain that all relevant predictor variables were considered. Finally, though we validated the models using split-sample replication techniques, we did not conduct an external validation study. WIDER IMPLICATIONS OF THE FINDINGS Given a wide range of predictor data, machine learning algorithms can be leveraged to analyze epidemiologic data and predict the probability of conception with discrimination that exceeds earlier work. STUDY FUNDING/COMPETING INTEREST(S) The research was partially supported by the U.S. National Science Foundation (under grants DMS-1664644, CNS-1645681 and IIS-1914792) and the National Institutes for Health (under grants R01 GM135930 and UL54 TR004130). In the last 3 years, L.A.W. has received in-kind donations for primary data collection in PRESTO from FertilityFriend.com, Kindara.com, Sandstone Diagnostics and Swiss Precision Diagnostics. L.A.W. also serves as a fibroid consultant to AbbVie, Inc. The other authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA,Correspondence address. Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA. E-mail:
| | - Taiyao Wang
- Center for Information and Systems Engineering, Boston University, Boston, MA, USA,Philips Research North America, Cambridge, MA, USA
| | - Zahra Zad
- Center for Information and Systems Engineering, Boston University, Boston, MA, USA,Division of Systems Engineering, Department of Electrical and Computer Engineering, Boston University, Boston, MA, USA
| | - Sydney K Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ioannis Ch Paschalidis
- Center for Information and Systems Engineering, Boston University, Boston, MA, USA,Division of Systems Engineering, Department of Electrical and Computer Engineering, Boston University, Boston, MA, USA,Department of Biomedical Engineering, Boston University, Boston, MA, USA
| |
Collapse
|
13
|
Polis CB, Otupiri E, Hindin M, Chiu DW, Keogh SC, Aidoo C, Larsen-Reindorf R, Bell SO. Prevalence and Correlates of Perceived Infertility in Ghana. Stud Fam Plann 2021; 51:207-224. [PMID: 32964426 PMCID: PMC7539950 DOI: 10.1111/sifp.12136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Perceived infertility is an understudied phenomenon in low‐ and middle‐income countries, where biomedical infertility can have severe consequences, particularly for women. We conducted a nationally representative survey of Ghanaian women, estimated the prevalence of and reasons for perceived infertility, and assessed factors associated with higher levels of perceived infertility using a partial proportional odds model. Among 4,070 women, 13 percent believed they were “very likely” to have difficulty getting pregnant when they wanted to, 21 percent believed this was “somewhat likely,” and 66 percent believed this was “not at all likely.” Reasons for perceived infertility varied by whether the respondent was currently seeking pregnancy. In multivariable analysis, several factors were associated with higher levels of perceived infertility, while unexpectedly, women who reported ever using contraception were less likely to report perceived infertility. Acknowledging the need to address infertility globally and understanding the role of perceived infertility are important components in supporting people's ability to decide whether and when to have children.
Collapse
Affiliation(s)
- Chelsea B Polis
- Chelsea B. Polis, Guttmacher Institute, New York, NY.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Easmon Otupiri
- Doris W. Chiu, Sarah C. Keogh, Guttmacher Institute, New York, NY
| | - Michelle Hindin
- Suzanne O. Bell, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Easmon Otupiri, Cara Aidoo, Roderick Larsen-Reindorf, School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana. Michelle Hindin, Population Council, New York, NY
| | - Doris W Chiu
- Chelsea B. Polis, Guttmacher Institute, New York, NY
| | - Sarah C Keogh
- Chelsea B. Polis, Guttmacher Institute, New York, NY
| | - Cara Aidoo
- Doris W. Chiu, Sarah C. Keogh, Guttmacher Institute, New York, NY
| | | | - Suzanne O Bell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
14
|
Rovira-Vizcaíno NE, Sáez-Padilla J, Romero-Márquez JM, Merino-Godoy MDLÁ. Preconception Care for Men and Women during the Pandemic, an Intervention Proposal. Healthcare (Basel) 2021; 9:healthcare9070816. [PMID: 34203317 PMCID: PMC8304192 DOI: 10.3390/healthcare9070816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic and its measures resulted in limited outdoor activities, reduced group meetings, etc., leading to unhealthy habits. Several studies showed how certain unhealthy habits can lead to serious consequences for both men and women, as well as affect future offspring. (1) Background: Therefore, we present a community intervention at the preconception stage to avoid future risks. The purpose of this intervention is to change lifestyles and beliefs about the health of men and women in the preconception period; (2) Methods: For the design of the intervention, a bibliographic search was performed both in English and Spanish in the main databases of health sciences and nursing (Cochrane, PubMed, Web of Science, CINAHL, LILACS, Dialnet), using descriptors in MeSH health for sciences; (3) Results: We proposed that a variety of lifestyles be analyzed, including aspects such as physical activity, nutrition, etc. In addition, stress management should be emphasized through a relaxation workshop, where three different techniques be proposed to reduce anxiety levels in stressful situations; (4) Conclusions: Due to the limited scientific results of interventions carried out in the preconception period simultaneously with men and women, more community interventions that address this topic are needed to assess the impact of these actions on the health of the population.
Collapse
Affiliation(s)
| | - Jesús Sáez-Padilla
- Integrated Didactics Department, University of Huelva, 21071 Huelva, Spain
- Correspondence:
| | | | | |
Collapse
|
15
|
Kirca N, Ongen M. Perceived stress and sleep quality before oocyte pick-up, embryo transfer, and pregnancy test in women receiving in vitro fertilization treatment. Sleep Breath 2021; 25:1977-1985. [PMID: 33624218 DOI: 10.1007/s11325-021-02328-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infertility is a major health problem that affects both the family and the community. Women receiving infertility treatment may suffer from stress and even experience sleep disturbance. Sleep quality is an important factor of human health and well-being. Sleep disturbances tend to occur among infertile women during in vitro fertilization treatment. Many studies have focused on the stress and sleep quality associated with their treatment in infertile women. However, few studies have investigated factors linked to their sleep disturbances. OBJECTIVE This study investigated the relationship between perceived stress and sleep quality before oocyte pick-up, in vitro fertilization-embryo transfer, and pregnancy test in women receiving in vitro fertilization treatment. MATERIAL AND METHODS This prospective, longitudinal study was conducted between January and May 2020. One hundred fifty-seven women receiving infertility treatment were included in the study. A personal information form, the Perceived Stress Scale (PSS), and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. RESULTS The relationship between the Perceived Stress Scale scores and the Pittsburgh Sleep Quality Index scores in all stages of infertility treatment was found to be positively significant at the p < .001 significance level. CONCLUSION Perceived stress level was high in women throughout the infertility treatment. Our study suggested that sleep quality was impaired as stress increased. TRIAL REGISTRATION 70904504/38.
Collapse
Affiliation(s)
- Nurcan Kirca
- Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Boulevard, Antalya, Turkey.
| | - Meryem Ongen
- Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Boulevard, Antalya, Turkey
| |
Collapse
|
16
|
Harlow AF, Hatch EE, Wesselink AK, Rothman KJ, Wise LA. Electronic Cigarettes and Fecundability: Results From a Prospective Preconception Cohort Study. Am J Epidemiol 2021; 190:353-361. [PMID: 32378702 DOI: 10.1093/aje/kwaa067] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 01/07/2023] Open
Abstract
Although electronic cigarette (e-cigarette) aerosol contains similar toxicants to combustible cigarettes, few studies have examined their influence on fecundability. We assessed the association between e-cigarette use and fecundability, overall and according to combustible cigarette smoking history, in a cohort of 4,586 North American women (aged 21-45 years) enrolled during 2017-2020 in Pregnancy Study Online, a Web-based prospective preconception study. Women reported current and former e-cigarette use on baseline and follow-up questionnaires, and they completed bimonthly follow-up questionnaires until self-reported pregnancy or censoring. Fecundability ratios and 95% confidence intervals were calculated using proportional probabilities models, controlling for potential confounders. Overall, 17% of women had ever used e-cigarettes and 4% were current users. Compared with never use of e-cigarettes, current e-cigarette use was associated with slightly lower fecundability (fecundability ratio = 0.84, 95% confidence interval (CI): 0.67, 1.06). Compared with current nonusers of e-cigarettes and combustible cigarettes, fecundability ratios were 0.83 (95% CI: 0.54, 1.29) for current dual users of e-cigarettes and combustible cigarettes, 0.91 (95% CI: 0.70, 1.18) for current e-cigarette users who were nonsmokers of combustible cigarettes, and 1.01 (95% CI: 0.85, 1.20) for nonusers of e-cigarettes who were current smokers of combustible cigarettes. Current e-cigarette use was associated with slightly reduced fecundability, but estimates of its independent and joint associations with combustible cigarette smoking were inconsistent and imprecise.
Collapse
|
17
|
Residential proximity to major roads and fecundability in a preconception cohort. Environ Epidemiol 2020; 4:e112. [PMID: 33778352 PMCID: PMC7941774 DOI: 10.1097/ee9.0000000000000112] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023] Open
Abstract
Supplemental Digital Content is available in the text. Emerging evidence from animal and human studies indicates that exposure to traffic-related air pollution may adversely affect fertility.
Collapse
|
18
|
Lam MT, Li HWR, Wong CYG, Yeung WSB, Ho PC, Ng EHY. Women's age and total motile normal morphology sperm count predict fecundability: a prospective cohort study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:279-286. [PMID: 32718983 DOI: 10.1136/bmjsrh-2020-200639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study investigated the role of women's age, serum anti-Müllerian hormone (AMH) level and semen parameters in predicting fecundability. METHODS This was a prospective cohort study on couples attending for preconceptional health check. Occurrence of conception at 1 year after ceasing contraception and time to pregnancy were noted by telephone follow-up. The women's age, serum AMH level and total motile normal morphology sperm count (TMNC) were compared between those who conceived and those who did not after 1 year; their independent predictive value on conception at 1 year was analysed by logistic regression. Among those conceiving within 1 year, Spearman's correlations between time to pregnancy and the clinical parameters were studied. RESULTS Of the 100 couples analysed, we found younger age of the women (p=0.008), higher serum AMH level (p=0.038) and higher TMNC (p=0.015) in those that conceived within 1 year. Multivariate logistic regression found that women's age (OR 0.867, 95% CI 0.761 to 0.988, p=0.032) and TMNC (OR 1.089, 95% 1.001-1.185, p=0.047), but not serum AMH level, significantly predicted conception within 1 year. Among those that conceived within 1 year, none of the parameters analysed were correlated with time to pregnancy within 1 year. CONCLUSIONS Women's age and TNMC are significant independent predictors of conception within 1 year. No parameter was shown to predict the time to pregnancy within 1 year. This finding can aid preconceptional counselling of couples who are planning for pregnancy.
Collapse
Affiliation(s)
- Mei Ting Lam
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
- The Family Planning Association of Hong Kong, Wan Chai, Hong Kong
| | - Ching Yin Grace Wong
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- The Family Planning Association of Hong Kong, Wan Chai, Hong Kong
| | - William Shu Biu Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| |
Collapse
|
19
|
Sommer GJ, Wang TR, Epperson JG, Hatch EE, Wesselink AK, Rothman KJ, Fredriksen LL, Schaff UY, Behr B, Eisenberg ML, Wise LA. At-home sperm testing for epidemiologic studies: Evaluation of the Trak male fertility testing system in an internet-based preconception cohort. Paediatr Perinat Epidemiol 2020; 34:504-512. [PMID: 31838751 PMCID: PMC8052852 DOI: 10.1111/ppe.12612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/08/2019] [Accepted: 10/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Semen quality assessment in population-based epidemiologic studies presents logistical and financial challenges due to reliance on centralised laboratory semen analysis. The Trak Male Fertility Testing System is an FDA-cleared and validated at-home test for sperm concentration and semen volume, with a research use only sperm motility test. Here we evaluate the Trak System's overall utility among men participating in Pregnancy Study Online (PRESTO), a web-based study of North American couples planning pregnancy. METHODS US male participants aged ≥21 years with ≤6 months of pregnancy attempt time at study enrolment were invited to participate in the semen testing substudy after completing their baseline questionnaire. Consenting participants received a Trak Engine (battery-powered centrifuge) and two test kits. Participants shared their test results via smartphone images uploaded to online questionnaires. Data were then linked with covariate data from the baseline questionnaire. RESULTS Of the 688 men invited to participate, 373 (54%) provided consent and 271 (73%) completed at least one semen test result. The distributions of semen volume, sperm concentration, motile sperm concentration, total sperm count, and total motile sperm count were similar to 2010 World Health Organization (WHO) semen parameter data of men in the general population. The overall usability score for the Trak System was 1.4 on a 5-point Likert scale (1 = Very Easy, 5 = Difficult), and 92% of participants believed they performed the test correctly and received an accurate result. Lastly, men with higher motile sperm count were more likely to report feeling "at ease" or "excited" following testing, while men with low motile sperm count were more likely to report feeling "concerned" or "frustrated." Overall, 91% of men reported they would like to test again. CONCLUSIONS The Trak System provides a simple and potentially cost-effective means of measuring important semen parameters and may be useful in population-based epidemiologic fertility studies.
Collapse
Affiliation(s)
| | - Tanran R. Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Amelia K. Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Barry Behr
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Michael L. Eisenberg
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
20
|
Wesselink AK, Hatch EE, Rothman KJ, Mikkelsen EM, Aschengrau A, Wise LA. Prospective study of cigarette smoking and fecundability. Hum Reprod 2020; 34:558-567. [PMID: 30576495 DOI: 10.1093/humrep/dey372] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION To what extent is cigarette smoking associated with reduced fecundability? SUMMARY ANSWER Current female smokers, particularly those who had smoked ≥10 cigarettes/day for ≥10 years, had lower fecundability than never smokers, but current male smoking and passive smoking in either partner showed little association with reduced fecundability. WHAT IS KNOWN ALREADY Female smoking has been identified as a cause of infertility, yet there has been limited characterization of the dose and duration at which an effect is observed. Results for male active smoking and passive smoking in both partners are less consistent. STUDY DESIGN, SIZE, DURATION We analyzed data from a North American internet-based preconception cohort study of 5473 female and 1411 male pregnancy planners, enrolled from 2013 to 2018. Participants had been attempting conception for ≤6 menstrual cycles at study entry. PARTICIPANTS/MATERIALS, SETTING, METHODS We collected information on active and passive smoking history on baseline questionnaires. Pregnancy was reported on female bi-monthly follow-up questionnaires. We calculated fecundability ratios (FR) and 95% CI using proportional probabilities regression models, adjusted for demographic, behavioral, medical, reproductive and dietary variables. MAIN RESULTS AND THE ROLE OF CHANCE Female current regular smoking (FR = 0.90, 95% CI: 0.77, 1.07), current occasional smoking (FR = 0.88, 95% CI: 0.73, 1.06), and former smoking (FR = 0.89, 95% CI: 0.81, 0.98) were associated with small reductions in fecundability. Results were stronger among women who smoked ≥10 cigarettes/day for ≥10 years (FR = 0.77, 95% CI: 0.53, 1.10). Male current regular and former smoking, and current passive smoking in either partner were not meaningfully associated with reduced fecundability. In utero exposure to ≥10 cigarettes/day among females was associated with reduced fecundability (FR = 0.75, 95% CI: 0.52, 1.06). LIMITATIONS, REASONS FOR CAUTION Numbers of cigarette smokers, particularly within categories of intensity and duration, were small. Under-reporting of smoking may have resulted in non-differential misclassification, and smokers were more likely to be lost to follow-up. WIDER IMPLICATIONS OF THE FINDINGS Given the consistency of our findings with results from previous studies and our observation of a dose-response relation in intensity of smoking, this study supports an association between female cigarette smoking and lower fecundability. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the National Institute of Child Health and Human Development (R01-HD086742, R21-HD072326, R03-HD090315 and T32-HD052458). The authors declare no competing interests.
Collapse
Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA.,Research Triangle Institute, Durham, NC, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aaruhus University Hospital, Aarhus, Denmark
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA
| |
Collapse
|
21
|
Eick SM, Meeker JD, Swartzendruber A, Rios-McConnell R, Brown P, Vélez-Vega C, Shen Y, Alshawabkeh AN, Cordero JF, Ferguson KK. Relationships between psychosocial factors during pregnancy and preterm birth in Puerto Rico. PLoS One 2020; 15:e0227976. [PMID: 31995596 PMCID: PMC6988967 DOI: 10.1371/journal.pone.0227976] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022] Open
Abstract
Psychosocial stress during pregnancy has been associated with adverse pregnancy outcomes including preterm birth (PTB). This has not been studied in Puerto Rico, an area with high PTB rates. Our objective was to develop a conceptual model describing the interrelationships between measures of psychosocial stress and depression, a result of stress, among pregnant women in Puerto Rico and to examine their associations with PTB. We used data from the Puerto Rico Testsite for Exploring Contamination Threats pregnancy cohort (PROTECT, N = 1,047) to examine associations among depression and different continuous measures of psychosocial stress using path analysis. Psychosocial stress during pregnancy was assessed using validated measures of perceived stress, negative life experiences, neighborhood perceptions and social support. Logistic regression was used to examine associations between psychosocial stress measures in tertiles and PTB. Perceived stress, negative life experiences, and neighborhood perceptions influenced depression through multiple pathways. Our model indicated that perceived stress had the strongest direct effect on depression, where one standard deviation (SD) increase in perceived stress was associated with a 57% SD increase in depression. Negative life experiences were directly but also indirectly, through perceived stress, associated with depression. Finally, neighborhood perceptions directly influenced negative life experiences and perceived stress and consequently had an indirect effect on depression. Psychosocial stress was not associated with PTB across any of the measures examined. Our study examined interrelationships between multiple measures of psychosocial stress and depression among a pregnant Puerto Rican population and identified negative neighborhood perceptions as important upstream factors leading to depression. Our findings highlight the complex relationship between psychosocial stress measures and indicate that psychosocial stress and depression, assessed using 5 different scales, were not associated with PTB. Future research should investigate other environmental and behavioral risk factors contributing to higher rates of PTB in this population.
Collapse
Affiliation(s)
- Stephanie M. Eick
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Services, University of California, San Francisco, San Francisco, CA, United States of America
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Andrea Swartzendruber
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Rafael Rios-McConnell
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, PR, United States of America
| | - Phil Brown
- Department of Sociology and Anthropology and Department of Health Sciences, Northeastern University, Boston, MA, United States of America
| | - Carmen Vélez-Vega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, PR, United States of America
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Akram N. Alshawabkeh
- College of Engineering, Northeastern University, Boston, MA, United States of America
| | - José F. Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Kelly K. Ferguson
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States of America
| |
Collapse
|
22
|
Park J, Stanford JB, Porucznik CA, Christensen K, Schliep KC. Daily perceived stress and time to pregnancy: A prospective cohort study of women trying to conceive. Psychoneuroendocrinology 2019; 110:104446. [PMID: 31546113 PMCID: PMC7314282 DOI: 10.1016/j.psyneuen.2019.104446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prior studies among women with impaired fecundity have consistently demonstrated a positive association between daily perceived stress and the ability to conceive. However, the effects of daily stress on time to pregnancy (TTP) among women with proven fertility is not known. MATERIALS AND METHODS One hundred and forty-three women ages 18-35, in a relationship of proven fertility, who desired to conceive were included in the analysis. Daily diaries recording perceived stress (scale 0-10) were completed for up to 7 menstrual cycles or until pregnancy. Cox proportional hazards regression models were used to estimate the association between time-varying perceived stress tertiles (high [>4.1-7.2], moderate [>2.7-4.1], and low [0.1-2.7]) and adjusted fecundability odds ratio (aFOR), 95% confidence intervals (CI), after taking into account age, parity, education, time-varying caffeine and alcohol intake, fertility awareness tracking, and cycle intent to conceive. RESULTS Among the 111 participants who completed daily diaries, 90 (81.1%) conceived. Women reporting high or moderate stress, versus low stress, had no difference in probability of achieving pregnancy (aFOR: 1.11 [95% CI: 0.58, 2.14]; and aFOR: 1.37 [0.71, 2.67]), respectively. Additional adjustment for intercourse frequency during narrow fertile window, or narrowing exposure focus to pre-ovulatory or pre-implantation stress did not appreciably alter the estimates. CONCLUSION Daily perceived stress was not adversely associated with TTP among women with proven fertility. While a growing body of evidence supports adverse effects of more severe stressful life events on female reproductive function, moderate psychological stress, commonly referred to as eustress, among relatively healthy women with proven fertility does not appear to adversely impact TTP.
Collapse
Affiliation(s)
- Jihye Park
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, United States.
| | | | | | - Kylie Christensen
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, United States.
| | | |
Collapse
|