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Fruh V, Wesselink AK, Schildroth S, Bethea TN, Geller RJ, Calafat AM, Coull BA, Wegienka G, Harmon QE, Baird DD, Wise LA, Henn BC. Non-persistent Endocrine Disrupting Chemical Mixtures and Uterine Leiomyomata in the Study of Environment, Lifestyle and Fibroids (SELF). Chemosphere 2024:142050. [PMID: 38631496 DOI: 10.1016/j.chemosphere.2024.142050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Results of studies investigating associations between individual endocrine-disrupting chemicals (EDCs) and incidence of uterine leiomyomata (UL), a hormone-dependent gynecological condition, have been inconsistent. However, few studies have evaluated simultaneous exposure to a mixture of EDCs with UL incidence. METHODS We conducted a case-cohort analysis (n=708) of data from the Study of the Environment, Lifestyle and Fibroids (SELF), a prospective cohort study. Participants were aged 23-35 years at enrollment, had an intact uterus, and identified as Black or African American. We measured biomarker concentrations of 21 non-persistent EDCs, including phthalates, phenols, parabens, and triclocarban, in urine collected at baseline, 20-month, and 40-month clinic visits. We ascertained UL incidence and characteristics using ultrasounds at baseline and approximately every 20 months through 60 months. We used probit Bayesian Kernel Machine Regression (BKMR-P) to evaluate joint associations between EDC mixtures with cumulative UL incidence. We estimated the mean difference in the probit of UL incidence over the study period, adjusting for baseline age, education, years since last birth, parity, smoking status and body mass index. We converted probit estimates to odds ratios for ease of interpretation. RESULTS We observed that urinary concentrations of the overall EDC mixture were inversely associated with UL incidence in the overall mixtures model, with the strongest inverse associations at the 70th percentile of all biomarkers compared with their 50th percentile (odds ratio =0.59; 95% confidence interval: 0.36, 0.96). Strongest contributors to the joint association for the mixture were bisphenol S (BPS), ethyl paraben (EPB), bisphenol F (BPF) and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), which each demonstrated inverse associations except for MECPP. There was suggestive evidence of an interaction between MECPP and EPB. CONCLUSION In this prospective ultrasound study, we observed evidence of an inverse association between the overall mixture of urinary biomarker concentrations of non-persistent EDCs with UL incidence.
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Affiliation(s)
- Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Samantha Schildroth
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Center, Washington DC, USA
| | - Ruth J Geller
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ganesa Wegienka
- Henry Ford Health, Department of Public Health Sciences, Detroit, MI, USA
| | - Quaker E Harmon
- National Institute of Environmental Health Sciences, Epidemiology Branch, Durham, NC, USA
| | - Donna D Baird
- National Institute of Environmental Health Sciences, Epidemiology Branch, Durham, NC, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Yland JJ, Zad Z, Wang TR, Wesselink AK, Jiang T, Hatch EE, Paschalidis IC, Wise LA. Predictive models of miscarriage based on data from a preconception cohort study. Fertil Steril 2024:S0015-0282(24)00235-8. [PMID: 38604264 DOI: 10.1016/j.fertnstert.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To use self-reported preconception data to derive models that predict risk of miscarriage. DESIGN Prospective preconception cohort study. SUBJECTS Study participants were female, aged 21-45 years, residents of the United States or Canada, and attempting spontaneous pregnancy at enrollment during 2013-2022. Participants were followed for up to 12 months of pregnancy attempts; those who conceived were followed through pregnancy and postpartum. We restricted analyses to participants who conceived during the study period. EXPOSURE On baseline and follow-up questionnaires completed every 8 weeks until pregnancy, we collected self-reported data on sociodemographic factors, reproductive history, lifestyle, anthropometrics, diet, medical history, and male partner characteristics. We included 160 potential predictor variables in our models. MAIN OUTCOME MEASURES The primary outcome was miscarriage, defined as pregnancy loss before 20 weeks' gestation. We followed participants from their first positive pregnancy test until miscarriage or a censoring event (induced abortion, ectopic pregnancy, loss to follow-up, or 20 weeks' gestation), whichever occurred first. We fit both survival and static models, using Cox proportional hazards models, logistic regression, support vector machines, Gradient Boosted Trees, and Random Forest algorithms. We evaluated model performance using the concordance index (survival models) and the weighted-F1 score (static models). RESULTS Among 8,720 participants who conceived, 20.4% reported miscarriage. In multivariable models, the strongest predictors of miscarriage were female age, history of miscarriage, and male partner age. The weighted-F1 score ranged from 73-89% for static models and the concordance index ranged from 53-56% for survival models, indicating better discrimination for the static models compared with the survival models (i.e., ability of the model to discriminate between individuals with and without miscarriage). No appreciable differences were observed across strata of miscarriage history or among models restricted to ≥8 weeks' gestation. CONCLUSION Our findings suggest that miscarriage is not easily predicted based on preconception lifestyle characteristics, and that advancing age and history of miscarriage are the most important predictors of incident miscarriage.
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Affiliation(s)
- Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Zahra Zad
- Hariri Institute for Computing and Computational Science & Engineering, Boston University, Boston, MA, USA; Department of Electrical and Computer Engineering, Division of Systems Engineering, Boston University, 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
| | - Ioannis Ch Paschalidis
- Hariri Institute for Computing and Computational Science & Engineering, Boston University, Boston, MA, USA; Department of Electrical and Computer Engineering, Division of Systems Engineering, Boston University, Boston, MA, USA; Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Wesselink AK, Kirwa K, Hystad P, Kaufman JD, Szpiro AA, Willis MD, Savitz DA, Levy JI, Rothman KJ, Mikkelsen EM, Laursen ASD, Hatch EE, Wise LA. Ambient air pollution and rate of spontaneous abortion. Environ Res 2024; 246:118067. [PMID: 38157969 PMCID: PMC10947860 DOI: 10.1016/j.envres.2023.118067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
Spontaneous abortion (SAB), defined as a pregnancy loss before 20 weeks of gestation, affects up to 30% of conceptions, yet few modifiable risk factors have been identified. We estimated the effect of ambient air pollution exposure on SAB incidence in Pregnancy Study Online (PRESTO), a preconception cohort study of North American couples who were trying to conceive. Participants completed questionnaires at baseline, every 8 weeks during preconception follow-up, and in early and late pregnancy. We analyzed data on 4643 United States (U.S.) participants and 851 Canadian participants who enrolled during 2013-2019 and conceived during 12 months of follow-up. We used country-specific national spatiotemporal models to estimate concentrations of particulate matter <2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) during the preconception and prenatal periods at each participant's residential address. On follow-up and pregnancy questionnaires, participants reported information on pregnancy status, including SAB incidence and timing. We fit Cox proportional hazards regression models with gestational weeks as the time scale to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of time-varying prenatal concentrations of PM2.5, NO2, and O3 with rate of SAB, adjusting for individual- and neighborhood-level factors. Nineteen percent of pregnancies ended in SAB. Greater PM2.5 concentrations were associated with a higher incidence of SAB in Canada, but not in the U.S. (HRs for a 5 μg/m3 increase = 1.29, 95% CI: 0.99, 1.68 and 0.94, 95% CI: 0.83, 1.08, respectively). NO2 and O3 concentrations were not appreciably associated with SAB incidence. Results did not vary substantially by gestational weeks or season at risk. In summary, we found little evidence for an effect of residential ambient PM2.5, NO2, and O3 concentrations on SAB incidence in the U.S., but a moderate positive association of PM2.5 with SAB incidence in Canada.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, USA.
| | - Kipruto Kirwa
- Department of Environmental Health, Boston University School of Public Health, USA
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, USA
| | - Joel D Kaufman
- Departments of Environmental and Occupational Health Sciences, Epidemiology, and Medicine, University of Washington School of Public Health, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington School of Public Health, USA
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, USA
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Denmark
| | - Anne Sofie Dam Laursen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Denmark
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, USA
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Joseph MD, Koenig MR, Kuriyama AS, Wang TR, Wesselink AK, Eisenberg ML, Sommer GJ, Rothman KJ, Stuver SO, Wise LA, Hatch EE. A preconception cohort study of sugar-sweetened beverage consumption and semen quality. Andrology 2024. [PMID: 38450974 DOI: 10.1111/andr.13615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Dietary factors, including high sugar intake, may have adverse effects on male reproduction. Studies of the association between sugar-sweetened beverage (SSB) intake and semen quality have reported inconsistent results. OBJECTIVE We estimated the effects of SSB consumption on semen quality in a North American preconception cohort study. METHODS We analyzed baseline data from 690 males (n = 1,247 samples) participating in Pregnancy Study Online (PRESTO) during 2015-2022. Participants aged ≥21 years completed a baseline questionnaire on which they reported information about intake of SSBs, including sodas, energy drinks, sports drinks, and fruit juices. After enrollment, we invited U.S. participants to a semen testing substudy, in which they collected and analyzed two samples using an at-home semen testing kit. We used linear regression models to estimate adjusted percent differences (%D) and 95% confidence intervals (CI) for associations of SSB intake with semen volume, sperm concentration, total sperm count (TSC), motility, and total motile sperm count (TMSC). We used modified Poisson regression models to estimate adjusted risk ratios (RRs) and 95% CIs for the association of SSB intake with World Health Organization semen parameter cut points. RESULTS Relative to non-consumers of SSBs, those who consumed ≥7 SSBs/week had lower semen volume (%D = -6, 95% CI: -13, 0), sperm concentration (%D = -22, 95% CI: -38, 0), TSC (%D = -22, 95% CI: -38, -2), motility (%D = -4, 95% CI: -10, 2), and TMSC (%D = -25, 95% CI: -43, -2). High SSB consumers also had greater risks of low sperm concentration (≤16 million/mL; RR = 1.89, 95% CI: 1.11, 3.21), low TSC (≤39 million; RR = 1.75, 95% CI: 0.92, 3.33), low motility (≤42%; RR = 1.23, 95% CI: 0.87, 1.75) and low TMSC (≤21 million; RR = 1.95, 95% CI: 1.12, 3.38). Associations were stronger among participants with body mass index ≥ 25 kg/m2 . CONCLUSION Greater SSB consumption was associated with reduced semen quality in a North American preconception cohort.
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Affiliation(s)
- Marlon D Joseph
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha R Koenig
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Andrea S Kuriyama
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael L Eisenberg
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA
- Department of Urology, Stanford University, Stanford, California, USA
| | - Greg J Sommer
- Laboratory Corporation of America, Pleasanton, California, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sherri O Stuver
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Savitz DA, Wise LA, Bond JC, Hatch EE, Ncube CN, Wesselink AK, Willis MD, Yland JJ, Rothman KJ. Responding to Reviewers and Editors About Statistical Significance Testing. Ann Intern Med 2024; 177:385-386. [PMID: 38373303 DOI: 10.7326/m23-2430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Affiliation(s)
- David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island (D.A.S.)
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (L.A.W., J.C.B., E.E.H., C.N.N., A.K.W., M.D.W., J.J.Y., K.J.R.)
| | - Julia C Bond
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (L.A.W., J.C.B., E.E.H., C.N.N., A.K.W., M.D.W., J.J.Y., K.J.R.)
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (L.A.W., J.C.B., E.E.H., C.N.N., A.K.W., M.D.W., J.J.Y., K.J.R.)
| | - Collette N Ncube
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (L.A.W., J.C.B., E.E.H., C.N.N., A.K.W., M.D.W., J.J.Y., K.J.R.)
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (L.A.W., J.C.B., E.E.H., C.N.N., A.K.W., M.D.W., J.J.Y., K.J.R.)
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (L.A.W., J.C.B., E.E.H., C.N.N., A.K.W., M.D.W., J.J.Y., K.J.R.)
| | - Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (L.A.W., J.C.B., E.E.H., C.N.N., A.K.W., M.D.W., J.J.Y., K.J.R.)
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (L.A.W., J.C.B., E.E.H., C.N.N., A.K.W., M.D.W., J.J.Y., K.J.R.)
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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7
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Schildroth S, Bethea TN, Wesselink AK, Friedman A, Fruh V, Calafat AM, Wegienka G, Gaston S, Baird DD, Wise LA, Claus Henn B. Personal Care Products, Socioeconomic Status, and Endocrine-Disrupting Chemical Mixtures in Black Women. Environ Sci Technol 2024; 58:3641-3653. [PMID: 38347750 DOI: 10.1021/acs.est.3c06440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Personal care products (PCPs) are sources of exposure to endocrine-disrupting chemicals (EDCs) among women, and socioeconomic status (SES) may influence these exposures. Black women have inequitable exposure to EDCs from PCP use, but no study has investigated how exposure to EDCs through PCPs may vary by SES, independent of race. Using data from the Study of Environment, Lifestyle, and Fibroids, a cohort of reproductive-aged Black women (n = 751), we quantified associations between PCPs and urinary biomarker concentrations of EDC mixtures (i.e., phthalates, phenols, parabens) within SES groups, defined using k-modes clustering based on education, income, marital status, and employment. Information about PCP use and SES was collected through questionnaires and interviews. We used principal component analysis to characterize the EDC mixture profiles. Stratified linear regression models were fit to assess associations between PCP use and EDC mixture profiles, quantified as mean differences in PC scores, by SES group. Associations between PCP use and EDC mixture profiles varied by SES group; e.g., vaginal powder use was associated with a mixture of phenols among lower SES women, whereas this association was null for higher SES women. Findings suggest that SES influences PCP EDC exposure in Black women, which has implications for public health interventions.
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Affiliation(s)
- Samantha Schildroth
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachussetts 02118, United States
| | - Traci N Bethea
- Office of Minority Health & Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington D. C. 20007, United States
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachussetts 02118, United States
| | - Alexa Friedman
- National Institute of Environmental Health Sciences, Durham, North Carolina 27709, United States
| | - Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts 02118, United States
| | - Antonia M Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, United States
| | - Ganesa Wegienka
- Henry Ford Health System, Detroit, Michigan 48202, United States
| | - Symielle Gaston
- National Institute of Environmental Health Sciences, Durham, North Carolina 27709, United States
| | - Donna D Baird
- National Institute of Environmental Health Sciences, Durham, North Carolina 27709, United States
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachussetts 02118, United States
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts 02118, United States
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8
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Bond JC, Coleman CM, Yland JJ, Wesselink AK, Wang T, Willis M, Hatch EE, Rothman KJ, Savitz D, Eisenberg ML, Wise LA. Preconception sleep duration, non-daytime work schedules, and incidence of spontaneous abortion: a prospective cohort study. Hum Reprod 2024; 39:413-424. [PMID: 38059518 DOI: 10.1093/humrep/dead249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 10/25/2023] [Indexed: 12/08/2023] Open
Abstract
STUDY QUESTION To what extent do self-reported sleep duration and non-daytime work schedules in either partner affect the rate of spontaneous abortion (SAB)? SUMMARY ANSWER Incidence of SAB had little association with female sleep duration and a modest positive association with male short sleep duration, female work at night, and discrepant work schedules among partners. WHAT IS KNOWN ALREADY Several studies have reported an association between short sleep duration in either partner and reproductive health outcomes, including fecundability. Moreover, certain types of female occupational exposures during pregnancy have been associated with an increased risk of SAB. No studies have evaluated SAB risk in relation to male sleep and work schedules, or joint exposures within a couple. STUDY DESIGN, SIZE, DURATION This prospective cohort study included 9357 female participants and 2602 of their male partners residing in North America (June 2013 to April 2023). PARTICIPANTS/MATERIALS, SETTING, METHODS Participants enrolled when they were attempting pregnancy and completed self-administered baseline questionnaires about their average sleep duration and work schedules. Among those who conceived, we ascertained SAB and gestational age at loss via follow-up questionnaires. We used multivariable Cox proportional hazards models with gestational weeks as the time scale to estimate hazard ratios (HRs) and 95% CIs relating SAB with sleep duration and non-daytime work schedules for female and male participants, and the couple. We used inverse probability weighting to account for potential selection bias due to the possibility of differential participation of male partners with respect to the exposures. MAIN RESULTS AND THE ROLE OF CHANCE Compared to female participants with recommended sleep (7-8.9 h), those reporting short sleep duration (<6 h) did not have a higher rate of SAB (HR 0.88, 95% CI 0.69, 1.13). Short self-reported sleep duration among male participants was modestly associated with a higher rate of SAB (adjusted and weighted HR 1.30, 95% CI 0.96, 1.75). Female night work at night (adjusted HR 1.19, 95% CI 1.02, 1.38) and male non-daytime work (adjusted and weighted HR 1.26, 95% CI 1.00, 1.59) were associated with modestly higher rates of SAB, whereas female rotating shift work was not (adjusted HR 0.91, 0.78, 1.05) compared with daytime workers. Couples in which work schedules were discrepant had an elevated rate of SAB if the male partner worked a non-daytime shift (adjusted and weighted HR 1.46, 95% CI 1.13, 1.88) compared with couples in which both members worked during the day. The corresponding HR if only the female partner worked a non-daytime shift was 1.21 (95% CI 0.92, 1.58). LIMITATIONS, REASONS FOR CAUTION Data on sleep duration and work schedules were based on self-report, which is vulnerable to misclassification, particularly since participants were asked to report their average sleep duration during the past month. Work exposures were heterogeneous, as many different types of employment may require night and shift work and may have different associations with SAB. WIDER IMPLICATIONS OF THE FINDINGS Our findings are consistent with previous research indicating that some types of female employment schedules may be associated with SAB incidence. This is the first study to indicate a relationship between SAB and male employment schedules, indicating that discrepant work schedules within a couple might be relevant. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grants R01HD105863 (PIs: L.A.W. and M.L.E.), R01HD086742 (PIs: L.A.W. and E.E.H.), and R21HD072326 (PI: L.A.W.). PRESTO has received in-kind donations from Swiss Precision Diagnostics and Kindara.com for primary data collection. L.A.W. is a consultant for AbbVie, Inc. and the Gates Foundation. M.L.E. is an advisor for and holds stock in Ro, Hannah, Dadi, Underdog, Vseat, & Doveras. The other authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J C Bond
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - C M Coleman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - J J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - A K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - T Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - M Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - E E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - K J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - D Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - M L Eisenberg
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - L A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Yland JJ, Wesselink AK, Regan AK, Hatch EE, Rothman KJ, Savitz DA, Wang TR, Huybrechts KF, Hernández-Díaz S, Eisenberg ML, Wise LA. A prospective cohort study of preconception COVID-19 vaccination and miscarriage. Hum Reprod 2023; 38:2362-2372. [PMID: 37864485 PMCID: PMC10694406 DOI: 10.1093/humrep/dead211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 08/04/2023] [Indexed: 10/23/2023] Open
Abstract
STUDY QUESTION To what extent is preconception maternal or paternal coronavirus disease 2019 (COVID-19) vaccination associated with miscarriage incidence? SUMMARY ANSWER COVID-19 vaccination in either partner at any time before conception is not associated with an increased rate of miscarriage. WHAT IS KNOWN ALREADY Several observational studies have evaluated the safety of COVID-19 vaccination during pregnancy and found no association with miscarriage, though no study prospectively evaluated the risk of early miscarriage (gestational weeks [GW] <8) in relation to COVID-19 vaccination. Moreover, no study has evaluated the role of preconception vaccination in both male and female partners. STUDY DESIGN, SIZE, DURATION An Internet-based, prospective preconception cohort study of couples residing in the USA and Canada. We analyzed data from 1815 female participants who conceived during December 2020-November 2022, including 1570 couples with data on male partner vaccination. PARTICIPANTS/MATERIALS, SETTING, METHODS Eligible female participants were aged 21-45 years and were trying to conceive without use of fertility treatment at enrollment. Female participants completed questionnaires at baseline, every 8 weeks until pregnancy, and during early and late pregnancy; they could also invite their male partners to complete a baseline questionnaire. We collected data on COVID-19 vaccination (brand and date of doses), history of SARS-CoV-2 infection (yes/no and date of positive test), potential confounders (demographic, reproductive, and lifestyle characteristics), and pregnancy status on all questionnaires. Vaccination status was categorized as never (0 doses before conception), ever (≥1 dose before conception), having a full primary sequence before conception, and completing the full primary sequence ≤3 months before conception. These categories were not mutually exclusive. Participants were followed up from their first positive pregnancy test until miscarriage or a censoring event (induced abortion, ectopic pregnancy, loss to follow-up, 20 weeks' gestation), whichever occurred first. We estimated incidence rate ratios (IRRs) for miscarriage and corresponding 95% CIs using Cox proportional hazards models with GW as the time scale. We used propensity score fine stratification weights to adjust for confounding. MAIN RESULTS AND THE ROLE OF CHANCE Among 1815 eligible female participants, 75% had received at least one dose of a COVID-19 vaccine by the time of conception. Almost one-quarter of pregnancies resulted in miscarriage, and 75% of miscarriages occurred <8 weeks' gestation. The propensity score-weighted IRR comparing female participants who received at least one dose any time before conception versus those who had not been vaccinated was 0.85 (95% CI: 0.63, 1.14). COVID-19 vaccination was not associated with increased risk of either early miscarriage (GW: <8) or late miscarriage (GW: 8-19). There was no indication of an increased risk of miscarriage associated with male partner vaccination (IRR = 0.90; 95% CI: 0.56, 1.44). LIMITATIONS, REASONS FOR CAUTION The present study relied on self-reported vaccination status and infection history. Thus, there may be some non-differential misclassification of exposure status. While misclassification of miscarriage is also possible, the preconception cohort design and high prevalence of home pregnancy testing in this cohort reduced the potential for under-ascertainment of miscarriage. As in all observational studies, residual or unmeasured confounding is possible. WIDER IMPLICATIONS OF THE FINDINGS This is the first study to evaluate prospectively the relation between preconception COVID-19 vaccination in both partners and miscarriage, with more complete ascertainment of early miscarriages than earlier studies of vaccination. The findings are informative for individuals planning a pregnancy and their healthcare providers. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Health [R01-HD086742 (PI: L.A.W.); R01-HD105863S1 (PI: L.A.W. and M.L.E.)], the National Institute of Allergy and Infectious Diseases (R03-AI154544; PI: A.K.R.), and the National Science Foundation (NSF-1914792; PI: L.A.W.). The funders had no role in the study design, data collection, analysis and interpretation of data, writing of the report, or the decision to submit the paper for publication. L.A.W. is a fibroid consultant for AbbVie, Inc. She also receives in-kind donations from Swiss Precision Diagnostics (Clearblue home pregnancy tests) and Kindara.com (fertility apps). M.L.E. received consulting fees from Ro, Hannah, Dadi, VSeat, and Underdog, holds stock in Ro, Hannah, Dadi, and Underdog, is a past president of SSMR, and is a board member of SMRU. K.F.H. reports being an investigator on grants to her institution from UCB and Takeda, unrelated to this study. S.H.-D. reports being an investigator on grants to her institution from Takeda, unrelated to this study, and a methods consultant for UCB and Roche for unrelated drugs. The authors report no other relationships or activities that could appear to have influenced the submitted work. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Elizabeth E Hatch
- 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
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Deen L, Clark A, Hougaard KS, Petersen KU, Frederiksen M, Wise LA, Wesselink AK, Meyer HW, Bonde JP, Tøttenborg SS. Exposure to airborne polychlorinated biphenyls and type 2 diabetes in a Danish cohort. Environ Res 2023; 237:117000. [PMID: 37634693 DOI: 10.1016/j.envres.2023.117000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/17/2023] [Accepted: 08/25/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Previous research indicates an association between higher-chlorinated polychlorinated biphenyls (PCBs) and type 2 diabetes (T2D). However, less is known about the extent to which PCB exposure in indoor air, composed primarily of lower-chlorinated PCBs, affects T2D risk. We assessed the association between indoor air exposure to PCBs in residential buildings and T2D incidence. METHODS The register-based 'Health Effects of PCBs in Indoor Air' (HESPAIR) cohort comprises 51,921 Danish residents of two residential areas with apartments built with and without PCB-containing materials (reference apartments). We assessed exposure status by combining register-based information on relocation history with extrapolated values of exposure based on PCB-measurements in indoor air from subsets of the apartments. T2D cases were identified in the Danish registers during 1977-2018. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) using Cox regression analyses with time-varying exposure. RESULTS We identified 2737 incident T2D cases during the follow-up. Exposure to ≥3300 ng/m3 PCB × year (3rd tertile of PCByear) was associated with higher risk of T2D (HR 1.15, 95% CI 1.02-1.30) compared with exposure to <300 ng/m3 PCB × year (reference). However, among individuals with lower cumulated PCByear, the risk was similar to residents with exposure <300 ng/m3 PCB × year (300-899 ng/m3 PCB × year: HR 0.98, 95% CI 0.87-1.11; 900-3299 ng/m3 PCB × year: HR 0.96, 95% CI 0.83-1.10). DISCUSSION We observed a marginally higher risk of T2D, but there was no evidence of an exposure-response relationship. The results should be interpreted with caution until confirmed in other independent studies of PCB exposure in indoor air.
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Affiliation(s)
- Laura Deen
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Denmark.
| | | | - Karin Sørig Hougaard
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Denmark; National Research Centre for the Working Environment, Denmark
| | - Kajsa Ugelvig Petersen
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Denmark
| | | | - Lauren A Wise
- Department of Epidemiology, School of Public Health, Boston University, United States
| | - Amelia K Wesselink
- Department of Epidemiology, School of Public Health, Boston University, United States
| | - Harald William Meyer
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Denmark
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11
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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. Environ Int 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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12
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Geller RJ, Wesselink AK, Upson K, Claus Henn B, Schildroth S, Wright R, Coleman CM, Willis MD, Bethea TN, Williams PL, Harmon QE, Baird DD, Wegienka G, Wise LA. Correlates of whole blood metal concentrations among reproductive-aged Black women. J Expo Sci Environ Epidemiol 2023; 33:883-894. [PMID: 36104525 PMCID: PMC10011018 DOI: 10.1038/s41370-022-00477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Metals may influence reproductive health, but few studies have investigated correlates of metal body burden among reproductive-aged women outside of pregnancy. Furthermore, while there is evidence of racial disparities in exposure to metals among U.S. women, there is limited research about correlates of metal body burden among Black women. OBJECTIVE To identify correlates of whole blood metal concentrations among reproductive-aged Black women. METHODS We analyzed cross-sectional data from a cohort of 1664 Black women aged 23-35 years in Detroit, Michigan, 2010-2012. We collected blood samples and questionnaire data. We measured concentrations of 17 metals in whole blood using inductively-coupled plasma-mass spectrometer-triple quadrupole and total mercury using Direct Mercury Analyzer-80. We used multivariable linear regression models to identify sociodemographic, environmental, reproductive, and dietary correlates of individual metal concentrations. RESULTS In adjusted models, age was positively associated with multiple metals, including arsenic, cadmium, and mercury. Education and income were inversely associated with cadmium and lead. Current smoking was strongly, positively associated with cadmium and lead. Alcohol intake in the past year was positively associated with arsenic, barium, copper, lead, mercury, vanadium, and zinc. Having pumped gasoline in the past 24 h was positively associated with cadmium, chromium, and molybdenum. Having lived in an urban area for the majority of residence in Michigan was positively associated with arsenic, lead, and nickel. Higher water intake in the past year was positively associated with several metals, including lead. Fish intake in the past year was positively associated with arsenic, cesium, and mercury. We also observed associations with body mass index, season, and other environmental, reproductive, and dietary factors. SIGNIFICANCE We identified potential sources of exposure to metals among reproductive-aged Black women. Our findings improve understanding of exposures to metals among non-pregnant reproductive-aged women, and can inform policies in support of reducing disparities in exposures. IMPACT STATEMENT There are racial disparities in exposures to metals. We analyzed correlates of blood metal concentrations among reproductive-aged Black women in the Detroit, Michigan metropolitan area. We identified sociodemographic, anthropometric, lifestyle, environmental, reproductive, and dietary correlates of metal body burden. Age was positively associated with several metals. Education and income were inversely associated with cadmium and lead, indicating socioeconomic disparities. We identified potential exposure sources of metals among reproductive-aged Black women, including smoking, environmental tobacco smoke, pumping gasoline, living in an urban area, and intake of alcohol, water, fish, and rice.
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Affiliation(s)
- Ruth J Geller
- 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
| | - Kristen Upson
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Robert Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chad M Coleman
- 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
- School of Biological and Population Health Science, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Paige L Williams
- Departments of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Quaker E Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Wise LA, Wang TR, Mikkelsen EM, Wesselink AK, Calafat AM, Wegienka G, Geller RJ, Coleman CM, Willis MD, Marsh EE, Schildroth S, Botelho JC, Messerlian-Lambert G, Hatch EE. Per- and Polyfluoroalkyl Substances and Anti-Müllerian Hormone Concentrations in Two Preconception Cohort Studies. Environ Health Perspect 2023; 131:107703. [PMID: 37882725 PMCID: PMC10601879 DOI: 10.1289/ehp12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/16/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Tanran R. Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ellen M. Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Amelia K. Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ganesa Wegienka
- Division of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Ruth J. Geller
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Chad M. Coleman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mary D. Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Erica E. Marsh
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, Michigan, USA
| | - Samantha Schildroth
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julianne C. Botelho
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Geralyn Messerlian-Lambert
- Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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14
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Regan AK, Fell DB, Wise LA, Vazquez-Benitez G, Håberg SE, Ogar C, Yland JJ, Wesselink AK, Zerbo O. Challenges & opportunities for the epidemiological evaluation of the effects of COVID-19 vaccination on reproduction and pregnancy. Vaccine 2023; 41:5931-5935. [PMID: 37659894 DOI: 10.1016/j.vaccine.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, Orange, CA, United States; Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States.
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lauren A Wise
- Boston University School of Public Health, Boston, MA, United States
| | | | - Siri E Håberg
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Comfort Ogar
- Brighton Collaboration, A Program of the Task Force for Global Health, Decatur, GA, United States
| | - Jennifer J Yland
- Boston University School of Public Health, Boston, MA, United States
| | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
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15
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Yland JJ, Wesselink AK, Hernandez-Diaz S, Huybrechts K, Hatch EE, Wang TR, Savitz D, Kuohung W, Rothman KJ, Wise LA. Preconception contraceptive use and miscarriage: prospective cohort study. BMJ Med 2023; 2:e000569. [PMID: 37705685 PMCID: PMC10496668 DOI: 10.1136/bmjmed-2023-000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/14/2023] [Indexed: 09/15/2023]
Abstract
Objectives To evaluate the association between preconception contraceptive use and miscarriage. Design Prospective cohort study. Setting Residents of the United States of America or Canada, recruited from 2013 until the end of 2022. Participants 13 460 female identified participants aged 21-45 years who were planning a pregnancy were included, of whom 8899 conceived. Participants reported data for contraceptive history, early pregnancy, miscarriage, and potential confounders during preconception and pregnancy. Main outcome measure Miscarriage, defined as pregnancy loss before 20 weeks of gestation. Results Preconception use of combined and progestin-only oral contraceptives, hormonal intrauterine devices, copper intrauterine devices, rings, implants, or natural methods was not associated with miscarriage compared with use of barrier methods. Participants who most recently used patch (incidence rate ratios 1.34 (95% confidence interval 0.81 to 2.21)) or injectable contraceptives (1.44 (0.99 to 2.12)) had higher rates of miscarriage compared with recent users of barrier methods, although results were imprecise due to the small numbers of participants who used patch and injectable contraceptives. Conclusions Use of most contraceptives before conception was not appreciably associated with miscarriage rate. Individuals who used patch and injectable contraceptives had higher rates of miscarriage relative to users of barrier methods, although these results were imprecise and residual confounding was possible.
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Affiliation(s)
- Jennifer J Yland
- 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
| | - Sonia Hernandez-Diaz
- Department of Epidemiology and CAUSALab, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - Krista Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth E Hatch
- 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
| | - David Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Kenneth J Rothman
- 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
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16
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Regan AK, Wesselink AK, Wang TR, Savitz DA, Yland JJ, Rothman KJ, Hatch EE, Wise LA. Risk of Miscarriage in Relation to Seasonal Influenza Vaccination Before or During Pregnancy. Obstet Gynecol 2023; 142:625-635. [PMID: 37535959 PMCID: PMC10424825 DOI: 10.1097/aog.0000000000005279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/10/2023] [Accepted: 04/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To evaluate the association between seasonal influenza vaccination and miscarriage using data from an ongoing, prospective cohort study. METHODS We analyzed 2013-2022 data from PRESTO (Pregnancy Study Online), a prospective prepregnancy cohort study of female pregnancy planners and their male partners in the United States and Canada. Female participants completed a baseline questionnaire and then follow-up questionnaires every 8 weeks until pregnancy, during early and late pregnancy, and during the postpartum period. Vaccine information was self-reported on all questionnaires. Miscarriage was identified from self-reported information during follow-up. Male partners were invited to complete a baseline questionnaire only. We used Cox proportional hazard models to estimate the hazard ratio (HR) and 95% CI for the association between vaccination less than 3 months before pregnancy detection through the 19th week of pregnancy and miscarriage, with gestational weeks as the time scale. We modeled vaccination as a time-varying exposure and used propensity-score fine stratification to control for confounding from seasonal and female partner factors. RESULTS Of 6,946 pregnancies, 23.3% of female partners reported exposure to influenza vaccine before or during pregnancy: 3.2% during pregnancy (gestational age 4-19 weeks) and 20.1% during the 3 months before pregnancy detection. The miscarriage rate was 16.2% in unvaccinated and 17.0% among vaccinated participants. Compared with no vaccine exposure, influenza vaccination was not associated with increased rate of miscarriage when administered before (HR 0.99, 95% CI 0.81-1.20) or during (HR 0.83, 95% CI 0.47-1.47) pregnancy. Of the 1,135 couples with male partner vaccination data available, 10.8% reported vaccination less than 3 months before pregnancy. The HR for the association between male partner vaccination and miscarriage was 1.17 (95% CI 0.73-1.90). CONCLUSION Influenza vaccination before or during pregnancy was not associated with miscarriage.
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Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, Orange, and Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Boston University School of Public Health, Boston, Massachusetts; and Brown University School of Public Health, Providence, Rhode Island
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Wesselink AK, Wegienka G, Coleman CM, Geller RJ, Harmon QE, Upson K, Lovett SM, Claus Henn B, Marsh EE, Noel NL, Baird DD, Wise LA. A prospective ultrasound study of cigarette smoking and uterine leiomyomata incidence and growth. Am J Obstet Gynecol 2023; 229:151.e1-151.e8. [PMID: 37148957 PMCID: PMC10524545 DOI: 10.1016/j.ajog.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/12/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Uterine leiomyomata (fibroids) are common, benign neoplasms that contribute substantially to gynecologic morbidity. Some existing epidemiologic studies indicate that cigarette smoking is associated with lower uterine leiomyomata risk. However, no prospective studies have systematically screened an entire study population for uterine leiomyomata using transvaginal ultrasound or evaluated the association between cigarette smoking and uterine leiomyomata growth. OBJECTIVE This study aimed to examine the association between cigarette smoking and uterine leiomyomata incidence and growth in a prospective ultrasound study. STUDY DESIGN We enrolled 1693 residents from the Detroit metropolitan area into the Study of Environment, Lifestyle, and Fibroids during 2010 to 2012. Eligible participants were aged 23 to 34 years, had an intact uterus but no previous diagnosis of uterine leiomyomata, and self-identified as Black or African American. We invited participants to complete a baseline visit and 4 follow-up visits over approximately 10 years. At each visit, we used transvaginal ultrasound to assess uterine leiomyomata incidence and growth. Participants provided extensive self-reported data throughout follow-up including exposures to active and passive cigarette smoking in adulthood. We excluded participants who did not return for any follow-up visits (n=76; 4%). We fit Cox proportional hazards regression models to estimate hazard ratios and 95% confidence intervals for the association between time-varying smoking history and incidence rates of uterine leiomyomata. We fit linear mixed models to estimate the percentage difference and 95% confidence intervals for the association between smoking history and uterine leiomyomata growth. We adjusted for sociodemographic, lifestyle, and reproductive factors. We interpreted our results based on magnitude and precision rather than binary significance testing. RESULTS Among 1252 participants without ultrasound evidence of uterine leiomyomata at baseline, uterine leiomyomata were detected in 394 participants (31%) during follow-up. Current cigarette smoking was associated with a lower uterine leiomyomata incidence rate (hazard ratio, 0.67; 95% confidence interval, 0.49-0.92). Associations were stronger among participants who had smoked for longer durations (≥15 years vs never: hazard ratio, 0.49; 95% confidence interval, 0.25-0.95). The hazard ratio for former smokers was 0.78 (95% confidence interval, 0.50-1.20). Among never smokers, the hazard ratio for current passive smoke exposure was 0.84 (95% confidence interval, 0.65-1.07). Uterine leiomyomata growth was not appreciably associated with current (percent difference, -3%; 95% confidence interval, -13% to 8%) or former (percent difference, -9%; 95% confidence interval, -22% to 6%) smoking. CONCLUSION We provide evidence from a prospective ultrasound study that cigarette smoking is associated with lower uterine leiomyomata incidence.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.
| | - Ganesa Wegienka
- Department for Public Health Sciences, Henry Ford Health, Detroit, MI
| | - Chad M Coleman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Ruth J Geller
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Quaker E Harmon
- Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Kristen Upson
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
| | - Sharonda M Lovett
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Erica E Marsh
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Nyia L Noel
- Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA
| | - Donna D Baird
- Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
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Wise LA, Wang TR, Ncube CN, Lovett SM, Abrams J, Boynton-Jarrett R, Koenig MR, Geller RJ, Wesselink AK, Coleman CM, Hatch EE, James-Todd T. Use of Chemical Hair Straighteners and Fecundability in a North American Preconception Cohort. Am J Epidemiol 2023; 192:1066-1080. [PMID: 37005071 PMCID: PMC10505421 DOI: 10.1093/aje/kwad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/04/2023] Open
Abstract
Chemical hair straighteners ("relaxers") are used by millions of North Americans, particularly women of color. Hair relaxers may contain endocrine-disrupting compounds, which can harm fertility. We evaluated the association between hair relaxer use and fecundability among 11,274 participants from Pregnancy Study Online (PRESTO), a North American preconception cohort study. During 2014-2022, participants completed a baseline questionnaire in which they reported their history of relaxer use and completed follow-up questionnaires every 8 weeks for 12 months or until pregnancy, whichever came first. We used multivariable-adjusted proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs). Relative to never use, fecundability was lower among current (FR = 0.81, 95% CI: 0.64, 1.03) and former (FR = 0.89, 95% CI: 0.81, 0.98) users of hair relaxers. FRs for first use of hair relaxers at ages <10, 10-19, and ≥20 years were 0.73 (95% CI: 0.55, 0.96), 0.93 (95% CI: 0.83, 1.04), and 0.85 (95% CI: 0.74, 0.98), respectively. Fecundability was lowest among those with longer durations of use (≥10 years vs. never: FR = 0.71, 95% CI: 0.54, 0.91) and more frequent use (≥5 times/year vs. never: FR = 0.82, 95% CI: 0.60, 1.11), but associations were nonmonotonic. In this preconception cohort study, use of chemical hair straighteners was associated with slightly reduced fecundability.
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Affiliation(s)
- Lauren A Wise
- Correspondence to Dr. Lauren A. Wise, Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118 (e-mail: )
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Bond JC, White KO, Abrams JA, Wesselink AK, Wise LA. Sexual dysfunction, distress, and care-seeking among females during the preconception period. Am J Obstet Gynecol 2023; 229:43.e1-43.e12. [PMID: 37001576 PMCID: PMC10330018 DOI: 10.1016/j.ajog.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/08/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Despite the high prevalence of female sexual dysfunction in population-based studies and the importance of sexual functioning for mixed-sex couples attempting conception, little is known about female sexual function in the preconception period. OBJECTIVE This descriptive study aimed to assess the prevalence of female sexual dysfunction, distress, and pain with intercourse in a preconception population of pregnancy planners. The study also explored the extent to which participants discussed their sex lives with a healthcare provider during a preconception visit. STUDY DESIGN We used data from Pregnancy Study Online, a web-based preconception cohort study (August 2020-October 2022). Eligible participants identified as female and were aged 21 to 45 years, residents of the United States or Canada, attempting pregnancy, and not using fertility treatments at cohort entry. At enrollment, participants completed a detailed baseline questionnaire. Thirty days after enrollment, participants were invited to complete an optional questionnaire about sexual function. Our study included 1120 participants who responded to the sexual function questionnaire within 1 year of completing their baseline questionnaire. We assessed sexual dysfunction using the 6-item Female Sexual Function Index, and sexual distress using the Female Sexual Distress Scale, which assess sexual function and distress in the previous 4 weeks, respectively. We also asked participants whether they had discussed their plans to conceive with a healthcare provider, and if so, whether they discussed their sex lives. If not, we collected information on perceived barriers. RESULTS Twenty-five percent of the sample met criteria for female sexual dysfunction, whereas 12.2% met the criteria for sexual distress; 8% of our sample reported both sexual dysfunction and sexual distress. Thirty percent reported at least some pain with intercourse in the past 4 weeks. Although over 80% of the sample reported discussing their conception plans with a healthcare provider, 70% of these participants did not discuss their sex lives. The most commonly reported reasons for not discussing their sex life with a provider was not experiencing a sexual health issue, the provider not asking, feeling nervous/uncomfortable/ashamed, and feeling it was not relevant to becoming pregnant or inappropriate to discuss. The percentage of participants who reported discussing their sex lives varied across provider type, with those seeing midwives having the highest percentage (39%), followed by nurse practitioners (36%) and obstetrician-gynecologists (34%). CONCLUSION Sexual dysfunction, distress, and painful intercourse are prevalent in the preconception period, but participants frequently did not discuss their sex lives when discussing plans to conceive. The provider not asking was a commonly reported barrier. Providers may consider raising the issue of sexual functioning at the time of a preconception visit to better support patients who may be dealing with a sexual function issue while attempting pregnancy. These findings may not generalize beyond a primarily non-Hispanic White, highly educated, and high-income population.
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Affiliation(s)
- Julia C Bond
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.
| | - Katharine O White
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA
| | - Jasmine A Abrams
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT; Boston University School of Public Health, Maternal and Child Health Center of Excellence, 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
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20
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Wesselink AK, Lovett SM, Weinberg J, Geller RJ, Wang TR, Regan AK, Willis MD, Perkins RB, Yland JJ, Koenig MR, Rothman KJ, Hatch EE, Wise LA. COVID-19 vaccination and menstrual cycle characteristics: A prospective cohort study. Vaccine 2023; 41:4327-4334. [PMID: 37301706 PMCID: PMC10239900 DOI: 10.1016/j.vaccine.2023.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
We prospectively examined the association between COVID-19 vaccination and menstrual cycle characteristics in an internet-based prospective cohort study. We included a sample of 1,137 participants who enrolled in Pregnancy Study Online (PRESTO), a preconception cohort study of couples trying to conceive, during January 2021-August 2022. Eligible participants were aged 21-45 years, United States or Canadian residents, and trying to conceive without fertility treatment. At baseline and every 8 weeks for up to 12 months, participants completed questionnaires on which they provided information on COVID-19 vaccination and menstrual cycle characteristics, including cycle regularity, cycle length, bleed length, heaviness of bleed, and menstrual pain. We fit generalized estimating equation (GEE) models with a log link function and Poisson distribution to estimate the adjusted risk ratio (RR) for irregular cycles associated with COVID-19 vaccination. We used linear regression with GEE to estimate adjusted mean differences in menstrual cycle length associated with COVID-19 vaccination. We adjusted for sociodemographic, lifestyle, medical and reproductive factors. Participants had 1.1 day longer menstrual cycles after receiving the first dose of COVID-19 vaccine (95 % CI: 0.4, 1.9) and 1.3 day longer cycles after receiving the second dose (95 % CI: 0.2, 2.5). Associations were attenuated at the second cycle post-vaccination. We did not observe strong associations between COVID-19 vaccination and cycle regularity, bleed length, heaviness of bleed, or menstrual pain. In conclusion, COVID-19 vaccination was associated with a ∼1 day temporary increase in menstrual cycle length, but was not appreciably associated with other menstrual cycle characteristics.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States.
| | - Sharonda M Lovett
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Ruth J Geller
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | | | - Mary D Willis
- Department of Obstetrics & Gynecology, Boston University Chobanian and Avedesian School of Medicine, Boston, MA, United States
| | - Rebecca B Perkins
- Department of Obstetrics & Gynecology, Boston University Chobanian and Avedesian School of Medicine, Boston, MA, United States
| | - Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Martha R Koenig
- Department of Epidemiology, Boston University School of Public Health, Boston, 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
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Geller RJ, Wesselink AK, Koenig MR, Eisenberg ML, Tucker KL, Hatch EE, Wise LA. Association of male fatty acid intake with fecundability among couples planning pregnancy. Hum Reprod 2023:7177499. [PMID: 37221671 PMCID: PMC10391313 DOI: 10.1093/humrep/dead100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
STUDY QUESTION To what extent is male fatty acid intake associated with fecundability among couples planning pregnancy? SUMMARY ANSWER We observed weak positive associations of male dietary intakes of total and saturated fatty acids with fecundability; no other fatty acid subtypes were appreciably associated with fecundability. WHAT IS KNOWN ALREADY Male fatty acid intake has been associated with semen quality in previous studies. However, little is known about the extent to which male fatty acid intake is associated with fecundability among couples attempting spontaneous conception. STUDY DESIGN, SIZE, DURATION We conducted an internet-based preconception prospective cohort study of 697 couples who enrolled during 2015-2022. During 12 cycles of observation, 53 couples (7.6%) were lost to follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were residents of the USA or Canada, aged 21-45 years, and not using fertility treatment at enrollment. At baseline, male participants completed a food frequency questionnaire from which we estimated intakes of total fat and fatty acid subtypes. We ascertained time to pregnancy using questionnaires completed every 8 weeks by female participants until conception or up to 12 months. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% CIs for the associations of fat intakes with fecundability, adjusting for male and female partner characteristics. We used the multivariate nutrient density method to account for energy intake, allowing for interpretation of results as fat intake replacing carbohydrate intake. We conducted several sensitivity analyses to assess the potential for confounding, selection bias, and reverse causation. MAIN RESULTS AND THE ROLE OF CHANCE Among 697 couples, we observed 465 pregnancies during 2970 menstrual cycles of follow-up. The cumulative incidence of pregnancy during 12 cycles of follow-up after accounting for censoring was 76%. Intakes of total and saturated fatty acids were weakly, positively associated with fecundability. Fully adjusted FRs for quartiles of total fat intake were 1.32 (95% CI 1.01-1.71), 1.16 (95% CI 0.88-1.51), and 1.43 (95% CI 1.09-1.88) for the second, third, and fourth vs the first quartile, respectively. Fully adjusted FRs for saturated fatty acid intake were 1.21 (95% CI 0.94-1.55), 1.16 (95% CI 0.89-1.51), and 1.23 (95% CI 0.94-1.62) for the second, third, and fourth vs the first quartile, respectively. Intakes of monounsaturated, polyunsaturated, trans-, omega-3, and omega-6 fatty acids were not strongly associated with fecundability. Results were similar after adjustment for the female partner's intakes of trans- and omega-3 fats. LIMITATIONS, REASONS FOR CAUTION Dietary intakes estimated from the food frequency questionnaire may be subject to non-differential misclassification, which is expected to bias results toward the null in the extreme categories when exposures are modeled as quartiles. There may be residual confounding by unmeasured dietary, lifestyle, or environmental factors. Sample size was limited, especially in subgroup analyses. WIDER IMPLICATIONS OF THE FINDINGS Our results do not support a strong causal effect of male fatty acid intakes on fecundability among couples attempting to conceive spontaneously. The weak positive associations we observed between male dietary fat intakes and fecundability may reflect a combination of causal associations, measurement error, chance, and residual confounding. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the National Institutes of Health, grant numbers R01HD086742 and R01HD105863. In the last 3 years, PRESTO has received in-kind donations from Swiss Precision Diagnostics (home pregnancy tests) and Kindara.com (fertility app). L.A.W. is a consultant for AbbVie, Inc. M.L.E. is an advisor to Sandstone, Ro, Underdog, Dadi, Hannah, Doveras, and VSeat. The other authors have no competing interests to report. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ruth J Geller
- 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
| | - Martha R Koenig
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael L Eisenberg
- Departments of Urology and Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, 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
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Crowe HM, Wesselink AK, Hatch EE, Wise LA, Jick SS. Migraine and risk of hypertensive disorders of pregnancy: A population-based cohort study. Cephalalgia 2023; 43:3331024231161746. [PMID: 36935588 PMCID: PMC11000583 DOI: 10.1177/03331024231161746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Migraine is associated with hypertensive disorders of pregnancy through common pathophysiological features. This study evaluates the association between migraine diagnosis and treatment, and risk of hypertensive disorders of pregnancy. METHODS We conducted a prospective cohort study in the Clinical Practice Research Datalink GOLD, a large longitudinal database of patient records in the UK. We analyzed data from liveborn or stillborn singleton deliveries from 1993-2020 with at least 24 months of medical history and no history of cardiovascular disease (n = 1,049,839). We ascertained migraine through diagnosis or prescription codes before 20 weeks of gestation and hypertensive disorders of pregnancy through diagnosis codes between 20 weeks of pregnancy and delivery. We used log-binomial regression models to estimate the risk ratio and 95% confidence intervals, comparing risk of hypertensive disorders of pregnancy among individuals with migraine to those without migraine, adjusting for confounders. CONCLUSIONS A history of migraine prior to pregnancy was associated with an increased risk of hypertensive disorders of pregnancy (RR = 1.17, 95% CI: 1.09-1.26). The greatest risk was among those with pre-pregnancy migraine that persisted into the first trimester (RR = 1.84, 95% CI: 1.35-2.50). Use of migraine medication was associated with a higher risk of hypertensive disorders of pregnancy compared to non-migraineurs (RR = 1.50, 95% CI: 1.15-1.97). Results from this study indicate that migraine is a potential risk factor for hypertensive disorders of pregnancy.
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Affiliation(s)
- Holly M Crowe
- Department of Epidemiology, Harvard TH Chan School of Public Health, MA, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, MA, USA
| | - Susan S Jick
- Department of Epidemiology, Boston University School of Public Health, MA, USA
- Boston Collaborative Drug Surveillance Program, MA, USA
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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. Environ Health Perspect 2023; 131:47012. [PMID: 37098782 PMCID: PMC10132140 DOI: 10.1289/ehp10648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Wise LA, Wang TR, Stanford JB, Wesselink AK, Ncube CN, Rothman KJ, Murray EJ. A randomized trial of web-based fertility-tracking software and fecundability. Fertil Steril 2023; 119:1045-1056. [PMID: 36774978 DOI: 10.1016/j.fertnstert.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To assess the effect of randomization to FertilityFriend.com (FF), a mobile computing fertility-tracking app, on fecundability. DESIGN Parallel non-blinded randomized controlled trial nested within Pregnancy Study Online (PRESTO), a North American preconception cohort. SUBJECTS Female participants aged 21-45 years attempting conception for ≤6 menstrual cycles at enrollment (2013-2019). INTERVENTION Randomization (1:1) of 5,532 participants to receive a premium FF subscription. MAIN OUTCOME MEASURES Fecundability (per-cycle probability of conception). Participants completed bimonthly follow-up questionnaires until pregnancy or a censoring event, whichever came first. We first performed an intent-to-treat analysis of the effect of FF randomization on fecundability. In secondary analyses, we used a per-protocol approach that accounted for adherence in each trial arm. In both analyses, we used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CI) comparing those randomized vs. not randomized, and applied inverse probability weights to account for loss-to-follow-up (intent-to-treat and per-protocol analyses) and adherence (per-protocol analyses only). RESULTS Using life-table methods, 64% of the 2,775 participants randomized to FF and 63% of the 2,767 participants not randomized to FF conceived during 12 cycles; these respective percentages were each 70% among those with 0-1 cycles of attempt time at enrollment. Of those randomized to FF, 72% were defined as adherent (68% of observed menstrual cycles). In intent-to-treat analyses, there was no appreciable association overall (FR=0.97, 95% CI: 0.90-1.04) or within strata of pregnancy attempt time at enrollment, age, education, or other characteristics. In per-protocol analyses, we observed little association overall (FR=1.06, 95% CI: 0.99-1.14), but weak-to-moderate positive associations among participants who had longer attempt times at enrollment (FR=1.15, 95% CI: 0.98-1.35 for 3-4 cycles; 1.14, 95% CI: 0.87-1.48 for 5-6 cycles), were aged <25 years (FR=1.29, 95% CI: 1.01-1.66), had ≤12 years of education (FR=1.32, 95% CI: 0.92-1.89), or were non-users of hormonal contraception within 3 months before enrollment (FR=1.10, 95% CI: 1.02-1.19). CONCLUSION No appreciable associations were observed in intent-to-treat analyses. In secondary per-protocol analyses that accounted for adherence, randomization to FF was associated with slightly greater fecundability among selected subgroups of participants; however, these results are susceptible to unmeasured confounding.
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Affiliation(s)
- Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Massachusetts.
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Joseph B Stanford
- Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Collette N Ncube
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
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Willis SK, Wise LA, Laursen ASD, Wesselink AK, Mikkelsen EM, Tucker KL, Rothman KJ, Hatch EE. Glycemic Load, Dietary Fiber, Added Sugar, and Spontaneous Abortion in Two Preconception Cohorts. J Nutr 2023; 152:2818-2826. [PMID: 36057842 PMCID: PMC9839996 DOI: 10.1093/jn/nxac202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/29/2022] [Accepted: 08/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Spontaneous abortion (SAB)-pregnancy loss before the 20th week of gestation-has adverse psychological and physical sequelae. Some medical conditions known to affect insulin sensitivity, including polycystic ovary syndrome and diabetes, can affect the risk of SAB. No prior studies have examined glycemic load and incidence of SAB in populations without conditions known to affect insulin sensitivity. OBJECTIVES We prospectively evaluated the association between preconception glycemic load and intake of carbohydrates, dietary fiber, and added sugar and risk of SAB. METHODS During 2013-2020, we recruited pregnancy planners from Denmark (SnartForaeldre.dk; SF) and the United States and Canada (Pregnancy Study Online; PRESTO). Participants completed a baseline questionnaire and a cohort-specific FFQ evaluated for validity. We estimated preconception glycemic load and intake of carbohydrates, dietary fiber, and added sugar from individual foods and mixed recipes. We included 2238 SF and 4246 PRESTO participants who reported a pregnancy during the course of the study. SAB data were derived from questionnaires and population registries. We used Cox proportional hazards regression to estimate HRs and 95% CIs. RESULTS In the study population, 15% of SF participants and 22% of PRESTO participants experienced SAB. Across both cohorts, there was no appreciable association between glycemic load, carbohydrate quality, dietary fiber, or added sugar intake and SAB. Compared with daily mean glycemic load <110, the HR for women with daily mean glycemic load ≥130 was 0.76 (95% CI: 0.52, 1.10) in SF and 1.01 (95% CI: 0.86, 1.19) in PRESTO. CONCLUSIONS Diets with high glycemic load, carbohydrates, and added sugars were not consistently associated with risk of SAB in parallel analyses of 2 preconception cohort studies of women in North America and Denmark.
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Affiliation(s)
- Sydney K Willis
- 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
| | - Anne Sofie Dam Laursen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- RTI International, Research Triangle Park, NC, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Koenig MR, Wesselink AK, Kuriyama AS, Chaiyasarikul A, Hatch EE, Wise LA. Feasibility of mail-based biospecimen collection in an online preconception cohort study. Front Reprod Health 2023; 4:1052231. [PMID: 36699143 PMCID: PMC9869415 DOI: 10.3389/frph.2022.1052231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Prospective cohort studies that enroll participants before conception are crucial for deepening scientific understanding of how the preconception environment influences reproductive outcomes. While web-based research methods provide efficient and effective strategies to collect questionnaire-based data, few of these studies incorporate biospecimen collection, which can enhance the validity of exposure assessment. There is limited literature on the feasibility and cost-effectiveness of collecting biospecimens in web-based preconception cohort studies. Methods We evaluated the feasibility and cost-effectiveness of in-clinic and mail-based biospecimen collection in Pregnancy Study Online (PRESTO), a North American web-based preconception cohort study. Both members of the couple were eligible to participate if their conception attempt time was ≤3 months at enrollment. We invited study participants from the Boston, MA and Detroit, MI metropolitan areas to attend a study visit and provide urine and blood (hereafter "in-clinic protocol"). We invited all other participants to complete mail-based collection of urine and blood spots (hereafter "mail-based protocol"). We compared overall consent and protocol completion rates, demographic characteristics of those who consented and completed either of the protocols, and costs between mail-based and in-clinic protocols for biospecimen collection. Finally, we described logistical challenges pertaining to reliance on mail-based delivery of time-sensitive biospecimens compared with in-clinic methods. Results During January 2022-July 2022, 69% of female participants (134/195) and 42% of male participants (31/74) consented to participate in the mail-based protocol. Consent rates for the in-clinic protocol were 39% for female participants (289/739 during March 2014-July 2022) and 25% for male participants (40/157 during March 2017-July 2022). Participants who consented to participate were generally of higher socioeconomic position than non-participants. Deviations from the protocol occurred more frequently within the mail-based protocol but were easily corrected. The cost per participant enrolled was similar across protocols (mail-based: $276.14 vs. in-clinic: $270.38). Conclusions Our results indicate that mail-based collection of biospecimens may create opportunities to recruit a larger and more geographically diverse participant population at a comparable cost-per-participant enrolled to in-clinic methods.
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Lund KH, Laursen ASD, Grønborg TK, Toft G, Jacobsen BH, Wang TR, Wesselink AK, Hatch EE, Sommer GJ, Eisenberg ML, Rothman KJ, Sørensen HT, Wise LA, Mikkelsen EM. Perceived stress and semen quality. Andrology 2023; 11:45-53. [PMID: 36151857 PMCID: PMC10092477 DOI: 10.1111/andr.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychological stress is prevalent among reproductive-aged men. Assessment of semen quality for epidemiological studies is challenging as data collection is expensive and cumbersome, and studies evaluating the effect of perceived stress on semen quality are inconsistent. OBJECTIVE To examine the association between perceived stress and semen quality. MATERIAL AND METHODS We analyzed baseline data on 644 men (1,159 semen samples) from two prospective preconception cohort studies during 2015-2021: 592 in Pregnancy Study Online (PRESTO) and 52 in SnartForaeldre.dk (SF). At study entry, men aged ≥21 years (PRESTO) and ≥18 years (SF) trying to conceive without fertility treatment completed a questionnaire on reproductive and medical history, socio-demographics, lifestyle, and the 10-item version of the Perceived Stress Scale (PSS; interquartile range [IQR] of scores: 0-40). After enrollment (median weeks: 2.1, IQR: 1.3-3.7), men were invited to perform in-home semen testing, twice with 7-10 days between tests, using the Trak Male Fertility Testing System. Semen quality was characterized by semen volume, sperm concentration, and total sperm count. We fit generalized estimating equation linear regression models to estimate the percent difference in mean log-transformed semen parameters by four PSS groups (<10, 10-14, 15-19, ≥20), adjusting for potential confounders. RESULTS The median PSS score and IQR was 15 (10-19), and 136 men (21.1%) had a PSS score ≥20. Comparing men with PSS scores ≥20 with <10, the adjusted percent difference was -2.7 (95% CI: -9.8; 5.0) for semen volume, 6.8 (95% CI: -10.9; 28.1) for sperm concentration, and 4.3 (95% CI: -13.8; 26.2) for total sperm count. CONCLUSION Our findings indicate that perceived stress is not materially associated with semen volume, sperm concentration, or total sperm count.
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Affiliation(s)
- Katrine H Lund
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Sofie D Laursen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Therese K Grønborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarke H Jacobsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Greg J Sommer
- Laboratory Corporation of America, Pleasanton, California, USA
| | | | - Kenneth J Rothman
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,RTI, Health Solutions, Research Triangle Park, Triangle Park, North Carolina, USA
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Weissert SJ, Mikkelsen EM, Jacobsen BH, Hatch EE, Wesselink AK, Wise LA, Rothman KJ, Sørensen HT, Laursen ASD. Organic food consumption and fecundability in a preconception cohort study of Danish couples trying to conceive. Paediatr Perinat Epidemiol 2023; 37:57-68. [PMID: 36071679 PMCID: PMC10087289 DOI: 10.1111/ppe.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about potential health effects of eating organic food in relation to reproduction. OBJECTIVE We examined associations between organic food consumption and fecundability. METHODS Data were derived from a preconception cohort study of Danish couples trying to conceive (SnartForaeldre.dk, SF). Participants completed a baseline questionnaire on socio-demographics, anthropometrics and lifestyle and a validated food-frequency questionnaire, which included questions on proportions of organic food consumed within six food groups. Participants were followed up with bimonthly questionnaires for up to 12 months or until pregnancy. Analyses were restricted to 2061 participants attempting pregnancy for ≤6 cycles at enrollment and 1303 with <3 cycles. Fecundability ratios (FRs) and 95% confidence intervals (CI) were estimated by proportional probabilities regression models adjusted for potential confounders including age, lifestyle and socioeconomic factors. Associations were examined for vegetables, fruits, cereals, dairy products, eggs and meat, separately, and for the overall pattern of organic food consumption (organic sum score). RESULTS The final analytic sample comprised 2069 participants. In the full cohort, organic food consumption was not meaningfully associated with fecundability. Among participants <3 cycles of pregnancy attempt at study entry (n = 1303), the FR was 1.11 (95% CI 0.93, 1.33) for the category 'less than half', for 'more than half' the FR was 1.17 (95% CI 0.99, 1.38) and for 'almost everything' the FR was 1.12 (95% CI 0.97, 1.28). CONCLUSION Higher consumption of organic foods was not meaningfully associated with fecundability, although slightly greater fecundability was seen among participants with <3 cycles of pregnancy attempt time.
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Affiliation(s)
- Sissel Jessen Weissert
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Bjarke H Jacobsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Anne Sofie Dam Laursen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Crowe HM, Wesselink AK, Wise LA, Jick SS, Rothman KJ, Mikkelsen EM, Sørensen HT, Hatch EE. Pre-pregnancy migraine diagnosis, medication use, and spontaneous abortion: a prospective cohort study. J Headache Pain 2022; 23:162. [PMID: 36539705 PMCID: PMC9764528 DOI: 10.1186/s10194-022-01533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Migraine is common among females of reproductive age (estimated prevalence:17-24%) and may be associated with reproductive health through underlying central nervous system excitability, autoimmune conditions, and autonomic dysfunction. We evaluated the extent to which pre-pregnancy migraine diagnosis and medication use are associated with risk of spontaneous abortion (SAB). METHODS We analyzed data from a preconception study of pregnancy planners (2013-2021). Eligible participants self-identified as female, were aged 21-45 years, resided in the USA or Canada, and conceived during follow-up (n = 7890). Participants completed baseline and bimonthly follow-up questionnaires for up to 12 months or until a reported pregnancy, whichever occurred first. Pregnant participants then completed questionnaires during early (~ 8-9 weeks) and late (~ 32 weeks) gestation. We defined migraineurs as participants who reported a migraine diagnosis or use of a medication to treat migraine. Preconception questionnaires elicited migraine medication use during the past 4 weeks, and SAB on follow-up and pregnancy questionnaires. We used Cox regression models with gestational weeks as the time scale to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations among preconception migraine, migraine medication use, and SAB, controlling for potential demographic, medical, and lifestyle confounders. RESULTS Nineteen percent of study pregnancies ended in SAB. History of migraine before conception was not appreciably associated with SAB risk (HR = 1.03, 95% CI: 0.91-1.06). Use of any migraine medication was associated with a modest increase in SAB risk overall (HR = 1.14, 95% CI: 0.96-1.36). We observed the greatest increase in risk among those taking migraine medications daily (HR = 1.38, 95% CI: 0.81-2.35) and those taking prescription migraine prophylaxis (HR = 1.43, 95% CI: 0.72-2.84) or combination analgesic and caffeine medications (HR = 1.42, 95% CI: 0.99-2.04). CONCLUSIONS Migraine medication use patterns suggesting greater underlying migraine severity were associated with increased risk of SAB. This research adds to the limited information available on the reproductive effects of migraine.
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Affiliation(s)
- Holly M. Crowe
- grid.189504.10000 0004 1936 7558Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Avenue, Boston, MA 02115 USA ,grid.189504.10000 0004 1936 7558Boston University School of Public Health, Department of Epidemiology, 715 Albany Street, Boston, MA 02118 USA
| | - Amelia K. Wesselink
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Department of Epidemiology, 715 Albany Street, Boston, MA 02118 USA
| | - Lauren A. Wise
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Department of Epidemiology, 715 Albany Street, Boston, MA 02118 USA
| | - Susan S. Jick
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Department of Epidemiology, 715 Albany Street, Boston, MA 02118 USA
| | - Kenneth J. Rothman
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Department of Epidemiology, 715 Albany Street, Boston, MA 02118 USA
| | - Ellen M. Mikkelsen
- grid.7048.b0000 0001 1956 2722Aarhus University, Department of Clinical Epidemiology, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark
| | - Henrik T. Sørensen
- grid.7048.b0000 0001 1956 2722Aarhus University, Department of Clinical Epidemiology, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark
| | - Elizabeth E. Hatch
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Department of Epidemiology, 715 Albany Street, Boston, MA 02118 USA
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Bond JC, Abrams J, Wesselink AK, White KO, Rothman KJ, Wise LA. Predictors of Non-Response to a Sexual Health Survey in a North American Preconception Cohort Study. J Sex Med 2022; 19:1707-1715. [PMID: 36182572 PMCID: PMC9617790 DOI: 10.1016/j.jsxm.2022.08.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Refusal to participate in studies related to sexual health can compromise the internal and external validity of findings. Research examining non-response to sexual health studies has primarily focused on predictors such as specific sexual attitudes and behaviors. AIM Evaluate predictors of non-response to a supplemental sexual health survey added to a web-based cohort study, focusing on predictors that may be important in epidemiologic studies of sexual health. METHODS In March 2021, we added the "Sexual Health and Wellbeing Questionnaire" (SQ), an optional supplemental sexual health survey, to the protocol for Pregnancy Study Online , a web-based North American prospective cohort study. Eligible participants identified as female and were aged 21-45 years, actively trying to conceive, and in a relationship with a male partner. Participants completed a baseline questionnaire at enrollment and follow-up questionnaires every 8 weeks. Participants were invited to complete the SQ 30 days after baseline questionnaire completion. The analytic sample included all Pregnancy Study Online participants who enrolled between March 2021 and December 2021 and was divided into 3 mutually-exclusive groups: (i) those who completed the baseline questionnaire only (ie, did not complete a follow-up questionnaire or the SQ), (ii) those who completed at least 1 follow-up questionnaire but not the SQ, and (iii) participants who completed the SQ (with or without a follow-up questionnaire). We compared sociodemographic, medical, lifestyle, and reproductive factors across these groups. RESULTS Of the 1,491 enrolled participants, 302 (20.3%) completed the baseline questionnaire only, 259 (17.4%) completed a follow-up questionnaire but not the SQ, and 930 (62.4%) completed the SQ. Strong predictors of non-response (absolute difference in response >10% comparing SQ responders to baseline-only responders) included longer pregnancy attempt time at study entry, a history of infertility, and lower income and education. Compared with response to the follow-up questionnaire only, SQ response was lower among Hispanic/Latina participants and participants aged <25 years. CLINICAL TRANSLATION The addition of sexual health surveys to established cohort studies may be an effective way to expand epidemiologic sex research efforts. STRENGTHS & LIMITATIONS Study strengths include the prospective design, geographic heterogeneity of the cohort, and use of online methods. Our findings may not generalize to clinic-based sex research. CONCLUSION We report that in an established North American cohort study, response to the SQ exceeded 60%. We observed few strong predictors for SQ non-response among engaged participants. Bond JC, Abrams J, Wesselink AK, et al. Predictors of Non-Response to a Sexual Health Survey in a North American Preconception Cohort Study. J Sex Med 2022;19:1707-1715.
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Affiliation(s)
- Julia C Bond
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Jasmine Abrams
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA; Maternal and Child Health Center of Excellence, Boston University School of Public Health, Boston, MA, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Katharine O White
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Kenneth J Rothman
- 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
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McKinnon CJ, Joglekar DJ, Hatch EE, Rothman KJ, Wesselink AK, Willis MD, Wang TR, Mikkelsen EM, Eisenberg ML, Wise LA. Male personal heat exposures and fecundability: A preconception cohort study. Andrology 2022; 10:1511-1521. [PMID: 35924639 PMCID: PMC9588744 DOI: 10.1111/andr.13242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies indicate adverse effects of selected heat exposures on semen quality, but few studies have directly evaluated fertility as an endpoint. OBJECTIVE We evaluated prospectively the association between male heat exposures and fecundability, the per-cycle probability of conception. MATERIALS AND METHODS We analyzed data from 3041 couples residing in the United States or Canada who enrolled in a prospective preconception cohort study (2013-2021). At enrollment, males reported on several heat-related exposures, such as use of saunas, hot baths, seat heaters, and tight-fitting underwear. Pregnancy status was updated on female follow-up questionnaires every 8 weeks until conception or a censoring event (initiation of fertility treatment, cessation of pregnancy attempts, withdrawal, loss to follow-up, or 12 cycles), whichever came first. We used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CIs) for the association between heat exposures and fecundability, mutually adjusting for heat exposures and other potential confounders. RESULTS We observed small inverse associations for hot bath/tub use (≥3 vs. 0 times/month: FR = 0.87, 95% CI: 0.70-1.07) and fever in the 3 months before baseline (FR = 0.94, 95% CI: 0.79-1.12; one cycle of follow-up: FR = 0.84, 95% CI: 0.64-1.11). Little association was found for sauna use, hours of laptop use on one's lap, seat heater use, time spent sitting, and use of tight-fitting underwear. Based on a cumulative heat metric, FRs for 1, 2, 3, and ≥4 versus 0 heat exposures were 0.99 (95% CI: 0.87-1.12), 1.03 (95% CI: 0.89-1.19), 0.94 (95% CI: 0.74-1.19), and 0.77 (95% CI: 0.50-1.17), respectively. Associations were stronger among men aged ≥30 years (≥4 vs. 0 heat exposures: FR = 0.60, 95% CI: 0.34-1.04). CONCLUSION Male use of hot tubs/baths and fever showed weak inverse associations with fecundability. Cumulative exposure to multiple heat sources was associated with a moderate reduction in fecundability, particularly among males aged ≥30 years.
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Affiliation(s)
- Craig J. McKinnon
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Dhruv J. Joglekar
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194 Research Triangle Park, North Carolina, 27709
| | - Amelia K. Wesselink
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Mary D. Willis
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Tanran R. Wang
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Ellen M. Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45 8200 Aarhus N, Denmark
| | - Michael L. Eisenberg
- Department of Urology and Obstetrics & Gynecology, Stanford University School of Medicine, 291 Campus Drive, Stanford, California
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
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Willis SK, Hatch EE, Laursen AS, Wesselink AK, Mikkelsen EM, Tucker KL, Rothman KJ, Mumford SL, Wise LA. Dietary patterns and fecundability in 2 prospective preconception cohorts. Am J Clin Nutr 2022; 116:1441-1451. [PMID: 36192441 PMCID: PMC9630871 DOI: 10.1093/ajcn/nqac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/05/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Diet is increasingly recognized as an important determinant of human fertility, with most research focused on specific nutrients or food groups. However, there has been limited assessment of the effect of dietary patterns on fertility. OBJECTIVES We evaluated the association between 4 dietary patterns [the alternative Mediterranean Diet (aMed), the Healthy Eating Index-2010 (HEI-2010), the Danish Dietary Guidelines (DDGI), and the Dietary Inflammatory Index (DII)] and fecundability in 2 preconception cohorts of couples trying to conceive: SF (SnartForaeldre.dk) in Denmark and PRESTO (Pregnancy Study Online) in North America. METHODS Participants completed a baseline questionnaire on sociodemographic, anthropometric, and lifestyle factors and, 10 d later, a validated cohort-specific FFQ. We used data from these respective FFQs to calculate adherence to each dietary pattern. Participants completed bimonthly follow-up questionnaires for ≤12 mo or until pregnancy, whichever came first. We restricted analyses to 3429 SF and 5803 PRESTO participants attempting pregnancy for ≤6 cycles at enrollment. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% CIs, adjusting for potential confounders. RESULTS Greater DII, indicative of a less anti-inflammatory diet (i.e., poorer diet quality), was associated with reduced fecundability in both SF and PRESTO (DII ≥ -1.5 compared with < -3.3: FR: 0.83; 95% CI: 0.71, 0.97 and FR: 0.82; 95% CI: 0.73, 0.93, respectively). In PRESTO, greater adherence to the aMed or to the HEI-2010 was associated with greater fecundability. In SF, there was no appreciable association between the aMed and fecundability, whereas greater adherence to the DDGI was associated with greater fecundability. CONCLUSIONS In prospective preconception cohort studies from Denmark and North America, higher-quality diets, including diets lower in inflammatory effects, were associated with greater fecundability.
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Affiliation(s)
- Sydney K Willis
- 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
| | - Anne Sd Laursen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; RTI International, Research Triangle Park, NC, USA
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Eisenberg M, Zhang CA, Wang TR, Harlow AF, Wesselink AK, Hatch EE, Wise LA. THE ASSOCIATION BETWEEN A HISTORY OF PATERNAL VAPING AND SPONTANEOUS ABORTION. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Lovett SM, Fox MP, Gradus JL, Wesselink AK, Boynton-Jarrett R, Nillni YI, Wise LA. Bias analysis of childhood trauma and probable post-traumatic stress disorder. Ann Epidemiol 2022. [DOI: 10.1016/j.annepidem.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yland JJ, Wesselink AK, Lash TL, Fox MP. Yland et al. Respond to "Heuristics and Wish Bias". Am J Epidemiol 2022; 191:1498-1499. [PMID: 35641149 PMCID: PMC9989357 DOI: 10.1093/aje/kwac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Jennifer J Yland
- Correspondence to Jennifer J. Yland, Department of Epidemiology, School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118 (e-mail: )
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Wesselink AK, Hatch EE, Rothman KJ, Wang TR, Willis MD, Yland J, Crowe HM, Geller RJ, Willis SK, Perkins RB, Regan AK, Levinson J, Mikkelsen EM, Wise LA. A Prospective Cohort Study of COVID-19 Vaccination, SARS-CoV-2 Infection, and Fertility. Am J Epidemiol 2022; 191:1383-1395. [PMID: 35051292 PMCID: PMC8807200 DOI: 10.1093/aje/kwac011] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 01/28/2023] Open
Abstract
Some reproductive-aged individuals remain unvaccinated against coronavirus disease 2019 (COVID-19) because of concerns about potential adverse effects on fertility. Using data from an internet-based preconception cohort study, we examined the associations of COVID-19 vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with fertility among couples trying to conceive spontaneously. We enrolled 2,126 self-identified female participants aged 21-45 year residing in the United States or Canada during December 2020-September 2021 and followed them through November 2021. Participants completed questionnaires every 8 weeks on sociodemographics, lifestyle, medical factors, and partner information. We fit proportional probabilities regression models to estimate associations between self-reported COVID-19 vaccination and SARS-CoV-2 infection in both partners with fecundability (i.e., the per-cycle probability of conception), adjusting for potential confounders. COVID-19 vaccination was not appreciably associated with fecundability in either partner (female fecundability ratio (FR) = 1.08, 95% confidence interval (CI): 0.95, 1.23; male FR = 0.95, 95% CI: 0.83, 1.10). Female SARS-CoV-2 infection was not strongly associated with fecundability (FR = 1.07, 95% CI: 0.87, 1.31). Male infection was associated with a transient reduction in fecundability (for infection within 60 days, FR = 0.82, 95% CI: 0.47, 1.45; for infection after 60 days, FR = 1.16, 95% CI: 0.92, 1.47). These findings indicate that male SARS-CoV-2 infection may be associated with a short-term decline in fertility and that COVID-19 vaccination does not impair fertility in either partner.
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Affiliation(s)
- Amelia K Wesselink
- Correspondence to Amelia K. Wesselink, Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, T3E, Boston, MA 02118 (e-mail: )
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Yland JJ, Wesselink AK, Lash TL, Fox MP. Misconceptions About the Direction of Bias From Nondifferential Misclassification. Am J Epidemiol 2022; 191:1485-1495. [PMID: 35231925 PMCID: PMC9989338 DOI: 10.1093/aje/kwac035] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/22/2022] [Indexed: 01/28/2023] Open
Abstract
Measurement error is pervasive in epidemiologic research. Epidemiologists often assume that mismeasurement of study variables is nondifferential with respect to other analytical variables and then rely on the heuristic that "nondifferential misclassification will bias estimates towards the null." However, there are many exceptions to the heuristic for which bias towards the null cannot be assumed. In this paper, we compile and characterize 7 exceptions to this rule and encourage analysts to take a more critical and nuanced approach to evaluating and discussing bias from nondifferential mismeasurement.
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Affiliation(s)
- Jennifer J Yland
- Correspondence to Jennifer J. Yland, Department of Epidemiology, School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118 (e-mail: )
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Schildroth S, Wise LA, Wesselink AK, Bethea TN, Fruh V, Taylor KW, Calafat AM, Baird DD, Claus Henn B. Correlates of non-persistent endocrine disrupting chemical mixtures among reproductive-aged Black women in Detroit, Michigan. Chemosphere 2022; 299:134447. [PMID: 35358566 PMCID: PMC9215202 DOI: 10.1016/j.chemosphere.2022.134447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Some studies indicate that Black women have higher exposure to multiple non-persistent endocrine disrupting chemicals (EDCs) than white women, but little is known about correlates of exposure to EDC mixtures. Using baseline data from a prospective cohort study of reproductive-aged Black women (N = 751), we characterized profiles of EDC mixtures and identified correlates of exposure. At baseline, we quantified biomarkers of 16 phthalates, 7 phenols, 4 parabens, and triclocarban in urine and collected covariate data through self-administered questionnaires and interviews. We used principal component (PC) analysis and k-means clustering to describe EDC mixture profiles. Associations between correlates and PCs were estimated as the mean difference (β) in PC scores, while associations between correlates and cluster membership were estimated as the odds ratio (OR) of cluster membership. Personal care product use was consistently associated with profiles of higher biomarker concentrations of non-persistent EDCs. Use of nail polish, menstrual and vaginal products (e.g., vaginal powder, vaginal deodorant), and sunscreen was associated with a mixture of phthalate and some phenol biomarkers using both methods. Current vaginal ring use, a form of hormonal contraception placed inside the vagina, was strongly associated with higher concentrations of high molecular weight phthalate biomarkers (k-means clustering: OR = 2.42, 95% CI = 1.28, 4.59; PCA: β = -0.32, 95% CI = -0.71, 0.07). Several dietary, reproductive, and demographic correlates were also associated with mixtures of EDC biomarkers. These findings suggest that personal care product use, diet, and contraceptive use may be sources of exposure to multiple non-persistent EDCs among reproductive-aged Black women. Targeted interventions to reduce exposure to multiple EDCs among Black women are warranted.
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Affiliation(s)
- Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Lauren A Wise
- 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
| | - Traci N Bethea
- Office of Minority Health & Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Kyla W Taylor
- National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donna D Baird
- National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Laursen ASD, Johannesen BR, Willis SK, Hatch EE, Wise LA, Wesselink AK, Rothman KJ, Sørensen HT, Mikkelsen EM. Adherence to Nordic dietary patterns and risk of first-trimester spontaneous abortion. Eur J Nutr 2022; 61:3255-3265. [DOI: 10.1007/s00394-022-02886-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/31/2022] [Indexed: 11/04/2022]
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Cueto HT, Jacobsen BH, Laursen ASD, Riis AH, Hatch EE, Wise LA, Trolle E, Sørensen HT, Rothman KJ, Wesselink AK, Willis S, Johannesen BR, Mikkelsen EM. Dietary folate intake and fecundability in two preconception cohorts. Hum Reprod 2022; 37:828-837. [PMID: 35051293 PMCID: PMC8971647 DOI: 10.1093/humrep/deac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/28/2021] [Indexed: 01/22/2023] Open
Abstract
STUDY QUESTION To what extent is dietary folate intake and total folate intake (dietary and supplemental intakes) associated with fecundability, the per cycle probability of conception? SUMMARY ANSWER Preconception dietary folate intake was positively associated with fecundability in a monotonic pattern. WHAT IS KNOWN ALREADY Supplemental folic acid has been associated with improved fertility, but little is known about the relation between dietary folate and fecundability. STUDY DESIGN, SIZE, DURATION A prospective cohort study including 9559 women trying to conceive without fertility treatment and enrolled in the period 2013-2020. PARTICIPANTS/MATERIALS, SETTING, METHODS We used data from two internet-based prospective cohort studies of pregnancy planners from Denmark, where folic acid fortification is not performed (SnartForældre.dk (SF); n = 3755) and North America, where the food supply is fortified with folic acid (Pregnancy Study Online (PRESTO); n = 5804). Women contributed menstrual cycles at risk until they reported conception or experienced a censoring event. We used proportional probabilities regression models to compute fecundability ratios (FRs) and 95% CI, adjusting for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE Compared with a dietary folate intake ≥400 µg/day, the adjusted FRs for women in SF were 0.92 (95% CI: 0.85-0.99) for intake 250-399 µg/day, and 0.80 (95% CI: 0.68-0.94) for intake of <250 µg/day. The corresponding FRs in PRESTO were 0.95 (95% CI: 0.89-1.01) and 0.81 (95% CI: 0.65-1.00). Compared with the highest level of total folate intake (diet folate ≥400 µg/day plus folic acid supplementation), in both cohorts fecundability was lowest among women with the lowest dietary intake <250 µg/day dietary folate and no supplementation (FR: 0.76, 95% CI: 0.59-0.98 [SF] and 0.49, 95% CI: 0.31-0.77 [PRESTO]). Further, total intake dietary folate <250 µg/day plus supplementation was associated with reduced fecundability for SF participants (FR; 0.79, 95% CI: 0.65-0.98) and for PRESTO participants (FR; 0.92, 95% CI: 0.72-1.16). LIMITATIONS, REASONS FOR CAUTION It is unknown whether dietary folate and folic acid intake affect fecundability on its own or if there is an interaction with other micronutrients provided in healthy diet. Thus, the observed associations may not reflect dietary folate intake alone, but overall healthy diet. WIDER IMPLICATIONS OF THE FINDINGS Recommendations for preconception dietary folate intake and folic acid supplementation are of importance not only to prevent neural tube defects but also to enhance fecundability. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the National Institute of Child Health and Human Development (R01-HD086742). The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Heidi T Cueto
- The Danish Clinical Quality Program and National Clinical Registries (RKKP), Aarhus, Denmark,Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Bjarke H Jacobsen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Anne Sofie Dam Laursen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Anders H Riis
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - 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
| | - Ellen Trolle
- National Food Institute, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA,RTI International, Research Triangle Park, NC, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sydney Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Benjamin R Johannesen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark,Correspondence address. Department of Clinical Epidemiology, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. E-mail: https://orcid.org/0000-0003-0158-7950
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Wise LA, Wesselink AK, Schildroth S, Calafat AM, Bethea TN, Geller RJ, Coleman CM, Fruh V, Claus Henn B, Botelho JC, Harmon QE, Thirkill M, Wegienka GR, Baird DD. Correlates of plasma concentrations of per- and poly-fluoroalkyl substances among reproductive-aged Black women. Environ Res 2022; 203:111860. [PMID: 34403666 PMCID: PMC8616815 DOI: 10.1016/j.envres.2021.111860] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals used in commercial and consumer goods. Black women are underrepresented in studies of PFAS exposure. METHODS We performed a cross-sectional analysis of correlates of plasma PFAS concentrations among 1499 Black women aged 23-35 participating in the Study of Environment, Lifestyle, and Fibroids (SELF), a Detroit-based cohort study. At baseline (2010-2012), participants provided questionnaire data on socio-demographics; behaviors; diet; and menstrual, contraceptive, and reproductive histories. Using mass spectrometry in non-fasting plasma samples collected at enrollment, we quantified several PFAS, including perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorodecanoate (PFDA), perfluoroundecanoate (PFUnDA), and 2-N-methyl-perfluorooctane sulfonamido acetate (MeFOSAA). We used linear regression to calculate percentage differences (%D) and 95 % confidence intervals (CIs) for associations between selected correlates and PFAS concentrations, adjusting for all other correlates. RESULTS PFHxS, PFOS, PFOA, and PFNA were detected in ≥97 % of women; PFDA in 86 %; MeFOSAA in 70 %; and PFUnDA in 52 %. Age, income, education, and intakes of water, alcohol, and seafood were positively associated with several PFAS. Current smoking was positively associated with MeFOSAA. Body mass index was inversely associated with most PFAS, except PFHxS. Strong inverse associations (%D; 95 % CI) were observed between parity (≥3 vs. 0 births) and PFHxS (-34.7; -43.0, -25.1) and PFOA (-33.1; -39.2, -26.3); breastfeeding duration (≥6 months vs. nulliparous) and PFOA (-31.1; -37.8, -23.7), PFHxS (-24.2; -34.5, -12.3), and PFOS (-18.4; -28.3, -7.1); recent birth (<2 years ago vs. nulliparous) and PFOA (-33.1; -39.6, -25.8), PFHxS (-29.3; -39.0, -18.1), PFNA (-25.2; -32.7, -16.8), and PFOS (-18.3; -28.3, -6.9); and intensity of menstrual bleed (heavy vs. light) and PFHxS (-18.8; -28.3, -8.2), PFOS (-16.4; -24.9, -7.1), PFNA (-10.5; -17.8, -2.6), and PFOA (-10.0; -17.2, -2.1). Current use of depot medroxyprogesterone acetate (DMPA) was positively associated with PFOS (20.2; 1.4, 42.5), PFOA (16.2; 1.5, 33.0), and PFNA (15.3; 0.4, 32.4). CONCLUSIONS Reproductive factors that influence PFAS elimination showed strong associations with several PFAS (reduced concentrations with parity, recent birth, lactation, heavy menstrual bleeding; increased concentrations with DMPA use).
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Affiliation(s)
- Lauren A Wise
- 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
| | - Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Traci N Bethea
- Office of Minority Health & Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Ruth J Geller
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Chad M Coleman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Julianne C Botelho
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quaker E Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Maya Thirkill
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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Wesselink AK, Wang TR, Ketzel M, Mikkelsen EM, Brandt J, Khan J, Hertel O, Laursen ASD, Johannesen BR, Willis MD, Levy JI, Rothman KJ, Sørensen HT, Wise LA, Hatch EE. Air pollution and fecundability: Results from a Danish preconception cohort study. Paediatr Perinat Epidemiol 2022; 36:57-67. [PMID: 34890081 PMCID: PMC8712376 DOI: 10.1111/ppe.12832] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/24/2021] [Accepted: 10/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Animal and epidemiologic studies indicate that air pollution may adversely affect fertility. Epidemiologic studies have been restricted largely to couples undergoing fertility treatment or have retrospectively ascertained time-to-pregnancy among pregnant women. OBJECTIVES We examined the association between residential ambient air pollution and fecundability, the per-cycle probability of conception, in a large preconception cohort of Danish pregnancy planners. METHODS During 2007-2018, we used the Internet to recruit and follow women who were trying to conceive without the use of fertility treatment. Participants completed an online baseline questionnaire eliciting socio-demographic characteristics, lifestyle factors, and medical and reproductive histories and follow-up questionnaires every 8 weeks to ascertain pregnancy status. We determined concentrations of ambient nitrogen oxides (NOx ), nitrogen dioxide (NO2 ), carbon monoxide (CO), ozone (O3 ), particulate matter <2.5 µm (PM2.5 ) and <10 µm (PM10 ), and sulphur dioxide (SO2 ) at each participant's residential address. We calculated average exposure during the year before baseline, during each menstrual cycle over follow-up and during the entire pregnancy attempt time. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for potential confounders and co-pollutants. The analysis was restricted to the 10,183 participants who were trying to conceive for <12 cycles at study entry whose addresses could be geocoded. RESULTS During 12 months of follow-up, 73% of participants conceived. Higher concentrations of PM2.5 and PM10 were associated with small reductions in fecundability. For example, the FRs for a one interquartile range (IQR) increase in PM2.5 (IQR = 3.2 µg/m3 ) and PM10 (IQR = 5.3 µg/m3 ) during each menstrual cycle were 0.93 (95% CI: 0.87, 0.99) and 0.91 (95% CI: 0.84, 0.99), respectively. Other air pollutants were not appreciably associated with fecundability. CONCLUSIONS In this preconception cohort study of Danish women, residential exposures to PM2.5 and PM10 were associated with reduced fecundability.
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Affiliation(s)
- Amelia K. Wesselink
- 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
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Ellen M. Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate, interdisciplinary Centre for Climate Change, Aarhus University, Aarhus, Denmark
| | - Jibran Khan
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Denmark
| | - Anne Sofie D. Laursen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Benjamin R. Johannesen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mary D. Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Research Triangle Institute, Durham, NC, USA
| | - Henrik T. Sørensen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lauren A. Wise
- 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
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Wesselink AK, Wellenius GA. Impacts of climate change on reproductive, perinatal and paediatric health. Paediatr Perinat Epidemiol 2022; 36:1-3. [PMID: 34951027 DOI: 10.1111/ppe.12839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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47
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Schildroth S, Wise LA, Wesselink AK, De La Cruz P, Bethea TN, Weuve J, Fruh V, Botelho JC, Sjodin A, Calafat AM, Baird DD, Henn BC. Correlates of Persistent Endocrine-Disrupting Chemical Mixtures among Reproductive-Aged Black Women. Environ Sci Technol 2021; 55:14000-14014. [PMID: 34591461 PMCID: PMC9215200 DOI: 10.1021/acs.est.1c02549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Black women are exposed to multiple endocrine-disrupting chemicals (EDCs), but few studies have examined their profiles of exposure to EDC mixtures. We identified biomarker profiles and correlates of exposure to EDC mixtures in a cross-sectional analysis of data from a prospective cohort study of 749 Black women aged 23-35 years. We quantified plasma concentrations of polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), organochlorine pesticides (OCPs), and per- and polyfluoroalkyl substances (PFAS) in nonfasting samples collected at baseline. Demographic, behavioral, dietary, and reproductive covariates were also collected at baseline. We used k-means clustering and principal component analysis (PCA) to describe concentration profiles of EDC mixtures (17 PCBs, 6 PBDEs, 4 OCPs, 6 PFAS), followed by multinomial logistic and multivariable linear regression to estimate mean differences in PCA scores (β) and odds ratios (ORs) of cluster membership with their respective 95% confidence intervals (CIs). Older age (per 1 year increase: β = 0.47, CI = 0.39, 0.54; OR = 1.27, CI = 1.20, 1.35), lower body mass index (per 1 kg/m2 increase: β = -0.14, CI = -0.17, -0.12; OR = 0.91, CI = 0.89, 0.94), and current smoking (≥10 cigarettes/day vs never smokers: β = 1.37, CI = 0.20, 2.55; OR = 2.63, CI = 1.07, 6.50) were associated with profiles characterized by higher concentrations of all EDCs. Other behaviors and traits, including dietary factors and years since last birth, were also associated with EDC mixtures.
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Affiliation(s)
- Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston, USA
- Corresponding Author: Samantha Schildroth.
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Amelia K. Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Payton De La Cruz
- Department of Pathology and Laboratory Medicine, Brown University, Providence, USA
| | - Traci N. Bethea
- Office of Minority Health & Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Victoria Fruh
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, USA
| | - Julianne C. Botelho
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, USA
| | - Andreas Sjodin
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, USA
| | - Donna D. Baird
- National Institute of Environmental Health Sciences, Durham, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, USA
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48
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Wise LA, Wang TR, Wesselink AK, Willis SK, Chaiyasarikul A, Levinson JS, Rothman KJ, Hatch EE, Savitz DA. Accuracy of self-reported birth outcomes relative to birth certificate data in an Internet-based prospective cohort study. Paediatr Perinat Epidemiol 2021; 35:590-595. [PMID: 33956369 PMCID: PMC8380669 DOI: 10.1111/ppe.12769] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The accuracy of birth outcome data provided by Internet-based cohort study participants has not been well studied. METHODS We compared self-reported data on birth characteristics in Pregnancy Study Online (PRESTO), an Internet-based prospective cohort study of North American pregnancy planners, with birth certificate data. At enrolment, participants were aged 21-45 years, attempting conception, and not using fertility treatment. Women completed online questionnaires during preconception, early and late pregnancy, and postpartum. We requested birth certificate data during 2014-2019 from seven health departments in states with the most participants. After restricting to singleton births, we assessed specificity, sensitivity, and agreement comparing self-reported data from postpartum questionnaires with birth certificate data for gestational age at delivery (GA) and birthweight (grams). Our primary measure of self-reported GA (weeks) was calculated as [280-(due date-birth date)]/7. We used log-binomial regression to assess predictors of agreement. RESULTS We linked 85% (771/909) of women in selected states. Median age of women was 30 years (range: 21-42), 84% had ≥ 16 years of education, nearly 96% were married, 12% had household incomes <$50 000, 32% were parous, and 85% identified as non-Hispanic White. Median recall interval was 6 months. Among those with self-reported data, 89% reported the same GA as the birth certificate and 98% reported GA within 1 week of the birth certificate. Self-report of preterm birth (GA < 37 weeks) agreed with information from birth certificates for 100% of women; sensitivity was 100%, and specificity was 99%. Self-reported low birthweight (<2500 grams) agreed with birth certificates for 93% of women; sensitivity and specificity were 93% and ≥99%, respectively. Predictors of poorer agreement included higher parity and longer pregnancy attempt time for GA, and lower education and longer recall interval for birthweight. CONCLUSION Self-reported data on GA and birthweight from an Internet-based cohort showed high accuracy compared with birth certificates.
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Affiliation(s)
- Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Tanran R. Wang
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Amelia K. Wesselink
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Sydney K. Willis
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Alina Chaiyasarikul
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Jessica S. Levinson
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, Massachusetts,RTI Health Solutions, Research Triangle Park, North Carolina
| | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - David A. Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
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49
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Wesselink AK, Rosenberg L, Wise LA, Jerrett M, Coogan PF. A prospective cohort study of ambient air pollution exposure and risk of uterine leiomyomata. Hum Reprod 2021; 36:2321-2330. [PMID: 33984861 DOI: 10.1093/humrep/deab095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION To what extent are ambient concentrations of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) associated with risk of self-reported physician-diagnosed uterine leiomyomata (UL)? SUMMARY ANSWER In this large prospective cohort study of Black women, ambient concentrations of O3, but not PM2.5 or NO2, were associated with increased risk of UL. WHAT IS KNOWN ALREADY UL are benign tumors of the myometrium that are the leading cause of gynecologic inpatient care among reproductive-aged women. Black women are clinically diagnosed at two to three times the rate of white women and tend to exhibit earlier onset and more severe disease. Two epidemiologic studies have found positive associations between air pollution exposure and UL risk, but neither included large numbers of Black women. STUDY DESIGN, SIZE, DURATION We conducted a prospective cohort study of 21 998 premenopausal Black women residing in 56 US metropolitan areas from 1997 to 2011. PARTICIPANTS/MATERIAL, SETTING, METHODS Women reported incident UL diagnosis and method of confirmation (i.e. ultrasound, surgery) on biennial follow-up questionnaires. We modeled annual residential concentrations of PM2.5, NO2 and O3 throughout the study period. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for a one-interquartile range (IQR) increase in air pollutant concentrations, adjusting for confounders and co-pollutants. MAIN RESULTS AND THE ROLE OF CHANCE During 196 685 person-years of follow-up, 6238 participants (28.4%) reported physician-diagnosed UL confirmed by ultrasound or surgery. Although concentrations of PM2.5 and NO2 were not appreciably associated with UL (HRs for a one-IQR increase: 1.01 (95% CI: 0.93, 1.10) and 1.05 (95% CI: 0.95, 1.16), respectively), O3 concentrations were associated with increased UL risk (HR for a one-IQR increase: 1.19, 95% CI: 1.07, 1.32). The association was stronger among women age <35 years (HR: 1.26, 95% CI: 0.98, 1.62) and parous women (HR: 1.28, 95% CI: 1.11, 1.48). LIMITATIONS, REASONS FOR CAUTION Our measurement of air pollution is subject to misclassification, as monitoring data are not equally spatially distributed and we did not account for time-activity patterns. Our outcome measure was based on self-report of a physician diagnosis, likely resulting in under-ascertainment of UL. Although we controlled for several individual- and neighborhood-level confounding variables, residual confounding remains a possibility. WIDER IMPLICATIONS OF THE FINDINGS Inequitable burden of air pollution exposure has important implications for racial health disparities, and may be related to disparities in UL. Our results emphasize the need for additional research focused on environmental causes of UL. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the National Cancer Institute (U01-CAA164974) and the National Institute of Environmental Health Sciences (R01-ES019573). L.A.W. is a fibroid consultant for AbbVie, Inc. and accepts in-kind donations from Swiss Precision Diagnostics, Sandstone Diagnostics, FertilityFriend.com and Kindara.com for primary data collection in Pregnancy Study Online (PRESTO). M.J. declares consultancy fees from the Health Effects Institute (as a member of the review committee). The remaining authors declare they have no actual or potential competing financial interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael Jerrett
- Department of Environmental Health Sciences, University of California, Los Angeles, CA, USA
| | - Patricia F Coogan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
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50
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Wesselink AK, Weuve J, Fruh V, Bethea TN, Claus Henn B, Harmon QE, Hauser R, Williams PL, Calafat AM, McClean M, Baird DD, Wise LA. Urinary concentrations of phenols, parabens, and triclocarban in relation to uterine leiomyomata incidence and growth. Fertil Steril 2021; 116:1590-1600. [PMID: 34366109 DOI: 10.1016/j.fertnstert.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the association of urinary concentrations of phenols, parabens, and triclocarban with incidence and growth of uterine leiomyomata (UL; fibroids). DESIGN Case-cohort study, nested within the Study of Environment, Lifestyle, and Fibroids, a prospective cohort study. SETTING Clinic visits at baseline and every 20 months for 60 months. PATIENT(S) 754 Black women aged 23-35 years residing in the Detroit, Michigan area (enrolled during 2010-2012). INTERVENTION None. MAIN OUTCOME MEASURE(S) At each study visit, women underwent transvaginal ultrasound for measurement of UL incidence and growth and provided urine specimens in which we quantified concentrations of seven phenols, four parabens, and triclocarban. We used Cox proportional hazards regression to estimate hazard ratios and 95% confidence intervals (CIs) characterizing the relation of urinary biomarker concentrations with UL incidence during the 60 months of follow-up. In a subset of UL detected and measured at multiple time points, we used linear regression to assess the associations between biomarker concentrations and UL growth. RESULT(S) Urinary biomarker concentrations were generally inversely associated with UL incidence, but the associations were weak and nonmonotonic. For example, hazard ratios comparing concentrations ≥90th with <50th percentile were 0.77 (95% CI: 0.46, 1.27) for bisphenol A, 0.72 (95% CI: 0.40, 1.28) for bisphenol S, and 0.76 (95% CI: 0.43, 1.33) for methylparaben. Biomarker concentrations were not strongly associated with UL growth. CONCLUSION(S) In this study of reproductive-aged Black women, urinary phenols, parabens, and triclocarban biomarkers were neither strongly nor consistently associated with UL incidence and growth.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Traci N Bethea
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Quaker E Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Russ Hauser
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Paige L Williams
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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