Abstract
There is a lack of research on preconception diet and reproductive outcomes conducted in the Chinese population using individual assessment. Between April 2017 and April 2020, 2,796 couples undergoing in vitro fertilization treatment were recruited in this ongoing prospective cohort, and 1,500 eligible couples were included in the final analysis. A validated semi-quantitative food frequency questionnaire was used to evaluate the maternal preconception diet. Other lifestyle factors, including smoking status, psycho-mental status, sleep quality, and physical activity, were also assessed. Five dietary patterns were identified using principal component analysis, namely “Fruits-Vegetables-Dairy-Eggs,” “Fish/Seafood-Animal blood,” “Tubers-Beans-Cereals,” “Puffed food-Candy-Bakery,” and “Dried Fruits-Organs-Rice.” After adjusting for multiple confounders, we detected that the women who are more inclined to the “Fruits-Vegetables-Dairy-Eggs” pattern and less adherent to the “Tubers-Beans-Cereals” were more likely to achieve normally fertilized eggs and transferable embryos. Regarding pregnancy outcomes, we observed that a lower “Puffed food-Candy-Bakery” score and a higher “Dried fruits-Organs-Rice” score were related to a higher likelihood to achieve biochemical pregnancy. In terms of pregnancy complications, an inverse association between “Fish/Seafood-Animal blood” and hypertensive disorders was observed. We further clustered the dietary patterns based on the proportion of food groups consumed and found that dairy intake was beneficial to embryo quality, while frequent rice consumption was associated with a higher risk of macrosomia. Notably, in the stratified analysis, we observed that the positive relationship between the “Fruit-Dairy-Vegetables-Eggs” score and normal fertilization and the inverse association of the “Fish/Seafood-Animal blood” score with hypertensive disorders during pregnancy were exhibited only among women with body mass index ≥25 kg/m2. In conclusion, pre-treatment diets might be an important target for intervention to achieve a better reproductive outcome.
Highlights
Infertility is the inability to conceive within 12 months of regular, unprotected sexual intercourse [1], which has been recognized as a public health issue worldwide by the World Health Organization (WHO)
Between April 2017 and April 2021, a total of 2,796 couples were recruited in our prospective cohort, among which, 1,500 couples were included in the analysis in this study after selection (Figure 1)
Dried fruits-Organs-Rice aModels adjusted for age, BMI, the type and cause of infertility, insemination method, depression status, sleep quality, physical activity, alcoholic beverages consumption, spicy food intake, the supplement of vitamin D, calcium, and iron, and total energy. bModels adjusted for age, BMI, educational level, the type, duration, and cause of infertility, the consumption of alcoholic beverages and tea, spicy food intake, the supplement of multi-vitamins, vitamin A, vitamin D, and calcium, and total energy. cModels adjusted for age, educational level, the type, duration, and cause of infertility, physical activity, the consumption of tea and coffee, spicy food intake, the supplement of vitamin B, vitamin D, vitamin E, calcium, and iron, and total energy
Summary
Infertility is the inability to conceive within 12 months of regular, unprotected sexual intercourse [1], which has been recognized as a public health issue worldwide by the World Health Organization (WHO). The global disease burden of infertility has been increasing since 1999, estimated to affect about 10–15% of women of reproductive age [2,3,4]. As a result, emerging scientific studies have been devoted to identifying modifiable factors which may affect human fertility, including diet, physical activity, stress, and lifestyle [6,7,8,9]. Studies on the relationship between micronutrients and fertility suggested that nutrition affects reproductive health [10,11,12,13,14], among which, folic acid and vitamin D are widely concerned. Previous studies have suggested that dietary patterns are relatively stable from preconception to pregnancy [17]. Establishing a healthy habitual diet before pregnancy may be an important intervention target to improve reproductive health
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