Pregnancy Study Online Research Articles

Female sexual function and distress and time-to-pregnancy in a prospective preconception cohort

BackgroundFertility success among mixed-sex couples often depends on frequency and timing of sexual intercourse, yet little research has evaluated the association between preconception sexual function and time-to-pregnancy (TTP). Objective(s): To evaluate the effects of female sexual dysfunction, distress related to sexual functioning, and painful intercourse on TTP. Study DesignWe followed 2,500 participants from Pregnancy Study Online (PRESTO), a prospective cohort study of self-identified females attempting pregnancy without the use of fertility treatments. Participants enrolled between 2021 and 2024. Thirty days after enrollment, participants completed a supplemental questionnaire that contained questions about sexual health, including a modified version of the 6-item Female Sexual Function Index (score range 2-30, score ≤19 defined as sexual dysfunction) and the Female Sexual Distress Scale (score range 0-48, score ≥20 defined as clinically-relevant distress), which assess experiences in the previous 4 weeks. Participants completed the supplemental questionnaire no later than 6 months after initiating conception attempts. We estimated TTP based on self-reported pregnancy status on follow-up questionnaires completed every 8 weeks for up to 12 months. We used proportional probabilities regression to calculate fecundability ratios (FRs) and 95% confidence intervals (CIs) relating exposure measures with TTP, adjusting for a range of pre-specified confounders. As an exploratory analysis, we evaluated individual domains of sexual function (i.e., interest, arousal, orgasm, lubrication, and satisfaction) in relation to TTP. ResultsThe study population was primarily non-Hispanic White, high income, with college or graduate education. Exposure prevalence was 20.1% for female sexual dysfunction, 8.8% for distress, and 29.6% for any pain with intercourse. We observed no association between FSD and TTP (adjusted FR 1.00, 95% CI 0.890, 1.13) when FSD was defined using a clinically-validated cut point, but observed that those in the first, second, and third quartile of scores had delayed conception compared to those in the fourth (highest function) (adjusted FRs 0.90, 95% CI 0.76, 1.06; 0.88, 95% CI 0.75, 1.04; and 0.90, 95% CI 0.77, 1.04, respectively). We found 18% reduced fecundability among those with sexual distress as defined by a clinically-validated cut point compared to those without (adjusted FR 0.82, 95% CI 0.69, 0.98). Participants reporting painful intercourse most or all the time had a longer TTP than those reporting no pain (adjusted FR 0.81, 95% CI 0.62, 1.06). In exploratory analyses, lower function in orgasm and lubrication domains, but not interest, desire, and arousal, were associated with longer TTP. Conclusion(s)Preconception sexual dysfunction, specifically distress and frequent painful intercourse, was associated with delayed conception. Preconception clinical assessment of sexual function, including discussion of individual domains of sexual function, may elucidate important modifiable issues.

Residential Proximity to Oil and Gas Development and Mental Health in a North American Preconception Cohort Study: 2013-2023.

Objectives. To evaluate associations between oil and gas development (OGD) and mental health using cross-sectional data from a preconception cohort study, Pregnancy Study Online. Methods. We analyzed baseline data from a prospective cohort of US and Canadian women aged 21 to 45 years who were attempting conception without fertility treatment (2013-2023). We developed residential proximity measures for active OGD during preconception, including distance from nearest site. At baseline, participants completed validated scales for perceived stress (10-item Perceived Stress Scale, PSS) and depressive symptoms (Major Depression Inventory, MDI) and reported psychotropic medication use. We used log-binomial regression and restricted cubic splines to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results. Among 5725 participants across 37 states and provinces, residence at 2 km versus 20 to 50 km of active OGD was associated with moderate to high perceived stress (PSS ≥ 20 vs < 20: PR = 1.08; 95% CI = 0.98, 1.18), moderate to severe depressive symptoms (MDI ≥ 20 vs < 20: PR = 1.27; 95% CI = 1.11, 1.45), and psychotropic medication use (PR = 1.11; 95% CI = 0.97, 1.28). Conclusions. Among North American pregnancy planners, closer proximity to OGD was associated with adverse preconception mental health symptomatology. (Am J Public Health. 2024;114(9):923-934. https://doi.org/10.2105/AJPH.2024.307730).

Specifying a target trial protocol to estimate the effect of preconception treatment of periodontitis on time-to-pregnancy: A commentary and applied example.

The target trial framework was developed as a strategy to design and analyze observational epidemiologic studies with the aim of reducing bias due to analytic decisions. It involves designing a hypothetical randomized trial to answer a question of interest and systematically considering how to use observational data to emulate each trial component. The primary aim of this paper is to provide a detailed example of the application of the target trial framework to a research question in oral epidemiology. We describe the development of a hypothetical target trial and emulation protocol to evaluate the effect of preconception periodontitis treatment on time-to-pregnancy. We leverage data from Pregnancy Study Online (PRESTO), a preconception cohort, to ground our example in existing observational data. We discuss the decision-making process for each trial component, as well as limitations encountered. Our target trial application revealed data limitations that precluded us from carrying out the proposed emulation. Implications for data quality are discussed and we provide recommendations for researchers interested in conducting trial emulations in the field of oral epidemiology. The target trial framework has the potential to improve the validity of observational research in oral health, when properly applied. We encourage the broad adoption of the target trial framework to the field of observational oral health research and demonstrate its value as a tool to identify directions for future research.

Preconception Per- and Polyfluoroalkyl Substances and Breastfeeding Duration: Preliminary Findings from Pregnancy Study Online

Preconception Per- and Polyfluoroalkyl Substances and Breastfeeding Duration: Preliminary Findings from Pregnancy Study Online

Exposure to Ambient Heat and Risk of Spontaneous Abortion: A Case-Crossover Study.

Few epidemiologic studies have examined the association of ambient heat with spontaneous abortion, a common and devastating pregnancy outcome. We conducted a case-crossover study nested within Pregnancy Study Online, a preconception cohort study (2013-2022). We included all participants reporting spontaneous abortion (N = 1,524). We defined the case window as the 7 days preceding the event and used time-stratified referent selection to select control windows matched on calendar month and day of week. Within each 7-day case and control window, we measured the mean, maximum, and minimum of daily maximum outdoor air temperatures. We fit splines to examine nonlinear relationships across the entire year and conditional logistic regression to estimate odds ratios (ORs) and 95% confidence interval (CI) of spontaneous abortion with increases in temperature during the warm season (May-September) and decreases during the cool season (November-March). We found evidence of a U-shaped association between outdoor air temperature and spontaneous abortion risk based on year-round data. When restricting to warm season events (n = 657), the OR for a 10-percentile increase in the mean of lag 0-6 daily maximum temperatures was 1.1 (95% CI: 0.96, 1.2) and, for the maximum, 1.1 (95% CI: 0.99, 1.2). The OR associated with any extreme heat days (>95th county-specific percentile) in the preceding week was 1.2 (95% CI: 0.95, 1.5). Among cool season events (n = 615), there was no appreciable association between lower temperatures and spontaneous abortion risk. Our study provides evidence of an association between high outdoor temperatures and the incidence of spontaneous abortion.

Exposure to residential greenness, perceived stress, and depressive symptoms in a North American preconception cohort

BackgroundStudies suggest that greater exposure to natural vegetation (i.e., greenness) is associated with better mental health. However, there is limited research on greenness and mental health in the preconception period, a critical window of exposure in the life course. We investigated the associations of residential greenness with perceived stress and depressive symptoms using cross-sectional data from a cohort of pregnancy planners. MethodsFrom 2013 to 2019, we enrolled female-identified participants aged 21–45 years who were trying to conceive without the use of fertility treatment into a North American preconception cohort study (Pregnancy Study Online [PRESTO]). On the baseline questionnaire, participants completed the 10-item Perceived Stress Scale (PSS) and the Major Depression Inventory (MDI). Using geocoded addresses, we estimated residential greenness exposure via satellite imagery (Normalized Difference Vegetation Index [NDVI]) in a 100m buffer. We estimated mean differences and 95% confidence intervals for the association of greenness with perceived stress and depression scores using linear regression models, adjusting for individual and neighborhood sociodemographic characteristics. We also evaluated the extent to which associations were modified by urbanicity and neighborhood socioeconomic status (SES). ResultsAmong 9718 participants, mean age was 29.9 years, 81.5% identified as non-Hispanic White, 25% had household incomes <$50,000, and mean neighborhood income was $61,932. In adjusted models, higher greenness was associated with lower stress and depression scores (mean difference per interquartile range in greenness: −0.20, 95% CI: −0.39, −0.01; and −0.19, 95% CI: −0.48, 0.10, respectively). The association was stronger among residents of lower SES neighborhoods in urban areas (PSS: −0.57, 95% CI: −1.00, −0.15; MDI: −0.72, 95% CI: −1.40, −0.04). ConclusionsHigher greenness exposure was associated with lower stress and depressive symptoms among pregnancy planners, particularly in lower-SES neighborhoods.

(031) PAIN MITIGATION STRATEGIES AMONG FEMALES EXPERIENCING PAINFUL INTERCOURSE WHILE ATTEMPTING PREGNANCY

Abstract Introduction Pain during intercourse is a relatively common experience among reproductive-aged females but is often not discussed with healthcare providers. In the context of attempting pregnancy, people may find themselves unable to abstain from painful intercourse and so may attempt to mitigate their pain. Despite this connection, research evaluating experiences of painful intercourse among pregnancy planners is sparse. Objective To characterize pain mitigation strategies among females attempting pregnancy experiencing painful intercourse. Methods We used data from Pregnancy Study Online (PRESTO), an online preconception cohort study of females residing in the United States or Canada and actively attempting a pregnancy with a male partner without the use of assisted reproductive technology (2020-2023). To be eligible for this study, participants must have completed the optional Sexual Health and Well-Being Study within one year of cohort enrollment and before reporting a pregnancy (N=1,545). Participants were asked whether they experienced any pain during vaginal penetration in the past 4 weeks. Response options were five frequency options ranging from ‘Never or rarely’ to ‘Almost always or always.’ Those who responded that they experienced pain more frequently than ‘Never or rarely’ were categorized as experiencing any painful penetration and asked to rate the usual intensity of the pain on a scale of 1 to 10 and if they tried any strategies to mitigate the pain. For each reported strategy, participants were asked to rank its perceived efficacy at mitigating their pain on a scale of 1 ‘Never effective’ to 5 ‘Always Effective.’ Response options of ‘Often effective’ or ‘Always effective’ were grouped for descriptive analysis. Strategy effectiveness was also evaluated stratified by high pain (usual intensity ≥5) versus not high pain. Results Four-hundred and eighty participants (31%) reported experiencing any painful penetration in the past 4 weeks. The mean pain intensity was 3.6 (standard deviation [sd]=1.7). The most common reported strategies to try to mitigate pain were changing sexual positions (66%), using lubricant (59%), trying to finish intercourse quickly (49%), having an orgasm before penetration (32%) and only allowing partial vaginal penetration by the penis (30%). The most effective strategy was lubricant use, with 72% of participants reporting that strategy to be often or always effective, followed by partial penetration (66%), changing position (64%), and orgasm (62%). The least effective strategy was trying to finish quickly, with only 30% of participants saying that was often or always effective. The effectiveness of a given strategy changed with pain intensity, with all strategies being less likely to be often or always effective among those with higher pain intensity. Conclusions Among a sample of pregnancy planners, strategies to mitigate painful penetration varied. In general, most strategies were perceived as being often or always effective at mitigating pain, though less so for people with more intense pain. Because abstaining from painful intercourse is not always possible in the context of a desired pregnancy, understanding strategies that people use to mitigate pain can help providers who may wish to support patients in this context. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: LAW serves as a consultant to AbbVie, Inc.

(002) PER- AND POLYFLUOROALKYL SUBSTANCES (PFAS) AND FEMALE SEXUAL FUNCTION IN A PRECONCEPTION COHORT

Abstract Introduction Per- and polyfluoroalkyl substances (PFAS) are prevalent environmental chemicals used extensively in consumer and industrial products. Distressing disruptions to sexual function are prevalent in reproductive-aged women, yet its etiology is incompletely characterized. PFAS could plausibly affect sexual function because they interfere with the production, metabolism, and secretion of reproductive hormones and have known neurotoxic properties. To our knowledge, however, no research to date has evaluated associations between PFAS exposure and female sexual function. Objective To evaluate associations between PFAS biomarker concentrations and female sexual function. Methods We used cross-sectional data from the Pregnancy Study Online (PRESTO; n=82), a preconception cohort study of female-identified pregnancy planners living in the United States or Canada, to estimate associations between PFAS biomarker concentrations and female sexual function, measured using 6 select items from the Female Sexual Function Index (FSFI). We summed scores from the FSFI items to create a sexual function score (range=0-30; median in PRESTO=22). Lower scores were indicative of worse sexual function. We measured concentrations of four PFAS (specifically PFOS, PFOA, PFNA, and PFHxS) in serum using isotope-dilution tandem mass spectrometry. We used multivariable linear regression to estimate mean differences in sexual function scores per interquartile range (IQR) increase in PFAS concentrations with 95% confidence intervals (CIs), adjusting for potential confounders. We stratified results by parity (parous vs. nulliparous) to evaluate the potential for effect modification by prior pregnancy, as placental transfer, menstruation, and lactation are known routes of PFAS elimination. Results Median serum PFAS concentrations (ng/mL) were 1.3, 1.1, 0.3, and 0.7 for PFOS, PFOA, PFNA, and PFHxS, respectively. An IQR increase in PFHxS was associated with a 1.4-point decrease (95% CI -2.1, -0.6) in sexual function scores, reflecting a ~5% change. Among parous participants, there was a consistent trend of decreased sexual function scores per IQR increase in PFAS concentrations. The strongest association was observed for PFOS, where an IQR increase in serum concentration was associated with a 4.9-point decrease in sexual function scores (95% CI -9.1, -0.6). Conclusions These preliminary findings indicate that higher serum PFAS concentrations are associated with decreased self-reported female sexual function. Prior research evaluating the relationship between environmental chemical exposures and sexual function have historically focused on male outcomes (e.g., semen quality). These fundings suggest value in expanding research focused on the sexual health consequences of endocrine disrupting chemicals to include female sexual function. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: LAW serves as a consultant to AbbVie, Inc.

Childhood adversity and time to pregnancy in a preconception cohort.

We examined the association between childhood adversity and fecundability (the per-cycle probability of conception), and the extent to which childhood social support modified this association. We used data from 6318 female participants aged 21-45years in Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study (2013-2022). Participants completed a baseline questionnaire, bimonthly follow-up questionnaires (until pregnancy or a censoring event), and a supplemental questionnaire on experiences across the life course including adverse childhood experiences (ACEs) and social support (using the modified Berkman-Syme Social Network Index [SNI]). We used proportional probabilities regression models to compute fecundability ratios (FRs) and 95% CIs, adjusting for potential confounders and precision variables. Adjusted FRs for ACE scores 1-3 and≥4 vs 0 were 0.91 (95% CI, 0.85-0.97) and 0.84 (95% CI, 0.77-0.91), respectively. The FRs for ACE scores ≥4 vs 0 were 0.86 (95% CI, 0.78-0.94) among participants reporting high childhood social support (SNI ≥4) and 0.78 (95% CI, 0.56-1.07) among participants reporting low childhood social support (SNI <4). Our findings confirm results from 2 previous studies and indicate that high childhood social support slightly buffered the effects of childhood adversity on fecundability.

Evaluating participant engagement in a preconception cohort study in relation to the Dobbs decision.

On June 24th, 2022, the United States (US) Supreme Court's ruling in Dobbs v. Jackson, etal. (hereafter, the Dobbs decision) removed federal-level protections for induced abortion, sparking concerns about reproductive rights and health privacy. Although other pregnancy outcomes (e.g. spontaneous abortion, ectopic pregnancy) are not explicit targets of post-Dobbs abortion bans, study participants may be worried about how their reproductive health data are used by researchers in the post-Dobbs era. To evaluate the extent to which the Dobbs decision influenced participant's engagement in a preconception cohort study. We leveraged data spanning 20 weeks before and after the Dobbs decision (4 February 2022, to 11 November 2022) from US participants in Pregnancy Study Online (PRESTO), an internet-based prospective preconception cohort study of couples attempting conception. We categorised participants' state-level abortion access by residential location: banned or restricted rights; limited access; and protected rights. We evaluated three participant engagement outcomes: follow-up questionnaire completion; report of a pregnancy; and clicking on the invitation link for a fertility-tracking app. We fit separate linear regression models and restricted cubic splines to compare outcome prevalence before and after the Dobbs decision by state-level abortion category. A total of 585 newly enrolled participants and 1247 already-enrolled participants received 2802 invitations to complete a follow-up questionnaire. In states with limited or protected abortion rights, we observed little change in participant engagement. In states with banned or restricted abortion rights, however, we observed a 27.12 percentage point reduction (95% confidence interval -43.68, -10.51) in the prevalence of clicking on the invitation link for the fertility-tracking app comparing the post- versus pre-Dobbs periods. There was some evidence of reduced participant engagement after the Dobbs decision in states with banned or restricted abortion rights, indicating potentially deleterious effects on the conduct of reproductive health studies.

A preconception cohort study of sugar-sweetened beverage consumption and semen quality.

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. We estimated the effects of SSB consumption on semen quality in a North American preconception cohort study. 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. 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 ≥ 25kg/m2 . Greater SSB consumption was associated with reduced semen quality in a North American preconception cohort.

Ambient air pollution and rate of spontaneous abortion

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.

Association between job control and time to pregnancy in a preconception cohort

ObjectiveTo 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. DesignWe used data from Pregnancy Study Online (PRESTO), an internet-based preconception cohort study of couples trying to conceive in the U.S. and Canada. We estimated fecundability ratios (FRs) and 95% confidence intervals via proportional probabilities regression models, adjusting for sociodemographic and behavioral characteristics. SubjectsParticipants self-identified as female, were aged 21-45 years, and reported ≤6 cycles of pregnancy attempt time at enrollment (2018-2022). ExposureWe assessed job control by matching participants’ baseline self-reported occupation and industry with standardized occupation codes from the NIOSH Industry and Occupation Computerized Coding System, then linked codes to O*NET job exposure scores for job independence and freedom to make decisions. Main outcome measureOur 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. ResultsAmong 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 versus fourth quartile: FR=0.92; 95% CI: 0.80-1.05). ConclusionLower job control, a work-related stressor, may adversely influence time-to-pregnancy. As job control is a condition of work (i.e., not modifiable by individuals), findings may strengthen arguments for improving working conditions as a means of improving worker health, including fertility.

Air pollution and fecundability in a North American preconception cohort study

BackgroundAnimal 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. MethodsWe 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. ResultsIn 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. ConclusionsNeither 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.

Risk of Miscarriage in Relation to Seasonal Influenza Vaccination Before or During Pregnancy.

To evaluate the association between seasonal influenza vaccination and miscarriage using data from an ongoing, prospective cohort study. 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. 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). Influenza vaccination before or during pregnancy was not associated with miscarriage.

Preconception Periodontitis and Risk of Spontaneous Abortion in a Prospective Cohort Study.

Few studies have evaluated the association between periodontitis and spontaneous abortion (SAB), and all had limitations. We used data from the Pregnancy Study Online (PRESTO), a prospective preconception cohort study of 3,444 pregnancy planners in the United States and Canada (2019-2022), to address this question. Participants provided self-reported data on periodontitis diagnosis, treatment, and symptoms of severity (i.e., loose teeth) via the enrollment questionnaire. SAB (pregnancy loss at <20 weeks' gestation) was assessed via bimonthly follow-up questionnaires. Participants contributed person-time from the date of a positive pregnancy test to the gestational week of SAB, loss to follow-up, or 20 weeks' gestation, whichever came first. We fitted Cox regression models with weeks of gestation as the time scale to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs), and we used inverse probability of treatment weighting to account for differential loss to follow-up. We used probabilistic quantitative bias analysis to estimate the magnitude and direction of the effect of exposure misclassification bias on results. In weighted multivariable models, we saw no appreciable association between preconception periodontitis diagnosis (HR=0.97, 95% CI: 0.76, 1.23) or treatment (HR=1.01, 95% CI: 0.79, 1.27) and SAB. A history of loose teeth was positively associated with SAB (HR=1.38, 95% CI: 0.88, 2.14). Quantitative bias analysis indicated that our findings were biased towards the null but with considerable uncertainty in the bias-adjusted results.

COVID-19 vaccination and menstrual cycle characteristics: A prospective cohort study

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.

Associations between Residential Greenspace and Fecundability in a North American Preconception Cohort Study.

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. We examined associations between residential green space and fecundability, the per-cycle probability of conception. 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 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. When comparing the highest () with the lowest () NDVI exposures within , 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 of mediation across all NDVI metrics. In this cohort, greater residential green space was associated with a modest increase in fecundability. https://doi.org/10.1289/EHP10648.

Use of Chemical Hair Straighteners and Fecundability in a North American Preconception Cohort.

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.

Sexual dysfunction, distress, and care-seeking among females during the preconception period

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. 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. 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. 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%). 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.