Obstetrics and Gynaecology, Erasmus MC, University Medical Center, DR Rotterdam, The Netherlands.
Hum Reprod. 2011 Sep;26(9):2432-41. doi: 10.1093/humrep/der225. Epub 2011 Jul 12.
Adverse reproductive performance has been linked to unhealthy dietary intake and lifestyles. Our objectives were to investigate the prevalence of unhealthy dietary intake and lifestyles before conception and to evaluate whether tailored preconception counselling modifies these behaviours.
Between October 2007 and April 2009, 419 couples received tailored preconception dietary and lifestyle counselling at the outpatient clinic of Obstetrics and Gynaecology of the Erasmus University Medical Center Rotterdam, the Netherlands. A subgroup (n = 110 couples) was counselled twice with a fixed time interval of 3 months. Self-administered questionnaires were used for tailored dietary and lifestyle counselling. A cumulative score based on six Dutch dietary guidelines was displayed in the personal Preconception Dietary Risk score (PDR score). In a similar manner, the Rotterdam Reproduction Risk score (R3 score) was calculated from lifestyle factors (women: 13 items, men: 10 items). Univariate and paired tests were used.
Most couples (93.8%) were subfertile. At the second counselling, the percentage consuming the recommended intake of fruit had increased from 65 to 80 in women and from 49 to 68 in men and the percentage of women getting the recommended intake of fish increased from 39 to 52. As a consequence, the median PDR score was decreased [women: 2.6 (95% CI 2.4-2.9) to 2.4 (95% CI 2.1-2.6), men: 2.5 (95% CI 2.3-2.7) to 2.2 (95% CI 1.9-2.4), both P < 0.05]. The median R3 scores were also lower [women: 4.7 (95% CI 4.3-5.0) to 3.1 (95% CI 2.8-3.4), men: 3.0 (95% CI 2.8-3.3) to 2.0 (95% CI 1.7-2.3), both P < 0.01] due to less alcohol use (-14.6%), more physical exercise and folic acid use in women, and less alcohol use in men (-19.4%) (all P < 0.01). The R3 scores in women and men were decreased in all ethnicity, educational level, neighbourhood and BMI categories. However, low educated women appeared to show a larger reduction than better educated women and men with a normal BMI to show a larger decrease than overweight men. The reduction in the PDR score of women was similar in both ethnic groups. More than 85% women and men found the counselling useful and around 70% would recommend it to others.
Tailored preconception counselling about unhealthy dietary and lifestyle behaviours of subfertile couples in an outpatient tertiary clinic is feasible and seems to decrease the prevalence of harmful behaviours in the short term. These results with subfertile couples are promising and illustrate their opportunities to contribute to reproductive performance and pregnancy outcome.
不良的生殖表现与不健康的饮食摄入和生活方式有关。我们的目的是调查受孕前不良饮食摄入和生活方式的流行情况，并评估定制的孕前咨询是否会改变这些行为。
2007 年 10 月至 2009 年 4 月，419 对夫妇在荷兰鹿特丹伊拉斯谟大学医学中心妇产科的门诊接受了定制的孕前饮食和生活方式咨询。一个亚组（n=110 对夫妇）每隔 3 个月接受两次咨询。使用自我管理问卷进行定制的饮食和生活方式咨询。基于 6 个荷兰饮食指南的累积分数显示在个人孕前饮食风险评分（PDR 评分）中。同样，从生活方式因素（女性：13 项，男性：10 项）计算出鹿特丹生殖风险评分（R3 评分）。使用单变量和配对检验。
大多数夫妇（93.8%）为不孕。在第二次咨询时，女性摄入推荐水果量的比例从 65%增加到 80%，男性从 49%增加到 68%，女性摄入推荐鱼类量的比例从 39%增加到 52%。因此，中位数 PDR 评分降低[女性：2.6（95%CI 2.4-2.9）至 2.4（95%CI 2.1-2.6），男性：2.5（95%CI 2.3-2.7）至 2.2（95%CI 1.9-2.4），均 P<0.05]。中位数 R3 评分也较低[女性：4.7（95%CI 4.3-5.0）至 3.1（95%CI 2.8-3.4），男性：3.0（95%CI 2.8-3.3）至 2.0（95%CI 1.7-2.3），均 P<0.01]，原因是女性饮酒量减少（-14.6%）、更多的体育锻炼和叶酸使用，以及男性饮酒量减少（-19.4%）（均 P<0.01）。女性和男性的 R3 评分在所有种族、教育程度、社区和 BMI 类别中均降低。然而，低教育水平的女性似乎比高教育水平的女性有更大的降幅，而正常 BMI 的男性比超重男性有更大的降幅。女性 PDR 评分的降低在两个种族群体中相似。超过 85%的女性和男性认为咨询有用，约 70%的人会将其推荐给他人。
在一个三级门诊的不孕夫妇中进行定制的孕前关于不良饮食和生活方式行为的咨询是可行的，似乎可以在短期内降低有害行为的流行率。这些结果对于不孕夫妇来说是有希望的，并说明了他们改善生殖表现和妊娠结局的机会。
