Cox Kyley J, Stanford Joseph B, Blackburn Brenna E, Porucznik Christina A
Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah.
Environ Epidemiol. 2019 Jun 19;3(3):e050. doi: 10.1097/EE9.0000000000000050. eCollection 2019 Jun.
Exposures in the periconceptional environment may impact fertility and future health. Assessing time-varying exposures during the periconceptional window requires identifying approximate fertile windows around ovulation. In this prospective cohort study, we instructed women in daily cervical fluid observation and interpretation to identify incipient ovulation; they used this information to time daily urine collection for both partners. Timing and completeness of collection were compared to expert review.
One hundred seventy couples planning pregnancy enrolled from community volunteers from 2011 to 2015; women were taught the Peak Day method to identify fertile windows. Both partners collected daily urine specimens from the first day of fertile-quality fluid (estimator of the beginning of fertile window). Men discontinued on the estimated day of ovulation/conception +2 days; women continued through the onset of next menses, or positive pregnancy test at estimated day of ovulation/conception +18 days. We compared dates from samples with participants' fertility charts to determine proportion correctly collected. Also, expert reviewers judged on which days urine should have been collected, determining investigator-identified sampling days.
One hundred sixty-nine couples submitted 6,118 urine samples from 284 cycles. Reviewers and participants agreed in 87% of cycles for the date of the beginning of the fertile window ±3 days (65% exact-day agreement); agreement on ovulation date, ±3 days, was 93% (75% exact-day agreement). Five thousand three hundred twenty-nine female samples were expected based on investigator-identified sampling days, and 4,546 were collected, of which 82% were correctly collected on expected days. Fifty-nine percent of male samples were correctly collected relative to investigator-identified sampling days.
Intensively-scheduled, biologically-triggered, at-home biospecimen collection can successfully be targeted to the periconceptional window and completed in a longitudinal cohort study.
围孕期环境暴露可能会影响生育能力和未来健康。评估围孕期窗口期间随时间变化的暴露情况需要确定排卵前后的大致易孕期。在这项前瞻性队列研究中，我们指导女性进行每日宫颈黏液观察和解读以识别即将排卵；她们利用这些信息确定双方每日尿液收集的时间。将收集的时间和完整性与专家审查结果进行比较。
2011年至2015年从社区志愿者中招募了170对计划怀孕的夫妇；教导女性使用峰值日法来确定易孕期。双方从出现优质黏液的第一天（易孕期开始的估计指标）开始每日收集尿液样本。男性在估计的排卵/受孕日 +2天停止收集；女性持续收集至下次月经来潮，或在估计的排卵/受孕日 +18天进行妊娠试验呈阳性。我们将样本日期与参与者的生育图表进行比较，以确定正确收集的比例。此外，专家评审员判断应该在哪几天收集尿液，从而确定研究者确定的采样日期。
169对夫妇在284个周期中提交了6118份尿液样本。评审员和参与者在87%的周期中就易孕期开始日期达成一致，误差在±3天内（65%为精确日期一致）；排卵日期误差在±3天内的一致率为93%（75%为精确日期一致）。根据研究者确定的采样日期，预计应收集5329份女性样本，实际收集了4546份，其中82%是在预期日期正确收集的。相对于研究者确定的采样日期，59%的男性样本被正确收集。
密集安排、生物触发的家庭生物样本收集能够成功针对围孕期窗口，并在纵向队列研究中完成。
