Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
JAMA Netw Open. 2023 Feb 1;6(2):e2255001. doi: 10.1001/jamanetworkopen.2022.55001.
Although multiple modifiable risk factors have been identified for reduced fecundability (defined as lower probability of conception within a menstrual cycle), no scoring system has been established to systematically evaluate fecundability among females who are attempting to conceive.
To examine the association of a risk score based on 6 modifiable factors with fecundability, and to estimate the percentage reduction in incidence of nonconception if all study participants achieved a minimal risk score level.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study obtained data from the S-PRESTO (Singapore Preconception Study of Long-Term Maternal and Child Outcomes) prospective cohort study. Females of reproductive age who were trying to conceive were enrolled from February 2015 to October 2017 and followed for 1 year, ending in November 2018. Data were analyzed from March to May 2022.
A reduced fecundability risk score was derived by giving participants 1 point for each of the following factors: unhealthy body mass index, unhealthy diet, smoking, alcohol intake, folic acid supplement nonuser, and older maternal age. Total scores ranged from 0 to 6 and were classified into 5 levels: level 1 (score of 0 or 1), level 2 (score of 2), level 3 (score of 3), level 4 (score of 4), and level 5 (score of 5 or 6).
Fecundability, measured by time to conception in cycles, was analyzed using discrete-time proportional hazards models with confounder adjustment.
A total of 937 females (mean [SD] age, 30.8 [3.8] years) were included, among whom 401 (42.8%) spontaneously conceived within 1 year of attempting conception; the median (IQR) number of cycles before conception was 4 (2-7). Compared with participants with a level 1 risk score, those with level 2, 3, 4, and 5 risk scores had reductions in fecundability of 31% (adjusted fecundability ratio [FR], 0.69; 95% CI, 0.54-0.88), 41% (FR, 0.59; 95% CI, 0.45-0.78), 54% (FR, 0.46; 95% CI, 0.31-0.69) and 77% (FR, 0.23; 95% CI, 0.07-0.73), respectively. Assessment of the population attributable fraction showed that all participants achieving a minimal (level 1) risk level would be associated with a reduction of 34% (95% CI, 30%-39%) in nonconception within a year.
Results of this study revealed the co-occurrence of multiple modifiable risk factors for lowered fecundability and a substantially higher conception rate among participants with no or minimal risk factors. The risk assessment scoring system proposed is a simple and potentially useful public health tool for mitigating risks and guiding those who are trying to conceive.
尽管已经确定了多个可改变的风险因素与生育力降低（定义为在一个月经周期内受孕的可能性降低）有关，但尚未建立评分系统来系统地评估试图怀孕的女性的生育力。
检查基于 6 个可改变因素的风险评分与生育力的关联，并估计如果所有研究参与者达到最低风险评分水平，非妊娠发生率的降低百分比。
设计、地点和参与者：这项基于人群的队列研究从新加坡妊娠前研究（长期母婴结局）前瞻性队列研究中获取数据。从 2015 年 2 月至 2017 年 10 月招募了有生育能力的育龄女性，并对她们进行了为期 1 年的随访，随访于 2018 年 11 月结束。数据于 2022 年 3 月至 5 月进行分析。
通过给每个以下因素的参与者记 1 分来计算生育力降低的风险评分：不健康的体重指数、不健康的饮食、吸烟、饮酒、叶酸补充剂非使用者和高龄产妇。总分数范围为 0 至 6 分，分为 5 个级别：级别 1（分数为 0 或 1）、级别 2（分数为 2）、级别 3（分数为 3）、级别 4（分数为 4）和级别 5（分数为 5 或 6）。
生育力通过妊娠周期时间来衡量，使用混杂因素调整的离散时间比例风险模型进行分析。
共纳入 937 名女性（平均[标准差]年龄，30.8[3.8]岁），其中 401 名（42.8%）在尝试受孕后 1 年内自然受孕；受孕前的中位数（IQR）周期数为 4（2-7）。与具有 1 级风险评分的参与者相比，具有 2 级、3 级、4 级和 5 级风险评分的参与者的生育力分别降低了 31%（调整后的生育力比值[FR]，0.69；95%CI，0.54-0.88）、41%（FR，0.59；95%CI，0.45-0.78）、54%（FR，0.46；95%CI，0.31-0.69）和 77%（FR，0.23；95%CI，0.07-0.73）。人群归因分数的评估表明，所有参与者达到最低（1 级）风险水平，与一年内非妊娠率降低 34%（95%CI，30%-39%）相关。
这项研究的结果显示，生育力降低与多个可改变的风险因素共同发生，并且参与者中无风险因素或最低风险因素的妊娠率明显更高。所提出的风险评估评分系统是一种简单且潜在有用的公共卫生工具，可用于降低风险并指导那些正在尝试怀孕的人。
