Monash University, Clayton, VIC, Australia.
Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
Hum Reprod Update. 2023 Nov 2;29(6):811-828. doi: 10.1093/humupd/dmad018.
Preconception diet is a proposed modifiable risk factor for infertility. However, there is no official guidance for women in the preconception period as to which dietary approaches may improve fertility.
A comprehensive synthesis of the relevant evidence is key to determine the potentially effective dietary patterns and components as well as evidence gaps, and to provide information for nutritional recommendations for couples planning a pregnancy.
In this systematic scoping review, four electronic databases (Medline and EMBASE via Ovid processing, CAB Direct, and CINAHL via EBSCO) were searched for observational studies (prospective and retrospective cohort, cross-sectional, and case-control studies) from inception to 27 September 2021. Eligible studies included women of reproductive age during the preconception period, and evaluated exposures related to preconception diet and outcomes related to fertility. Results were synthesized using a descriptive approach.
A total of 36 studies were eligible for inclusion (31 prospective, 3 cross-sectional, and 2 case-control studies) and were published between 2007 and 2022. Of the assessed dietary exposures, increased adherence to the Mediterranean diet displayed the strongest and most consistent association with improved clinical pregnancy rates. Reducing trans fatty acids (TFAs), saturated fatty acids, and discretionary food intake (fast food and sugar-sweetened beverages) were associated with improvements in live birth, clinical pregnancy rates, and related ART outcomes. The dietary components of seafood, dairy, and soy demonstrated inconsistent findings across the few included studies.
Due to heterogeneity and the limited available literature on most exposures, there is insufficient evidence to support any specific dietary approach for improving fertility. However, following some of the dietary approaches outlined in this review (anti-inflammatory diets, reducing TFA, and discretionary food intake) are consistent with broad healthy eating guidelines, have little to no associated risk, and offer a plausible set of possible benefits. This warrants further exploration in randomized controlled trials.
孕前饮食被认为是不孕的一个可改变的风险因素。然而，对于处于孕前阶段的女性，目前还没有关于哪种饮食方法可能提高生育能力的官方指导。
综合相关证据对于确定潜在有效的饮食模式和组成部分以及证据差距至关重要，并为计划怀孕的夫妇提供营养建议的信息。
在本次系统范围的综述中，我们在四个电子数据库（通过 Ovid 处理的 Medline 和 EMBASE、CAB Direct 以及 EBSCO 的 CINAHL）中搜索了从成立到 2021 年 9 月 27 日的观察性研究（前瞻性和回顾性队列研究、横断面研究和病例对照研究）。合格的研究包括处于孕前阶段的育龄女性，并评估了与孕前饮食相关的暴露和与生育能力相关的结局。结果采用描述性方法进行综合。
共有 36 项研究符合纳入标准（31 项前瞻性研究、3 项横断面研究和 2 项病例对照研究），发表时间在 2007 年至 2022 年之间。在所评估的饮食暴露中，增加对地中海饮食的依从性与提高临床妊娠率的关系最强且最一致。减少反式脂肪酸（TFA）、饱和脂肪酸和随意性食物摄入（快餐和含糖饮料）与活产、临床妊娠率和相关 ART 结局的改善相关。纳入的少数几项研究中，海鲜、奶制品和大豆的饮食成分结果不一致。
由于存在异质性和大多数暴露的可用文献有限，目前没有足够的证据支持任何特定的饮食方法来提高生育能力。然而，遵循本综述中概述的一些饮食方法（抗炎饮食、减少 TFA 和随意性食物摄入）与广泛的健康饮食指南一致，几乎没有相关风险，并提供了一套合理的可能的益处。这需要进一步在随机对照试验中进行探索。
