Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Unit of Preventive Medicine and Public Health, Alimentació, Nutrició, Desenvolupament i Salut Mental, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.
JAMA Netw Open. 2023 Aug 1;6(8):e2329982. doi: 10.1001/jamanetworkopen.2023.29982.
Increasing evidence suggests that specific foods and nutrients may improve infertility treatment outcomes in women. However, less is known about the role of dietary patterns.
To investigate whether women's adherence to a priori-defined dietary patterns promoted for the prevention of chronic conditions is associated with outcomes of infertility treatment.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted at a fertility center at an academic medical center in Boston, Massachusetts. Women undergoing infertility treatment cycles, including intrauterine insemination cycles and in vitro fertilization with or without intracytoplasmic sperm injection were included. Data were collected from January 2007 to October 2019, and data were analyzed from February to December 2022.
Women's pretreatment diet was assessed with a validated food frequency questionnaire from which 8 a priori-defined scores were calculated (higher score indicates greater adherence): (1) Trichopoulou Mediterranean diet, (2) alternate Mediterranean diet, (3) Panagiotakos Mediterranean diet, (4) Healthy Eating Index, (5) Alternate Healthy Eating Index, (6) American Heart Association (AHA) index, (7) Dietary Approaches to Stop Hypertension index, and (8) plant-based diet.
The adjusted probability of clinically relevant outcomes (live birth as a primary outcome and clinical pregnancy and pregnancy loss as secondary outcomes) was evaluated across quartiles of adherence to each dietary pattern using multivariable generalized linear mixed models to account for repeated cycles.
This analysis included 612 women with a median (IQR) age of 35.0 (32.0-38.0) years. There was no association between women's adherence to the 8 a priori dietary patterns and probability of clinical pregnancy or live birth following in vitro fertilization or intrauterine insemination. However, an inverse association was found between adherence to AHA dietary pattern and risks of total and clinical pregnancy loss. Among women who became pregnant during the course of infertility treatment, the adjusted probabilities of pregnancy loss in the lowest and highest quartile of the AHA dietary pattern were 0.41 (95% CI, 0.33-0.50) and 0.28 (95% CI, 0.21-0.36), respectively (P for trend = .02). The corresponding adjusted probabilities of clinical pregnancy loss were 0.30 (95% CI, 0.22-0.39) and 0.15 (95% CI, 0.10-0.23) (P for trend = .007). A similar pattern was observed for all other dietary patterns, with the exception of the plant-based diet pattern.
Findings of this cohort study suggest that preconception adherence to the AHA diet may be associated with a lower likelihood of pregnancy loss during the course of infertility treatment.
越来越多的证据表明，某些食物和营养素可能会改善女性的不孕治疗效果。然而，对于饮食模式的作用知之甚少。
研究女性遵循先前定义的饮食模式（旨在预防慢性病）是否与不孕治疗结果相关。
设计、地点和参与者：这项前瞻性队列研究在马萨诸塞州波士顿一家学术医学中心的生育中心进行。纳入接受不孕治疗周期的女性，包括宫腔内人工授精周期和体外受精（无论是否联合胞浆内精子注射）。数据于 2007 年 1 月至 2019 年 10 月收集，并于 2022 年 2 月至 12 月进行分析。
女性的预处理饮食通过验证过的食物频率问卷进行评估，该问卷可计算出 8 个预先定义的分数（分数越高表示依从性越高）：（1） Trichopoulou 地中海饮食，（2）替代地中海饮食，（3）Panagiotakos 地中海饮食，（4）健康饮食指数，（5）替代健康饮食指数，（6）美国心脏协会（AHA）指数，（7）停止高血压的饮食法指数，和（8）植物性饮食。
使用多变量广义线性混合模型评估每个饮食模式依从性的四分位数与临床相关结局（活产作为主要结局，临床妊娠和妊娠丢失作为次要结局）的调整后概率，以考虑重复周期。
本分析纳入了 612 名中位（IQR）年龄为 35.0（32.0-38.0）岁的女性。女性对 8 种预先确定的饮食模式的依从性与体外受精或宫腔内人工授精后的临床妊娠或活产概率之间没有关联。然而，发现 AHA 饮食模式的依从性与总妊娠丢失和临床妊娠丢失的风险呈负相关。在不孕治疗过程中怀孕的女性中，AHA 饮食模式最低和最高四分位的妊娠丢失调整概率分别为 0.41（95%CI，0.33-0.50）和 0.28（95%CI，0.21-0.36）（趋势 P 值=0.02）。相应的临床妊娠丢失调整概率分别为 0.30（95%CI，0.22-0.39）和 0.15（95%CI，0.10-0.23）（趋势 P 值=0.007）。其他饮食模式也观察到类似的模式，除了植物性饮食模式。
这项队列研究的结果表明，在不孕治疗前遵循 AHA 饮食可能与降低治疗过程中的妊娠丢失几率相关。
