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Do Subfertile Women Adjust Their Habits When Trying to Conceive?

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Do Subfertile Women Adjust Their Habits When Trying to Conceive? Upsala Journal of Medical Sciences ISSN: 0300-9734 (Print) 2000-1967 (Online) Journal homepage: http://www.tandfonline.com/loi/iups20 Do subfertile women adjust their habits when trying to conceive? Lana Salih Joelsson, Anna Berglund, Kjell Wånggren, Mikael Lood, Andreas Rosenblad & Tanja Tydén To cite this article: Lana Salih Joelsson, Anna Berglund, Kjell Wånggren, Mikael Lood, Andreas Rosenblad & Tanja Tydén (2016) Do subfertile women adjust their habits when trying to conceive?, Upsala Journal of Medical Sciences, 121:3, 184-191, DOI: 10.1080/03009734.2016.1176094 To link to this article: http://dx.doi.org/10.1080/03009734.2016.1176094 © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. View supplementary material Published online: 23 May 2016. Submit your article to this journal Article views: 220 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iups20 Download by: [Uppsala Universitetsbibliotek] Date: 05 October 2016, At: 09:51 UPSALA JOURNAL OF MEDICAL SCIENCES, 2016 VOL. 121, NO. 3, 184–191 http://dx.doi.org/10.1080/03009734.2016.1176094 ORIGINAL ARTICLE Do subfertile women adjust their habits when trying to conceive? Lana Salih Joelssona,b, Anna Berglundc, Kjell Wånggrena,d, Mikael Loode, Andreas Rosenbladb and Tanja Tyden f aDepartment of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; bCentre for Clinical Research, Uppsala University, County Council of V€astmanland, V€astmanland County Hospital, V€asterås, Sweden; cThe National Centre for Knowledge of Men’s Violence against Women, Uppsala University, Uppsala, Sweden; dDepartment of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; eDepartment of Women’s Health, Fertility Unit, Orebro€ University Hospital, Orebro,€ Sweden; fDepartment of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden ABSTRACT ARTICLE HISTORY Aim: The aim of this study was to investigate lifestyle habits and lifestyle adjustments among subfertile Received 8 February 2016 women trying to conceive. Revised 3 April 2016 Materials and methods: Women (n ¼ 747) were recruited consecutively at their first visit to fertility Accepted 4 April 2016 clinics in mid-Sweden. Participants completed a questionnaire. Data were analyzed using logistic regres- KEYWORDS sion, t tests, and chi-square tests. Alcohol consumption; Results: The response rate was 62% (n ¼ 466). Mean duration of infertility was 1.9 years. During this assisted reproduction; diet; time 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% con- infertility; lifestyle; obesity; sumed more than two glasses of alcohol weekly. In this sample, 23.9% of the women were overweight pregnancy; tobacco use (body mass index, BMI 25–29.9 kg/m2), and 12.5% were obese (BMI 30 kg/m2). Obese women exer- cised more and changed to healthy diets more frequently than normal-weight women (odds ratio 7.43; 95% confidence interval 3.7–14.9). Six out of ten women (n ¼ 266) took folic acid when they started trying to conceive, but 11% stopped taking folic acid after some time. Taking folic acid was associated with a higher level of education (p < 0.001). Conclusions: Among subfertile women, one-third were overweight or obese, and some had other life- style factors with known adverse effects on fertility such as use of tobacco. Overweight and obese women adjusted their habits but did not reduce their body mass index. Women of fertile age would benefit from preconception counseling, and the treatment of infertility should routinely offer interven- tions for lifestyle changes. Introduction parenthood as a rational adaptation to changes in society such as having a sound personal economy. Participants A healthy lifestyle is known to be of importance for women, believed that fertility could be restored by assisted reproduct- especially when they are planning to get pregnant, since ive technologies (ART) (6). A consequence of this demo- negative lifestyle factors may contribute to impaired repro- graphic trend seems to be associated with an increase in the duction and a lower chance of having a healthy child. Such incidence of female subfertility (7). negative factors include smoking, drinking alcohol and over- Major advances have been achieved in the field of infertil- use of other drugs, underweight or overweight, unhealthy ity treatment and assisted reproductive technology (ART) dur- diet, harmful infections, exposure to environmental hazards, ing the past 25 years, leading to increased pregnancy rates. and an adverse medical history. These issues might be par- However, researchers and clinicians are still trying to identify ticularly important for women seeking treatment for infertility additional factors that might impact on live birth rates. Also (1–3). Another important factor affecting female fertility is in ART, factors such as nutrition and diet, exercise, and the age. Women in Europe have delayed their childbearing con- use of tobacco and alcohol, as well as being overweight or siderably during the past decades, and the mean age for underweight, might have an impact on outcomes (2,8). childbearing is currently 30 years or more in almost half of The effectiveness of preconception care and counseling the member states of the European Union (4,5). In Sweden, (PCC) in general, and for couples with a fertility problem in the mean age for having the first child was 28.5 years in particular, has been demonstrated (9,10). Studies have shown 2013 compared with 24 years in 1973. that PCC reduces costs, improves reproductive outcomes, pro- The postponement of the birth of the first child is due to motes healthy pregnancies, and reduces pregnancy complica- different reasons throughout Europe. Interviews with Swedish tions and poor neonatal birth outcomes. men and women who had an academic education showed There is a lack of homogeneous guidelines, recommenda- that a majority of them wanted children, but postponed their tions, and services for preconception health care in European CONTACT Lana Salih Joelsson [email protected] Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden Supplemental data for this article can be accessed here. ß 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. UPSALA JOURNAL OF MEDICAL SCIENCES 185 countries (11,12). The European Society of Human up is scheduled to take place 2 years after the return of the Reproduction and Embryology (ESHRE) Guideline questionnaire. Development Group recommends that fertility staff should consider providing women with information about the impact Participants and recruitment of lifestyle habits and supporting them in making necessary changes (13). Some counseling about lifestyle is generally Women attending 10 fertility clinics in mid-Sweden partici- included in initial consultations in fertility clinics. Brochures pated. Eligible women (n ¼ 782) were asked to participate in and hand-outs about lifestyle are generally available at fertil- the study at their first visit to the clinic. The time of this first ity clinics in Sweden, but this information is usually not visit to the clinic is defined as ‘Baseline year’. Data collection handed out or explained to the patients actively. Effective started in May 2013 and ended in March 2015 with a planned strategies and support for making healthy changes are not follow-up 2 years later. Being able to read and write Swedish routinely offered. and having no previous infertility diagnosis were inclusion cri- Despite the existing knowledge about the association of teria for the study. Midwives gave oral and written informa- risk of fertility problems and adverse pregnancy outcomes tion about the study to eligible women who fulfilled the with unhealthy lifestyles (14,15), it is largely unknown to what inclusion criteria. In 19 cases, women were excluded from the extent subfertile women adjust their habits during the time study either because they reported having a female partner they are trying to conceive. Effective individual counseling to or did not answer the question about lifestyle changes while subfertile women demands an understanding about what they tried to conceive. Thirty-five women declined to partici- measures women take to increase the chances of conception. pate in the study. Those who agreed to participate received a The aim of this study was therefore to investigate lifestyle questionnaire to complete at the clinic or at home and return habits among subfertile women trying to conceive in relation it by mail in a prepaid envelope. The midwife registered a to their background characteristics. It was hypothesized that telephone number or an email address for participating age, duration of infertility, BMI (body mass index), immigra- women, and a reminder was sent by text message or email tion status, education, occupation, income, and information to those who had not returned the questionnaire within 2 weeks. The completed questionnaires were returned including searching were associated with lifestyle habits and lifestyle the signed informed consent, which immediately
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