Modifiable Risk Factor Score and Fecundability in a Preconception Cohort in Singapore

• Published in: JAMA network open 2023-02, Vol.6 (2), p.e2255001-e2255001
• Main Authors: Loy, See Ling, Ku, Chee Wai, Tiong, Michelle Mei Ying, Ng, Carissa Shi Tong, Cheung, Yin Bun, Godfrey, Keith M, Lim, Shan Xuan, Colega, Marjorelee T, Lai, Jun Shi, Chong, Yap-Seng, Shek, Lynette Pei-Chi, Tan, Kok Hian, Chan, Shiao-Yng, Chong, Mary Foong-Fong, Yap, Fabian, Chan, Jerry Kok Yen
• Format: Article
• Language: English
• Subjects: Adult; Child; Cohort Studies; Female; Fertility; Humans; Obstetrics and Gynecology; Online Only; Original Investigation; Prospective Studies; Risk Factors; Singapore
• ISSN: 2574-3805; 2574-3805
• 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. 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 publi