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Abstract
Objective
The primary objective of this analysis was to describe demographic, physical, lifestyle, and psychosocial factors related to becoming pregnant in six months or less among women under 35 years of age who delivered a live-born infant. We also wished to determine the relative impact of these factors on time to pregnancy, regardless of use of fertility treatment.
Methods
Between July 2002 and September 2003, we conducted a survey by telephone interview of 1044 randomly selected women who had recently delivered their first live-born infant in Calgary or Edmonton, Alberta.
Results
Among 575 women who were less than 35 years of age when they began trying to conceive and who ultimately delivered a live-born infant, the most significant predictors of taking more than six months to conceive included being overweight or obese (hazard ratio [HR] 1.34; 95% CI 1.05 to 1.72), having a history of pregnancy complications (HR 1.42; 95% CI 1.02 to 1.99), and having fair or poor self-rated emotional health six months prior to pregnancy (HR 2.02; 95% CI 1.27 to 3.22). The influence of BMI and emotional health on time to conception did not change substantially when women who had assistance with conception (16% of the sample) were excluded from the analysis.
Conclusion
Among those who ultimately carry a pregnancy to delivery, the relationship between high BMI or poor emotional health and delays in conception was evident among women who conceived with or without assistance. Public health strategies that help women to achieve optimal body weight and address issues of emotional health may reduce the need for assisted reproduction.
Résumé
Objectif
Le principal objectif de cette analyse était de décrire les facteurs démographiques, physiques, psychosociaux et liés au mode de vie qui sont associés au fait de devenir enceinte dans six ois ou moins chez les femmes de moins de 35 ans qui ont accouché d’un enfant vivant. Nous souhaitions également déterminer l’effet relatif de ces facteurs sur le délai avant la grossesse, sans égard au recours à un traitement de fertilité.
Méthodes
Entre juillet 2002 et septembre 2003, nous avons mené un sondage au moyen d’entrevues téléphoniques auprès d’un échantillon aléatoire de 1 044 femmes ayant récemment accouché de leur premier enfant vivant à Calgary ou à Edmonton, en Alberta.
Résultats
Chez les 575 femmes qui avaient moins de 35 ans au moment où elles ont commencé à tenter de devenir enceintes et qui, en bout de ligne, ont accouché d’un enfant vivant, on trouvait, parmi les facteurs prédictifs les plus importants du fait de prendre plus de six mois pour obtenir une grossesse, la surcharge pondérale ou l’obésité (densité de l’incidence [DI], 1,34; IC à 95 %, 1,05 – 1,72), la présence d’antécédents de complications de la grossesse (DI, 1,42; IC à 95 %, 1,02 – 1,99) et le fait d’avoir présenté une santé émotionnelle moyenne ou faible (d’après les résultats d’une autoévaluation) six mois avant la grossesse (DI, 2,02; IC à 95 %, 1,27 – 3,22). L’influence de l’IMC et de la santé émotionnelle sur le délai avant la grossesse n’a pas connu de modification substantielle lorsque les femmes ayant bénéficié d’une aide à la conception (16 % de l’échantillon) ont été exclues de l’analyse.
Conclusion
Chez les femmes (étant devenues enceintes avec ou sans aide) qui, en bout de ligne, ont mené une grossesse jusqu’à l’accouchement, la relation entre un IMC élevé ou une faible santé émotionnelle et le délai avant la grossesse était évidente. La mise en œuvre de stratégies de santé publique aidant les femmes à atteindre un poids corporel optimal et à faire face à leurs problèmes de santé émotionnelle pourrait atténuer la nécessité d’avoir recours à la procréation assistée.
Key Words
References
- Work-Life Compendium 2001: 150 Canadian Statistics on Work, Family, and Well-Being.Centre for Families, Work and Well-Being, University of Guelph, Guelph, ON, Canada2001
- Factors influencing childbearing decisions and knowledge of perinatal risks among Canadian men and women.Matern Child Health J. 2007; 11: 189-198
- Prepared for the Alberta Centre for Child, Family and Community Research.Reproduction in Alberta: a look at the preconception, prenatal and postnatal periods. 2006;
Statistics Canada. Table 102–4508—Live births, by age and parity of mother, Canada, annual, CANSIM (database). Available at: http://www.statcan.gc.ca. Accessed October 7, 2010.
- Paternal exposure to lead and infertility.Epidemiology. 2000; 11: 148-152
- Time to pregnancy among the wives of men occupationally exposed to lead.Epidemiology. 2000; 11: 141-147
- Time to pregnancy and occupational lead exposure.Occup Environ Med. 2003; 60: 752-758
- Solvent use and time to pregnancy among female personnel in biomedical laboratories in Sweden.Occup Environ Med. 2001; 58: 225-231
- Exposure to toluene in the printing industry is associated with subfecundity in women but not in men.Occup Environ Med. 1999; 56: 443-448
- Smoking reduces fecundity: a European multicenter study on infertility and subfecundity. The European Study Group on Infertility and Subfecundity.Am J Epidemiol. 1996; 143: 578-587
- Negative lifestyle is associated with a significant reduction in fecundity.Fertil Steril. 2004; 81: 384-392
- Does moderate alcohol intake reduce fecundability? A European multicenter study on infertility and subfecundity. European Study Group on Infertility and Subfecundity.Alcohol Clin Exp Res. 1997; 21: 206-212
- Does moderate alcohol consumption affect fertility? Follow-up study among couples planning first pregnancy.BMJ. 1998; 317: 505-510
- Parental consumption of contaminated sport fish from Lake Ontario and predicted fecundability.Epidemiology. 2000; 11: 388-393
- Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes.Epidemiology. 2007; 18: 112-119
- Factors affecting time to pregnancy.Hum Reprod. 2006; 21: 1279-1284
- Body mass index and delayed conception: a European Multicenter Study on Infertility and Subfecundity.Am J Epidemiol. 2000; 151: 1072-1079
- Obesity and time to pregnancy.Hum Reprod. 2007; 22: 414-420
- The influence of occupational physical activity on the menstrual cycle and fecundability.Epidemiology. 1994; 5: 14-18
- Are long working hours and shiftwork risk factors for subfecundity? A study among couples from southern Thailand.Occup Environ Med. 1998; 55: 99-105
- Psychological interactions with infertility among women.Eur J Obstet Gynecol Reprod Biol. 2004; 117: 126-131
- Psychosocial aspects of selected issues in women’s reproductive health: current status and future directions.J Consult Clin Psychol. 2002; 70: 751-770
- Age and social position moderate the effect of stress on fertility.Evol Hum Behav. 2006; 27: 345-356
- Waiting time to pregnancy according to maternal birthweight and prepregnancy BMI.Hum Reprod. 2009; 24: 226-232
- Subfecundity in overweight and obese couples.Hum Reprod. 2007; 22: 1634-1637
- The relationship between obesity and fecundity.J Womens Health. 2009; 18: 633-636
- Distress and reduced fertility: a follow-up study of first-pregnancy planners.Fertil Steril. 1999; 72: 47-53
- Work-life balance in the new millennium: where are we? Where Do We Need to Go? (CPRN Discussion Paper No. W|12).Ottawa, ON, Canadian Policy Research Networks2001
- Validity issues relating to time-to-pregnancy studies of fertility.Epidemiology. 2006; 17: 347-349
- Human Assisted Reproduction 2009 Live Birth Rates for Canada. December 2009 (Available at, Accessed October 12, 2010)
- Factors influencing women’s decisions about timing of motherhood.J Obstet Gynecol Neonatal Nurs. 2006; 35: 625-633
- Society and the Adolescent Self-Image.Revised ed. Wesleyan University Press, Middletown, CT1989
- Selected topics in the epidemiology of reproductive outcomes.Epidemiologic Reviews. 2000; 22: 71-75
- Studying time to pregnancy by use of a retrospective design.Am J Epidemiol. 2005; 162: 115-124
- Time to pregnancy: a measure of reproductive function in either sex.Occup Environ Med. 1997; 54: 289-295
- Measuring time to pregnancy. Methodological issues to consider.Hum Reprod. 1998; 13: 1751-1753
- Maternal and perinatal outcome in nulliparous women aged 35 and older.Gynecol Obstet Invest. 2002; 54: 6-10
- Changes with age in the level and duration of fertility in the menstrual cycle.Hum Reprod. 2002; 17: 1399-1403
- Does advanced maternal age affect pregnancy outcome in women with mild hypertension remote from term?.Am J Obstet Gynecol. 1997; 176: 1236-1240
- Underappreciated risks of the elderly multipara.Am J Obstet Gynecol. 1995; 172: 1764-1767
- Maternal age and malformations in singleton births.Obstet Gynecol. 2000; 96: 701-706
- Maternal age-specific Down syndrome rates by maternal race/ethnicity, Hawaii, 1986–2000.Birth Defects Res Part A Clin Mol Teratol. 2003; 67: 625-629
- Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery.Pediatrics. 2002; 109: 399-403
- Prognosis of a new pregnancy following previous spontaneous abortions.Eur J Obstet Gynecol Reprod Biol. 1991; 39: 31-36
- Time to pregnancy as a correlate of fecundity: differential persistence in trying to become pregnant as a source of bias.Int J Epidemiol. 2000; 29: 856-861
- Retrospectively sampled time-to-pregnancy data may make age-decreasing fecundity look increasing. European Infertility and Subfecundity Study Group.Epidemiology. 2000; 11: 717-719
- Applied survival analysis: regression modelling of time to event data.Wiley, New York1999
- Selection bias in determining the age dependence of waiting time to pregnancy.Am J Epidemiol. 2000; 152: 565-572
- Time trends in human fecundability in Sweden.Epidemiology. 2008; 19: 191-196
- Increased risks of pregnancy complications and adverse infant outcomes associated with assisted reproduction.International Congress Series. 2004; 1271: 376-379
- Obesity and pregnancy.BMJ. 2008; 337: a2450
- Effects of obesity on pregnancy.J Obstet Gynecol Neonatal Nurs. 2008; 37: 176-184
- Obesity in pregnancy: pre-conceptional to postpartum consequences.J Obstet Gynaecol Can. 2008; 30: 477-488
- Medical consequences of obesity.J Clin Endocrinol Metab. 2004; 89: 2583-2589
- Overweight and obesity: prevalence, consequences, and causes of a growing public health problem.Am J Med Sci. 2006; 331: 166-174
Statistics Canada. Table 105–0507—Measured adult body mass index (BMI), by age group and sex, household population aged 18 and over excluding pregnant females, Canada (excluding territories), occasional (number), 2005 to 2008: Canadian Community Health Survey, 2005 and 2007/08. CANSIM (database). Available at: http://www.statcan.gc.ca. Accessed October 7, 2010.
Statistics Canada. Table 105–0209—Body mass index (BMI), by age group and sex, household population aged 18 and over excluding pregnant females, Canada, provinces, territories, health regions (June 2003 boundaries) and peer groups, every 2 years: Canadian Community Health Survey, 2003. CANSIM (database). Available at: http://www.statcan.gc.ca. Accessed October 7, 2010.
- Stress and pregnancy loss: role of immune mediators, hormones and neurotransmitters.Am J Reprod Immunol. 2001; 46: 117-123
- Psychological stress during pregnancy and stillbirth: prospective study.BJOG. 2008; 115: 882-885
- Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones.Am J Epidemiol. 2009; 169: 1319-1326
- “Letting go” coping is associated with successful IVF treatment outcome.Fertil Steril. 2009; 92: 1384-1388
- What do women know about the risks of delayed childbearing?.Can J Public Health. 2006; 97: 330-334
- Parents’ global rating of mental health correlates with SF-36 scores and health services satisfaction.Qual Life Res. 2006; 15: 1395-1401
- Is previous use of hormonal contraception associated with a detrimental effect on subsequent fecundity?.Hum Reprod. 2004; 19: 344-351
- Return of fertility in nulliparous women after discontinuation of the intrauterine device: comparison with women discontinuing other methods of contraception.BJOG. 2001; 108: 304-314
- Fertility after discontinuation of treatment with an oral contraceptive containing 30 microg of ethinyl estradiol and 2 mg of dienogest.Fertil Steril. 2006; 85: 1812-1819
- Effects of sexual intercourse patterns in time to pregnancy studies.Am J Epidemiol. 2007; 165: 1088-1095
Article info
Publication history
Accepted:
July 13,
2010
Received:
June 24,
2010
Footnotes
Competing Interests: None declared.
Identification
Copyright
© 2010 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.
