Lifestyle and pregnancy loss in a contemporary cohort of women recruited before conception: The LIFE Study

Germaine M. Buck Louis, Ph.D., M.S.,a Katherine J. Sapra, M.Phil., M.P.H.,a Enrique F. Schisterman, Ph.D., M.A.,b Courtney D. Lynch, Ph.D., M.P.H.,c Jose M. Maisog, M.D., M.S., d Katherine L. Grantz, M.D., M.S.,b and Rajeshwari Sundaram, Ph.D., M.S.e a

Office of the Director and b Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; c Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; d Glotech, Inc.; and e Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland

Objective: To estimate pregnancy loss incidence in a contemporary cohort of couples whose lifestyles were measured during sensitive windows of reproduction to identify factors associated with pregnancy loss for the continual refinement of preconception guidance. Design: Prospective cohort with preconception enrollment. Setting: Sixteen counties in Michigan and Texas. Patient(s): Three hundred forty-four couples with a singleton pregnancy followed daily through 7 postconception weeks of gestation. Intervention(s): None. Couples daily recorded use of cigarettes, caffeinated and alcoholic beverages, and multivitamins. Women used fertility monitors for ovulation detection and digital pregnancy tests. Pregnancy loss was denoted by conversion to a negative pregnancy test, onset of menses, or clinical confirmation depending upon gestation. Using proportional hazards regression and accounting for right censoring, we estimated adjusted hazard ratios and 95% confidence intervals (aHR, 95% CI) for couples' lifestyles (cigarette smoking, alcoholic and caffeinated drinks, multivitamins) during three sensitive windows: preconception, early pregnancy, and periconception. Main Outcome Measure(s): Incidence and risk factors for pregnancy loss. Result(s): Ninety-eight of 344 (28%) women with a singleton pregnancy experienced an observed pregnancy loss. In the preconception window, loss was associated with female age R35 years (1.96, 1.13–3.38) accounting for couples' ages, women's and men's consumption of >2 daily caffeinated beverages (1.74, 1.07–2.81; and 1.73, 1.10–2.72, respectively), and women's vitamin adherence (0.45, 0.25– 0.80). The findings were similar for lifestyle during the early pregnancy and periconception windows. Conclusion(s): Couples' preconception lifestyle factors were associated with pregnancy loss, although women's multivitamin adherence dramatically reduced risk. The findings support continual refinement and implementation of preconception guidance. (Fertil Steril 2016;106:180–8. 2016 by American Society for Reproductive Medicine.)