Prepregnancy adherence to plant-based diet indices and exploratory dietary patterns in relation to fecundability

Abstract

Background Modest associations have been reported between specific food groups or nutrients and fecundability [measured by time to pregnancy (TTP)]. Examining overall diets provides a more holistic approach towards understanding the relationships with fecundability. It is not known if plant-based diets indices or exploratory dietary patterns are associated with fecundability. Objective We examine the associations between adherence to 1) plant-based diet indices and 2) exploratory dietary patterns and fecundability among women planning pregnancy. Design Data were analysed from the Singapore S-PRESTO study. Pre-pregnancy diet was assessed using a semi-quantitative food frequency questionnaire from which the overall, healthful and unhealthful plant-based diet indices (oPDI, hPDI and uPDI) were calculated. Exploratory dietary patterns were derived using factor analysis based on forty-four pre-defined food groups. Participants were categorized into quintiles based on their dietary pattern scores. TTP (in menstrual cycles) was ascertained within a year of dietary assessment. Discrete-time proportional hazard models, adjusted for confounders, were used to estimate fecundability ratios (FRs) and 95% CIs, with FR > 1 indicating a shorter TTP. Results Among 805 women, 383 pregnancies confirmed by ultrasound scans occurred. Compared to women in the lowest quintile, those in the highest quintile of the uPDI had reduced fecundability [FR of Q5 vs Q1 (95% CI): 0.65 (0.46, 0.91), p trend: 0.009]. Conversely, greater adherence to the hPDI was associated with increased fecundability [1.46 (1.02, 2.07), p trend: 0.036]. The oPDI was not associated with fecundability. Among the three exploratory dietary patterns, only greater adherence to the “Fast Food and Sweetened Beverages” pattern (FFSB) was associated with reduced fecundability [0.61 (0.40, 0.91), p trend: 0.018]. Conclusions Greater adherence to the uPDI or the FFSB dietary pattern was associated with reduced fecundability among Asian women. Greater adherence to the hPDI may be beneficial for fecundability, though this requires confirmation by future studies. Clinical Trial Registry number: NCT 03531658 Secondary Abstract: Plant-based diets are increasingly popular as they are associated with reduced risks of chronic diseases and considered a sustainable diet for planetary health. Do these diets contribute to fecundability (as measured by time to pregnancy)?

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ORCID for Keith Godfrey: orcid.org/0000-0002-4643-0618

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