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Socioeconomic and lifestyle factors in relation to folic acid supplement use in infertile and fertile Swedish women
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Örebro University, Karolinska Institutet.
Karolinska Institutet.
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(English)Manuscript (preprint) (Other academic)
Abstract [sv]

Background: Socioeconomic and lifestyle factors are considered to be associated with folic acid supplement use and intake in the general population, but studies on infertile women are lacking. When investigating dietary supplement intake, the validity of the assessment of reported supplement use and actual intake is crucial. The objective of the study was to investigate socioeconomic, lifestyle and dietary factors in relation to folic acid supplement use and folate status in infertile and fertile women. In addition, a sub-analysis was performed to validate the used questionnaire. Methods: In this observational study, 340 infertile women and 188 fertile women were investigated. A questionnaire was used to assess lifestyle and dietary habits and use of dietary supplements. Blood samples were obtained for analyses of plasma folate and homocysteine levels. 24-hour recall interviews were performed to validate the questionnaire. Results: Folic acid supplement use was related to marital status, educational level and employment status. Infertile women had significantly higher mean folic acid daily intake and better folate status. However, folate status did not correlate with socioeconomic or lifestyle factors. The infertile women were physically more active, smoked less and had better employment status, but they were also more obese than fertile women. Socioeconomic and lifestyle factors were not related to in vitro fertilization outcome. Dietary data from the questionnaires showed good validity compared with the data from the 24-hour recall interviews, but data regarding folic acid supplement use showed only fair agreement between these methods. Conclusions: Highly educated, employed, married and infertile women were most prone to using folic acid supplements. Only a few socioeconomic and lifestyle factors differed between infertile and fertile women, and these were not related to folate status or IVF outcome. Methods other than a questionnaire are recommended when investigating folic acid supplement use.

 

Keyword [en]
Folic acid supplement, infertility, socioeconomic status, lifestyle, dietary
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-220409OAI: oai:DiVA.org:uu-220409DiVA: diva2:705291
Available from: 2014-03-15 Created: 2014-03-13 Last updated: 2014-04-29
In thesis
1. Folate, Hormones and Infertility: Different factors affecting IVF pregnancy outcome
Open this publication in new window or tab >>Folate, Hormones and Infertility: Different factors affecting IVF pregnancy outcome
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Various hormones have been studied as regards prediction of pregnancy outcome after infertility treatment, but no ideal candidate has been found. Folate and genetic variations in folate metabolism have also been associated with infertility, but it remains unclear how these factors affect IVF pregnancy outcome. It is known that infertility is associated with active folic acid supplement use, but the effect of socioeconomic and lifestyle factors on folic acid supplement use in infertile women has not been well investigated. The overall aim of this work was to obtain information on the prediction of live birth, and to study factors affecting the role of folate and folic acid intake in relation to IVF pregnancy outcome. Infertile women with various infertility diagnoses were studied. Healthy, fertile non-pregnant women were used as controls in three of the studies. Blood samples were taken for assay of eight different hormones, folate and homocysteine, and for genomic DNA extraction. A questionnaire was used to assess background data and use of folic acid supplements. Twenty-four-hour recall interviews were performed for validation of the questionnaire. The studied hormones were not good predictors of live birth. The best predictor was age of the women, together with ovulatory menstrual cycles, and thyroid-stimulating hormone and anti-Müllerian hormone (AMH) status. Well-educated women, high-status employed women, and married and infertile women used the most folic acid supplements. Infertile women had better folate status than fertile women. However, pregnancy outcome after infertility treatment was not dependent on folic acid intake, folate status, genetic variation of 5,10-methylenetetrahydrofolate reductase or socioeconomic status. In conclusion, AMH levels vary less than those of other hormones during the menstrual cycle, and AMH could be used as a predictive marker of live birth together with age and ovulation. Folate might play a minor role in IVF pregnancy outcome, but the importance of folate as regards other health perspectives should not be forgotten.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 987
Keyword
Folate, folic acid supplement, homocysteine, hormones, infertility, IVF, lifestyle factor, MTHFR, predictive value, socioeconomic factor, women
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-220476 (URN)978-91-554-8919-9 (ISBN)
Public defence
2014-05-22, Gustavianum, Auditorium Minus, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-04-29 Created: 2014-03-15 Last updated: 2014-06-30

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