Association Between Pesticide Residue Intake From Consumption of Fruits and Vegetables and Pregnancy Outcomes Among Women Undergoing Infertility Treatment With Assisted Reproductive Technology

Yu-Han Chiu; Paige L Williams; Matthew W Gillman; Audrey J Gaskins; Lidia Mínguez-Alarcón; Irene Souter; Thomas L Toth; Jennifer B Ford; Russ Hauser; Jorge E Chavarro; EARTH Study Team

doi:10.1001/jamainternmed.2017.5038

Lifestyle and Environment · Environmental Exposures

Association Between Pesticide Residue Intake From Consumption of Fruits and Vegetables and Pregnancy Outcomes Among Women Undergoing Infertility Treatment With Assisted Reproductive Technology

Chiu YH, Williams PL, Gillman MW, Gaskins AJ, Mínguez-Alarcón L, Souter I, Toth TL, Ford JB, Hauser R, Chavarro JE, EARTH Study Team

JAMA internal medicine, 2018

DOI 10.1001/jamainternmed.2017.5038 PMID 29084307 PMC PMC5814112

RRM Academy Synopsis

High-pesticide produce intake linked to fewer live births with ART

Highest intake of high-pesticide-residue produce was linked to a 26% lower probability of live birth per cycle than lowest intake. This prospective cohort followed 325 women through 541 ART cycles. Clinical pregnancy probability was 18% lower in the same comparison. Low-residue produce showed no significant link to ART outcomes.

Key Findings

The probability of clinical pregnancy was 18% (95% CI, 5%–30%) lower in the highest quartile of high-pesticide residue intake (≥2.3 servings/d) than in the lowest quartile (<1.0 servings/d).
Live birth probability was 26% lower in the highest quartile than the lowest (95% CI, 13%–37%): adjusted 0.65 (95% CI, 0.52–0.76) in the lowest, 0.39 (95% CI, 0.28–0.52) in the highest.
Among 256 women with successful implantation, the adjusted probability of total pregnancy loss rose from 7% (95% CI, 3%–15%) in the lowest quartile to 34% (95% CI, 20%–51%) in the highest.
Low-pesticide residue intake was not significantly related to ART outcomes. Neither type of produce was associated with ovarian response to stimulation, fertilization rate, or embryo quality.
Of the 541 ART cycles that the 325 women underwent, 228 (42%) resulted in a live birth.

Interpretation

The Environment and Reproductive Health (EARTH) study is a prospective cohort that followed women forward in time, so its results are associations between intake and outcomes. Pesticide exposure was estimated from a food questionnaire matched to US government residue data. Pesticides were not measured. The authors state that unmeasured confounding cannot be ruled out and that the method cannot link specific pesticides to outcomes. Participants were patients at one fertility center, and the authors caution that findings may not generalize to the general population. They call for confirmation.

RRM Context

Restorative reproductive medicine searches for the cause of infertility. The evaluation includes both partners and daily life. This analysis included women who completed a diet assessment. The outcomes were ART cycle results. Higher intake of high-residue produce was associated with more pregnancy loss after implantation.

Our editorial summary of this paper, not the article's abstract.

Abstract

Importance

Animal experiments suggest that ingestion of pesticide mixtures at environmentally relevant concentrations decreases the number of live-born offspring. Whether the same is true in humans is unknown.

Objective

To examine the association of preconception intake of pesticide residues in fruits and vegetables (FVs) with outcomes of infertility treatment with assisted reproductive technologies (ART).

Design, Setting, and Participants

This analysis included 325 women who completed a diet assessment and subsequently underwent 541 ART cycles in the Environment and Reproductive Health (EARTH) prospective cohort study (2007-2016) at a fertility center at a teaching hospital. We categorized FVs as having high or low pesticide residues using a validated method based on surveillance data from the US Department of Agriculture. Cluster-weighted generalized estimating equations were used to analyze associations of high- and low-pesticide residue FV intake with ART outcomes.

Main Outcomes and Measures

Adjusted probabilities of clinical pregnancy and live birth per treatment cycle.

Results

In the 325 participants (mean [SD] age, 35.1 [4.0] y; body mass index, 24.1 [4.3]), mean (SD) intakes of high- and low-pesticide residue FVs were 1.7 (1.0) and 2.8 (1.6) servings/d, respectively. Greater intake of high-pesticide residue FVs was associated with a lower probability of clinical pregnancy and live birth. Compared with women in the lowest quartile of high-pesticide FV intake (<1.0 servings/d), women in the highest quartile (≥2.3 servings/d) had 18% (95% CI, 5%-30%) lower probability of clinical pregnancy and 26% (95% CI, 13%-37%) lower probability of live birth. Intake of low-pesticide residue FVs was not significantly related to ART outcomes.

Conclusions and Relevance

Higher consumption of high-pesticide residue FVs was associated with lower probabilities of pregnancy and live birth following infertility treatment with ART. These data suggest that dietary pesticide exposure within the range of typical human exposure may be associated with adverse reproductive consequences.

Topics

Lifestyle and Environment › Environmental Exposures › Pesticides and Agricultural Chemicals · Assisted Reproduction › Outcomes and Effectiveness › Live Birth Rates

Yu-Han Chiu, Paige L Williams, Matthew W Gillman, Audrey J Gaskins, Lidia Mínguez-Alarcón, Irene Souter, Thomas L Toth, Jennifer B Ford, Russ Hauser, Jorge E Chavarro

Y Chiu, P Williams, Matt Gillman, M Gillman, A Gaskins, L Mínguez-Alarcón, I Souter, Tom Toth, T Toth, Jen Ford, Jenny Ford, J Ford, R Hauser, J Chavarro

PMID 29084307 29084307 DOI 10.1001/jamainternmed.2017.5038 10.1001/jamainternmed.2017.5038 Chiu et al. 2018, Chiu 2018

Association Between Pesticide Residue Intake From Consumption of Fruits and Vegetables and Pregnancy Outcomes Among Women Undergoing Infertility Treatment With Assisted Reproductive Technology

High-pesticide produce intake linked to fewer live births with ART

Key Findings

Interpretation

RRM Context

Abstract

Topics

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