Neighbourhood socioeconomic environment may influence reproductive health: JAMA

USA: Residence in a socioeconomically disadvantaged neighbourhood is associated with moderately decreased fecundability, states an article published in the JAMA Network Open

Infertility is a global health issue affecting millions of people of reproductive age worldwide. Infertility prevention is often discussed concerning personal behavioural changes that may improve the probability of conception. However, structural, political, and environmental factors may also play a substantial role in fertility. A growing body of literature demonstrates associations between a disadvantaged neighbourhood environment and adverse reproductive health outcomes. There are multiple pathways by which neighbourhood disadvantage may reduce fecundability(a sensitive marker of fertility with many health implications.). Residing in a socioeconomically disadvantaged neighbourhood is associated with increased perceived stress, cortisol levels, and allostatic load. Perceived stress has been associated with poorer in vitro fertilization outcomes and reduced fecundability(a sensitive marker of fertility with many health implications) among couples attempting spontaneous conception. To date, no studies of disadvantaged neighbourhood environments have directly examined fertility-related outcomes

Willis MD, Oregon State University, Corvallis, USA and colleagues conducted a study to examine the association between residence in disadvantaged neighbourhoods and fecundability.

Researchers analyzed baseline data of 6356 participants ( female, 21 to 45 years of age), of the Pregnancy Study Online — an online cohort study of couples who were attempting conception without fertility treatment. A standardized area deprivation index (ADI) derived at the census block group level was applied to each residential address provided by the participants. Fecundability, the per-cycle probability of conception was determined via questionnaires that were completed every 8 weeks for 12 months, until conception or a censoring event. Models were adjusted for demographic characteristics and factors associated with fertility. Of the total participants, 3725 pregnancies were observed for 27 427 menstrual cycles of follow-up.

Key findings of the study,

• Comparing the top and bottom deciles of disadvantaged neighbourhood status, adjusted fecundability ratios were 0.79 for national-level ADI rankings and 0.77 for within-state ADI rankings.

• Associations were slightly stronger among participants with lower annual incomes

• Restricted cubic splines showed some evidence of nonlinearity in the association.

The authors conclude that living in a disadvantaged neighbourhood may decrease fertility. Results show that residence in a socioeconomically disadvantaged neighbourhood is associated with moderately decreased fecundability. If confirmed in other studies, the present study results, suggest that policies and programs that address socioeconomic inequities may reduce infertility in local communities

The study findings suggest that investments in disadvantaged neighbourhoods may yield positive benefits for fertility, the authors wrote.

Heading----Lower fecundability observed in residents of the disadvantaged neighbourhood: JAMA

Willis MD, Orta OR, Ncube C, et al. Association Between Neighborhood Disadvantage and Fertility Among Pregnancy Planners in the US. JAMA Netw Open. 2022;5(6):e2218738.