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Official websites use. Share sensitive information only on official, secure websites. Dietary factors, including sugar-sweetened beverages, may have adverse effects on fertility. Sugar-sweetened beverages have been associated with poor semen quality in cross-sectional studies, and female soda intake has been associated with lower fecundability in some, but not all, studies. We evaluated the association of female and male sugar-sweetened beverage intake with fecundability among women planning pregnancy and of their male partners in a North American prospective cohort study. We followed participants enrolled between June and May until pregnancy or for up to twelve menstrual cycles. Participants completed a comprehensive baseline questionnaire, including questions on soda sugar-sweetened and diet , fruit juice, energy, and sports drink consumption during the previous 4 weeks. We estimated time-to-pregnancy from follow-up questionnaires completed every 2 months by the female partner. Diet soda had little association with fecundability. Higher intake of sugar-sweetened beverages has been associated with earlier menarche 10 and elevated follicular estradiol, but not with anovulation. In males, three cross-sectional studies reported an association between soda consumption and poor semen quality, 19 — 21 but semen quality may be a poor proxy for male fecundity. Here, we use data from a prospective cohort study of North American pregnancy planners to examine the association between female and male preconception sugar-sweetened beverage consumption and fecundability. Couples are eligible if trying to conceive and not using contraception or fertility treatments. The study methods are described elsewhere. Ten days after completing the baseline questionnaire, participants complete a separate food frequency questionnaire FFQ developed by the National Cancer Institute. On the baseline questionnaire, female and male participants reported their average soda consumption number of ounce servings per week in the past month, selecting from a list of popular sodas. Total sugar-sweetened soda intake was calculated by summing the number of ounce servings of Coca-Cola, Pepsi, Mountain Dew, Dr. In addition, participants reported consumption of popular energy drinks e. They also answered an open-ended question on other types of sugar-sweetened energy drinks. Consumption of sugar-sweetened sports drinks e. We estimated time-to-pregnancy TTP using data from the female questionnaires screening, baseline, and follow-up. Women reported their pregnancy attempt time in months and menstrual cycles at baseline. Those with regular menstrual cycles were asked their usual menstrual cycle length. For women with irregular cycles, we estimated cycle length based on date of LMP at baseline and on prospectively-reported LMP dates during follow-up. Body mass index was calculated as weight kg divided by height m 2. Total metabolic equivalents METs of physical activity were calculated by multiplying the average number of hours per week engaging in various activities by metabolic equivalents estimated from the Compendium of Physical Activities. Analyses were run separately among the female and the male participants. Couples contributed menstrual cycles to follow-up until pregnancy, initiation of fertility treatment, cessation of pregnancy attempts, withdrawal, loss to follow-up, or completion of 12 cycles, whichever came first. To account for variation in time trying to conceive at study entry range: 0—6 cycles and avoid left truncation bias, 34 we analyzed observed cycles at risk using the Anderson-Gill data structure. We controlled for variables hypothesized to be associated with sugar-sweetened beverage consumption and subfertility. In a sub-analysis, we also controlled for Healthy Eating Index and total energy intake calculated from the female FFQ. Sugar-sweetened and diet sodas were mutually adjusted, and estimates for all other individual beverages energy drinks, sports drinks and juice were adjusted for intake of sugar-sweetened sodas. Among the couples with complete FFQ data, we computed Pearson correlation coefficients between female and male Healthy Eating Index. We evaluated female and male intake of sugar-sweetened beverages jointly to look for evidence of synergistic effects. Because the male FFQ was not implemented until November , only males have completed it, limiting our ability to control for additional dietary variables in males. We used multiple imputation to impute missing covariate values. Among the women included in the study, 8. Men consumed an average of 2. Women consumed an average of 1. The average Healthy Eating Index score for females was Women who consumed more sugar-sweetened beverages were slightly younger and were more likely to be non-white Table 1. Participants who drank more sugar-sweetened beverages were more likely to smoke, have a higher BMI, lower physical activity, lower Healthy Eating Index scores and higher caloric intake, and lower education and household income. Intercourse frequency and using methods to improve conception were similar across categories of sugar-sweetened beverage consumption. Baseline characteristics of 3, female and 1, male pregnancy planners in relation to sugar-sweetened beverage consumption. Among 2, females and males who completed the Food frequency questionnaire. Female consumption of sugar-sweetened sodas, a subset of all SSB, was also associated with reduced fecundability, with FRs of 0. There was little association between diet soda consumption and fecundability Table 2. Fruit juice intake was not appreciably associated with fecundability and fecundability ratio estimates for intake of sports drinks did not follow a dose—response pattern and were imprecise. Among the subset of females with male partners in the study, adjustment for male sugar-sweetened beverage intake also had little effect data not shown. Additionally adjusted for diet soda intake for sugar-sweetened soda models , or for sugar-sweetened soda intake for all other models. Men who consumed the most fruit juices and sports drinks appeared to have slightly higher fecundability, but estimates were imprecise. We also adjusted the male models for female Healthy Eating Index and total energy intake which produced similar results data not shown. Additionally adjusted for daily servings of diet soda for sugar-sweetened soda model or daily servings of sugar-sweetened soda all other models. Table 4 presents the results for the joint effects of male and female sugar-sweetened beverage and sugar-sweetened soda consumption. In general the strongest effects were seen among couples where both partners had high intake but the effects were approximately additive, with little indication of any interaction. Both splines show a decline in fecundability with increasing intake. Association between female a and male b sugar-sweetened soda intake and fecundability, fitted by restricted cubic splines, PRESTO, — Associations were stronger among couples trying for fewer than three cycles at entry, but were absent among couples who had been trying for three to six cycles at entry eTable 1. Associations did not vary appreciably across strata of female age data not shown. Among females, results were similar across BMI strata eTable 2. We found little change when sugar-sweetened and diet sodas were mutually adjusted for each other, or when other beverage types were adjusted for consumption of sugar-sweetened sodas. As a sensitivity analysis to evaluate possible residual confounding by caffeine, we compared FRs for caffeinated and decaffeinated sodas; both groups comprise a mixture of sugar-sweetened and diet sodas. FRs for caffeinated and decaffeinated sodas were similar data not shown. In this preconception cohort study of North American pregnancy planners, both female and male consumption of any sugar-sweetened beverages were associated with reduced fecundability. The associations were driven mainly by intake of sugar-sweetened sodas. Energy drink consumption also was associated with reduced fecundability, but numbers were small. We found little consistent evidence for associations between consumption of diet soda, sport drinks, or fruit juice and fecundability. Adjustment for caffeine intake had little effect on our results. Similarly, adjustment for female and male BMI had minimal effects, but the association between intake of sugar-sweetened soda and fecundability was stronger among overweight and obese men. To our knowledge, only three studies have evaluated female soda intake and fecundability. No prior prospective studies to our knowledge have evaluated male soda consumption and fecundability. A Canadian retrospective cohort study of couples found little association between colas diet and regular combined and fecundability. We were unable to evaluate sugar-sweetened, non-caffeinated beverages separately in the current study because of small numbers. Adjustment for total caffeine intake had virtually no effect on our estimates for sugar-sweetened beverages and thus caffeine is unlikely to explain our findings. In addition, when we compared effects of caffeinated with non-caffeinated sodas, results were similar, suggesting that caffeine is not responsible for the observed reductions in fecundability. We evaluated exposure information reported at baseline, introducing potential for misclassification if beverage consumption changed over time. Because we provided a list of individual beverages for sodas and energy drinks, overestimation of these specific beverages may have occurred. Conversely, other types of sugar-sweetened beverages not on our list may not have been captured e. Any misclassification is likely to be non-differential across time-to-pregnancy categories, however, because beverage consumption was assessed prospectively before the occurrence of infertility. Furthermore, evidence that associations were stronger among couples who had been trying to conceive for fewer than 3 cycles at study entry argues against reverse causation. However, we lacked information on male dietary factors that may have confounded the observed associations, such as total energy intake and consumption of high glycemic or high-fat diets. When we controlled for female Healthy Eating Index score which was moderately correlated with male scores , we found no material effect on our results for either male or female intake of sugar-sweetened beverages. Nevertheless, if a dietary pattern or food item among males was positively associated with both sugar-sweetened beverage consumption and subfertility, confounding would have exaggerated the inverse association between sugar-sweetened beverages and fecundability. Critics occasionally have questioned whether Internet-based studies are prone to selection bias. The selection issues related to internet volunteers, however, applies more generally. Many cohort studies, including all randomized trials, enroll volunteers, and some randomized trials recruit via the Internet. Regardless of the method used to recruit volunteers for a cohort study, recruitment of volunteers should not affect validity of study results based on internal comparisons, unless the relation between the study factors differed between those who volunteer and those who do not, which seems unlikely. Furthermore, our study 45 and others 46 , 47 have shown that even when participation at cohort entry differs by characteristics such as age, parity, or smoking, measures of association are not biased due to self-selection. A possible mechanism for an association between sugar-sweetened beverage consumption and fertility includes increased insulin resistance, leading to oxidative stress, 19 , 48 which may deleteriously affect semen quality, 49 or ovulatory function. Most sodas in North America are sweetened with HFCS and have higher fructose to glucose ratios than other sugar-sweetened beverages. In summary, we found an association between female and male consumption of sugar-sweetened beverages and reduced fecundability, which appeared to be driven mainly by sugar-sweetened sodas, the most commonly consumed sugar-sweetened beverages. We also found a large reduction in fecundability among both females and males who consumed more than one sugar-sweetened energy drink per day, but these results were based on small numbers. Given the high levels of sugar-sweetened beverages consumed by reproductive-aged couples in North America, these findings could have important public health implications. We thank Mr. The authors declare that they have no conflict of interest. The computing code and de-identified data are available by contacting the first or last author. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Published in final edited form as: Epidemiology. Find articles by EE Hatch. Find articles by AK Wesselink. Find articles by KA Hahn. Find articles by JJ Michiel. Find articles by EM Mikkelsen. Find articles by HT Sorensen. Find articles by KJ Rothman. Find articles by LA Wise. PMC Copyright notice. The publisher's version of this article is available at Epidemiology. Open in a new tab. Female and male sugar-sweetened beverage consumption and fecundability. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Healthy Eating Index score mean b.

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