Food, nutrition, and fertility: from soil to fork.

Food and nutrition-related factors, including foods and nutrients consumed, dietary patterns, use of dietary supplements, adiposity, and exposure to food-related environmental contaminants, have the potential to impact semen quality and male and female fertility; obstetric, fetal, and birth outcomes; and the health of future generations, but gaps in evidence remain. On 9 November 2022, Tufts University's Friedman School of Nutrition Science and Policy and the school's Food and Nutrition Innovation Institute hosted a 1-d meeting to explore the evidence and evidence gaps regarding the relationships between food, nutrition, and fertility. Topics addressed included male fertility, female fertility and gestation, and intergenerational effects. This meeting report summarizes the presentations and deliberations from the meeting. Regarding male fertility, a positive association exists with a healthy dietary pattern, with high-quality evidence for semen quality and lower quality evidence for clinical outcomes. Folic acid and zinc supplementation have been found to not impact male fertility. In females, body weight status and other nutrition-related factors are linked to nearly half of all ovulation disorders, a leading cause of female infertility. Females with obesity have worse fertility treatment, pregnancy-related, and birth outcomes. Environmental contaminants found in food, water, or its packaging, including lead, perfluorinated alkyl substances, phthalates, and phenols, adversely impact female reproductive outcomes. Epigenetic research has found that maternal and paternal dietary-related factors can impact outcomes for future generations. Priority evidence gaps identified by meeting participants relate to the effects of nutrition and dietary patterns on fertility, gaps in communication regarding fertility optimization through changes in nutritional and environmental exposures, and interventions impacting germ cell mechanisms through dietary effects. Participants developed research proposals to address the priority evidence gaps. The workshop findings serve as a foundation for future prioritization of scientific research to address evidence gaps related to food, nutrition, and fertility.

The Potential Role for Myoinositol in the Prevention of Gestational Diabetes Mellitus.

More than 9% of overweight and obese women develop gestational diabetes mellitus (GDM) during pregnancy. Myoinositol is a promising supplement that may represent the first GDM-risk modifier that could be implemented on a population-level. It has been shown in animal and small human trials to prevent GDM through its insulin-mimetic properties. In animal studies, it also appears to decrease intra-abdominal adiposity and protect against diabetic embryopathies. In humans, four small randomized trials have demonstrated that myoinositol supplementation can lead to more than a 50% rate reduction in GDM compared with placebo. We now need a large, multicentered randomized controlled trial to demonstrate whether myoinositol has not only the promised impact on GDM rates, but also an effect on important secondary outcomes intricately linked to GDM, such as birth weight and neonatal intensive care unit admission.

Cost savings of red cell salvage during cesarean delivery.

OBJECTIVE: To use decision analysis to evaluate whether and under what conditions routine setup of intraoperative cell salvage during cesarean delivery is cost-saving. METHODS: We developed a decision model to compare costs associated with two strategies for cesarean delivery: 1) routine setup of intraoperative cell salvage; or 2) standard care without intraoperative cell salvage. One-, two-, and three-way sensitivity analyses as well as Monte Carlo simulation were used to assess the robustness of our findings. RESULTS: Among nonselected women undergoing cesarean delivery, our base case estimate was that 3.2% would require red blood cell transfusion. Under this assumption, cell salvage is cost-saving only if each woman requires at least 60 units. Conversely, if only two units on average are required, the probability of transfusion needs to be at least 58% for cell salvage to be cost-saving. In our base case analysis, setup of intraoperative cell salvage during routine cesarean deliveries is not cost-saving, increasing the cost per cesarean delivery by $223.80. We found that cell salvage would be cost-saving only in very high-risk scenarios. For example, severe maternal anemia or abnormal placentation, in which 54% and 75% of women are transfused three and two units per case, respectively, would make cell salvage cost-saving. CONCLUSION: Setup of intraoperative cell salvage during cesarean delivery is cost-saving and should be considered only when there is a predictably high probability of transfusion or when a massive transfusion is reasonably likely.

Cost-effectiveness of percutaneous tibial nerve stimulation versus extended release tolterodine for overactive bladder.

PURPOSE: We assessed the cost-effectiveness of percutaneous tibial nerve stimulation vs extended release tolterodine for the treatment of overactive bladder. MATERIALS AND METHODS: A 1-year time frame cost-effectiveness model from a societal perspective was developed by comparing medical costs and quality of life determined by improved continence and therapy side effects of percutaneous tibial nerve stimulation and tolterodine ER. Percutaneous tibial nerve stimulation therapy consisted of 12 sessions for 3 months followed by maintenance therapy. Significant side effects of both strategies can result in reduced quality of life or therapy termination. Parameter estimates included utilities of improved urinary incontinence (0.92) and continued urinary incontinence (0.73), reduction in quality of life from side effects (5%), cost of percutaneous tibial nerve stimulation per session ($203) and cost of tolterodine ER per month ($150). Our primary outcome was the incremental cost-effectiveness ratio, defined as the marginal cost per quality adjusted life-years gained. Less than $50,000 per quality adjusted life-year gained was considered cost-effective. The uncertainty of input parameters was addressed by 1-way sensitivity analyses and Monte Carlo simulation to assess the robustness of the model. RESULTS: Percutaneous tibial nerve stimulation added significant cost to the management of overactive bladder with modest improvement in quality of life. For every 100 patients treated with percutaneous tibial nerve stimulation the costs increased by $303,480 and resulted in an additional 4.3 quality adjusted life-years gained compared to tolterodine ER. The incremental cost-effectiveness ratio was $70,754 per quality adjusted life-year gained. In the Monte Carlo analysis percutaneous tibial nerve stimulation was cost-effective only 21% of the time. CONCLUSIONS: Percutaneous tibial nerve stimulation was not cost-effective for treating overactive bladder vs tolterodine ER under a wide range of clinical circumstances.