Skip to main content Accessibility help

Dietary quality, as measured by the Alternative Healthy Eating Index for Pregnancy (AHEI-P), in couples planning their first pregnancy

  • Pao Ying Hsiao (a1), June L Fung (a2), Diane C Mitchell (a3), Terryl J Hartman (a4) and Marlene B Goldman (a2)...



Dietary quality (DQ), as assessed by the Alternative Healthy Eating Index for Pregnancy (AHEI-P), and conception and pregnancy outcomes were evaluated.


In this prospective cohort study on couples planning their first pregnancy. Cox proportional hazards regression assessed the relationship between AHEI-P score and clinical pregnancy, live birth and pregnancy loss.


Participants were recruited from the Northeast region of the USA.

Participants: Healthy, nulliparous couples (females, n 132; males, n 131; one male did not enrol).


There were eighty clinical pregnancies, of which sixty-nine resulted in live births and eleven were pregnancy losses. Mean (sd) female AHEI-P was 71·0 (13·7). Of those who achieved pregnancy, those in the highest tertile of AHEI-P had the greatest proportion of clinical pregnancies; however, this association was not statistically significant (P = 0·41). When the time it took to conceive was considered, females with the highest AHEI-P scores were 20 % and 14 % more likely to achieve clinical pregnancy (model 1: hazard ratio (HR) = 1·20; 95 % CI 0·66, 2·17) and live birth (model 1: HR = 1·14; 95 % CI 0·59, 2·20), respectively. Likelihood of achieving clinical pregnancy and live birth increased when the fully adjusted model, including male AHEI-P score, was examined (clinical pregnancy model 4: HR = 1·55; 95 % CI 0·71, 3·39; live birth model 4: HR = 1·36; 95 % CI 0·59, 3·13).


The present study is the first to examine AHEI-P score and achievement of clinical pregnancy. DQ was not significantly related to pregnancy outcomes, even after adjustments for covariates.


Corresponding author

*Corresponding author: Email


Hide All
1.Sharma, R, Biedenharn, KR, Fedor, JM et al. (2013) Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol 11, 66.
2.Peck, JD, Leviton, A & Cowan, LD (2010) A review of the epidemiologic evidence concerning the reproductive health effects of caffeine consumption: a 2000–2009 update. Food Chem Toxicol 48, 25492576.
3.Gaskins, AJ & Chavarro, JE (2018) Diet and fertility: a review. Am J Obstet Gynecol 218, 379389.
4.Arab, A, Rafie, N, Mansourian, M et al. (2018) Dietary patterns and semen quality: a systematic review and meta-analysis of observational studies. Andrology 6, 2028.
5.Chavarro, JE (2017) Healthy diets and men’s contribution to fertility; is semen quality good enough? Fertil Steril 107, 906907.
6.Nassan, FL, Chavarro, JE & Tanrikut, C (2018) Diet and men’s fertility: does diet affect sperm quality? Fertil Steril 110, 570577.
7.Efrat, M, Stein, A, Pinkas, H et al. (2018) Dietary patterns are positively associated with semen quality. Fertil Steril 109, 809816.
8.Mendiola, J, Torres-Cantero, AM, Vioque, J et al. (2010) A low intake of antioxidant nutrients is associated with poor semen quality in patients attending fertility clinics. Fertil Steril 93, 11281133.
9.Wong, WY, Zielhuis, GA, Thomas, CM et al. (2003) New evidence of the influence of exogenous and endogenous factors on sperm count in man. Eur J Obstet Gynecol Reprod Biol 110, 4954.
10.Attaman, JA, Toth, TL, Furtado, J et al. (2012) Dietary fat and semen quality among men attending a fertility clinic. Hum Reprod 27, 14661474.
11.Chavarro, JE, Furtado, J, Toth, TL et al. (2011) Trans-fatty acid levels in sperm are associated with sperm concentration among men from an infertility clinic. Fertil Steril 95, 17941797.
12.Muthusami, KR & Chinnaswamy, P (2005) Effect of chronic alcoholism on male fertility hormones and semen quality. Fertil Steril 84, 919924.
13.Hu, FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 39.
14.Kennedy, ET, Ohls, J, Carlson, S et al. (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 11031108.
15.McCullough, ML, Feskanich, D, Stampfer, MJ et al. (2002) Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 76, 12611271.
16.Chiuve, SE, Fung, TT, Rimm, EB et al. (2012) Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 142, 10091018.
17.Poon, AK, Yeung, E, Boghossian, N et al. (2013) Maternal dietary patterns during third trimester in association with birthweight characteristics and early infant growth. Scientifica 2013, 786409.
18.Jonnalagadda, SS, Mitchell, DC, Smiciklas-Wright, H et al. (2000) Accuracy of energy intake data estimated by a multiple-pass, 24-hour dietary recall technique. J Am Diet Assoc 100, 303308.
19.Monden, CWS, van Lenthe, F, De Graaf, NDD et al. (2003) Partner’s and own education: does who you live with matter for self-assessed health, smoking and excessive alcohol consumption? Soc Sci Med 57, 19011912.
20.Gaskins, AJ, Rich-Edwards, JW, Hauser, R et al. (2014) Prepregnancy dietary patterns and risk of pregnancy loss. Am J Clin Nutr 100, 11661172.
21.Twigt, JM, Bolhuis, ME, Steegers, EA et al. (2012) The preconception diet is associated with the chance of ongoing pregnancy in women undergoing IVF/ICSI treatment. Hum Reprod 27, 25262531.
22.Vujkovic, M, de Vries, JH, Lindemans, J et al. (2010) The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril 94, 20962101.
23.Chavarro, JE, Rich-Edwards, JW, Rosner, BA et al. (2007) Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol 110, 10501058.
24.Maconochie, N, Doyle, P, Prior, S et al. (2007) Risk factors for first trimester miscarriage – results from a UK-population-based case–control study. BJOG 114, 170186.
25.Di Cintio, E, Parazzini, F, Chatenoud, L et al. (2001) Dietary factors and risk of spontaneous abortion. Eur J Obstet Gynecol Reprod Biol 95, 132136.
26.Rodriguez-Bernal, CL, Rebagliato, M, Iniguez, C et al. (2010) Diet quality in early pregnancy and its effects on fetal growth outcomes: the Infancia y Medio Ambiente (Childhood and Environment) Mother and Child Cohort Study in Spain. Am J Clin Nutr 91, 16591666.
27.Rifas-Shiman, SL, Rich-Edwards, JW, Kleinman, KP et al. (2009) Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort. J Am Diet Assoc 109, 10041011.
28.Afeiche, MC, Gaskins, AJ, Williams, PL et al. (2014) Processed meat intake is unfavorably and fish intake favorably associated with semen quality indicators among men attending a fertility clinic. J Nutr 144, 10911098.
29.Jensen, TK, Swan, SH, Skakkebaek, NE et al. (2010) Caffeine intake and semen quality in a population of 2,554 young Danish men. Am J Epidemiol 171, 883891.


Type Description Title
Supplementary materials

Hsiao et al. supplementary material
Hsiao et al. supplementary material 1

 Word (15 KB)
15 KB


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed