Abstract
BackgroundWhile the potential adverse outcomes of prenatal exposure to unhealthy lifestyle are widely evidenced, little is known about these exposures in the periconception period. We investigated the associations between lifestyle behaviours and adverse pregnancy outcomes with a unique distinction between preconceptional- and prenatal lifestyle behaviours.MethodsA secondary analysis took place within a prospective multicentre cohort study in the Netherlands, including 3,684 pregnant women. Baseline characteristics and preconceptional and first trimester lifestyle behaviours were assessed through a self-administered questionnaire in the first trimester. Adverse pregnancy outcomes (hypertensive disorders in pregnancy (HDP), small for gestational age (SGA), gestational diabetes (GDM) and spontaneous preterm birth (sPTB)) were reported by healthcare professionals. Data were collected between 2012 and 2014 and analysed using multivariate logistic regression.ResultsWomen who are overweight, and especially obese, have the highest odds of developing any adverse pregnancy outcome (adjusted odds ratio (aOR) 1.61 (95 % Confidence Interval (CI) 1.31–1.99) and aOR 2.85 (95 %CI 2.20–3.68), respectively), particularly HDP and GDM. Women who prenatally continued smoking attained higher odds for SGA (aOR 1.91 (95 %CI 1.05–1.15)) compared to the reference group, but these odds decreased when women prenatally quit smoking (aOR 1.14 (95 %CI 0.59–2.21)). Women who did not use folic acid supplements tended to have a higher odds of developing adverse pregnancy outcomes (aOR 1.28 (95 %CI 0.97–1.69)), while women who prenatally started folic acid supplements did not (aOR 1.01 (95 %CI 0.82–1.25)).ConclusionsOur results indicate that smoking cessation, having a normal body mass index (BMI) and initiating folic acid supplements preconceptionally may decrease the risk of adverse pregnancy outcomes. Therefore, intervening as early as the preconception period could benefit the health of future generations.
Highlights
While the potential adverse outcomes of prenatal exposure to unhealthy lifestyle are widely evidenced, little is known about these exposures in the periconception period
We found that women with a body mass index (BMI) of 25 kg/m2 or more, especially women with a BMI above 30 kg/m2, have the highest odds of developing adverse pregnancy outcomes
Daily fruit intake ≥ 2 pieces ref ref ref ref ref ref ref ref ref ref hypertensive disorders of pregnancy (HDP) hypertensive disorders in pregnancy, Gestational diabetes (GDM) gestational diabetes, sPTB spontaneous preterm birth, small for gestations age (SGA) small for gestational age, OR odds ratio, confidence intervals (CI) confidence interval acomposite outcome: women with one of the following complications; HDP, GDM, sPTB, SGA or fetal death. badjusted for non-modifiable factors cn was too small in total population (n=28) to calculate odds ratios dincluding multivitamin use ewomen using multivitamin were categorized in both ‘folic acid use’ and ‘vitamin use’ fvitamin C, vitamin D, calcium or multivitamin use our results show that women who quit smoking and women who continue to smoke both have increased odds for sPTB [42,43,44]
Summary
While the potential adverse outcomes of prenatal exposure to unhealthy lifestyle are widely evidenced, little is known about these exposures in the periconception period. Adverse neonatal outcomes, for example, preterm birth and small for gestations age (SGA), can have long term consequences among surviving infants, such as medical disabilities, impaired cognitive development, learning difficulties and behaviouraland psychological problems [3]. The periconception period, defined as the 14 weeks before and 10 weeks after conception, is a critical window with a substantial impact on fetal growth and development [8]. Within this period, gametogenesis, organogenesis and placental development occur. The maternal metabolic environment of women who are overweight or obese tends to affect placental development and these women are more prone to develop adverse pregnancy outcomes like GDM or pre-eclampsia [14]
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