Preconception Lifestyle Research Articles

8570 Association Between Preconception Lifestyle and Anthropometric Modifications and Fertility outcomes in Women with Infertility and Obesity

Abstract Disclosure: A. Thibodeau: None. C. Richer dit Laflèche: None. G. Ngueta: None. M. Belan: None. F. Jean-Denis: None. M. Langlois: None. M. Pesant: None. B. Carranza Mamane: None. J. Baillargeon: Grant Recipient; Self; Ferring Pharmaceuticals. Introduction: Infertility is a common problem that is affected by many lifestyle behaviors, and preconception lifestyle modifications are recommended in women with infertility and obesity. This study thus aims to explore whether preconception lifestyle or anthropometric changes are associated with a viable pregnancy or a live birth in this population. Methods: This prospective cohort study, nested within a randomized controlled trial that recruited 127 women with infertility and obesity at an academic fertility clinic, reports on 70 women who had at least one research visit during their follow-up until the onset of pregnancy or a maximum of 18 months. Lifestyles were assessed using a questionnaire. Logistic regression was used to examine the association between changes in lifestyle or anthropometry and the occurrence of a viable pregnancy or live birth. Changes were defined by the incremental area under the curve (divided by follow-up time; iAUC) and the difference between baseline and the minimum or maximum measure achieved during follow-up. Regressions were corrected for baseline measures of the age of both partners, waist circumference, multiparity, socioeconomic status and multivitamin use. Results: The odds of a pregnancy and live birth were higher among women who had a greater minimum change (improvement) in their weekly consumption of fruits (p=.028/.014) or dairy products (p=.005/.003), in their reduction of tobacco use (p=.038/NS), in their sleep duration (p=.044/NS), or in their loss of weight, waist circumference or fat mass (p=.007/.007; .006/.006; .045/.019). Unexpectedly, a higher maximum change in energy expenditure was associated with lower odds of pregnancy (p=.013). Multivariate analyses showed that a higher minimum change in fruit consumption (p=.008), in tobacco use reduction (p=.033), and waist circumference loss (p=.002), and a lower maximum change in energy expenditure (p=.008) were all independently associated with the occurrence of pregnancy, after adjustment for the abovementioned potential confounders. For live birth, a higher minimum change in dairy products consumption (p=.012), in tobacco use reduction (p=.017), and in weight loss (p=.003) were all independently associated with a live birth. Conclusion: Our exploratory analyses are among the first to show that preconception lifestyle improvements are associated with the occurrence of a viable pregnancy and live birth in women with infertility and obesity, particularly higher minimal and sustained changes in fruit and dairy product intake and tobacco reduction. Higher minimal and sustained weight or waist circumference losses also contributed to improve their fertility, as expected. However, the negative association between higher energy expenditure and pregnancy was unexpected and requires further evaluation. Presentation: 6/1/2024

221 - Preconception lifestyle interventions for women – a systematic review and meta-analysis of intervention characteristics and behaviour change techniques

221 - Preconception lifestyle interventions for women – a systematic review and meta-analysis of intervention characteristics and behaviour change techniques

O-135 The consequences of paternal pre-conceptional health for offspring health and pregnancy outcomes: involvement of the germ-cell epigenome and non-germ cell factors

Abstract Study question Paternal health at conception is important for offspring health. The susceptibility windows within the male reproductive tract and the molecular mechanisms are not completely understood. Summary answer Using mouse genetics, (epi)genomics and in-depth phenotyping, we show that the germ-cell epigenome and components of the seminal fluid are critical for paternal intergenerational effects. What is known already Paternal intergenerational effects are highly conserved across mammals and lower organisms including flies and nematodes. In mammals, the sperm epigenome, as well as the composition of the seminal fluid are sensitive to environmental challenges and influence offspring development and adult phenotypic trajectories. The best known of these mechanisms are DNA methylation and small non-coding RNAs in spermatozoa and the balance between inflammatory and tolerogenic cytokines in the seminal fluid. Small non-coding RNAs are mostly acquired by maturing spermatozoa during the epididymal transit from extracellular vesicle of epididymal epithelial origin, and have the potential to influence embryonic development and offspring health. Study design, size, duration We use two paternal paradigms of pre-conceptional challenge in wild-type C57BL6 mice: high-fat diet feeding for 2 weeks and circadian disruption for 4 weeks before conception. The duration of the environmental challenges has been chosen to meet timing of sperm maturation in the mouse (high-fat diet) or to be the minimum sufficient to induce circadian disruption without overt side effects. Exposed males and their offspring have undergone deep metabolic and molecular phenotyping. Participants/materials, setting, methods We used both bulk and single cell (epi)genomics on exposed males as well as male and female offspring. The molecular phenotyping has been instructed by the results of the metabolic phenotyping performed in collaboration with the German Mouse Clinic, the biggest mouse clinic in Europe, using highly standardized and robust procedures. Importantly, we have used a family-based approach for the data analysis, according to which the experimental n is the exposed father. Main results and the role of chance Paternal circadian disruption achieved by four weeks of day-restricted feeding (food only during the light phase), leads to hyperphagia, hyperglycemia, hypercorticosteronemia and partial circadian disruption in unexposed male offspring. The phenotypes are gender-specific and the females feature partial protection from the paternal effects. Mechanistically, mouse seminal fluid contains corticosterone, whose appearance dynamic follows the organismal circadian rhythm and is blunted upon circadian disruption. Offspring phenotypes are sensitive to the levels of corticosterone in the seminal fluid and consequential to impaired placentation, reduced placental efficiency and fetal growth restriction. Paternal exposure to an acute high-fat diet challenge, instead, leads to a 30% penetrant glucose intolerance phenotype exclusively in male offspring. Mechanistically, this is linked to diet-induced mitochondrial dysfunction in somatic and germ cells and a compensatory burst of mitochondrial DNA transcription in spermatozoa. Mitochondrial DNA encoded small non-coding RNAs accumulate in spermatozoa, are inherited at fertilization, and reprogram early embryo transcription towards premature activation of oxidative metabolism, a predisposing factor to adult-onset glucose intolerance. Importantly, phenotypes and mechanisms are conserved across highly characterized human cohorts. These studies strengthen the importance of paternal health at conception for pregnancy and offspring health and identify germ-cell and non-germ cell factors as potential mechanistic mediators. Limitations, reasons for caution Although we have shown for the first time that stress hormones are present in the seminal fluid and relay paternal stress to the offspring and provided the first example of epigenetic inheritance of sperm small non-coding RNAs, mechanisms are still to be completely uncovered. Complementary mechanisms cannot be excluded. Wider implications of the findings Our findings strengthen the importance of paternal health at conception for pregnancy and offspring health. They also provide potential male tract biomarkers and novel strategies to monitor paternal health at conception and preconception lifestyle interventions aimed at improving pregnancy outcomes and preventing the spread of metabolic disorders through epigenetic inheritance. Trial registration number not applicable

Predictive models of miscarriage on the basis of data from a preconception cohort study

To use self-reported preconception data to derive models that predict the risk of miscarriage. Prospective preconception cohort study. Not applicable. Study participants were female, aged 21-45 years, residents of the United States or Canada, and attempting spontaneous pregnancy at enrollment during 2013-2022. Participants were followed for up to 12 months of pregnancy attempts; those who conceived were followed through pregnancy and postpartum. We restricted analyses to participants who conceived during the study period. On baseline and follow-up questionnaires completed every 8 weeks until pregnancy, we collected self-reported data on sociodemographic factors, reproductive history, lifestyle, anthropometrics, diet, medical history, and male partner characteristics. We included 160 potential predictor variables in our models. The primary outcome was a miscarriage, defined as pregnancy loss before 20 weeks of gestation. We followed participants from their first positive pregnancy test until miscarriage or a censoring event (induced abortion, ectopic pregnancy, loss of follow-up, or 20 weeks of gestation), whichever occurred first. We fit both survival and static models using Cox proportional hazards models, logistic regression, support vector machines, gradient-boosted trees, and random forest algorithms. We evaluated model performance using the concordance index (survival models) and the weighted F1 score (static models). Among the 8,720 participants who conceived, 20.4% reported miscarriage. In multivariable models, the strongest predictors of miscarriage were female age, history of miscarriage, and male partner age. The weighted F1 score ranged from 73%-89% for static models and the concordance index ranged from 53%-56% for survival models, indicating better discrimination for the static models compared with the survival models (i.e., the ability of the model to discriminate between individuals with and without miscarriage). No appreciable differences were observed across strata of miscarriage history or among models restricted to ≥8 weeks of gestation. Our findings suggest that miscarriage is not easily predicted on the basis of preconception lifestyle characteristics and that advancing age and a history of miscarriage are the most important predictors of incident miscarriage.

Diverse Preconception Cohort of Digital Health Platform Shows Promise for Addressing Fertility Care Gaps

About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant. Addressing fertility challenges requires an understanding of not only the causes of infertility, but also modifiable risk factors that can impact the likelihood of pregnancy. However, current research on factors influencing conception is often conducted among people who are already engaged in medical fertility treatments. In addition, existing databases are not representative of the U.S. population demographically. This retrospective study describes the demographics of participants of a digital fertility platform who were seeking fertility guidance prior to conception. Demographic data collected from participants who enrolled in Doveras Fertility Inc. (Doveras)’s digital health offerings in 2023 and 2024 were analyzed. Doveras offers personalized preconception lifestyle and behavioral intervention programs, delivered through an innovative digital fertility health platform, for individuals and couples to improve various endpoints along the reproductive and maternal health journey. This paper reports on the inception cohort of the first 600 enrolled participants (Doveras Preconception Cohort I), a subset of a wider pool of Doveras participants enrolled. Doveras achieved this enrollment of a notably diverse and representative population: 65.9% of female-identifying participants identify as White and 34.1% as non-white; 60.5% of male-identifying participants identify as White and 39.5% identify as non-white. The cohort also demonstrates a wide geographical spread, with participants recruited from 46 U.S. states, and represents a population that may have limited access to preconception healthcare: more than half (61%) of participants live in states with 13 OBGYNS or fewer per 100,000 population. The Doveras digital fertility platform presented herein may provide an opportunity to reach a broader and more diverse U.S. population during the preconception period than currently has access to medical fertility care.

Randomised controlled trial of preconception lifestyle intervention on maternal and offspring health in people with increased risk of gestational diabetes: study protocol for the BEFORE THE BEGINNING trial

IntroductionGestational diabetes mellitus (GDM) is associated with increased risk for type 2 diabetes in the mother and cardiometabolic diseases in the child. The preconception period is an optimal window to...

A blended preconception lifestyle programme for couples undergoing IVF: lessons learned from a multicentre randomized controlled trial.

What is the effect of a blended preconception lifestyle programme on reproductive and lifestyle outcomes of couples going through their first 12 months of IVF as compared to an attention control condition? This randomized controlled trial (RCT) was stopped prematurely because of the coronavirus disease 2019 (Covid-19) pandemic but the available data did not suggest that a blended preconception lifestyle programme could meaningfully affect time to ongoing pregnancy or other reproductive and lifestyle outcomes. Increasing evidence shows associations between a healthy lifestyle and IVF success rates. Lifestyle programmes provided through a mobile phone application have yet to be evaluated by RCTs in couples undergoing IVF. A multicentre RCT (1:1) was carried out. The RCT started in January 2019 and was prematurely stopped because of the Covid-19 pandemic, leading to a reduced sample size (211 couples initiating IVF) and change in primary outcome (cumulative ongoing pregnancy to time to ongoing pregnancy). Heterosexual couples initiating IVF in five fertility clinics were randomized between an attention control arm and an intervention arm for 12 months. The attention control arm received treatment information by mobile phone in addition to standard care. The intervention arm received the blended preconception lifestyle (PreLiFe)-programme in addition to standard care. The PreLiFe-programme included a mobile application, offering tailored advice and skills training on diet, physical activity and mindfulness, in combination with motivational interviewing over the telephone. The primary outcome was 'time to ongoing pregnancy'. Secondary reproductive outcomes included the Core Outcome Measures for Infertility Trials and IVF discontinuation. Changes in the following secondary lifestyle outcomes over 3 and 6 months were studied in both partners: diet quality, fruit intake, vegetable intake, total moderate to vigorous physical activity, sedentary behaviour, emotional distress, quality of life, BMI, and waist circumference. Finally, in the intervention arm, acceptability of the programme was evaluated and actual use of the mobile application part of the programme was tracked. Analysis was according to intention to treat. A total of 211 couples were randomized (105 control arm, 106 intervention arm). The hazard ratio of the intervention for time to ongoing pregnancy was 0.94 (95% CI 0.63 to 1.4). Little to no effect on other reproductive or lifestyle outcomes was identified. Although acceptability of the programme was good (6/10), considerable proportions of men (38%) and 9% of women did not actively use all the modules of the mobile application (diet, physical activity, or mindfulness). The findings of this RCT should be considered exploratory, as the Covid-19 pandemic limited its power and the actual use of the mobile application was low. This is the first multicentre RCT evaluating the effect of a blended preconception lifestyle programme for women and their partners undergoing IVF on both reproductive and lifestyle outcomes. This exploratory RCT highlights the need for further studies into optimal intervention characteristics and actual use of preconception lifestyle programmes, as well as RCTs evaluating effectiveness. Supported by the Research foundation Flanders (Belgium) (FWO-TBM; reference: T005417N). No competing interests to declare. ClinicalTrials.gov Identifier: NCT03790449. 31 December 2018. 2 January 2019.

Preconception lifestyle advice for people with infertility (Russian Translation of Cochrane Plain Language Summary)

Preconception lifestyle advice for people with infertility (Russian Translation of Cochrane Plain Language Summary)

Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus

Preconception lifestyle intervention holds potential for reducing gestational diabetes mellitus, but clinical trial data are lacking. This study aimed to determine the effects of a prepregnancy weight loss intervention on gestational diabetes mellitus recurrence in women with overweight/obesity and previous gestational diabetes mellitus. A 2-site, randomized controlled trial comparing a prepregnancy lifestyle intervention with educational control was conducted between December 2017 and February 2022. A total of 199 English- and Spanish-speaking adults with overweight/obesity and previous gestational diabetes mellitus were randomized to a 16-week prepregnancy lifestyle intervention with ongoing treatment until conception or educational control. The primary outcome was gestational diabetes mellitus recurrence. Analyses excluded 6 participants who conceived but did not have gestational diabetes mellitus ascertained by standard methods. In the 63 (33%) women who conceived and had gestational diabetes mellitus ascertained (Ns=38/102 [37%] intervention vs 25/91 [28.0%] control; P=.17), those in the intervention group had significantly greater weight loss at 16 weeks compared with controls (4.8 [3.4-6.0] vs 0.7 [-0.9 to 2.3] kg; P=.001) and a greater proportion lost ≥5% of body weight (50.0% [17/34] vs 13.6% [3/22]; P=.005). There was no significant difference in the incidence of gestational diabetes mellitus recurrence between the intervention (57.9% [ns=23/38]) and the control group (44.0% [ns=11/25]; odds ratio, 1.8 [0.59-5.8]). Independent of group, greater prepregnancy weight loss predicted 21% lower odds of gestational diabetes mellitus recurrence (odds ratio, 0.79 [0.66-0.94]; P=.008). A ≥5% weight loss before conception reduced the odds of gestational diabetes mellitus recurrence by 82% (odds ratio, 0.18 [0.04-0.88]; P=.03). Lifestyle intervention produced considerable prepregnancy weight loss but did not affect gestational diabetes mellitus rates. Given that the conception rate was 50% lower than expected, this study was underpowered.

Policies and healthcare to support preconception planning and weight management: optimising long-term health for women and children.

To explore opportunities to change increasing weight gain trajectories for women during their reproductive lives, focusing on optimising health before pregnancy. Type of program: Identifying optimal policies, health promotion and health services to support preconception health for women (with a focus on achieving a healthy weight). Narrative description of changing policies and approaches for improving preconception health. Preconception preventive health priorities have been clearly determined globally and nationally. However, further rigorous research for effective interventions to facilitate healthy weight and other aspects of preconception health, alongside effective policies and strategies for implementing these interventions, remains potentially important. Barriers for women, their partners, families, communities and health professionals must be overcome and enablers fostered. The inclusion of preconception lifestyle health to tackle maternal and childhood obesity as a key priority of the World Health Organization as well as in the Australian National obesity strategy 2022-2032 are steps in the right direction. Improving health across the life course requires a whole of system, integrated and equitable approach to health promotion, healthcare and policy. This includes integrating education, work, community environments, and health professionals to engage girls and young women well before pregnancy, to optimise their health. National coordination to determine core indicators and systems to evaluate and monitor change has been shown to help internationally and can be applied in Australia.

Planning is not equivalent to preparing, how Dutch women perceive their pregnancy planning in relation to preconceptional lifestyle behaviour change - a cross-sectional study

BackgroundUnhealthy prenatal lifestyle behaviours are associated with adverse pregnancy outcomes, but little is known about what motivates women to comply with preconceptional lifestyle recommendations or consciously plan their pregnancy. Therefore, the objective of this study is to explore the associations between preconceptional lifestyle behaviours, health beliefs and pregnancy planning among Dutch pregnant women.MethodsIn this cross-sectional study based on the data of the APROPOS-II study, 1,077 low-risk pregnant women were eligible for inclusion. Preconception lifestyle behaviours and actively preparing for pregnancy were assessed in relation to planned pregnancies (based on the London Measure of Unplanned Pregnancies) and health beliefs (14 statements). The following preconceptional lifestyle behaviours were assessed through a self-administered questionnaire in the first trimester of pregnancy: fruit intake, vegetable intake, caffeine intake, (second-hand)smoking, alcohol intake, folic acid supplement use and exercise. Data were analysed using multivariate logistic regression analyses.ResultsA total of 921 (85.5%) women in our cohort had a planned pregnancy. However, of these women, 640 (69.5%) adequately used folic acid supplements and 465 (50.5%) women consumed alcohol at any point during pregnancy. Of the women considering themselves ‘healthy enough and not needing preconception care’, 48 (9.1%) women had an adequate vegetable intake, 294 (55.6%) women consumed alcohol at any point during pregnancy and 161 (30.4%) women were either over-or underweight.ConclusionDespite consciously planning their pregnancy, most women did not adhere to preconceptional lifestyle behaviour recommendations. Women’s health beliefs and overestimation of their health status seem to interfere with actively planning and preparing for pregnancy. Findings from our study may encourage the development of prospective health-promoting interventions that focus on health beliefs and actively preparing for pregnancy, to improve preconceptional lifestyle behaviours, thereby optimizing the health of future generations.

O-273 Risk of hypertensive disorders in pregnancy after fresh and frozen embryo transfer in assisted reproduction: A population-based cohort study with within sibship analysis

Abstract Study question Is the risk of hypertensive disorders in pregnancy (HDP) increased following assisted reproductive technology (ART) with fresh or frozen cycles compared to conception without ART? Summary answer Pregnancies after frozen embryo transfer (FET) had a substantially higher risk of HDP, also after accounting for constant parental factors in within sibship comparisons. What is known already FET in assisted reproductive technology (ART) is increasingly common because of improved cryopreservation methods, blastocyst culture, and freeze-all practice. Conventional observational studies have raised concerns about treatment safety due to higher risk of HDP after FET compared to both non-ART and fresh embryo transfer (fresh-ET). Whether this is attributable to parental factors or treatment is unknown. Within sibship comparisons can provide unique insight by controlling for confounding from unmeasured, constant parental factors, like genetics, preconception lifestyle and health, as well as socioeconomic status. Study design, size, duration Population-based cohort study with within sibship comparison using health registry data from three Nordic countries. In total, 4,523,028 singleton pregnancies resulting in delivery between 1988 and 2015 were included, of which 78,300 were after fresh-ET, and 18,037 were after FET. We identified 33,209 sibships that were conceived using two or three different conception methods (fresh-ET, FET, and non-ART). Participants/materials, setting, methods Data were collected from several national health registries in Denmark, Norway, and Sweden, including ART, medical birth, and patient registries, and linked using the residents’ unique identification numbers. Adjusted odds ratios (aOR) of HDP with 95% confidence intervals (CI) were estimated using multilevel logistic regression, where random effects provided conventional population estimates, and fixed effects gave within sibship estimates. Main models included adjustment for maternal age, parity, birth year and country. Main results and the role of chance Risk of HDP was higher after FET compared to non-ART conception, both at the population level (7.4% vs 4.3%, aOR 1.74, 95% CI 1.61 to 1.89) and within sibships (aOR 2.02, 95% CI 1.72 to 2.39). For fresh-ET, the risk was similar to non-ART, both at the population level (5.9% vs 4.3%, aOR 1.02, 95% CI 0.98 to 1.07) and within sibships (aOR 0.99, 95% CI 0.89 to 1.09). Sensitivity analyses with adjustment for body mass index (BMI) and smoking, restriction to full siblings (same mother and father) and siblings born within a three-year interval, were all consistent with our main findings. Furthermore, the results were not driven by order of conception method or other ART procedures (intracytoplasmic sperm injection, culture duration or number of embryos transferred). Limitations, reasons for caution Despite the extra control for shared confounders provided by the within sibship analyses, we cannot exclude residual confounding from non-shared confounders, such as smoking and BMI, where confounder control was limited by a large proportion of missingness, and causes of infertility, which were largely unknown. Wider implications of the findings Our findings are important for the ongoing discussion about the freeze-all policy, and further investigation of which treatment factors might be involved is warranted. Trial registration number Not applicable

P-399 Effect of male body mass index on miscarriage rate following fertility treatment, a systematic review and meta-analysis

Abstract Study question Is raised paternal body mass index (BMI) important for the miscarriage rate following assisted reproductive technology (ART)? Summary answer Based on the available evidence, raised male BMI is not associated with higher risk of miscarriage following ART. What is known already More than half women and men of reproductive age worldwide are overweight or obese.There is extensive literature exploring the importance of normal female BMI for reproductive outcomes. However, little attention has been given to male BMI for couples seeking fertility treatment [1] .The adverse effect of male obesity on sperm parameters including DNA damage is well documented and there is evidence suggesting that raised male BMI results in significant decrease in live birth rate following ART [2] .Furthermore, emerging evidence from human and animal studies demonstrates that paternal obesity can affect the future health of the offspring through epigenetic pathways[3]. Study design, size, duration A computerized literature search was performed using EMBASE, MEDLINE, CINAHL and the Cochrane Central register of trials from database inception to November 2021. The aim was to explore the association between male BMI on miscarriage rate following ART. Reference lists of relevant studies were cross-checked. Only articles with full manuscripts available and published in English were included. Papers not relating to human subjects were excluded. All eligible studies were included (observational, prospective and retrospective studies). Participants/materials, setting, methods Included studies reported on couples undergoing ART for any indication using partner’s fresh sperm. Outcomes of interest were miscarriage rate and clinical pregnancy rate. Outcome data from each study were pooled and expressed as odds ratio (OR) with 95% confidence interval (CI) by using a random-effect model due to statistical heterogeneity in the outcome data[4]. Heterogeneity of treatment effects was evaluated using the I2 statistic to quantify the variation across studies caused by heterogeneity. Main results and the role of chance Abstract screening identified 197 relevant studies. After excluding duplicates, reviews and studies which did not fulfill the inclusion criteria, full manuscripts were accessed for 13 studies. Six studies were identified exploring the effect of male BMI on miscarriage following ART, two prospective and four retrospective. The quality of evidence was low using the GRADE framework. Meta-analysis was possible for three studies including 6793 couples undergoing ART. Outcomes were compared for male BMI < 25 kg/m2 versus BMI >/=25 kg/m2 . The pooled results did not show a statistically significant increase in miscarriage rate when the male partner was overweight or obese compare to normoweight (OR 1.32, 95% CI 0.82–2.1, P = 0.249). There was significant heterogeneity between the included studies (I 2 = 48.7%). There was no significant effect of male BMI on clinical pregnancy rate (OR 0.90, 95% CI 0.59–1.38, P = 0.637). For two of the remaining studies which could not be included in the meta-analysis due to missing data, the authors concluded that male BMI >25 was not associated with increased miscarriage risk whilst the most recent prospective study showed that high male BMI was associated with increased risk of chromosomal aberration-related miscarriages. Limitations, reasons for caution The number of the included studies and significant heterogeneity are the main limitations. It was not possible to account for important confounders such as age, subfertility diagnosis, type of stimulation and laboratory parameters including embryo grade. We grouped participants in two BMI categories therefore did not distinguish between overweight/obesity/morbid obesity. Wider implications of the findings Despite increasing evidence suggestive of adverse effect of raised male BMI on reproductive outcomes, there is limited literature exploring the impact on miscarriage rate following ART. More well-designed studies are needed for sound conclusions. Paternal characteristics, general health and preconception lifestyle should not be overlooked in the fertility consultation. Trial registration number not applicable

Preconception dietary inflammatory index and hypertension disorders of pregnancy: The Japan environment and children's study.

We aimed to examine the impact of preconception pro-inflammatory diet on hypertensive disorders of pregnancy. Data from the Japan Environmental Children's Study (JECS), a nation-wide birth cohort study, were used. Information on meal patterns before pregnancy, derived through food frequency questionnaires, was used to calculate the dietary inflammatory index. Based on the dietary inflammatory index, participants were categorized into quartiles (Q1 and Q4 representing the diet with the highest anti-inflammatory and pro-inflammatory effects, respectively), and a multiple logistic regression model was used to estimate the effect of pro-inflammatory diet on hypertensive disorders of pregnancy, early-onset-hypertensive disorders of pregnancy, late-onset-hypertensive disorders of pregnancy, and hypertensive disorders of pregnancy with/without small for gestational age birth. After applying our inclusion criteria, 93,265 participants were eligible. The mean white blood cell count during the first trimester and urine 8-hydroxy-2'-deoxyguanosine levels during pregnancy were highest in the Q4 group (both p<0.01). Multiple regression analysis showed that pro-inflammatory diet consumption increased the risk of both early-onset-hypertensive disorders of pregnancy (adjusted odds ratio: 1.53, 95% confidence interval: 1.06-2.20) and hypertensive disorders of pregnancy without small for gestational age birth (adjusted odds ratio: 1.26, 95% confidence interval: 1.03-1.54) among multiparous women. Consumption of diet with a high dietary inflammatory index score before pregnancy increases maternal inflammation and oxidative stress during pregnancy. Preconception lifestyle influences the risk of hypertensive disorders of pregnancy, especially among multiparous women.

A Network Analysis of Multiple Preconception Health Behaviors in Chinese Women.

A healthy preconception lifestyle, consisting of multiple health behaviors, is crucial for preventing adverse health outcomes in mothers and offspring. Although knowledge about the pattern of inter-behavior relations may provide insights for nudging multiple health behavior changes, this has not been adequately explored in the existing literature. Adopting a network perspective, the present study conceptualized multiple health behaviors as a behavior network (i.e., behaviors as nodes, inter-behavior relations as edges) and utilized network analysis to investigate the pattern of interrelations of preconception health behaviors in a large sample of Chinese women. We used the data of a population-based cohort study in China to estimate the behavior network. An analytic sample included 41,127 Chinese women who were surveyed about their adoptions of multiple health behaviors during the preconception period. Network analysis revealed a relatively dense behavior network and visualized the network structure of multiple preconception health behaviors. Subsequent centrality analysis identified three central behaviors (i.e., avoiding second- or third-hand smoke, reducing psychosocial stress, and reducing alcohol) that had distinctively stronger connections to other behaviors. Preconception health behaviors were strongly interconnected, and certain behaviors had stronger influences than others within the behavior network. Our findings highlight the strong inter-relatedness of preconception health behaviors. This study also encourages targeting the three central behaviors in preconception lifestyle promotions because this may bring more secondary improvements on other non-targeted behaviors and thereby achieve comprehensive lifestyle change.

Preconception lifestyle intervention in women with obesity and echocardiographic indices of cardiovascular health in their children

Improving maternal lifestyle before conception may prevent the adverse effects of maternal obesity on their children's future cardiovascular disease (CVD) risk. In the current study, we examined whether a preconception lifestyle intervention in women with obesity could alter echocardiographic indices of cardiovascular health in their children. Six years after a randomized controlled trial comparing the effects of a 6-month preconception lifestyle intervention in women with obesity and infertility prior to fertility care to prompt fertility care, 315 of the 341 children conceived within 24 months after randomization were eligible for this study. The intervention was aimed at weight loss (≥5% or until BMI < 29 kg/m2). Children underwent echocardiographic assessment of cardiac structure and function, conducted by a single pediatric cardiologist, blinded to group allocation. Results were adjusted for multiple variables including body surface area, age, and sex in linear regression analyses. Sixty children (32 girls, 53%) were included, mean age 6.5 years (SD 1.09). Twenty-four children (40%) were born to mothers in the intervention group. Children of mothers from the intervention group had a lower end-diastolic interventricular septum thickness (-0.88 Z-score, 95%CI -1.18 to -0.58), a lower left ventricle mass index (-8.56 g/m2, 95%CI -13.09 to -4.03), and higher peak systolic and early diastolic annular velocity of the left ventricle (1.43 cm/s 95%CI 0.65 to 2.20 and 2.39 cm/s 95%CI 0.68 to 4.11, respectively) compared to children of mothers from the control group. Children of women with obesity, who underwent a preconception lifestyle intervention, had improved cardiac structure and function; a thinner interventricular septum, lower left ventricle mass, and improved systolic and diastolic tissue Doppler velocities. Despite its high attrition rates, our study provides the first experimental human evidence suggesting that preconception lifestyle interventions may present a method of reducing CVD risk in the next generation. LIFEstyle study: Netherlands Trial Register: NTR1530 ( https://www.trialregister.nl/trial/1461 ). This follow-up study was approved by the medical ethics committee of the University Medical Centre Groningen (METC code: 2008/284).

Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial.

BackgroundWomen with obesity and infertility are counseled to lose weight prior to conception and infertility treatment to improve pregnancy rates and birth outcomes, although confirmatory evidence from randomized trials is lacking. We assessed whether a preconception intensive lifestyle intervention with acute weight loss is superior to a weight neutral intervention at achieving a healthy live birth.Methods and findingsIn this open-label, randomized controlled study (FIT-PLESE), 379 women with obesity (BMI ≥ 30 kg/m2) and unexplained infertility were randomly assigned in a 1:1 ratio to 2 preconception lifestyle modification groups lasting 16 weeks, between July 2015 and July 2018 (final follow-up September 2019) followed by infertility therapy. The primary outcome was the healthy live birth (term infant of normal weight without major anomalies) incidence. This was conducted at 9 academic health centers across the United States. The intensive group underwent increased physical activity and weight loss (target 7%) through meal replacements and medication (Orlistat) compared to a standard group with increased physical activity alone without weight loss. This was followed by standardized empiric infertility treatment consisting of 3 cycles of ovarian stimulation/intrauterine insemination. Outcomes of any resulting pregnancy were tracked. Among 191 women randomized to standard lifestyle group, 40 dropped out of the study before conception; among 188 women randomized to intensive lifestyle group, 31 dropped out of the study before conception. All the randomized women were included in the intent-to-treat analysis for primary outcome of a healthy live birth. There were no significant differences in the incidence of healthy live births [standard 29/191(15.2%), intensive 23/188(12.2%), rate ratio 0.81 (0.48 to 1.34), P = 0.40]. Intensive had significant weight loss compared to standard (−6.6 ± 5.4% versus −0.3 ± 3.2%, P < 0.001). There were improvements in metabolic health, including a marked decrease in incidence of the metabolic syndrome (baseline to 16 weeks: standard: 53.6% to 49.4%, intensive 52.8% to 32.2%, P = 0.003). Gastrointestinal side effects were significantly more common in intensive. There was a higher, but nonsignificant, first trimester pregnancy loss in the intensive group (33.3% versus 23.7% in standard, 95% rate ratio 1.40, 95% confidence interval [CI]: 0.79 to 2.50). The main limitations of the study are the limited power of the study to detect rare complications and the design difficulty in finding an adequate time matched control intervention, as the standard exercise intervention may have potentially been helpful or harmful.ConclusionsA preconception intensive lifestyle intervention for weight loss did not improve fertility or birth outcomes compared to an exercise intervention without targeted weight loss. Improvement in metabolic health may not translate into improved female fecundity.Trial registrationClinicalTrials.gov NCT02432209.

Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial

Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial

The Effects of a Preconception Lifestyle Intervention on Childhood Cardiometabolic Health-Follow-Up of a Randomized Controlled Trial.

Maternal obesity is associated with adverse metabolic outcomes in her offspring, from the earliest stages of development leading to obesity and poorer cardiometabolic health in her offspring. We investigated whether an effective preconception lifestyle intervention in obese women affected cardiometabolic health of their offspring. We randomly allocated 577 infertile women with obesity to a 6-month lifestyle intervention, or to prompt infertility management. Of the 305 eligible children, despite intensive efforts, 17 in the intervention and 29 in the control group were available for follow-up at age 3–6 years. We compared the child’s Body Mass Index (BMI) Z score, waist and hip circumference, body-fat percentage, blood pressure Z scores, pulse wave velocity and serum lipids, glucose and insulin concentrations. Between the intervention and control groups, the mean (±SD) offspring BMI Z score (0.69 (±1.17) vs. 0.62 (±1.04)) and systolic and diastolic blood pressure Z scores (0.45 (±0.65) vs. 0.54 (±0.57); 0.91 (±0.66) vs. 0.96 (±0.57)) were similar, although elevated compared to the norm population. We also did not detect any differences between the groups in the other outcomes. In this study, we could not detect effects of a preconception lifestyle intervention in obese infertile women on the cardiometabolic health of their offspring. Low follow-up rates, perhaps due to the children’s age or the subject matter, combined with selection bias abating contrast in periconceptional weight between participating mothers, hampered the detection of potential effects. Future studies that account for these factors are needed to confirm whether a preconception lifestyle intervention may improve the cardiometabolic health of children of obese mothers.

Preconception Lifestyle Intervention could Reduce the Incidence of Recurrent or New GDM: An Interventional Body Mass Index-Based Study

Preconception Lifestyle Intervention could Reduce the Incidence of Recurrent or New GDM: An Interventional Body Mass Index-Based Study