Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model

Abstract

Prevention of pregnancy complications related to the "great obstetrical syndromes" (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11-14 weeks' gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks' gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes.

Keywords: angiogenic ratio; aspirin; exercise; fetal growth restriction; lifestyle; multivariate screening; nutrition; pre-eclampsia; preterm labor; stillbirth.

Figure 1

Components of the multimodal screening and medical management model.

Figure 2

Risk assessment and management of women before and during pregnancy. First-trimester multivariable screening is based on references [10,24,26] (see https://fetalmedicine.org/research/assess/preeclampsia/first-trimester, accessed on 3 May 2024). The use of the aFlt-1:PIGF ratio is based on references [10,11,97,98,99]. Mean arterial pressure (MAP); uterine artery pulsatility index (UtAPI); placental growth factor (PlGF); soluble fms-like tyrosine kinase-1 (sFlt-1). Modified with permission from Parker et al. [4].