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. 2025 Feb;132(3):375-386.
doi: 10.1111/1471-0528.17994. Epub 2024 Nov 18.

Adherence to Healthy Prepregnancy Lifestyle and Risk of Adverse Pregnancy Outcomes: A Prospective Cohort Study

Hitomi Okubo  1   2 , Shoji F Nakayama  2 , Asako Mito  3 , Naoko Arata  3 , Yukihiro Ohya  4   5 ; Japan Environment and Children's Study Group
Collaborators, Affiliations

Adherence to Healthy Prepregnancy Lifestyle and Risk of Adverse Pregnancy Outcomes: A Prospective Cohort Study

Hitomi Okubo et al. BJOG. 2025 Feb.

Abstract

Objective: To quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).

Design: Prospective cohort study.

Setting: The Japan Environment and Children's Study.

Population: A total of 79 703 pregnant Japanese women without chronic disease.

Methods: Maternal lifestyle before pregnancy was assessed using a self-administered questionnaire. A healthy lifestyle score (HLS, 0-5 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high-quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log-binomial regression model.

Main outcome measures: Composite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small-for-gestational-age, transcribed from medical records.

Results: A total of 13 894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose-response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61-0.74) lower risk of APOs than those with the lowest HLS (0-1 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1-point increase of HLS could have reduced APO cases by 6.6%.

Conclusions: A higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.

Keywords: birth outcomes; healthy lifestyle score; maternal lifestyle; preconception care; pregnancy outcomes.

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Conflict of interest statement

H.O. belongs to the Department of Nutritional Epidemiology and Behavioural Nutrition, Graduate School of Medicine, The University of Tokyo, which is a social cooperation program with Ajinomoto, Co. Inc. The authors declare that Ajinomoto, Co. Inc. had no role in the design of the study, in the collection, analysis, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. The remaining authors declare that they have no competing interests.

Figures

FIGURE 1
FIGURE 1
Flow chart of study subject selection.
See this image and copyright information in PMC

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