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Muhammad T, Wan Y, Lv Y, Li H, Naushad W, Chan WY, Lu G, Chen ZJ, Liu H. Maternal obesity: A potential disruptor of female fertility and current interventions to reduce associated risks. Obes Rev 2023; 24:e13603. [PMID: 37452501 DOI: 10.1111/obr.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Currently, obesity has achieved epidemic levels in reproductive-aged women with a myriad of consequences. Obesity is susceptible to several reproductive complications that eventually affect fertility rates. These complications originate from the deteriorated quality of oocytes from mothers with obesity, which increases the probability of chromosomal aneuploidy, elevated reactive oxygen species production, compromised embryonic developmental competency, and eventually reduced fertility. Maternal obesity is linked to pregnancy complications such as implantation error, abortion, miscarriage, and early pregnancy loss. This review highlights the adverse effects of maternal obesity on female fertility, with a focus on the mechanistic link between maternal obesity and oocyte quality and discusses possible measures to reduce its associated risks.
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Affiliation(s)
- Tahir Muhammad
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Jinan, Shandong, 250012, China
- Department of Cell Biology and Anatomy, New York Medical College, 15 Dana Road, Valhalla, NY, 10595, USA
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, 54000, Pakistan
| | - Yanling Wan
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Jinan, Shandong, 250012, China
| | - Yue Lv
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250012, China
- CUHK-SDU Joint Laboratory on Reproductive Genetics, School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Hanzhen Li
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Jinan, Shandong, 250012, China
| | - Wasifa Naushad
- Department of Pathology, Microbiology and Immunology, New York Medical College, 15 Dana Road, Valhalla, NY, 10595, USA
| | - Wai-Yee Chan
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Jinan, Shandong, 250012, China
- CUHK-SDU Joint Laboratory on Reproductive Genetics, School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Gang Lu
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Jinan, Shandong, 250012, China
- CUHK-SDU Joint Laboratory on Reproductive Genetics, School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250012, China
- CUHK-SDU Joint Laboratory on Reproductive Genetics, School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, 999077, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200000, China
| | - Hongbin Liu
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Jinan, Shandong, 250012, China
- CUHK-SDU Joint Laboratory on Reproductive Genetics, School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, 999077, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, China
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van der Windt M, van Zundert SKM, Schoenmakers S, van Rossem L, Steegers-Theunissen RPM. Prototyping of a Digital Life Course Care Platform for Preconception and Pregnancy Care: Pilot Feasibility and Acceptability Study. J Med Internet Res 2023; 25:e37537. [PMID: 36662557 PMCID: PMC9898832 DOI: 10.2196/37537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 11/03/2022] [Accepted: 12/18/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A healthy lifestyle plays a key role in the prevention of lifestyle-related diseases, including subfertility and pregnancy complications. Although the benefits of a healthy lifestyle are well-known, long-term adherence is limited. Moreover, memory for lifestyle-related information as well as medical information provided by the medical professional is often poor and insufficient. In order to innovate and improve health care for both the patients and health care professionals, we developed a prototype of a digital life course care platform (Smarter Health app), providing personalized lifestyle care trajectories integrated in medical care journeys. OBJECTIVE This pilot study aimed to evaluate the feasibility, defined as the actual app use, and the acceptability, which included patient satisfaction and appreciation, of the Smarter Health app. METHODS Between March 17, 2021, and September 30, 2021, pregnant women familiar with the Dutch language seeking tertiary preconception and pregnancy care were offered the app as part of standard medical care at the outpatient clinic Healthy Pregnancy of the Department of Obstetrics and Gynecology of the Erasmus University Medical Center. Three months after activation of the app, patients received a digital questionnaire consisting of aspects of feasibility and acceptability. RESULTS During this pilot study, 440 patients visited the outpatient clinic Healthy Pregnancy. Of the 440 patients, 293 (66.6%) activated the app. Of the 293 patients who activated the app, 125 (42.7%) filled out the questionnaire. Of these 125 patients, 48 (38.4%) used the app. Most app users used it occasionally and logged in 8 times during their medical care trajectory. Overall, app users were satisfied with the app (median 5-point Likert scale=2.4, IQR 2.0-3.3). CONCLUSIONS Our findings showed that the Smarter Health app, which integrates lifestyle care in medical care, is a feasible health care innovation, and that patients were satisfied with the app. Follow-up and evaluation of pregnancy outcomes should be performed to further substantiate wider clinical implementation.
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Affiliation(s)
- Melissa van der Windt
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sofie Karolina Maria van Zundert
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Lenie van Rossem
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
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Maas VYF, Poels M, Ista E, Menge LF, Vanden Auweele KLHE, de Bie RWA, de Smit DJ, van Vliet-Lachotzki EH, Franx A, Koster MPH. The effect of a locally tailored intervention on the uptake of preconception care in the Netherlands: a stepped-wedge cluster randomized trial (APROPOS-II study). BMC Public Health 2022; 22:1997. [PMID: 36319990 PMCID: PMC9623982 DOI: 10.1186/s12889-022-14343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The preconception period provides a window of opportunity for interventions aiming to reduce unhealthy lifestyle behaviours and their negative effect on pregnancy outcomes. This study aimed to assess the effectiveness of a locally tailored preconception care (PCC) intervention in a hybrid-II effectiveness implementation design. METHODS A stepped-wedge cluster randomized controlled trial was performed in four Dutch municipalities. The intervention contained a social marketing strategy aiming to improve the uptake (prospective parents) and the provision (healthcare providers) of PCC. Prospective parents participated by administering a questionnaire in early pregnancy recalling their preconceptional behaviours. Experiences of healthcare providers were also evaluated through questionnaires. The composite primary outcome was adherence to at least three out of four preconceptional lifestyle recommendations (early initiation of folic acid supplements, healthy nutrition, no smoking or alcohol use). Secondary outcomes were preconceptional lifestyle behaviour change, (online) reach of the intervention and improved knowledge among healthcare providers. RESULTS A total of 850 women and 154 men participated in the control phase and 213 women and 39 men in the intervention phase. The composite primary outcome significantly improved among women participating in the municipality where the reach of the intervention was highest (Relative Risk (RR) 1.57 (95% Confidence Interval (CI) 1.11-2.22). Among women, vegetable intake had significantly improved in the intervention phase (RR 1.82 (95%CI 1.14-2.91)). The aimed online reach- and engagement rate of the intervention was achieved most of the time. Also, after the intervention, more healthcare providers were aware of PCC-risk factors (54.5% vs. 47.7%; p = 0.040) and more healthcare providers considered it easier to start a conversation about PCC (75.0% vs. 47.9%; p = 0.030). CONCLUSION The intervention showed some tentative positive effects on lifestyle behaviours among prospective parents. Primarily on vegetable intake and the knowledge and competence of healthcare providers. The results of this study contribute to the evidence regarding successfully implementing PCC-interventions to optimize the health of prospective parents and future generations. TRIAL REGISTRATION Dutch Trial Register: NL7784 (Registered 06/06/2019).
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Affiliation(s)
- V. Y. F. Maas
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - M. Poels
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ,House of Women, Niasstraat 7, 1095 TS Amsterdam, The Netherlands
| | - E. Ista
- grid.5645.2000000040459992XDepartment of Internal Medicine - Nursing Science, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ,grid.416135.40000 0004 0649 0805Department of Paediatric Surgery, Paediatric intensive care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - L. F. Menge
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | - R. W. A. de Bie
- grid.425719.c0000 0001 2232 838XDutch Ministry of Health, Welfare and Sports, Parnassusplein 5, 2511 VX The Hague, The Netherlands ,grid.413681.90000 0004 0631 9258Department of Obstetrics, Diakonessenhuis Hospital, Bosboomstraat 1, Utrecht, 3582 KE The Netherlands
| | - D. J. de Smit
- MediClara Projects, Prinses Beatrixstraat 7, 1396 KD Baambrugge, The Netherlands
| | - E. H. van Vliet-Lachotzki
- grid.426579.b0000 0004 9129 9166Dutch Genetic Alliance, VSOP, Koninginnelaan 23, 3762 DA Soest, The Netherlands
| | - A. Franx
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - M. P. H. Koster
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Zundert SKV, Rossem LV, Schoenmakers S, Steegers-Theunissen RP. Lifestyle care for transformation of medical care using an early life course approach. Reprod Biomed Online 2022; 45:847-850. [DOI: 10.1016/j.rbmo.2022.08.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022]
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Kohil A, Chouliaras S, Alabduljabbar S, Lakshmanan AP, Ahmed SH, Awwad J, Terranegra A. Female infertility and diet, is there a role for a personalized nutritional approach in assisted reproductive technologies? A Narrative Review. Front Nutr 2022; 9:927972. [PMID: 35938101 PMCID: PMC9353397 DOI: 10.3389/fnut.2022.927972] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Female infertility is a major public health concern and a global challenge. It is a disorder of the reproductive system, defined as the inability to achieve a clinical pregnancy. Nutrition and other environmental factors are found to impact reproductive health in women as well as the outcome of assisted reproductive technologies (ART). Dietary factors, such as polyunsaturated fatty acids (PUFA), fiber as well as the intake of Mediterranean diet appear to exert beneficial effects on female reproductive outcomes. The exact mechanisms associating diet to female fertility are yet to be identified, although genomic, epigenomic, and microbial pathways may be implicated. This review aims to summarize the current knowledge on the impact of dietary components on female reproduction and ART outcomes, and to discuss the relevant interplay of diet with genome, epigenome and microbial composition.
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Affiliation(s)
- Amira Kohil
- Research Department, Sidra Medicine, Doha, Qatar
| | | | | | | | | | - Johnny Awwad
- Reproductive Medicine Unit, Sidra Medicine, Doha, Qatar
| | - Annalisa Terranegra
- Research Department, Sidra Medicine, Doha, Qatar
- *Correspondence: Annalisa Terranegra
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Smith SM, van der Kleij RMJJ, Bais B, Schermer MHN, Ismaili M'hamdi H, Steegers-Theunissen RPM. Preferences of women with a vulnerable health status towards nudging for adequate pregnancy preparation as investment in health of future generations: a qualitative study. BMC Pregnancy Childbirth 2022; 22:559. [PMID: 35831786 PMCID: PMC9281116 DOI: 10.1186/s12884-022-04887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with a vulnerable health status, as determined by a low socioeconomic status and poor lifestyle behaviours, are at risk for adverse pregnancy outcomes. Offering tailored preconception lifestyle care can significantly help to improve pregnancy outcomes. We hypothesize that so-called 'nudges' can be a successful way of increasing the uptake of preconception lifestyle care. A nudge is a behavioural intervention that supports healthy choices by making them easier to choose. Nudging, however, raises many moral questions. Effectiveness and respect for autonomy are, among other criteria, required for a nudge to be morally permissible. In general, the target group knows best what they find permissible and what would motivate them to change their lifestyle. Therefore, this study - conducted in women with a vulnerable health status - aimed to identify their preferences towards a nudge, provided via a mobile application that aims to help them adopt healthy lifestyle behaviours by offering rewards. METHODS: We conducted semi-structured interviews with twelve women with a vulnerable health status. A framework approach was used to analyse the data. A thematic content analysis was conducted on five themes: (1) "Usefulness of an app as an integral information source", (2) "Permissibility and effects of offering rewards", (3) "Preferences regarding content", (4) "Preferences regarding type of rewards and system of allocation", and (5) "Barriers". RESULTS Of the 12 participants, 11 deemed an app as integral information source concerning the preconception period useful. None of the participants objected to being nudged i.e., being rewarded for healthy behaviour. All participants stated that they would like the app to contain information on healthy nutrition and 8 participants wanted to know how to get pregnant quickly. Furthermore, participants stated that the freedom to choose the timing and content of the reward would increase the probability of successful behavioural change, and having to pay or contact a healthcare provider to access the app may prevent women using the app. CONCLUSIONS These insights into the preferences of women with a vulnerable health status towards nudging will inform the design of an effective app-based nudge. This may help to improve prepregnancy health as investment in health of current and future generations.
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Affiliation(s)
- Sharissa M Smith
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Rianne M J J van der Kleij
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Babette Bais
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Maartje H N Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Hafez Ismaili M'hamdi
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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van der Windt M, Schoenmakers S, Willemsen S, van Rossem L, Steegers-Theunissen R. Optimizing the Periconception Lifestyle of Women With Overweight Using a Blended Personalized Care Intervention Combining eHealth and Face-to-face Counseling (eFUSE): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e28600. [PMID: 34477561 PMCID: PMC8449297 DOI: 10.2196/28600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions. Objective The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI≥25 and who are contemplating pregnancy or are already pregnant (≤12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome. Methods The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI≥25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications. Results The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023. Conclusions This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI≥25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies. Trial Registration Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264 International Registered Report Identifier (IRRID) PRR1-10.2196/28600
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Affiliation(s)
- Melissa van der Windt
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Sten Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Lenie van Rossem
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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Boedt T, Matthys C, Lie Fong S, De Neubourg D, Vereeck S, Seghers J, Van der Gucht K, Weyn B, Geerts D, Spiessens C, Dancet EAF. Systematic development of a mobile preconception lifestyle programme for couples undergoing IVF: the PreLiFe-programme. Hum Reprod 2021; 36:2493-2505. [PMID: 34379119 DOI: 10.1093/humrep/deab166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 06/04/2021] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Can we develop a preconception lifestyle programme for couples undergoing IVF that is in line with their needs. SUMMARY ANSWER A mobile preconception lifestyle programme was systematically developed based on expert opinion, literature and needs of IVF-patients. WHAT IS KNOWN ALREADY A healthy lifestyle prior to conception is not only beneficial for the general health of couples, but evidence on its importance for their reproductive health and the health of their children is also emerging. So far, the vast majority of fertility clinics do not offer a lifestyle programme for couples undergoing IVF. Therefore, the present study aimed to develop a lifestyle programme for IVF-couples. STUDY DESIGN, SIZE, DURATION The development of the PreLiFe-programme was guided by the steps of the Medical Research Council (MRC) framework for developing complex interventions, a systematic approach for developing theory- and evidence-based health promotion interventions. PARTICIPANTS/MATERIALS, SETTINGS, METHODS First, the evidence base on lifestyle programmes for IVF-couples was reviewed. Second, several iterations between an expert panel, the literature, and quantitative and qualitative data from IVF-patients identified the content, the format, behaviour change techniques and theory of the programme. Third, the PreLiFe-programme was produced and the expected process and outcomes of a randomized controlled trial assessing it were modelled. Finally, user tests among experts and patients and pilot tests among patients were conducted. MAIN RESULTS AND ROLE OF CHANCE The finally developed PreLiFe-programme is a mobile application to be used autonomously by both partners of IVF-couples during the first year of IVF, in combination with motivational interviewing over the telephone every three months (i.e. blended care). The PreLiFe-programme provides advice and skills training on physical activity, diet and mindfulness based stress reduction and is in part tailored based on monitoring and tracking the lifestyle of patients. Based on the literature the expert panel considers it plausible that all three components contribute to IVF-success rates. The PreLiFe-programme is likely to be acceptable to patients as it meets the need of patients for lifestyle advice and treatment information. LIMITATIONS, REASON FOR CAUTION The pilot in IVF-couples had a 3-month duration. The feasibility of the PreLiFe-programme in other infertile populations and/or upon longer use is yet to be examined. Whether the PreLiFe-programme effectively improves lifestyle and IVF-success rates is currently being examined in a trial randomizing heterosexual couples starting IVF to the PreLiFe-programme or an attention-control group for 12 months. WIDER IMPLICATIONS OF THE FINDINGS If the PreLiFe-programme improves lifestyle and the chance of IVF-success, it will be a powerful tool and provide guidance for implementing lifestyle programmes in fertility clinics. STUDY FUNDING/COMPETING INTEREST(S) Funded by the Research Foundation Flanders (FWO-TBM (Applied Biomedical Research with a Primary Social finality); reference: T005417N). The authors have no conflict of interest to report. TRIAL REGISTRATION NUMBER NCT03790449.
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Affiliation(s)
- T Boedt
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.,Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - C Matthys
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - S Lie Fong
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D De Neubourg
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium
| | - S Vereeck
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium
| | - J Seghers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - K Van der Gucht
- Leuven Mindfulness Centre, KU Leuven, Leuven, Belgium.,Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - B Weyn
- Department of Electric Engineering, Leuven, Belgium
| | - D Geerts
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | - C Spiessens
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - E A F Dancet
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Chronopoulou E, Seifalian A, Stephenson J, Serhal P, Saab W, Seshadri S. Preconceptual care for couples seeking fertility treatment, an evidence-based approach. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.xfnr.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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10
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van der Windt M, van der Kleij RM, Snoek KM, Willemsen SP, Dykgraaf RHM, Laven JSE, Schoenmakers S, Steegers-Theunissen RPM. Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study. J Med Internet Res 2020; 22:e19378. [PMID: 32996885 PMCID: PMC7557440 DOI: 10.2196/19378] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 12/15/2022] Open
Abstract
Background Periconception lifestyle behaviors affect maternal, paternal, offspring, and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions, in which face-to-face counseling and eHealth (“blended care”) are combined, may effectively target these lifestyle behaviors. Objective We aimed to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components. Methods A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counseling service “Healthy Pregnancy” with the eHealth platform “Smarter Pregnancy” (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (≤12 weeks of gestation) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (BMI ≥30 kg/m2), women pregnant at the start of the intervention, and those participating as a couple. Results A total of 539 women were screened for eligibility, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4% (263/450) were included in the preconception period. Moreover, 78.9% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2%) and men (58/61, 95.1%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P<.001) and median vegetable intake increased from 151 to 165 grams/day (P<.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P<.001), and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P=.002) and from 0.20 to 0.15 (P=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively. Conclusions We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further.
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Affiliation(s)
- Melissa van der Windt
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Rianne Maria van der Kleij
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands.,Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Katinka Marianne Snoek
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sten Paul Willemsen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
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11
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Oostingh EC, Koster MPH, van Dijk MR, Willemsen SP, Broekmans FJM, Hoek A, Goddijn M, Klijn NF, van Santbrink EJP, Steegers EAP, Laven JSE, Steegers-Theunissen RPM. First effective mHealth nutrition and lifestyle coaching program for subfertile couples undergoing in vitro fertilization treatment: a single-blinded multicenter randomized controlled trial. Fertil Steril 2020; 114:945-954. [PMID: 32741619 DOI: 10.1016/j.fertnstert.2020.04.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To study compliance and effectiveness of the mHealth nutrition and lifestyle coaching program Smarter Pregnancy in couples undergoing in vitro fertilization (IVF) treatment with or without intracytoplasmic sperm injection (ICSI). DESIGN Multicenter, single-blinded, randomized controlled trial, conducted from July 2014 to March 2017. SETTING IVF clinics. PATIENT(S) A total of 626 women undergoing IVF treatment with or without ICSI and 222 male partners. INTERVENTIONS(S) Couples were randomly assigned to the light (control group) or regular (intervention group) Smarter Pregnancy program. Both groups filled out a baseline screening questionnaire on nutrition and lifestyle behaviors, and the intervention group received coaching tailored to inadequate behaviors during the 24-week period. MAIN OUTCOME MEASURE(S) Difference in improvement of a composite dietary and lifestyle risk score for the intake of vegetables, fruits, folic acid supplements, smoking, and alcohol use after 24 weeks of the program. RESULT(S) Compared with control subjects, women and men in the intervention group showed a significantly larger improvement of inadequate nutrition behaviors after 24 weeks of coaching. At the same time, the women also showed a significantly larger improvement of inadequate lifestyle behaviors. CONCLUSION(S) The mHealth coaching program Smarter Pregnancy is effective and improves the most important nutritional and lifestyle behaviors among couples undergoing IVF/ICSI treatment. International multicenter randomized trials are recommended to study the effect of using Smarter Pregnancy on pregnancy, live birth, and neonatal outcome. NETHERLANDS TRIAL REGISTER NUMBER NTR4150.
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Affiliation(s)
- Elsje C Oostingh
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Matthijs R van Dijk
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Frank J M Broekmans
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, University Medical Center, Utrecht, the Netherlands
| | - Annemieke Hoek
- University of Groningen, Department of Obstetrics and Gynecology, University Medical Center, Groningen, the Netherlands
| | - Marriëte Goddijn
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicole F Klijn
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, University Medical Center, Leiden, the Netherlands
| | - Evert J P van Santbrink
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Joop S E Laven
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
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12
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Hoek J, Schoenmakers S, Baart EB, Koster MPH, Willemsen SP, van Marion ES, Steegers EAP, Laven JSE, Steegers-Theunissen RPM. Preconceptional Maternal Vegetable Intake and Paternal Smoking Are Associated with Pre-implantation Embryo Quality. Reprod Sci 2020; 27:2018-2028. [PMID: 32542536 PMCID: PMC7522074 DOI: 10.1007/s43032-020-00220-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Abstract
Inadequate nutrition and lifestyle behaviors, particularly during the periconception period, are associated with a negative impact on embryonic and subsequent fetal development. We investigated the associations between parental nutritional and lifestyle factors and pre-implantation embryo development. A total of 113 women and 41 partners, with a corresponding 490 embryos, who underwent intracytoplasmic sperm injection (ICSI) treatment subscribed to the mHealth coaching platform "Smarter Pregnancy." At baseline, nutrition and lifestyle behaviors (intake of fruits, vegetables, folic acid, and smoking and alcohol use) were identified and risk scores were calculated. A lower risk score represents healthier behavior. As outcome measure, a time-lapse morphokinetic selection algorithm (KIDScore) was used to rank pre-implantation embryo quality on a scale from 1 (poor) to 5 (good) after being cultured in the Embryoscope™ time-lapse incubator until embryonic day 3. To study the association between the nutritional and lifestyle risk scores and the KIDScore in men and women, we used a proportional odds model. In women, the dietary risk score (DRS), a combination of the risk score of fruits, vegetables, and folic acid, was negatively associated with the KIDScore (OR 0.86 (95% CI 0.76 to 0.98), p = 0.02). This could mainly be attributed to an inadequate vegetable intake (OR 0.76 (95% CI 0.59 to 0.96), p = 0.02). In men, smoking was negatively associated with the KIDscore (OR 0.53 (95% CI 0.33 to 0.85), p < 0.01). We conclude that inadequate periconceptional maternal vegetable intake and paternal smoking significantly reduce the implantation potential of embryos after ICSI treatment. Identifying modifiable lifestyle risk factors can contribute to directed, personalized, and individual recommendations that can potentially increase the chance of a healthy pregnancy.
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Affiliation(s)
- Jeffrey Hoek
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Esther B Baart
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Eva S van Marion
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
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13
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van Dijk MR, Koster MPH, Oostingh EC, Willemsen SP, Steegers EAP, Steegers-Theunissen RPM. A Mobile App Lifestyle Intervention to Improve Healthy Nutrition in Women Before and During Early Pregnancy: Single-Center Randomized Controlled Trial. J Med Internet Res 2020; 22:e15773. [PMID: 32412417 PMCID: PMC7260659 DOI: 10.2196/15773] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/30/2019] [Accepted: 12/16/2019] [Indexed: 01/29/2023] Open
Abstract
Background Unhealthy nutrition contributes to the worldwide rising prevalence of noncommunicable diseases. As most adverse reproductive outcomes originate during the periconception period, effective interventions targeting this period are needed. Therefore, we developed the lifestyle intervention Smarter Pregnancy to empower women to adapt a healthy diet prior to conception and during early pregnancy and performed a randomized controlled trial. Objective The objectives of this trial were to investigate compliance and effectiveness in women using the Smarter Pregnancy program. Methods Women aged between 18 and 45 years who were contemplating pregnancy or <13 weeks pregnant and their male partners living in the urban area of Rotterdam, the Netherlands, were eligible for participation. After baseline screening, the intervention group received personal online coaching based on identified inadequate intakes of vegetables, fruits, and folic acid supplements. The sum of these risk factors was used as a dietary risk score (DRS), ranging from 0 (healthy) to 9 (unhealthy). The control group did not receive coaching. We applied an intention-to-treat principle and used a multivariable linear regression model to evaluate the change in DRS after 24 weeks. Compliance was defined as the percentage of women who completed the screening questionnaire at 24 weeks. Results Of women recruited, 81.2% (177/218) completed the program (intervention: 91/218, 83.5%; control: 86/218, 78.9%; P=.95). After 24 weeks, the reduction in DRS of women in the intervention group was significantly larger than in the control group (β=.75, 95% CI 0.18-1.34). This reduction was mainly due to increased vegetable intake (β=.55, 95% CI 0.25-0.86). Conclusions The high compliance and the larger improvements in nutritional behaviors, especially vegetable intake, in women in the intervention group emphasizes the effectiveness of empowering women by using the lifestyle change intervention Smarter Pregnancy. Trial Registration Netherlands Trial Register: NL3927; https://www.trialregister.nl/trial/3927 International Registered Report Identifier (IRRID) RR2-10.1186/s12884-017-1228-5
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Affiliation(s)
- Matthijs R van Dijk
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Elsje C Oostingh
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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14
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Reijnders IF, Mulders AGMGJ, van der Windt M, Steegers EAP, Steegers-Theunissen RPM. The impact of periconceptional maternal lifestyle on clinical features and biomarkers of placental development and function: a systematic review. Hum Reprod Update 2020; 25:72-94. [PMID: 30407510 DOI: 10.1093/humupd/dmy037] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Worldwide, placenta-related complications contribute to adverse pregnancy outcomes, such as pre-eclampsia, fetal growth restriction and preterm birth, with implications for the future health of mothers and offspring. The placenta develops in the periconception period and forms the interface between mother and embryo/fetus. An unhealthy periconceptional maternal lifestyle, such as smoking, alcohol and under- and over-nutrition, can detrimentally influence placental development and function. OBJECTIVE AND RATIONALE The impact of maternal lifestyle on placental health is largely unknown. Therefore, we aim to summarize the evidence of the impact of periconceptional maternal lifestyle on clinical features and biomarkers of placental development and function throughout pregnancy. SEARCH METHODS A comprehensive search in Medline, Embase, Pubmed, The Cochrane Library Web of Science and Google Scholar was conducted. The search strategy included keywords related to the maternal lifestyle, smoking, alcohol, caffeine, nutrition (including folic acid supplement intake) and body weight. For placental markers throughout pregnancy, keywords related to ultrasound imaging, serum biomarkers and histological characteristics were used. We included randomized controlled trials and observational studies published between January 2000 and March 2017 and restricted the analysis to singleton pregnancies and maternal periconceptional lifestyle. Methodological quality was scored using the ErasmusAGE tool. A protocol of this systematic review has been registered in PROSPERO International prospective register of systematic reviews (PROSPERO 2016:CRD42016045596). OUTCOMES Of 2593 unique citations found, 82 studies were included. The median quality score was 5 (range: 0-10). The findings revealed that maternal smoking was associated with lower first-trimester placental vascularization flow indices, higher second- and third-trimester resistance of the uterine and umbilical arteries and lower resistance of the middle cerebral artery. Although a negative impact of smoking on placental weight was expected, this was less clear. Alcohol use was associated with a lower placental weight. One study described higher second- and third-trimester placental growth factor (PlGF) levels after periconceptional alcohol use. None of the studies looked at caffeine intake. Adequate nutrition in the first trimester, periconceptional folic acid supplement intake and strong adherence to a Mediterranean diet, were all associated with a lower resistance of the uterine and umbilical arteries in the second and third trimester. A low caloric intake resulted in a lower placental weight, length, breadth, thickness, area and volume. Higher maternal body weight was associated with a larger placenta measured by ultrasound in the second and third trimester of pregnancy or weighed at birth. In addition, higher maternal body weight was associated with decreased PlGF-levels. WIDER IMPLICATIONS Evidence of the impact of periconceptional maternal lifestyle on placental health was demonstrated. However, due to poorly defined lifestyle exposures and time windows of investigation, unstandardized measurements of placenta-related outcomes and small sample sizes of the included studies, a cautious interpretation of the effect estimates is indicated. We suggest that future research should focus more on physiological consequences of unhealthy lifestyle during the critical periconception window. Moreover, we foresee that new evidence will support the development of lifestyle interventions to improve the health of mothers and their offspring from the earliest moment in life.
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Affiliation(s)
- Ignatia F Reijnders
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Melissa van der Windt
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
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15
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Oostingh EC, Huijgen NA, Koedooder R, Dohle GR, Stricker BH, Steegers-Theunissen RP. Potential benefits of the use of sympathomimetics for asthmatic disease, on semen quality in men of subfertile couples. Reprod Biomed Online 2019; 40:423-428. [PMID: 32122752 DOI: 10.1016/j.rbmo.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022]
Abstract
RESEARCH QUESTION Is there an association between the use of sympathomimetics for asthmatic disease and semen quality in humans? DESIGN Between 2007 and 2012 a prospective cohort study was conducted among couples visiting the preconception counselling clinic at a tertiary hospital in the Netherlands. The study included 882 men of subfertile couples and information on medication use was obtained from self-administered questionnaires. Moreover, data on semen parameters were retrieved from medical records. RESULTS The study population of men revealed a mean (± SD) age of 34 ± 4 years with a mean body mass index (BMI) of 26.1 ± 2.3 kg/m2, and sympathomimetic use was reported by 3.6%. The use of sympathomimetics was positively associated with a 10% higher sperm motility (beta 10.265; 95% confidence interval [CI] 3.258-17.272) after adjustment for smoking, alcohol use, age, geographic background, BMI, folic acid supplement use, the four astronomical seasons and asthma/bronchitis. Subgroup analysis between men with total motile sperm count (TMSC) < or ≥10 million showed that this association remained (P ≤ 0.001) after adjustment for these confounders. After adjustment for confounders the sperm concentration was also positively associated with the use of sympathomimetics, but only in men with TMSC ≥10 million (beta 0.300; 95% CI 0.032-0.568). CONCLUSIONS These preliminary data show the potential benefits of the use of sympathomimetics to improve sperm motility in men of subfertile couples, which needs further investigation.
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Affiliation(s)
- Elsje C Oostingh
- Department of Obstetrics and Gynecology, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Nicole A Huijgen
- Department of Obstetrics and Gynecology, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Rivka Koedooder
- Department of Obstetrics and Gynecology, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Gert R Dohle
- Department of Urology, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Bruno Hc Stricker
- Department of Epidemiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Régine Pm Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands.
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16
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Priani IF, Afiyanti Y, Kurniawati W. Preparing pregnancy through Preconception Education Training. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Gootjes DV, van Dijk MR, Koster MP, Willemsen SP, Steegers EA, Steegers-Theunissen RP. Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands. JMIR Mhealth Uhealth 2019; 7:e11664. [PMID: 30973345 PMCID: PMC6482404 DOI: 10.2196/11664] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/27/2018] [Accepted: 12/19/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In 2011, we launched the Smarter Pregnancy mobile health (mHealth) coaching program, which has shown to effectively improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. It is known that in deprived neighborhoods, risk factors for adverse pregnancy outcomes like inadequate nutrition and lifestyle behaviors accumulate. However, it has not yet been investigated whether the Smarter Pregnancy program is equally effective in women living in deprived neighborhoods. OBJECTIVE This paper aimed to study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women who were either contemplating pregnancy or already pregnant and subscribed to the Smarter Pregnancy program. METHODS We performed an additional analysis on data from women who used the Smarter Pregnancy program from 2011 to 2016. The program comprised 24 weeks of coaching on 5 nutrition and lifestyle behaviors, of which adequate intakes or lifestyle behaviors were defined as an intake of 200 grams or above of vegetables, 2 pieces of fruit, daily folic acid supplement use of 400 µg per day, and no smoking or alcohol consumption. Neighborhood deprivation was determined according to the status scores of the Netherlands Institute for Social Research. Logistic regression analyses and generalized estimating equation models were used to assess the associations between the neighborhood status score (NSS) and the improvement of inadequate nutrition and lifestyle behaviors, taking into account the behaviors at baseline. We adjusted the analyses for maternal age, body mass index, geographic origin, pregnancy status, and participation as a couple. RESULTS Of the 2554 women included, 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (77.72, 1985/2554). Women with a higher NSS (ie, nondeprived neighborhood) smoked less often (adjusted odds ratio [OR] 0.85; 95% CI 0.77-0.93), consumed alcohol more often (adjusted OR 1.14, 95% CI 1.04-1.24), and were less likely to complete the 24 weeks of coaching (OR 0.91, 95% CI 0.88-0.95) compared with women who lived in a neighborhood with a low NSS (ie, deprived). In the total group, the relative improvement of inadequate nutrition and lifestyle behaviors after 24 weeks of coaching was between 26% and 64%. NSS was negatively associated with this improvement, indicating that women with a higher NSS were less likely to improve inadequate nutrition and lifestyle behaviors, especially vegetable intake (adjusted OR 0.89, 95% CI 0.82-0.97). CONCLUSIONS The Smarter Pregnancy mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women living in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups to further tailor the mHealth program on the basis of demographic characteristics like neighborhood deprivation.
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Affiliation(s)
- Dionne V Gootjes
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Matthijs R van Dijk
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria Ph Koster
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eric Ap Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Régine Pm Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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Shawe J, Patel D, Joy M, Howden B, Barrett G, Stephenson J. Preparation for fatherhood: A survey of men's preconception health knowledge and behaviour in England. PLoS One 2019; 14:e0213897. [PMID: 30893380 PMCID: PMC6426231 DOI: 10.1371/journal.pone.0213897] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/03/2019] [Indexed: 12/26/2022] Open
Abstract
Methods A cross-sectional survey of men attending antenatal care with their partners at three London Maternity Units. We assessed level of pregnancy planning using the partner version of the London Measure of Unplanned Pregnancy (LMUP), preconception health behaviours, and whether they had sought information and health professional advice before conception. Main results We recruited 573 men (91% response rate). Mean age was 34 years, 86% were in employment or full time education and 66% had a degree. Half were overweight or obese, 16% were still smoking and 79% had consumed alcohol in the three months before conception. Of 250 men answering questions about medication, a third were taking medication with potentially adverse effects on male reproductive health, while 23% reported taking pre-pregnancy vitamins. 46.9% had looked at information about pregnancy from a variety of sources, including online, before their partner became pregnant. Assessed by the LMUP, 74% of pregnancies were planned. Male ‘planners’ were more likely than other men to reduce smoking, reduce alcohol consumption and to eat more healthily in preparation for pregnancy. However, 57% took no action to improve their health. Significance of the findings In a sample of relatively educated men accompanying their partners on an antenatal visit, nearly half had made at least one positive health behaviour change before pregnancy, but half were overweight or obese and a third were on medication that could impair male reproductive health. These findings, together with a high prevalence of alcohol consumption and smoking, indicate the need for greater paternal preconception health awareness and care. Innovative ways to promote positive messages about fatherhood, including medication review as part of preconception care, should be evaluated for impact on improving paternal reproductive health and pregnancy and neonatal outcomes.
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Affiliation(s)
- Jill Shawe
- Institute of Health & Community University of Plymouth, Plymouth, United Kingdom
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Dilisha Patel
- Institute for Women’s Health, University College London, London, United Kingdom
- * E-mail:
| | - Mark Joy
- School of Health Sciences University of Surrey, Guildford, United Kingdom
| | - Beth Howden
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Geraldine Barrett
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Judith Stephenson
- Institute for Women’s Health, University College London, London, United Kingdom
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van Elten TM, Karsten MDA, Geelen A, Gemke RJBJ, Groen H, Hoek A, van Poppel MNM, Roseboom TJ. Preconception lifestyle intervention reduces long term energy intake in women with obesity and infertility: a randomised controlled trial. Int J Behav Nutr Phys Act 2019; 16:3. [PMID: 30621789 PMCID: PMC6325811 DOI: 10.1186/s12966-018-0761-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background The preconceptional period may be an optimal window of opportunity to improve lifestyle. We previously showed that a 6 month preconception lifestyle intervention among women with obesity and infertility was successful in decreasing the intake of high caloric snacks and beverages, increasing physical activity and in reducing weight in the short term. We now report the effects of the preconception lifestyle intervention on diet, physical activity and body mass index (BMI) at 5.5 years (range = 3.7–7.0 years) after the intervention. Methods We followed women who participated in the LIFEstyle study, a multicentre RCT in which women with obesity and infertility were assigned to a six-month lifestyle intervention program or prompt infertility treatment (N = 577). Diet and physical activity 5.5 years later were assessed with an 173-item food frequency questionnaire (N = 175) and Actigraph triaxial accelerometers (N = 155), respectively. BMI was calculated from self-reported weight and previously measured height (N = 179). Dietary intake, physical activity, and BMI in the intervention and control group were compared using multivariate regression models. Additionally, dietary intake, physical activity and BMI of women allocated to the intervention arm with successful weight loss during the intervention (i.e. BMI < 29 kg/m2 or ≥ 5% weight loss), unsuccessful weight loss and the control group were compared with ANCOVA. Results Although BMI did not differ between the intervention and control group 5.5 years after the intervention (− 0.5 kg/m2 [− 2.0;1.1]; P = 0.56), the intervention group did report a lower energy intake (− 216 kcal/day [− 417;-16]; P = 0.04). Women in the intervention arm who successfully lost weight during the intervention had a significantly lower BMI at follow-up compared to women in the intervention arm who did not lose weight successfully (− 3.4 kg/m2 [− 6.3;-0.6]; P = 0.01), and they reported a significantly lower energy intake compared to the control group (− 301 kcal [− 589;-14]; P = 0.04). Macronutrient intake, diet quality, and physical activity did not differ between the intervention and control group, irrespective of successful weight loss during the intervention. Conclusions In our study population, a preconception lifestyle intervention led to reduced energy intake 5.5 years later. Additionally, women allocated to the intervention group who were successful in losing weight during the intervention also had a lower BMI at follow-up. This shows the potential sustainable effect of a preconception lifestyle intervention. Trial registration This trial was registered on 16 November 2008 in the Dutch trial register; clinical trial registry number NTR1530. Electronic supplementary material The online version of this article (10.1186/s12966-018-0761-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T M van Elten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical centre, de Boelelaan 1117, Amsterdam, The Netherlands. .,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - M D A Karsten
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam, The Netherlands. .,Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - A Geelen
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - R J B J Gemke
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Department of Paediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical centre, de Boelelaan 1117, Amsterdam, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - M N M van Poppel
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical centre, de Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,University of Graz, Institute of Sport Science, Graz, Austria
| | - T J Roseboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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20
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Ng KYB, Wellstead S, Cheong Y, Macklon N. A randomised controlled trial of a personalised lifestyle coaching application in modifying periconceptional behaviours in women suffering from reproductive failures (iPLAN trial). BMC WOMENS HEALTH 2018; 18:196. [PMID: 30514285 PMCID: PMC6280350 DOI: 10.1186/s12905-018-0689-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/22/2018] [Indexed: 12/18/2022]
Abstract
Background Lifestyle, in particular obesity and smoking has significant impacts on fertility and an important focus for the treatment of reproductive failures is the optimisation of periconceptional lifestyle behaviours. The preimplantation intrauterine environment within the uterus is also key for embryo development and early programming. Although the benefits a healthy periconceptional lifestyle are well described, there remains a paucity of data demonstrating the efficacy of interventions designed to optimise preconceptional lifestyle behaviours and choices. Methods This study is a prospective randomised controlled trial which aims to address the question of whether an online personalised lifestyle coaching application is an effective means of delivering periconceptional advice in women suffering from reproductive failures. Women suffering from subfertility or recurrent miscarriages attending the outpatient clinic will be randomised into either the intervention arm (personalised online lifestyle coaching application) or the control arm (standard periconceptional advice including information from NHS websites). Both groups will be asked to complete a validated lifestyle questionnaire at baseline, and 6, 12, 18 and 24 weeks after randomisation. The primary outcome is the composite dietary and lifestyle risk score at 12 weeks. The secondary outcomes will include compliance with the program, proportion achieving spontaneous conception during the study period and the dietary and lifestyle risk score at 24 weeks. Discussion With this study, we aim to clarify whether a personalised online based lifestyle coaching application is more effective at improving behaviours than standard advice offered by National Health Service (NHS) resources. A personalised lifestyle coaching application may represent an empowering and cost effective means of delivering periconceptional advice in women with subfertility or recurrent miscarriages. Trial registration The iPLAN trial was retrospectively registered (ISRCTN 89523555). Electronic supplementary material The online version of this article (10.1186/s12905-018-0689-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ka Ying Bonnie Ng
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK. .,Department of Obstetrics and Gynaecology, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK.
| | - Susan Wellstead
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.,Department of Obstetrics and Gynaecology, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK
| | - Ying Cheong
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.,Department of Obstetrics and Gynaecology, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK
| | - Nick Macklon
- Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark.,London Women's Clinic, 113-115 Harley Street, Marylebone, London, W1G 6AP, UK
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21
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Oostingh EC, Hall J, Koster MPH, Grace B, Jauniaux E, Steegers-Theunissen RPM. The impact of maternal lifestyle factors on periconception outcomes: a systematic review of observational studies. Reprod Biomed Online 2018; 38:77-94. [PMID: 30424937 DOI: 10.1016/j.rbmo.2018.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
Abstract
The main risk factors for important reproductive health issues such as subfertility and perinatal mortality largely originate in the periconception period. To evaluate associations between modifiable maternal lifestyle factors and periconception outcomes, a systematic search was conducted for relevant studies published from 1990 to February 2017 on Embase, Medline, Web of Science, Cochrane database, PubMed and Google Scholar. The initial search identified 6166 articles, of which 49 studies were eligible for inclusion. Fecundity (the capacity to have a live birth) showed significant inverse associations with smoking, alcohol use and poor diet. Studies regarding time to pregnancy showed a decline in fecundity ratios (the monthly conception rate among exposed relative to unexposed couples) with increasing body mass index (BMI). Furthermore, risk of first-trimester miscarriage was found to be increased in smokers, alcohol and caffeine consumers, and with increasing BMI. Vitamin supplement use showed a decrease in this risk. This review demonstrates that maternal modifiable lifestyle factors affect periconception outcomes. If couples planning a pregnancy are more aware and supported to adopt healthy lifestyles during the periconceptional 'window of opportunity', short-term reproductive health as well as health in later life and even of future generations can be further improved.
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Affiliation(s)
- Elsje C Oostingh
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jennifer Hall
- Research Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Maria P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bola Grace
- Research Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Eric Jauniaux
- Research Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
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22
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Rönö K, Stach-Lempinen B, Eriksson JG, Pöyhönen-Alho M, Klemetti MM, Roine RP, Huvinen E, Andersson S, Laivuori H, Valkama A, Meinilä J, Kautiainen H, Tiitinen A, Koivusalo SB. Prevention of gestational diabetes with a prepregnancy lifestyle intervention - findings from a randomized controlled trial. Int J Womens Health 2018; 10:493-501. [PMID: 30214318 PMCID: PMC6118269 DOI: 10.2147/ijwh.s162061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Lifestyle intervention studies performed during pregnancy have shown inconsistent results in relation to prevention of gestational diabetes mellitus (GDM). Therefore, the aim of this study was to assess the effect of an intervention initiated already before pregnancy in prevention of GDM in high-risk women. Patients and methods A randomized controlled trial was conducted in four Finnish maternity hospitals between the years 2008 and 2014. Altogether 228 high-risk women planning pregnancy were randomized to an intervention (n=116) or a control group (n=112). The risk factors were body mass index ≥30 kg/m2 (n=46), prior GDM (n=120), or both (n=62), without manifest diabetes at study inclusion. Trained study nurses provided individualized lifestyle counseling every 3 months in addition to a group session with a dietician. The control group received standard antenatal care. GDM was defined as one or more pathological glucose values in a 75 g 2-hour oral glucose tolerance test, performed between 12 and 16 weeks of gestation and if normal repeated between 24 and 28 weeks of gestation. Results Within 12 months, 67% of the women (n=72) in the intervention group and 63% of the women (n=71) in the control group (p=0.84) became pregnant. The cumulative incidence of GDM among the women available for the final analyses was 60% (n=39/65) in the intervention group and 54% (n=34/63) in the control group (p=0.49). GDM was diagnosed already before 20 weeks of gestation in 60% (n=44/73) of the cases. Conclusion The preconceptional lifestyle intervention applied in the present study did not reduce the incidence of GDM.
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Affiliation(s)
- Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
| | - Johan Gunnar Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
| | - Maritta Pöyhönen-Alho
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
| | - Miira Marjuska Klemetti
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland, .,Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland.,Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto Paavo Roine
- Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Emilia Huvinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
| | - Sture Andersson
- University of Helsinki and Helsinki University Hospital, Children's Hospital, Pediatric Research Center, Helsinki, Finland
| | - Hannele Laivuori
- Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Anita Valkama
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
| | - Jelena Meinilä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Eastern Finland, Kuopio, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
| | - Saila Birgitta Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
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23
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Karami Z, Nekuei N, Kazemi A, Paknahad Z. Psychosocial Factors Related to Dietary Habits in Women Undergoing Preconception Care. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:311-315. [PMID: 30034493 PMCID: PMC6034532 DOI: 10.4103/ijnmr.ijnmr_22_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Correct health behaviors such as dietary habits before pregnancy ensure desired pregnancy outcomes. The aim of this study was to determine the relationship between psychosocial factors and dietary habits using social cognitive theory (SCT) in women undergoing preconception care (PCC). Materials and Methods: This cross-sectional study was conducted among 120 women from October to December 2015 in health centres in Isfahan, Iran. Using a researcher-made questionnaire, the researcher conducted stratified random sampling and convenience sampling for selecting health centres and participants, respectively. For data analysis, the researcher applied the Pearson, Spearman's, and linear regression test in SPSS software. Results: The results showed that perceived support from healthcare personnel and outcome expectations are not associated with any of the components of dietary habits. Access to healthy food was inversely correlated with incorrect dietary habits (β = −0.19, p = 0.039) and had a direct correlation with daily consumption of fruits (β = 0.27, p = 0.006). Perceived support from the spouse had a direct correlation with desired dietary habits (β = 0.27, p = 0.006). Self-efficacy was inversely correlated with incorrect dietary habits (β = −0.22, p = 0.011) and had a direct relationship with desired dietary habits (β = 0.25, p = 0.004). Conclusions: To improve the nutritional status of women prior to pregnancy, interventions must be focused on increasing women's access to healthy food and their self-efficacy in maintaining a healthy diet.
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Affiliation(s)
- Zahra Karami
- Students Research Centre, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafisehsadat Nekuei
- Nursing and Midwifery Care Research Center, Midwifery and Reproductive Health Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Nursing and Midwifery Care Research Center, Midwifery and Reproductive Health Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zamzam Paknahad
- Department of Clinical Nutrition, Faculty of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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Barker M, Dombrowski SU, Colbourn T, Fall CHD, Kriznik NM, Lawrence WT, Norris SA, Ngaiza G, Patel D, Skordis-Worrall J, Sniehotta FF, Steegers-Theunissen R, Vogel C, Woods-Townsend K, Stephenson J. Intervention strategies to improve nutrition and health behaviours before conception. Lancet 2018; 391:1853-1864. [PMID: 29673875 PMCID: PMC6075694 DOI: 10.1016/s0140-6736(18)30313-1] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/11/2022]
Abstract
The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.
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Affiliation(s)
- Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Stephan U Dombrowski
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, UK
| | - Tim Colbourn
- UCL Institute for Global Health, University College London, London, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Natasha M Kriznik
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Wendy T Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gloria Ngaiza
- UCL Institute for Global Health, University College London, London, UK
| | - Dilisha Patel
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University and Fuse, the UK Clinical Research Collaboration Centre of Excellence for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Régine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, and Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK; Southampton Education School, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Judith Stephenson
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
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25
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Poels M, van Stel HF, Franx A, Koster MPH. The effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care. EUR J CONTRACEP REPR 2018; 23:38-44. [PMID: 29377741 DOI: 10.1080/13625187.2018.1426744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective of this study was to investigate the effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care (PCC). MATERIAL AND METHODS This quasi-comparative study was carried out between February 2015 and February 2016 at a community midwifery practice in the Netherlands. The intervention consisted of a dual track approach (i) a promotional campaign for couples who wish to conceive and (ii) a PCC pathway for health care providers. Questionnaires were collected from a sample of women who received antenatal care during the pre-intervention (n = 283) and post-intervention (n = 257) period. Main outcome measures were preconceptional lifestyle changes and PCC use (defined as searching for information and/or consulting a health care provider). RESULTS Women who were exposed to the intervention were significantly more likely to make at least one lifestyle change during the preconception period [adjusted OR 1.56 (95% CI 1.02-2.39)]. Women were especially more likely to preconceptionally reduce or quit [adjusted OR 1.72 (95% CI 1.05-2.83)] their alcohol consumption after exposure to the intervention. Although non-significant, it appeared that women who were exposed to the intervention more often prepared themselves for pregnancy by means of independently searching for preconception health information [adjusted OR 1.13 (95% CI 0.77-1.65)] or consulting a health care provider regarding their wish to conceive [adjusted OR 1.24 (95% CI 0.81-1.92)]. CONCLUSIONS Exposure to a local promotional campaign targeted at preconceptional health was associated with improved preconceptional lifestyle behaviours, especially with regard to alcohol consumption, and has the potential to improve the use of PCC.
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Affiliation(s)
- Marjolein Poels
- a Department of Obstetrics and Gynecology, Division Woman and Baby , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Henk F van Stel
- b Department of Healthcare Innovation and Evaluation, Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Arie Franx
- a Department of Obstetrics and Gynecology, Division Woman and Baby , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Maria P H Koster
- a Department of Obstetrics and Gynecology, Division Woman and Baby , University Medical Center Utrecht , Utrecht , The Netherlands
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26
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Poels M, Koster MPH, Franx A, van Stel HF. Parental perspectives on the awareness and delivery of preconception care. BMC Pregnancy Childbirth 2017; 17:324. [PMID: 28950838 PMCID: PMC5615801 DOI: 10.1186/s12884-017-1531-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/21/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The attention for Preconception Care (PCC) has grown substantially in recent years, yet the implementation of PCC appears challenging as uptake rates remain low. The objective of this study was to assess parental perspectives on how PCC should be provided. METHODS Recruitment of participants took place among couples who received antenatal care at a Dutch community midwifery practice. Between June and September 2014, five focus group sessions were held with 29 women and one focus group session with 5 men. Thematic analysis was conducted using NVivo 10 software. RESULTS Participants were generally unfamiliar with the concept of PCC. It was proposed to raise awareness by means of a promotional campaign, stipulating that PCC is suited for every couple with a (future) child wish. Suggestions were made to display marketing materials in both formal and informal (local community) settings. Addressing existing social networks and raising social dialogue was expected to be most efficient. It was recommended to make PCC more accessible by offering multiple forms and to involve male partners. Opportunistic offering PCC by healthcare providers was considered more acceptable when the subject was deliberately raised, for example while discussing contraceptives, lifestyle risks or drug prescriptions. GP's or midwifes were regarded the most suitable PCC providers, however provider characteristics such as experience, empathy and communication skills were considered more important. CONCLUSIONS This study showed that from the parental perspective it is recommended to address every couple with a (future) child wish by means of enlarging the awareness and accessibility of PCC. In order to enlarge the awareness, it is recommended to address social networks, to raise the social dialogue and to conduct promotional campaigns regarding PCC. In order to improve the accessibility of PCC, it was suggested to simultaneously offer multiple forms: group sessions, individual consultations, walk-in-hours and online sessions, and to involve male partners.
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Affiliation(s)
- M Poels
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, the Netherlands.
| | - M P H Koster
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, the Netherlands.,Present address: Department of Obstetrics and Gynecology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, the Netherlands
| | - H F van Stel
- Department of Healthcare Innovation and Evaluation, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
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27
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Hemsing N, Greaves L, Poole N. Preconception health care interventions: A scoping review. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 14:24-32. [PMID: 29195631 DOI: 10.1016/j.srhc.2017.08.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
Pregnancy is often framed as a "window of opportunity" for intervening on a variety of health practices such as alcohol and tobacco use. However, there is evidence that interventions focusing solely on the time of pregnancy can be too narrow and potentially stigmatizing. Indeed, health risks observed in the preconception period often continue during pregnancy. Using a scoping review methodology, this study consolidates knowledge and information related to current preconception and interconception health care interventions published in the academic literature. We identified a total of 29 intervention evaluations, and summarized these narratively. Findings suggest that there has been some progress in intervening on preconception health, with the majority of interventions offering assessment or screening followed by brief intervention or counselling. Overall, these interventions demonstrated improvements in at least some of the outcomes measured. However, further preconception care research and intervention design is needed. In particular, the integration of gender transformative principles into preconception care is needed, along with further intervention design for partners/ men, and more investigation on how best to deliver preconception care.
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Affiliation(s)
- Natalie Hemsing
- Centre of Excellence for Women's Health, 4500 Oak Street, Box 48, Vancouver, BC V6H 3N1, Canada.
| | - Lorraine Greaves
- Centre of Excellence for Women's Health, 4500 Oak Street, Box 48, Vancouver, BC V6H 3N1, Canada
| | - Nancy Poole
- Centre of Excellence for Women's Health, 4500 Oak Street, Box 48, Vancouver, BC V6H 3N1, Canada
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Poels M, van Stel HF, Franx A, Koster MP. Actively preparing for pregnancy is associated with healthier lifestyle of women during the preconception period. Midwifery 2017; 50:228-234. [DOI: 10.1016/j.midw.2017.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/23/2017] [Accepted: 04/26/2017] [Indexed: 11/29/2022]
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Healthy preconception nutrition and lifestyle using personalized mobile health coaching is associated with enhanced pregnancy chance. Reprod Biomed Online 2017; 35:453-460. [PMID: 28688924 DOI: 10.1016/j.rbmo.2017.06.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 01/13/2023]
Abstract
Periconceptional nutrition and lifestyle are essential in pathogenesis and prevention of most reproductive failures, pregnancy outcome and future health. We aimed to investigate whether personalized mobile health (mHealth) coaching empowers couples contemplating pregnancy to increase healthy behaviour and chances of pregnancy. A survey was conducted among 1053 women and 332 male partners who received individual coaching using the mHealth programme 'Smarter Pregnancy' to change poor nutrition and lifestyle for 26 weeks, depending on pregnancy state and gender. Poor behaviours were translated into a total risk score (TRS) and Poisson regression analysis was performed to estimate associations with the chance of pregnancy adjusted for fertility status, age and baseline body mass index expressed as adjusted hazard ratio (aHR) and 95% confidence interval (95% CI). A lower (a)HR suggests a higher chance of achieving pregnancy. A higher TRS was significantly associated with a lower chance of pregnancy in all women (aHR 0.79, 95% CI 0.72-0.85) and (a)HR was lowest in women whose male partner participated (aHR 0.75, 95% CI 0.61-0.91). This survey shows that empowerment of couples in changing poor nutrition and lifestyle using personalized mHealth coaching is associated with an enhanced pregnancy chance in both infertile and fertile couples.
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Periconception mHealth platform for prevention of placental-related outcomes and non-communicable diseases. Placenta 2017; 60:115-118. [PMID: 28473168 DOI: 10.1016/j.placenta.2017.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/19/2017] [Accepted: 04/21/2017] [Indexed: 11/22/2022]
Abstract
Most placental-related pregnancy complications originate during the first trimester of pregnancy where gene-environmental interactions play a role. The environmental factors also include parental behaviors that can be positive, such as folic acid supplement use, or negative, e.g. poor lifestyle choices like smoking, and nutritional choices that contribute to obesity or micronutrient deficits. The overlapping risk factors associated with non-communicable disease are poor nutrition, smoking, and obesity. These modifiable factors differ between individuals, populations and high, middle and low income countries, but have in common that they are extremely difficult to change. Parents-to-be however are most motivated to change poor behaviors when they are aware of short-term health benefits of having a healthy baby. Therefore, these couples should be empowered to use evidence-based and personalized effective tools to improve poor behaviors. Moreover, these tools should be implemented to support healthcare professionals in delivering 'nutrition and lifestyle care' in routine patient care. From this background the usability and effectiveness of the mHealth coaching program www.SmarterPregnancy.co.uk (Dutch version www.SlimmerZwanger.nl) is presented as an opportunity to further customize this tool for specific target groups, healthcare professionals and low resource settings with the potential to prevent placental-related and non-communicable disease during the life course.
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Steegers-Theunissen RPM, Steegers EAP. Embryonic health: new insights, mHealth and personalised patient care. Reprod Fertil Dev 2017; 27:712-5. [PMID: 25771352 DOI: 10.1071/rd14386] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/18/2015] [Indexed: 01/30/2023] Open
Abstract
The worldwide epidemic of non-communicable diseases (NCD), including obesity, is a burden to which poor lifestyles contribute significantly. Events in early life may enhance susceptibility to NCD, with transmission into succeeding generations. This may also explain, in part, why interventions in adulthood are less effective to reduce NCD risk. New insights reveal that the early embryo, in particular, is extremely sensitive to signals from gametes, trophoblastic tissue and periconception maternal lifestyles. Embryonic size and growth as determinants of embryonic health seem to impact future health. A relatively small embryo for gestational age is associated with pregnancy complications, as well as with the risk of early features of NCD in childhood. Although personal lifestyles are modifiable, they are extremely difficult to change. Therefore, adopting a life course approach from the periconception period onwards and integrated into patient care with short-term reproductive health benefits may have important implications for future prevention of NCD. The current reproductive population is used to Internet and social media. Therefore, they can be reached via mobile phone (mHealth) platforms that provide personalised lifestyle (pre)pregnancy programs. This will offer opportunities and possibly great benefits for the health of current and succeeding generations.
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Affiliation(s)
- Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
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Dietary patterns and the phenotype of polycystic ovary syndrome: the chance of ongoing pregnancy. Reprod Biomed Online 2017; 34:668-676. [PMID: 28363463 DOI: 10.1016/j.rbmo.2017.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/16/2017] [Accepted: 02/28/2017] [Indexed: 12/20/2022]
Abstract
Polycystic ovary syndrome (PCOS) is generally considered a complex disorder caused by interactions between genetic and environmental factors. In a sub-cohort of women with PCOS visiting the preconception outpatient clinic of a tertiary hospital with follow-up in a periconception cohort, we identified specific dietary patterns and adherence in patients with PCOS with and without hyperandrogenism and the chance of ongoing pregnancy. Food frequency questionnaires were available from 55 patients diagnosed with PCOS during follow-up in routine clinical practice, including 25 with hyperandrogenism and 30 without hyperandrogenism. Strong adherence to the healthy dietary pattern was inversely associated with the hyperandrogenic PCOS phenotype (Adjusted OR 0.27; 95% CI 0.07 to 0.99). In women with PCOS overall, a strong adherence to the healthy dietary pattern showed a three-fold higher chance of ongoing pregnancy (adjusted OR 3.38; 95% CI 1.01 to 11.36) and an association with anti-Müllerian hormone concentration (β -0.569 µg/L; 95% CI -0.97 to -0.17). The effect of this dietary pattern on the chance of ongoing pregnancy and AMH suggests causality, which needs further investigation in prospective studies in the general population.
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van Dijk MR, Oostingh EC, Koster MPH, Willemsen SP, Laven JSE, Steegers-Theunissen RPM. The use of the mHealth program Smarter Pregnancy in preconception care: rationale, study design and data collection of a randomized controlled trial. BMC Pregnancy Childbirth 2017; 17:46. [PMID: 28125970 PMCID: PMC5270226 DOI: 10.1186/s12884-017-1228-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/16/2017] [Indexed: 12/13/2022] Open
Abstract
Background Unhealthy nutrition and lifestyle contribute to the worldwide rising prevalence of non-communicable diseases. This also accounts for the reproductive population, in which unhealthy behavior affects fertility and pregnancy outcome. Maternal smoking, alcohol consumption and inadequate folic acid supplement use are strongly associated with fetal complications as small for gestational age, premature birth and congenital malformations. In the Netherlands 83% of the perinatal mortality rate is due to these complications and is relatively high compared to other European countries. In order to reduce this prevalence rate, preconception care should be focused on the promotion of health of prospective parents by identification and intervention on modifiable nutrition and lifestyle risk factors. We developed the personal mHealth program ‘Smarter Pregnancy’ (Dutch version available on: https://www.slimmerzwanger.nl) to provide individual coaching and information to improve nutrition and lifestyle during the preconception period in order to improve health of the reproductive population and subsequent generations. Methods Women between 18 and 45 years of age, and trying to conceive are eligible for inclusion in a randomized controlled trial. Participants are allocated either to a general population cohort or a subfertile (IVF/ICSI) population cohort. The intervention group receives personal online coaching based on the identified nutrition and lifestyle risk factors at baseline. Coaching comprises recipes, incentives, additional questions including feedback and text and e-mail messages, with a maximum of three per week. The control group only receives one recipe per week to maintain adherence to the program and prevent drop out. Screening questionnaires are send in both groups at 6, 12, 18, and 24 weeks of the program to monitor the change in the identified risk factors. Discussion We expect to demonstrate that the mHealth program ‘Smarter Pregnancy’ can effectively improve nutrition and lifestyle in couples contemplating pregnancy. By the identification and improvement of modifiable nutrition and lifestyle risk factors on a large scale, both reproductive and pregnancy outcomes can be improved and subsequent perinatal morbidity and mortality rates are expected to be reduced. The current use and rapid development of mHealth applications offers new opportunities to reach and educate large populations, which can facilitate the implementation of preconception care. Trial registration Dutch trial register: NTR4150. (Registered 19th August 2013) Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1228-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthijs R van Dijk
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam, 3000CA, The Netherlands
| | - Elsje C Oostingh
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam, 3000CA, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam, 3000CA, The Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam, 3000CA, The Netherlands
| | - Joop S E Laven
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam, 3000CA, The Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam, 3000CA, The Netherlands. .,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, Rotterdam, 3000CA, The Netherlands.
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Hanson M, Barker M, Dodd JM, Kumanyika S, Norris S, Steegers E, Stephenson J, Thangaratinam S, Yang H. Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol 2017; 5:65-76. [PMID: 27743974 DOI: 10.1016/s2213-8587(16)30108-5] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/29/2016] [Accepted: 05/24/2016] [Indexed: 01/07/2023]
Abstract
Prevention of obesity in women of reproductive age is widely recognised to be important both for their health and for that of their offspring. Weight-control interventions, including drug treatment, in pregnant women who are obese or overweight have not had sufficient impact on pregnancy and birth outcomes, which suggests that the focus for intervention should include preconception or post-partum periods. Further research is needed into the long-term effects of nutritional and lifestyle interventions before conception. To improve preconception health, an integrated approach, including pregnancy prevention, planning, and preparation is needed, involving more than the primary health-care sector and adopting an ecological approach to risk reduction that addresses personal, societal, and cultural influences. Raising awareness of the importance of good health in the period before pregnancy will require a new social movement: combining bottom-up mobilisation of individuals and communities with a top-down approach from policy initiatives. Interventions to reduce or prevent obesity before conception and during pregnancy could contribute substantially to achievement of the global Sustainable Development Goals, in terms of health, wellbeing, productivity, and equity in current and future generations.
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Affiliation(s)
- Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jodie M Dodd
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Women's and Babies Division, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Shiriki Kumanyika
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shane Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eric Steegers
- Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Judith Stephenson
- Department of Reproductive Health, Institute for Women's Health, University College London, London, UK; Children, Young People and Maternal Health Programme, UCL Partners Academic Health Science Partnership, London, UK
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Epigenetic Influences During the Periconception Period and Assisted Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1014:15-39. [PMID: 28864983 DOI: 10.1007/978-3-319-62414-3_2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The periconception period starts 6 months before conception and lasts until the tenth week of gestation. In this chapter, we will focus on epigenetic modifications to DNA and gene expression within this period and during assisted reproduction. There are two critical times during the periconception window when significant epigenetic 'reprogramming' occur: one during gametogenesis and another during the pre-implantation embryonic stage. Furthermore, assisted conception treatments, laboratory protocols and culture media can affect the embryo development and birth weights in laboratory animals. There is, however, an ongoing debate as to whether epigenetic changes in humans, causing embryo mal-development, placenta dysfunction and birth defects, result from assisted reproductive technologies or are consequences of pre-existing medical and/or genetic conditions in the parents. The periconception period starts from ovarian folliculogenesis, through resumption of oogenesis, fertilisation, peri-implantation embryo development, embryogenesis until the end of organogenesis. In men, it is the period from spermatogenesis to epididymal sperm storage and fertilisation. Gametes and developing embryos are sensitive to environmental factors during this period, and epigenetic modifications can occur in response to adverse lifestyles and environmental factors. We now know that lifestyle factors such as advanced parentage age, obesity or undernutrition, smoking, excessive alcohol and caffeine intake and recreational drugs used during gamete production and embryogenesis could induce epigenetic alterations, which could impact adversely on pregnancy outcomes and health of the offspring. Furthermore, these can also result in a permanent and irreversible effect in a dose-dependent manner, which can be passed on to the future generations.
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Kaya Y, Kizilkaya Beji N, Aydin Y, Hassa H. The effect of health-promoting lifestyle education on the treatment of unexplained female infertility. Eur J Obstet Gynecol Reprod Biol 2016; 207:109-114. [PMID: 27838534 DOI: 10.1016/j.ejogrb.2016.10.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 07/23/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to reveal the 1) awareness, 2) improvements of a health-promoting lifestyle on women with unexplained infertility having at least one of the risk factors that have been indicated to negatively affect fertility (smoking, body mass index lower than 18.5kg/m2 and more than 25kg/m2, over-exercising or not exercising at all, alcohol consumption, caffeine consumption of more than 300mg/day, and high levels of stress) by means of health-promoting lifestyle education, 3) the effect of this improvement on the result of assisted-reproduction treatment in terms of clinical pregnancy. STUDY DESIGN 64 women diagnosed with unexplained infertility were divided into a group receiving Health-Promoting Lifestyle (HPL) education and a control group. 1) Risk Factors Questionnaire (BMI, Smoking, Alcohol, Stress, Exercise, Caffeine), 2) Depression, Anxiety and Stress Scale, 3) Health-Promoting Lifestyle Profile II. The health promoting lifestyle was given to the education group. The Risk Factors Questionnaire; Depression, Anxiety, Stress Scale and Healthcare-Promoting Lifestyle Profile II were also administered after the first-second-third month of education but before ART treatment. RESULTS A statistically significant decrease was found in the average levels of four variables as; BMI (p<0.001)-stress (p<0.001)-caffeine consumption (p<0.001)-lower exercise levels (p<0.001). Moreover, the total number of risk factors that females had between the first and third interview decreased significantly. Clinical pregnancy rate after ART was 12 (46.1%) and 5 (19.2%) in education and control group consequently (p=0.02). CONCLUSION Health-promoting lifestyle education was found to be effective in reducing the lifestyle risk factors for infertility and increasing the success rates of assisted reproduction treatment by correcting these risk factors.
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Affiliation(s)
- Yeliz Kaya
- Eskişehir Osmangazi University, Faculty of Health Sciences, Department of Nursing, Eskişehir, Turkey.
| | - Nezihe Kizilkaya Beji
- Biruni University, Faculty of Health Sciences, Department of Nursing, Istanbul, Turkey
| | - Yunus Aydin
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Gynecology and Obstetrics, Reproductive Endocrinology and Infertility, Eskişehir, Turkey
| | - Hikmet Hassa
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Gynecology and Obstetrics, Reproductive Endocrinology and Infertility, Eskişehir, Turkey
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Poels M, Koster MPH, Boeije HR, Franx A, van Stel HF. Why Do Women Not Use Preconception Care? A Systematic Review On Barriers And Facilitators. Obstet Gynecol Surv 2016; 71:603-612. [DOI: 10.1097/ogx.0000000000000360] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Joelsson LS, Berglund A, Wånggren K, Lood M, Rosenblad A, Tydén T. Do subfertile women adjust their habits when trying to conceive? Ups J Med Sci 2016; 121:184-91. [PMID: 27216564 PMCID: PMC4967265 DOI: 10.1080/03009734.2016.1176094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 01/07/2023] Open
Abstract
AIM The aim of this study was to investigate lifestyle habits and lifestyle adjustments among subfertile women trying to conceive. MATERIALS AND METHODS Women (n = 747) were recruited consecutively at their first visit to fertility clinics in mid-Sweden. Participants completed a questionnaire. Data were analyzed using logistic regression, t tests, and chi-square tests. RESULTS The response rate was 62% (n = 466). Mean duration of infertility was 1.9 years. During this time 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. In this sample, 23.9% of the women were overweight (body mass index, BMI 25-29.9 kg/m(2)), and 12.5% were obese (BMI ≥30 kg/m(2)). Obese women exercised more and changed to healthy diets more frequently than normal-weight women (odds ratio 7.43; 95% confidence interval 3.7-14.9). Six out of ten women (n = 266) took folic acid when they started trying to conceive, but 11% stopped taking folic acid after some time. Taking folic acid was associated with a higher level of education (p < 0.001). CONCLUSIONS Among subfertile women, one-third were overweight or obese, and some had other lifestyle factors with known adverse effects on fertility such as use of tobacco. Overweight and obese women adjusted their habits but did not reduce their body mass index. Women of fertile age would benefit from preconception counseling, and the treatment of infertility should routinely offer interventions for lifestyle changes.
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Affiliation(s)
- Lana Salih Joelsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västmanland County Hospital, Västerås, Sweden
| | - Anna Berglund
- The National Centre for Knowledge of Men’s Violence against Women, Uppsala University, Uppsala, Sweden
| | - Kjell Wånggren
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Lood
- Department of Women’s Health, Fertility Unit, Örebro University Hospital, Örebro, Sweden
| | - Andreas Rosenblad
- Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västmanland County Hospital, Västerås, Sweden
| | - Tanja Tydén
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Van Dijk MR, Huijgen NA, Willemsen SP, Laven JS, Steegers EA, Steegers-Theunissen RP. Impact of an mHealth Platform for Pregnancy on Nutrition and Lifestyle of the Reproductive Population: A Survey. JMIR Mhealth Uhealth 2016; 4:e53. [PMID: 27234926 PMCID: PMC4902855 DOI: 10.2196/mhealth.5197] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/21/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background Poor nutrition and lifestyle behaviors exert detrimental effects on reproduction and health during the life course. Therefore, lifestyle interventions during the periconceptional period can improve fertility, pregnancy outcome, and health of subsequent generations. Objective This survey investigates the compliance, usability, and initial effectiveness of the Web-based mHealth platform, Smarter Pregnancy. Methods A free subscription to the mHealth platform, Smarter Pregnancy, was provided to couples contemplating pregnancy (n=1275) or already pregnant (n=603). After baseline identification of inadequate nutrition and lifestyle behaviors, a personal online coaching program of 6 months was generated. Using multiple imputation and the generalized estimating equation model with independent correlations, we estimated the changes from inadequate to adequate nutrition and lifestyle behaviors over time. Subgroup analyses were performed for (1) overweight and obese women (body mass index [BMI] ≥25 kg/m2), (2) pregnant women at the start of the program, and (3) couples. Results A 64.86% (1218/1878) compliance rate was observed and 54.7% (range 39.2-73.4%) of participants rated the program usability as positive or very positive. Adequate nutrition and lifestyle behaviors at baseline were 21.57% (405/1878) for vegetable intake, 52.61% (988/1878) for fruit intake, 85.44% (1303/1525) for folic acid use, 86.79% (1630/1878) for no tobacco use, and 64.43% (1210/1878) for no alcohol consumption. After 6 months of coaching, these lifestyle behaviors improved by 26.3% (95% CI 23.0-29.9) for vegetable intake, 38.4% (95% CI 34.5-42.5) for fruit intake, 56.3% (95% CI 48.8-63.6) for folic acid use, 35.1% (95% CI 29.1-41.6) for no tobacco use, and 41.9% (95% CI 35.2-48.9) for no alcohol consumption. The program showed the strongest effectiveness for participating couples. Conclusions This novel Web-based mHealth platform shows high compliance and usability, and users demonstrate improvements in nutrition and lifestyle behaviors. The next step will be further validation in randomized controlled trials and implementation.
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Affiliation(s)
- Matthijs R Van Dijk
- Erasmus Medical Center (MC), Department of Obstetrics and Gynecology, University Medical Center, Rotterdam, Netherlands
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Harrison CL, Brown WJ, Hayman M, Moran LJ, Redman LM. The Role of Physical Activity in Preconception, Pregnancy and Postpartum Health. Semin Reprod Med 2016; 34:e28-37. [PMID: 27169984 DOI: 10.1055/s-0036-1583530] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rise in obesity and associated morbidity is currently one of our greatest public health challenges. Women represent a high risk group for weight gain with associated metabolic, cardiovascular, reproductive and psychological health impacts. Regular physical activity is fundamental for health and well-being with protective benefits across the spectrum of women's health. Preconception, pregnancy and the early postpartum period represent opportune windows to engage women in regular physical activity to optimize health and prevent weight gain with added potential to transfer behavior change more broadly to children and families. This review summarizes the current evidence for the role of physical activity for women in relation to preconception (infertility, assisted reproductive therapy, polycystic ovary syndrome, weight gain prevention and psychological well-being) pregnancy (prevention of excess gestational weight gain, gestational diabetes and preeclampsia as well as labor and neonatal outcomes) and postpartum (lactation and breastfeeding, postpartum weight retention and depression) health. Beneficial outcomes validate the importance of regular physical activity, yet key methodological gaps highlight the need for large, high-quality studies to clarify the optimal type, frequency, duration and intensity of physical activity required for beneficial health outcomes during preconception, pregnancy and postpartum.
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Affiliation(s)
- Cheryce L Harrison
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy J Brown
- Centre for Research on Exercise Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Melanie Hayman
- School of Medical and Applied Sciences, Central Queensland University, Queensland, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
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Wijnands K, van Uitert E, Roeters van Lennep J, Koning A, Mulders A, Laven J, Steegers E, Steegers-Theunissen R. The periconception maternal cardiovascular risk profile influences human embryonic growth trajectories in IVF/ICSI pregnancies. Hum Reprod 2016; 31:1173-81. [DOI: 10.1093/humrep/dew060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/18/2016] [Indexed: 11/14/2022] Open
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Are Dieting and Dietary Inadequacy a Second Hit in the Association with Polycystic Ovary Syndrome Severity? PLoS One 2015; 10:e0142772. [PMID: 26569630 PMCID: PMC4646482 DOI: 10.1371/journal.pone.0142772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/27/2015] [Indexed: 12/26/2022] Open
Abstract
Background The composition of the diet is of increasing importance for the development and maturation of the ovarian follicles. In Polycystic Ovary Syndrome (PCOS) healthy dietary interventions improve the clinical spectrum. We hypothesized that dieting and diet inadequacy in the reproductive life course is associated with impaired programming of ovarian follicles and contributes to the severity of the PCOS phenotype. Methods and Findings To determine associations between the use of a self-initiated diet and diet inadequacy and the severity of the PCOS phenotype, we performed an explorative nested case control study embedded in a periconception cohort of 1,251 patients visiting the preconception outpatient clinic. 218 patients with PCOS and 799 subfertile controls were selected from the cohort and self-administered questionnaires, anthropometric measurements and blood samples were obtained. The Preconception Dietary Risk Score (PDR score), based on the Dutch dietary guidelines, was used to determine diet inadequacy in all women. The PDR score was negatively associated to cobalamin, serum and red blood cell folate and positively to tHcy. PCOS patients (19.9%), in particular the hyperandrogenic (HA) phenotype (22.5%) reported more often the use of a self-initiated diet than controls (13.1%; p = 0.023). The use of an inadequate diet was also significantly higher in PCOS than in controls (PDR score 3.7 vs 3.5; p = 0.017) and every point increase was associated with a more than 1.3 fold higher risk of the HA phenotype (adjusted OR 1.351, 95% CI 1.09–1.68). Diet inadequacy was independently associated with the anti-Müllerian Hormone (AMH) concentration (β 0.084; p = 0.044; 95% CI 0.002 to 0.165) and free androgen index (β 0.128; p = 0.013; 95% CI 0.028 to 0.229) in PCOS patients. Conclusions The use of a self-initiated diet and diet inadequacy is associated with PCOS, in particular with the severe HA phenotype. This novel finding substantiated by the association between diet inadequacy and AMH needs further investigation.
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Steegers-Theunissen RP, Verheijden-Paulissen JJ, van Uitert EM, Wildhagen MF, Exalto N, Koning AH, Eggink AJ, Duvekot JJ, Laven JS, Tibboel D, Reiss I, Steegers EA. Cohort Profile: The Rotterdam Periconceptional Cohort (Predict Study). Int J Epidemiol 2015. [PMID: 26224071 DOI: 10.1093/ije/dyv147] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
| | | | | | - Mark F Wildhagen
- Department of Obstetrics and Gynaecology, Research Office Sophia Sophia
| | | | | | | | | | | | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery and
| | - Irwin Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Vink-van Os LC, Birnie E, van Vliet-Lachotzki EH, Bonsel GJ, Steegers EA. Determining Pre-Conception Risk Profiles Using a National Online Self-Reported Risk Assessment: A Cross-Sectional Study. Public Health Genomics 2015; 18:204-15. [DOI: 10.1159/000381449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/06/2015] [Indexed: 11/19/2022] Open
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Zeinab H, Zohreh S, Samadaee Gelehkolaee K. Lifestyle and Outcomes of Assisted Reproductive Techniques: A Narrative Review. Glob J Health Sci 2015; 7:11-22. [PMID: 26156898 PMCID: PMC4803851 DOI: 10.5539/gjhs.v7n5p11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022] Open
Abstract
Background: Studies reveal that lifestyles such as physical activity patterns, obesity, nutrition, and smoking, are factors that affect laboratory test results and pregnancy outcomes induced by assisted fertility techniques in infertile couples. The present study is a narrative review of studies in this area. Methods: In this study, researchers conducted their computer search in public databases Google Scholar general search engine, and then more specific: Science Direct, ProQuest, SID, Magiran, Irandoc, Pubmed, Scopus, cochrane library, and Psych info; Cumulative Index to Nursing and Allied Health Literature (CINAHL), using Medical Subject Headings (MeSH) keywords: infertility (sterility, infertility), lifestyle (life behavior, lifestyle), Assisted Reproductive Techniques (ART), antioxidant and infertility, social health, spiritual health, mental health, Alcohol and drug abuse, preventive factors, and instruments., and selected relevant articles to the study subject from 2004 to 2013. Firstly, a list of 150 papers generated from the initial search. Then reviewers studied titles and abstracts. Secondly, 111 papers were included. Finally, quality assessment of full text studies was performed by two independent reviewers. Researchers reviewed summary of all articles sought, ultimately used data from 62 full articles to compile this review paper. Results: Review of literature led to arrangement of 9 general categories of ART results’ relationship with weight watch and diet, exercise and physical activity, psychological health, avoiding medications, alcohol and drugs, preventing diseases, environmental health, spiritual health, social health, and physical health. Conclusion: The following was obtained from review of studies: since lifestyle is among important, changeable, and influential factors in fertility, success of these methods can be greatly helped through assessment of lifestyle patterns of infertile couples, and design and implementation of healthy lifestyle counseling programs, before and during implementing assisted fertility techniques.
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Affiliation(s)
| | | | - Keshvar Samadaee Gelehkolaee
- Department of Reproductive Health and Midwifery, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
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Do some addictions interfere with fertility? Fertil Steril 2015; 103:22-6. [DOI: 10.1016/j.fertnstert.2014.11.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 01/08/2023]
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Huijgen NA, van de Kamp ME, Twigt JM, de Vries JH, Eilers PH, Steegers EA, Laven JS, Steegers-Theunissen RP. The Preconception Dietary Risk score; a simple tool to assess an inadequate habitual diet for clinical practice. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.clnme.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Temel S, van Voorst SF, Jack BW, Denktaş S, Steegers EAP. Evidence-Based Preconceptional Lifestyle Interventions. Epidemiol Rev 2013; 36:19-30. [DOI: 10.1093/epirev/mxt003] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van der Zee B, de Wert G, Steegers EA, de Beaufort ID. Ethical aspects of paternal preconception lifestyle modification. Am J Obstet Gynecol 2013; 209:11-6. [PMID: 23313726 DOI: 10.1016/j.ajog.2013.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/10/2012] [Accepted: 01/04/2013] [Indexed: 11/30/2022]
Abstract
This Clinical Opinion points to a potential conflict between the scarcity of evidence on paternal preconception risk factors for adverse pregnancy outcomes and the view that preconception care should be also directed at men. We argue that from an ethical perspective, responsible fatherhood starts already before conception, as long as the evidence increases on the benefits of paternal preconception lifestyle (modification). Our explorative study suggests that the strength of the evidence for paternal preconception lifestyle modification is important for men. We argue that 5 aspects together determine the moral responsibility of prospective fathers to modify their behavior: the strength of the evidence of the risk factor, the modifiability of the risk, the efforts necessary to eliminate or diminish the risk factor, the severity of harm, and the probability that harm will occur and that it will be prevented by modifying the risk factor. The case of paternal preconception smoking illustrates the analysis.
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Affiliation(s)
- Boukje van der Zee
- Department of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Abstracts of Congress Sessions. EUR J CONTRACEP REPR 2013. [DOI: 10.3109/13625187.2013.793027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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