Okubo Hitomi, Nakayama Shoji F, Mito Asako, Arata Naoko, Ohya Yukihiro
Department of Nutritional Epidemiology and Behavioural Nutrition, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Ibaraki, Japan.
BJOG. 2025 Feb;132(3):375-386. doi: 10.1111/1471-0528.17994. Epub 2024 Nov 18.
To quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).
Prospective cohort study.
The Japan Environment and Children's Study.
A total of 79 703 pregnant Japanese women without chronic disease.
Maternal lifestyle before pregnancy was assessed using a self-administered questionnaire. A healthy lifestyle score (HLS, 0-5 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high-quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log-binomial regression model.
Composite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small-for-gestational-age, transcribed from medical records.
A total of 13 894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose-response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61-0.74) lower risk of APOs than those with the lowest HLS (0-1 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1-point increase of HLS could have reduced APO cases by 6.6%.
A higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.
量化孕前可改变的生活方式因素组合与不良妊娠结局（APO）风险之间的关联。
前瞻性队列研究。
日本环境与儿童研究。
总共79703名无慢性病的日本孕妇。
采用自填式问卷评估孕前母亲的生活方式。根据对五个孕前健康生活方式因素的遵循情况计算健康生活方式得分（HLS，0 - 5分），这五个因素包括健康体重、高质量饮食、规律体育活动、不吸烟和不饮酒。使用贝叶斯对数二项回归模型估计相对风险（RRs）和95%可信区间（CrIs）。
复合APO，定义为发生任何APO，包括妊娠期糖尿病、妊娠高血压疾病、早产、低出生体重和小于胎龄儿，数据转录自医疗记录。
共有13894名女性（17.4%）经历了一种或多种APO。HLS与APO风险呈剂量反应关系的负相关。HLS为5分的女性发生APO的风险比HLS最低（0 - 1分）的女性低33%（RR 0.67；95% CrI，0.61 - 0.74）。五个健康生活方式因素的人群归因分数为10.3%。HLS每增加1分可使APO病例减少6.6%。
较高的HLS与较低的APO风险相关，这表明孕前采取健康的生活方式可能降低APO风险，而APO会增加母婴未来患慢性病的风险。
