This study examined the extent to which women of childbrearing age comply with nutritional and lifestyle advice before pregnancy
- Only a small proportion of women follow the recommendations for those preparing for pregnancy.
- For those who want to plan for pregnancy, the advice is not widely promoted and greater efforts are needed to improve nutrition and lifestyles among women of childbearing age.
Keywords: Nutrition, Lifestyle, Pregnancy
There is a wide variety of nutritional and lifestyle advice available for pregnant women, but less so for those planning a pregnancy.
NICE recently reinforced the focus on optimising women’s nutrition and lifestyle in the periconceptional period, a key time for foetal development. Taking folic acid supplements during this time has been shown to reduce the risk of neural tube defects.
Since 2007, women planning a pregnancy in the UK have been urged to avoid alcohol altogether or to consume at most one or two units (8g–16g of alcohol) once or twice a week.
Additional advice on healthy diet, exercise and avoiding smoking is the same as for the general population.
Non-pregnant women aged 20–34 were recruited to the Southampton Women’s Survey via their GP practice then interviewed in their own homes.
Information was recorded on diet, physical activity, smoking, alcohol consumption and the use of nutritional supplements over the preceding three months.
The researchers analysed data on 12,445 women, 238 of whom became pregnant within three months of the interview.
For the main analyses, the authors compared women who became pregnant within three months with those who did not.
The only significant difference between the groups was the percentage of women receiving social security benefits: they comprised 12% of those who became pregnant and 18% of those who did not.
Only a small proportion of women planning a pregnancy followed the recommendations for nutrition and lifestyle.
The women who became pregnant within three months were slightly less likely to be smoking than those who did not, but the difference was not significant. Their diets were marginally healthier, although the effect was small. However, they were less likely to have taken any strenuous exercise in the three months before the interview.
In both groups, 53% of women reported consuming five or more portions of fruit and vegetables a day.
Those who became pregnant within three months consumed a median 4.0 units of alcohol a week – around the upper limit recommended for women planning a pregnancy. For those who did not become pregnant, the median was slightly higher, at 4.8 units a week.
Fewer than half (44%) of those who became pregnant had taken any folic acid supplements in the three months before the interview.
The researchers said that, although the difference between the two groups was highly significant for following specific advice on alcohol and folic acid intake before pregnancy, the actual differences were small. Only 2.9% of those who became pregnant within three months were following this advice fully at the time of interview, compared with 0.66% of those who did not become pregnant.
At interview, 55 of the 238 women who became pregnant within three months said that they did not anticipate trying for a baby in the next 12 months. In this unplanned pregnancy group, only one woman who became pregnant within three months had complied with the advice on alcohol and folic acid.
This study shows that few women follow the recommendations for those preparing for pregnancy. However, it shows that higher percentages of women follow this advice during pregnancy, which suggests that a change in behaviour is possible.
No amount of advice for planning a pregnancy will affect those who become pregnant unintentionally. However, even for those who want to plan for pregnancy, the advice is not promoted widely. As a result, it is not surprising that such a small proportion of women follow the advice.
Only a small percentage of women took folic acid in sufficient quantities, although supplement intake was higher among those who became pregnant within three months.
Only 7.6% of those who became pregnant within three months were not drinking any alcohol at the time of interview, and it is only these women who complied fully with current advice on alcohol intake. However, the authors suggest that women may not want to admit to trying for a pregnancy, and cutting alcohol out of their lifestyle could be difficult.
Inskip et al (2009) conclude the data shows limited evidence of changes in health behaviours before pregnancy, although higher percentages of women follow advice during pregnancy. They add that substantial rates of unplanned pregnancies mean that greater efforts are needed to improve nutrition and lifestyles in women of childbearing age.
Inskip, H.M. et al (2009) Women’s compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study. BMJ; 338: b481.
Click here to read this study in full