Very few women follow the nutritional and lifestyle recommendations before they become pregnant, even when pregnancy is in some sense planned, finds a study published on the British Medical Journal website.
Nutrition and lifestyle advice is widely available for women during pregnancy, but much less emphasis is given to advice for women who may become pregnant. Yet promoting good health and nutrition before pregnancy may be at least as important as during pregnancy as the time around conception is vital for the development of the baby.
So researchers at the MRC Epidemiology Resource Centre at the University of Southampton set out to examine the degree to which women comply with these recommendations before they become pregnant.
Between 1998 and 2002, they interviewed 12,445 non-pregnant women aged 20-34 years as part of a general survey on health. Information on their diet, physical activity, smoking, alcohol consumption and nutritional supplement use over the past three months was recorded.
A total of 238 women became pregnant within three months of interview. These women were compared with those who did not become pregnant.
The women who became pregnant were only marginally more likely to comply with the alcohol and folic acid recommendations than those who did not become pregnant. Among those who became pregnant only seven (2.9%) were taking the recommended daily dose of 400µg folic acid and drinking no more than four units of alcohol per week, compared with 0.66% of those who did not become pregnant.
The women who became pregnant were slightly less likely to smoke than those who did not become pregnant (74% v 69% were non-smokers) but this difference was not statistically significant.
Women in both groups were equally likely to consume five or more portions of fruit and vegetables per day, but only 57% of those who became pregnant had taken any strenuous exercise in the past three months compared with 64% of those who did not become pregnant.
At interview, 55 (23%) of the 238 women who became pregnant said that they did not anticipate trying for a baby in the next 12 months. Among this 'unplanned' group only one woman (1.8%) who became pregnant complied with the alcohol and folic acid recommendations, but among the remainder, who were, in some sense, 'planning' a pregnancy, the percentage was only slightly higher at 3.3% (six women).
In conclusion, our data show limited evidence of changes in health behaviours before pregnancy, say the authors. They call for greater publicity for pre-pregnancy recommendations, but point out that substantial unplanned pregnancy rates mean that greater efforts are needed to improve the nutrition and lifestyles of all women of child-bearing age.
In an accompanying editorial, public health experts from the University of Southern Denmark believe there is a need to reconsider the timing and setting for public health campaigns aimed at improving the conditions for the developing fetus. They also suggest that it is time to not only focus on women, but include men as targets for health promotion too.
- Inskip et al. Women's compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study. BMJ, 2009; 338 (feb12 2): b481 DOI: 10.1136/bmj.b481
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