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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

Published on: January 12, 2018

Healthy preconception and early-pregnancy lifestyle and risk of preterm birth: a prospective cohort study

Yeyi Zhu^1,2, Monique M Hedderson¹, Susan D Brown^1,3

¹Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.

The American Journal of Clinical Nutrition

|April 26, 2021

Insights

A healthy prenatal lifestyle, including healthy weight, quality diet, and low stress, significantly reduces preterm birth (PTB) risk. Adopting multiple healthy factors offers the greatest protection against PTB.

Area of Science:

Obstetrics and Gynecology
Public Health
Maternal-Child Health

Background:

Preterm birth (PTB) is a major cause of infant mortality and morbidity.
Individual risk factors for PTB are known, but the impact of a healthy lifestyle is unclear.

Purpose of the Study:

To investigate the association between preconceptional and early-pregnancy low-risk modifiable factors and PTB risk.
To assess the combined effect of these factors on PTB risk.

Main Methods:

Prospective cohort study of 2449 women.
Defined PTB as delivery <37 weeks gestation.
Assessed healthy weight (BMI), high-quality diet (AHEI-Pregnancy), and low-to-moderate stress (Perceived Stress Scale) in early pregnancy.

Main Results:

Healthy weight, quality diet, and low stress were individually associated with lower PTB risk.
Women with 1, 2, or 3 low-risk factors had 38%, 51%, and 70% lower PTB risk, respectively, compared to those with none.
The protective effect was more pronounced for medically indicated and late PTB.

Conclusions:

A healthy prenatal lifestyle incorporating multiple low-risk factors is linked to reduced PTB risk.
Findings support developing multicomponent prevention strategies for preconceptional and early pregnancy.

Read full analysis

Abstract

Background:

Preterm birth (PTB) remains a leading cause of neonatal mortality and long-term morbidity. Individual factors have been linked to PTB risk. The impact of a healthy lifestyle, with multiple modifiable prenatal factors, remains unknown.

Objectives:

We aimed to examine the associations of preconceptional and early-pregnancy low-risk modifiable factors (individually and in combination) with PTB risk.

Methods:

This prospective cohort study included 2449 women with singleton pregnancies in the Pregnancy Environment and Lifestyle Study. PTB was defined as ultrasound-confirmed obstetric estimate-based gestational age at delivery <37 wk. A set of low-risk modifiable factors were identified: healthy weight (prepregnancy BMI: 18.5-24.9 kg/m2) based on clinical measurements and high-quality diet (Alternate Healthy Eating Index-Pregnancy score ≥75th percentile) and low-to-moderate stress during early pregnancy (Perceived Stress Scale score <75th percentile) assessed at gestational weeks 10-13. Poisson regression estimated adjusted relative risk (aRR) of PTB in association with individual and combined low-risk modifiable prenatal factors, adjusting for sociodemographic, clinical, and other prenatal factors.

Results:

One hundred and sixty women (6.5%) delivered preterm. Risk of PTB was lower among women who had a healthy weight (aRR: 0.58; 95% CI: 0.39, 0.86), high-quality diet (aRR: 0.68; 95% CI: 0.39, 0.99), and low-to-moderate stress (aRR: 0.60; 95% CI: 0.41, 0.88). Women with 1, 2, or 3 low-risk modifiable prenatal factors compared with none had a 38% (aRR: 0.72; 95% CI: 0.45, 1.16), 51% (aRR: 0.49; 95% CI: 0.29, 0.84), or 70% (aRR: 0.30; 95% CI: 0.13, 0.70) lower PTB risk, respectively. Associations of having ≥1 low-risk factor with PTB risk were more pronounced for medically indicated than for spontaneous PTB and for late than for early or moderate PTB. Associations also varied by race or ethnicity, although with overlapping 95% CIs.

Conclusions:

A healthy prenatal lifestyle with multiple low-risk modifiable factors was associated with lower risk of PTB. Our findings may inform multicomponent preconceptional or early-pregnancy prevention strategies to mitigate PTB risk.

Keywords:

dietary quality lifestyle preconception pregnancy preterm birth primary prevention stress weight

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