Hostname: page-component-77c89778f8-n9wrp Total loading time: 0 Render date: 2024-07-18T18:32:26.791Z Has data issue: false hasContentIssue false

Lifestyle intervention strategies in early life to improve pregnancy outcomes and long-term health of offspring: a narrative review

Published online by Cambridge University Press:  09 November 2018

Romy Gaillard*
The Generation R Study Group Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
John Wright
Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
Vincent W.V. Jaddoe
The Generation R Study Group Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
*Address for correspondence: Romy Gaillard MD PhD, The Generation R Study Group (Na 29-15). Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail:


Adverse exposures during fetal life and the postnatal period influence physical, cognitive and emotional development, and predispose to an increased risk of various chronic diseases throughout the life course. Findings from large observational studies in various populations and experimental animal studies have identified different modifiable risk factors in early life. Adverse maternal lifestyle factors, including overweight, unhealthy diet, sedentary behavior, smoking, alcohol consumption and stress in the preconception period and during pregnancy, are the most common modifiable risk factors leading to a suboptimal in-utero environment for fetal development. In the postnatal period, breastfeeding, infant growth and infant dietary intake are important modifiable factors influencing long-term offspring health outcomes. Despite the large amount of findings from observational studies, translation to lifestyle interventions seems to be challenging. Currently, randomized controlled trials focused on the influence of lifestyle interventions in these critical periods on short-term and long-term maternal and offspring health outcomes are scarce, have major limitations and do not show strong effects on maternal and offspring outcomes. New and innovative approaches are needed to move from describing these causes of ill-health to start tackling them using intervention approaches. Future randomized controlled lifestyle intervention studies and innovative observational studies, using quasi-experimental designs, are needed focused on the effects of an integrated lifestyle advice from preconception onwards on pregnancy outcomes and long-term health outcomes in offspring on a population level.

© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1. Gluckman, PD, Hanson, MA, Cooper, C, Thornburg, KL. Effect of in utero and early-life conditions on adult health and disease. The New England journal of medicine. 2008; 359, 6173.CrossRefGoogle ScholarPubMed
2. Gaillard, R, Durmus, B, Hofman, A, et al. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Obesity (Silver Spring). 2013; 21, 10461055.CrossRefGoogle ScholarPubMed
3. Gaillard, R. Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol. 2015; 30, 11411152.CrossRefGoogle ScholarPubMed
4. Zhang, J, Savitz, DA. Exercise during pregnancy among US women. Ann Epidemiol. 1996; 6, 5359.CrossRefGoogle ScholarPubMed
5. Melzer, K, Schutz, Y, Boulvain, M, Kayser, B. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Med. 2010; 40, 493507.CrossRefGoogle ScholarPubMed
6. Reid, EW, McNeill, JA, Alderdice, FA, Tully, MA, Holmes, VA. Physical activity, sedentary behaviour and fetal macrosomia in uncomplicated pregnancies: a prospective cohort study. Midwifery. 2014; 30, 12021209.CrossRefGoogle ScholarPubMed
7. Flenady, V, Koopmans, L, Middleton, P, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 2011; 377, 13311340.CrossRefGoogle ScholarPubMed
8. Mund, M, Louwen, F, Klingelhoefer, D, Gerber, A. Smoking and pregnancy--a review on the first major environmental risk factor of the unborn. Int J Environ Res Public Health. 2013; 10, 64856499.CrossRefGoogle ScholarPubMed
9. Lowensohn, RI, Stadler, DD, Naze, C. Current Concepts of Maternal Nutrition. Obstet Gynecol Surv. 2016; 71, 413426.CrossRefGoogle ScholarPubMed
10. Jaddoe, VW, Bakker, R, Hofman, A, et al. Moderate alcohol consumption during pregnancy and the risk of low birth weight and preterm birth. The generation R study. Ann Epidemiol . 2007; 17, 834840.CrossRefGoogle ScholarPubMed
11. Henrichs, J, Schenk, JJ, Roza, SJ, et al. Maternal psychological distress and fetal growth trajectories: the Generation R Study. Psychol Med. 2010; 40, 633643.CrossRefGoogle ScholarPubMed
12. Lindsay, KL, Buss, C, Wadhwa, PD, Entringer, S. The Interplay between Maternal Nutrition and Stress during Pregnancy: Issues and Considerations. Ann Nutr Metab. 2017; 70, 191200.CrossRefGoogle ScholarPubMed
13. Barker, DJ, Osmond, C, Forsen, TJ, Kajantie, E, Eriksson, JG. Trajectories of growth among children who have coronary events as adults. The New England journal of medicine. 2005; 353, 18021809.CrossRefGoogle ScholarPubMed
14. Dieterich, CM, Felice, JP, O’Sullivan, E, Rasmussen, KM. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin North Am. 2013; 60, 3148.CrossRefGoogle ScholarPubMed
15. Fewtrell, MS. Can Optimal Complementary Feeding Improve Later Health and Development? Nestle Nutr Inst Workshop Ser. 2016; 85, 113123.CrossRefGoogle ScholarPubMed
16. Gillman, MW, Ludwig, DS. How early should obesity prevention start? The New England journal of medicine. 2013; 369, 21732175.CrossRefGoogle ScholarPubMed
17. Troe, EJ, Raat, H, Jaddoe, VW, et al. Smoking during pregnancy in ethnic populations: the Generation R study. Nicotine Tob Res. 2008; 10, 13731384.CrossRefGoogle ScholarPubMed
18. Bahadoer, S, Gaillard, R, Felix, JF, et al. Ethnic disparities in maternal obesity and weight gain during pregnancy. The Generation R Study. Eur J Obstet Gynecol Reprod Biol. 2015; 193, 5160.CrossRefGoogle ScholarPubMed
19. van Rossem, L, Vogel, I, Steegers, EA, et al. Breastfeeding patterns among ethnic minorities: the Generation R Study. J Epidemiol Community Health. 2010; 64, 10801085.CrossRefGoogle ScholarPubMed
20. van Rossem, L, Oenema, A, Steegers, EA, et al. Are starting and continuing breastfeeding related to educational background? The generation R study. Pediatrics. 2009; 123, e10171027.CrossRefGoogle ScholarPubMed
21. Guyatt, GH, Sackett, DL, Sinclair, JC, et al. Users’ guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group. JAMA. 1995; 274, 18001804.CrossRefGoogle Scholar
22. MacInnis, N, Woolcott, CG, McDonald, S, Kuhle, S. Population Attributable Risk Fractions of Maternal Overweight and Obesity for Adverse Perinatal Outcomes. Sci Rep. 2016; 6, 22895.CrossRefGoogle ScholarPubMed
23. Gardosi, J, Madurasinghe, V, Williams, M, Malik, A, Francis, A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013; 346, f108.CrossRefGoogle ScholarPubMed
24. Hedderson, M, Ehrlich, S, Sridhar, S, et al. Racial/ethnic disparities in the prevalence of gestational diabetes mellitus by BMI. Diabetes Care. 2012; 35, 14921498.CrossRefGoogle Scholar
25. Thangaratinam, S, Rogozinska, E, Jolly, K, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012; 344, e2088.CrossRefGoogle ScholarPubMed
26. Richmond, RC, Al-Amin, A, Smith, GD, Relton, CL. Approaches for drawing causal inferences from epidemiological birth cohorts: a review. Early Hum Dev. 2014; 90, 769780.CrossRefGoogle ScholarPubMed
27. Temel, S, van Voorst, SF, Jack, BW, Denktas, S, Steegers, EA. Evidence-based preconceptional lifestyle interventions. Epidemiol Rev. 2014; 36, 1930.CrossRefGoogle ScholarPubMed
28. Whitworth, M, Dowswell, T. Routine pre-pregnancy health promotion for improving pregnancy outcomes. Cochrane Database Syst Rev. 2009; 7, CD007536.Google Scholar
29. Mutsaerts, MA, van Oers, AM, Groen, H, et al. Randomized Trial of a Lifestyle Program in Obese Infertile Women. The New England journal of medicine. 2016; 374, 19421953.CrossRefGoogle ScholarPubMed
30. Chamberlain, C, O’Mara-Eves, A, Porter, J, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2017; 2, CD001055.Google ScholarPubMed
31. Flynn, AC, Dalrymple, K, Barr, S, et al. Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials. Nutr Rev. 2016; 74, 312328.CrossRefGoogle ScholarPubMed
32. Thangaratinam S, Rogozinska E, Jolly K, et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess. 2012;16:iii-iv, 1-191.Google Scholar
33. Dodd, JM, Grivell, RM, Crowther, CA, Robinson, JS. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. BJOG. 2010; 117, 13161326.CrossRefGoogle ScholarPubMed
34. Tanentsapf, I, Heitmann, BL, Adegboye, AR. Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth. 2011; 11, 81.CrossRefGoogle ScholarPubMed
35. Quinlivan, JA, Julania, S, Lam, L. Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to Institute of Medicine recommendations: a meta-analysis. Obstet Gynecol. 2011; 118, 13951401.CrossRefGoogle ScholarPubMed
36. International Weight Management in Pregnancy Collaborative G. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ. 2017; 358, j3119.Google Scholar
37. Shi, Z, MacBeth, A. The Effectiveness of Mindfulness-Based Interventions on Maternal Perinatal Mental Health Outcomes: a Systematic Review. Mindfulness (N Y). 2017; 8, 823847.CrossRefGoogle ScholarPubMed
38. Babbar, S, Shyken, J. Yoga in Pregnancy. Clin Obstet Gynecol. 2016; 59, 600612.CrossRefGoogle ScholarPubMed
39. Roth, DE, Leung, M, Mesfin, E, et al. Vitamin D supplementation during pregnancy: state of the evidence from a systematic review of randomised trials. BMJ. 2017; 359, j5237.CrossRefGoogle ScholarPubMed
40. Litonjua, AA, Carey, VJ, Laranjo, N, et al. Effect of Prenatal Supplementation With Vitamin D on Asthma or Recurrent Wheezing in Offspring by Age 3 Years: The VDAART Randomized Clinical Trial. JAMA. 2016; 315, 362370.CrossRefGoogle ScholarPubMed
41. Chawes, BL, Bonnelykke, K, Stokholm, J, et al. Effect of Vitamin D3 Supplementation During Pregnancy on Risk of Persistent Wheeze in the Offspring: A Randomized Clinical Trial. JAMA. 2016; 315, 353361.CrossRefGoogle ScholarPubMed
42. Saccone, G, Saccone, I, Berghella, V. Omega-3 long-chain polyunsaturated fatty acids and fish oil supplementation during pregnancy: which evidence? J Matern Fetal Neonatal Med. 2016; 29, 23892397.Google ScholarPubMed
43. Saccone, G, Berghella, V. Omega-3 long chain polyunsaturated fatty acids to prevent preterm birth: a systematic review and meta-analysis. Obstet Gynecol. 2015; 125, 663672.CrossRefGoogle ScholarPubMed
44. Saccone, G, Berghella, V, Maruotti, GM, Sarno, L, Martinelli, P. Omega-3 supplementation during pregnancy to prevent recurrent intrauterine growth restriction: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol. 2015; 46, 659664.CrossRefGoogle ScholarPubMed
45. Szajewska, H, Horvath, A, Koletzko, B. Effect of n-3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2006; 83, 13371344.CrossRefGoogle ScholarPubMed
46. Best, KP, Gold, M, Kennedy, D, Martin, J, Makrides, M. Omega-3 long-chain PUFA intake during pregnancy and allergic disease outcomes in the offspring: a systematic review and meta-analysis of observational studies and randomized controlled trials. Am J Clin Nutr. 2016; 103, 128143.CrossRefGoogle ScholarPubMed
47. Gould, JF, Smithers, LG, Makrides, M. The effect of maternal omega-3 (n-3) LCPUFA supplementation during pregnancy on early childhood cognitive and visual development: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2013; 97, 531544.CrossRefGoogle ScholarPubMed
48. Muhlhausler, BS, Yelland, LN, McDermott, R, et al. DHA supplementation during pregnancy does not reduce BMI or body fat mass in children: follow-up of the DHA to Optimize Mother Infant Outcome randomized controlled trial. Am J Clin Nutr. 2016; 103, 14891496.CrossRefGoogle ScholarPubMed
49. Haider, BA, Bhutta, ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017; 4, CD004905.Google ScholarPubMed
50. Roberfroid, D, Huybregts, L, Lanou, H, et al. Impact of prenatal multiple micronutrients on survival and growth during infancy: a randomized controlled trial. Am J Clin Nutr. 2012; 95, 916924.CrossRefGoogle ScholarPubMed
51. Vaidya, A, Saville, N, Shrestha, BP, et al. Effects of antenatal multiple micronutrient supplementation on children’s weight and size at 2 years of age in Nepal: follow-up of a double-blind randomised controlled trial. Lancet. 2008; 371, 492499.CrossRefGoogle ScholarPubMed
52. Kramer, MS, Chalmers, B, Hodnett, ED, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001; 285, 413420.CrossRefGoogle ScholarPubMed
53. Oken, E, Patel, R, Guthrie, LB, et al. Effects of an intervention to promote breastfeeding on maternal adiposity and blood pressure at 11.5 y postpartum: results from the Promotion of Breastfeeding Intervention Trial, a cluster-randomized controlled trial. Am J Clin Nutr. 2013; 98, 10481056.CrossRefGoogle Scholar
54. Flohr, C, Henderson, AJ, Kramer, MS, et al. Effect of an Intervention to Promote Breastfeeding on Asthma, Lung Function, and Atopic Eczema at Age 16 Years: Follow-up of the PROBIT Randomized Trial. JAMA Pediatr. 2018; 172, e174064.CrossRefGoogle ScholarPubMed
55. Martin, RM, Patel, R, Kramer, MS, et al. Effects of promoting longer-term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial. Circulation. 2014; 129, 321329.CrossRefGoogle ScholarPubMed
56. Dotterud, CK, Storro, O, Simpson, MR, Johnsen, R, Oien, T. The impact of pre- and postnatal exposures on allergy related diseases in childhood: a controlled multicentre intervention study in primary health care. BMC Public Health. 2013; 13, 123.CrossRefGoogle ScholarPubMed
57. Fangupo, LJ, Heath, AL, Williams, SM, et al. Impact of an early-life intervention on the nutrition behaviors of 2-y-old children: a randomized controlled trial. Am J Clin Nutr. 2015; 102, 704712.CrossRefGoogle ScholarPubMed
58. Galland, BC, Sayers, RM, Cameron, SL, et al. Anticipatory guidance to prevent infant sleep problems within a randomised controlled trial: infant, maternal and partner outcomes at 6 months of age. BMJ Open. 2017; 7, e014908.CrossRefGoogle ScholarPubMed
59. Qawasmi, A, Landeros-Weisenberger, A, Leckman, JF, Bloch, MH. Meta-analysis of long-chain polyunsaturated fatty acid supplementation of formula and infant cognition. Pediatrics. 2012; 129, 11411149.CrossRefGoogle ScholarPubMed
60. Voortman, T, van den Hooven, EH, Braun, KV, et al. Effects of polyunsaturated fatty acid intake and status during pregnancy, lactation, and early childhood on cardiometabolic health: A systematic review. Prog Lipid Res. 2015; 59, 6787.CrossRefGoogle ScholarPubMed
61. Rosenfeld, E, Beyerlein, A, Hadders-Algra, M, et al. IPD meta-analysis shows no effect of LC-PUFA supplementation on infant growth at 18 months. Acta Paediatr. 2009; 98, 9197.CrossRefGoogle ScholarPubMed
62. Patro-Golab, B, Zalewski, BM, Kolodziej, M, et al. Nutritional interventions or exposures in infants and children aged up to 3 years and their effects on subsequent risk of overweight, obesity and body fat: a systematic review of systematic reviews. Obes Rev. 2016; 17, 12451257.CrossRefGoogle ScholarPubMed
63. Koletzko, B, von Kries, R, Closa, R, et al. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr. 2009; 89, 18361845.Google Scholar
64. Imdad, A, Mayo-Wilson, E, Herzer, K, Bhutta, ZA. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database Syst Rev. 2017; 3, CD008524.Google ScholarPubMed
65. Berglund, SK, Westrup, B, Hagglof, B, Hernell, O, Domellof, M. Effects of iron supplementation of LBW infants on cognition and behavior at 3 years. Pediatrics. 2013; 131, 4755.CrossRefGoogle ScholarPubMed
66. Lindberg, J, Norman, M, Westrup, B, Domellof, M, Berglund, SK. Lower systolic blood pressure at age 7 y in low-birth-weight children who received iron supplements in infancy: results from a randomized controlled trial. Am J Clin Nutr. 2017; 106, 475480.CrossRefGoogle Scholar
67. Catalano, PM, Shankar, K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017; 356, j1.CrossRefGoogle ScholarPubMed
68. Nascimento, SL, Pudwell, J, Surita, FG, Adamo, KB, Smith, GN. The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis. Int J Obes (Lond). 2014; 38, 626635.CrossRefGoogle ScholarPubMed
69. Dickerson, J, Bird, PK, McEachan, RR, et al. Born in Bradford’s Better Start: an experimental birth cohort study to evaluate the impact of early life interventions. BMC Public Health. 2016; 15, 711.CrossRefGoogle ScholarPubMed
70. Rutter, H, Savona, N, Glonti, K, et al. The need for a complex systems model of evidence for public health. Lancet. 2017; 390, 26022604.CrossRefGoogle ScholarPubMed