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

  • Romy Gaillard (a1) (a2), John Wright (a3) and Vincent W.V. Jaddoe (a1) (a2)
Abstract

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.

Copyright
Corresponding author
*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: r.gaillard@erasmusmc.nl
References
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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.
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.
3. Gaillard, R. Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol. 2015; 30, 11411152.
4. Zhang, J, Savitz, DA. Exercise during pregnancy among US women. Ann Epidemiol. 1996; 6, 5359.
5. Melzer, K, Schutz, Y, Boulvain, M, Kayser, B. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Med. 2010; 40, 493507.
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.
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.
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.
9. Lowensohn, RI, Stadler, DD, Naze, C. Current Concepts of Maternal Nutrition. Obstet Gynecol Surv. 2016; 71, 413426.
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.
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.
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.
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.
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.
15. Fewtrell, MS. Can Optimal Complementary Feeding Improve Later Health and Development? Nestle Nutr Inst Workshop Ser. 2016; 85, 113123.
16. Gillman, MW, Ludwig, DS. How early should obesity prevention start? The New England journal of medicine. 2013; 369, 21732175.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
27. Temel, S, van Voorst, SF, Jack, BW, Denktas, S, Steegers, EA. Evidence-based preconceptional lifestyle interventions. Epidemiol Rev. 2014; 36, 1930.
28. Whitworth, M, Dowswell, T. Routine pre-pregnancy health promotion for improving pregnancy outcomes. Cochrane Database Syst Rev. 2009; 7, CD007536.
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.
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.
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.
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.
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.
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.
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.
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.
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.
38. Babbar, S, Shyken, J. Yoga in Pregnancy. Clin Obstet Gynecol. 2016; 59, 600612.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
49. Haider, BA, Bhutta, ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017; 4, CD004905.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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