BACKGROUND: Many modifiable factors prior to conception may affect pregnancy and fetal outcomes. No consensus is available on the effect of multicomponent preconception lifestyle interventions on optimising maternal and fetal health. This systematic review aims to review evidence on preconception lifestyle interventions in males and females and the impact on pregnancy, obstetric and fetal outcomes.
METHODS: Inclusion criteria were randomised controlled trials assessing lifestyle interventions compared to standard care. Interventions solely focused on micronutrient supplementation, diabetes control, alcohol or smoking cessation were excluded. Pregnancy, obstetrics, fetal, anthropometric and metabolic outcomes were analysed and quality assessment performed. Meta-analysis were performed where appropriate.
RESULTS: Database search returned 1428 articles with 10 articles comprising 7 studies meeting inclusion criteria. Interventions were heterogeneous in design and duration. Where meta-analysis could not be performed, individual studies didn’t show statistically significant differences in number of assisted reproductive technology adverse events, delivery complications or anxiety. Where meta-analysis could be performed, there were statistically significant difference in spontaneous pregnancy in favour of control group (n=2 studies, OR:1.87, 95% CI: 1.24, 2.81, P=0.003) and change in weight (n=2 studies, mean difference: -3.85kg, 95% CI: -5.42, -2.29, p<0.00001) and BMI (n=2 studies, mean difference -1.4 kg/m2, 95% CI: -1.95, -0.84, p<0.00001) in favour of intervention group. No significant statistical differences were observed for ongoing clinical pregnancy, live birth, birthweight, premature birth rate, gestational diabetes, pregnancy loss, preeclampsia or neonatal mortality. No studies were found pertaining to male lifestyle interventions.
CONCLUSION: The majority of randomised controlled trials in preconception interventions focus on weight loss in subfertile women, which show overweight women would benefit from structured lifestyle intervention for weight loss. However, this does not necessarily translate to better obstetric or fetal outcomes. There is considerable paucity of literature on effective holistic preconception interventions, especially in the male population.