Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.
Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.
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DOI：
10.1016/s0140-6736(18)30311-8
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发表时间：
2018-05-05
期刊：
影响因子：
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通讯作者：
Mishra GD
中科院分区：
文献类型：
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作者：
Stephenson J;Heslehurst N;Hall J;Schoenaker DAJM;Hutchinson J;Cade JE;Poston L;Barrett G;Crozier SR;Barker M;Kumaran K;Yajnik CS;Baird J;Mishra GD
怀孕时健康的妇女更有可能成功怀孕并生下健康的孩子。我们回顾了已发表的证据，并提出了来自高收入、低收入和中等收入国家的关于孕前健康对随后的孕产妇和儿童健康的时间和重要性的新数据。我们描述了计划怀孕的程度，以及计划是否与孕前健康行为有关。观察性研究表明，孕前健康与孕产妇和儿童健康结果之间存在密切联系，其后果可能会延续几代人，但对这些联系的认识并不普遍。营养不良和肥胖症在育龄妇女中很普遍，高收入国家和低收入国家之间的差异已经变得不那么明显，两种环境中的典型饮食远远低于营养建议，尤其是在青少年中。许多研究表明，从怀孕开始补充微量营养素可以纠正重要的孕产妇营养缺乏症，但对儿童健康结果的影响令人失望。改善怀孕期间饮食的其他干预措施对孕产妇和新生儿的健康结果影响甚微。在孕前饮食和生活方式干预方面的尝试相对较少。怀孕计划测量的改进量化了怀孕计划的程度，并表明这比以前认识到的更常见。怀孕计划与怀孕前的健康行为混合模式有关。我们提出了新的定义有关的胚胎发育和行动在个人或群体水平的孕前时期。需要更加注重怀孕前的干预，以改善孕产妇和儿童健康，减少非传染性疾病日益增加的负担。在继续努力减少人口中吸烟、酗酒和肥胖的同时，我们呼吁提高对孕前健康的认识，特别是在饮食和营养方面。重要的是，应提醒卫生专业人员如何识别计划怀孕的妇女。
A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from high, low and middle income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high and lower income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Numerous studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little impact on maternal and newborn health outcomes. There have been comparatively few attempts at preconception diet and lifestyle intervention. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that this is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and to action at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable disease. Alongside continued efforts to reduce smoking, alcohol and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly health professionals should be alerted to ways of identifying women who are planning a pregnancy.