- Academic Editor
†These authors contributed equally.
Background: Proper health education and lifestyle information to be adopted during pregnancy are crucial for the well-being of the pregnant women and the health of the child. The aim of our study was to evaluate the impact of proper health education and lifestyle information to be adopted during pregnancy on obstetrical, neonatal and infant outcomes. Methods: A retrospective single-center cohort study was carried out including all consecutive pregnant women admitted to our Institution, from December 2019 to February 2021. The study outcomes were the difference in obstetrical, neonatal and infant outcomes between women differentiated by Body Mass Index (BMI) at the end of pregnancy (i.e., normal weight vs overweight, and normal weight vs obese), physical activity (yes vs no), and smoking during pregnancy (yes vs no). Results: Ninety-one women were included. Compared with normal weight women, obese women showed an increased incidence of major maternal pathologies (p = 0.048) and caesarean delivery (p = 0.042). Regarding physical activity, significant differences were observed between pregnant women who do and do not perform physical activity with a lower value of the incidence of spontaneous vaginal delivery (p = 0.025) in sedentary women. Compared with non-smoking groups, smoking women showed significantly higher BMI at the end of pregnancy (p = 0.036), lower neonatal weight (p = 0.001) and lower Apgar index (p = 0.033). Lastly, the percentage of infants with weight and height percentiles within the mean value did not differ significantly among mothers stratified by BMI, physical activity and smoking. Conclusions: Our data, in agreement with the literature, confirm that the proper information and education about lifestyle changes, particularly regarding BMI and smoking during pregnancy, can improve the health of the women and newborn.
In the medical field, the definition of lifestyle includes several factors, such as diet and adequate hydration, physical activity, smoking habit, and alcohol consumption. The lifestyle adopted by women during pregnancy is crucial both their well-being and the health of the baby [1, 2, 3, 4]. Inappropriate nutrition, obesity and maternal smoking can lead to digestive/respiratory problems in the mother and child, low neonatal weight and reduced foetal size. An increased risk of perinatal death was observed in infants exposed to environmental tobacco smoke compared with unexposed infants [2, 3, 5, 6, 7]. Neonatal deafness due to smoking or alcohol abuse during pregnancy has also been reported [8, 9, 10].
Furthermore, an increased risk of caesarean delivery and complications has been observed in obese women as maternal obesity may be associated with poor perinatal outcomes due to early placental and foetal dysfunction [4, 11, 12].
During pregnancy, the Hydrogen potential (pH) of the vagina becomes more alkaline and less acidic, riche in sugar and infections can easily develop [13]. As a result of these infections, cases of spontaneous abortion, premature induction of childbirth, the presence of oral Candida in the newborn have been reported, although rarely. Hence the importance of adopting a proper lifestyle, such as drinking plenty, eating a balanced diet, low in sugar and fat.
In pregnancy, an unbalanced diet can stimulate the onset of oxidative stress, which may be at the basis of the development of pre-eclampsia, spontaneous abortion, fetal growth restriction, and increased risk of hypertensive disorders [14, 15, 16].
Therefore, proper health education and information during pregnancy is essential to promote the most appropriate choices regarding both lifestyles to be adopted and therapeutic treatments to be used in conditions such as vaginal infections [17, 18], gestational diabetes [19, 20], and skin dermatoses [21, 22, 23, 24] with better outcomes for the mother and fetus.
Based on these considerations, the aim of this study was to evaluate the impact of lifestyle adopted during pregnancy on obstetrical, neonatal, and infant outcomes.
The study was designed as a single-center observational retrospective cohort study, according to an a priori defined study protocol. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and checklist [25, 26] were followed in writing the entire study.
All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki.
The medical records and clinical electronic databases were searched for all consecutive pregnant women admitted to the Obstetrics and Gynaecology Unit of the University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy, from December 2019 to February 2021. We included women older than 18 years with available extractable on lifestyle and obstetrical and neonatal outcomes.
The final measurement of Body Mass Index (BMI) was performed after delivery (end of pregnancy). The timing was the same for all women included in the study, and BMI was measured in the first week after delivery for all pregnant women enrolled.
The study outcomes were the difference in obstetrical, neonatal, and infant
outcomes between: women who were normal weight (i.e., BMI 18.5–24.99 kg/m
Obstetric, neonatal, and infant outcomes considered were as follows: type of delivery (caesarean delivery, spontaneous vaginal delivery, ventouse suction cup-assisted delivery); major (e.g., gestational diabetes, gestational hypertension, deep vein thrombosis, placenta praevia, etc.) or minor (e.g., urinary tract infections, constipation, bladder incontinence, etc.) maternal pathologies; neonatal weight; Apgar index; major (e.g., hypoglycemia, childbirth cancer respiratory distress) or minor (e.g., neonatal jaundice, caput succedaneum) neonatal pathologies; perinatal death; infant growth percentile at six months; infant pathologies at six months.
The results were expressed as mean
During the study period, 91 pregnant women were included in the study.
Demographic characteristics of the women are shown in Table 1. Mean age was 32.6
Study population | p | |||
---|---|---|---|---|
n = 91 pregnant women | ||||
First month of pregnancy | End of pregnancy | |||
Age, year | ||||
Mean |
32.6 |
32.6 |
||
Median (range) | 32 (19–50) | 32 (19–50) | ||
Height, m | ||||
Mean |
1.6 |
1.6 |
||
(range) | (1.47–1.78) | (1.47–1.78) | ||
Weight, kg | ||||
Mean |
63.9 |
75.5 |
||
(range) | (43–111) | (53–115) | ||
BMI, kg/m |
||||
Mean |
24.0 |
28.5 |
||
(range) | (17–41) | (20–44) | ||
BMI categories, % | ||||
Underweight | 7 | 0 | ||
Normal weight | 62 | 29 | ||
Overweight | 21 | 36 | ||
Obese | 11 | 35 | ||
Age group % | ||||
19–24 years | 10 | |||
25–30 years | 25 | |||
31–36 years | 38 | |||
37–42 years | 21 | |||
43–50 years | 5 |
At the first month of pregnancy, women showed a mean weight of 63.9
Outcomes | Normal weight women | Overweight women | p | Obese women | p |
---|---|---|---|---|---|
N = 26 | N = 33 | N = 32 | |||
Newborns: N = 26 | Newborns: N = 33 | Newborns: N = 32 | |||
BMI at the end of pregnancy, kg/m |
23.2 |
27.4 |
0.001 | 33.9 |
0.001 |
Spontaneous vaginal delivery, % | 54 | 45 | 0.052 | 37.5 | 0.004 |
Caesarean delivery, % | 46 | 55 | 0.052 | 59.4 | 0.042 |
Ventous suction cup-assisted delivery, % | 0 | 0 | 1 | 3.1 | - |
Minor Maternal pathologies, % | 38 | 42 | 0.758 | 44 | 0.684 |
Major Maternal pathologies % | 8 | 6 | 0.805 | 28 | 0.048 |
Neonatal weight. g, mean |
3092 |
3157 |
0.546 | 3139 |
0.691 |
Apgar index, mean |
8.9 |
8.9 |
1.000 | 8.6 |
0.135 |
Minor Neonatal pathologies, % | 8 | 6 | 0.805 | 6.5 | 0.829 |
Major Neonatal pathologies, % | 0 | 3 | - | 6.5 | - |
Comparison of normal and increased BMI pregnant women at the end of pregnancy showed a significant: increased incidence of major maternal pathologies (p = 0.048) and caesarean delivery (p = 0.042) in obese pregnant women; decreased incidence of spontaneous vaginal delivery in obese (p = 0.004) women compared with normal weight women. Other obstetrical outcomes showed no significant differences among groups (Table 2).
In addition, no perinatal deaths were observed in normal, overweight, or obese pregnant women enrolled.
Before and during pregnancy, 31 (34%) pregnant women reported mild-moderate physical activity (such as walking, swimming, water aerobics, dancing, pilates), while the remaining 60 (66%) did not engage in any physical activity.
The comparative analysis between these two groups showed, at the end of pregnancy, a significantly lower value of the caesarean section rate (39% vs 62%), and an increase in the number of spontaneous vaginal delivery (61% vs 36%) in pregnant women who performed physical activity vs sedentary pregnant women. The remaining, differences in obstetric and neonatal outcomes were not statistically significant (Table 3). In addition, no perinatal deaths were evident in either of the observed subgroups.
Outcomes | Women performing physical activity | Sedentary women | p |
---|---|---|---|
N = 31 | N = 60 | ||
Newborns N = 31 | Newborns N = 60 | ||
BMI at the end of pregnancy, kg/m |
28.1 |
28.7 |
0.593 |
Weight gain at the end of pregnancy, kg, mean |
10.5 |
12.1 |
0.093 |
Spontaneous Vaginal Delivery, % | 61 | 36 | 0.025 |
Caesarean Delivery, % | 39 | 62 | 0.037 |
Ventous suction cup-assisted Delivery, % | 0 | 2 | - |
Minor Maternal pathologies, % | 35 | 42 | 0.568 |
Major Maternal pathologies, % | 23 | 15 | 0.368 |
Neonatal weight, g, mean |
3041 |
3179 |
0.138 |
Apgar index, mean |
8.8 |
8.8 |
1.000 |
Minor Neonatal Pathologies, % | 3 | 5 | 0.696 |
Major Neonatal Pathologies, % | 3 | 3 | 0.978 |
Concerning smoke during pregnancy, 16 women were smoking and 75 were no smoking. Comparing the two groups of women, smoking women’s group showed a significantly: higher BMI at the end of pregnancy (p = 0.036); lower neonatal weight (p = 0.001); lower Apgar index (p = 0.033, Table 4).
Outcomes | Smoking | No smoking | p |
---|---|---|---|
N = 16 | N = 75 | ||
Newborns = 16 | Newborns = 75 | ||
BMI at the end of pregnancy, kg/m |
30.9 |
28.0 |
0.036 |
Weight gain during pregnancy, kg, mean |
11.6 |
11.5 |
1 |
Spontaneous Vaginal Delivery, % | 44 | 46 | 0.908 |
Caesarian Delivery, % | 56 | 53 | 0.832 |
Ventous suction cup-assisted delivery % | 0 | 1 | - |
Minor Maternal pathologies % | 31 | 45 | 0.301 |
Major Maternal pathologies % | 25 | 15 | 0.312 |
Neonatal weight, g, mean |
2872.3 |
3156.0 |
0.001 |
Apgar index, mean |
8.4 |
8.8 |
0.033 |
Minor Neonatal pathologies, % | 6.5 | 4.0 | 0.690 |
Major neonatal pathologies, % | 6.5 | 4.0 | 0.690 |
Not statistically significant differences were observed in other obstetrical and neonatal outcomes.
Height and weight and presence of infants’ pathologies at six months of age were
recorded in 39 infants (51% girls and 49% boys). In relation to the World
Health Organization (WHO) growth curves [27], data analysis showed that the
growth percentile was within the mean value (15°–85°P) in
28.2% of the infants in weight, and at 46.1% for height. The 10.3% of infants
showed a percentile much lower than the mean (
Percentile value | % of infants for weight (N of infants) | % of infants for height (N of infants) |
---|---|---|
10.3% | 10.3% | |
(much lower than the mean value) | (N = 4) | (N = 4) |
3°–15°P | 56.4% | 28.2% |
(slightly below average) | (N = 22) | (N = 11) |
15°–85°P | 28.2% | 46.1% |
(within the mean value) | (N = 11) | (N = 18) |
85°–97°P | 5.1% | 7.7% |
(slightly above average) | (N = 2) | (N = 3) |
0% | 7.7% | |
(much higher than the mean value) | (N = 0) | (N = 3) |
Infant pathologies were observed in 36% (N = 14) of the 39 infants. Specifically, neonatal reflux, lactose intolerance, transient monolateral deafness and constipation were evidenced in 15% of the girls; while congenital malformation, cryptorchidism, neonatal reflux, and lactose intolerance were observed in 21% of the boys.
Collection of BMI at the end of pregnancy, physical activity and smoking of the mothers of the 39 infants evaluated showed that 10% (N = 4) were normal weight, 54% (N = 21) overweight, 36% (N = 14) obese, 18% (N = 7) engaged in physical activity, and 26% (N = 10) smoked.
Comparison of infant weight and height percentiles among mothers stratified by BMI, physical activity and smoking showed no significant differences in the percentages of infants with weight and height percentiles within the mean value (15°–85°P, Table 6A,6B,6C).
Parameter | Normal weight mothers | Overweight mothers | p | Obese mothers | p |
---|---|---|---|---|---|
(N = 4) | (N = 21) | (N = 14) | |||
(%) | (%) | (%) | |||
Infants with 15°–85° percentile for weight at six months age, % | 25 | 38 | 0.723 | 14 | 0.676 |
Infants with 15°–85° percentile for height at six months age, % | 50 | 43 | 0.871 | 43 | 0.877 |
Parameter | Mothers performing physical activity | Sedentary mothers | p |
---|---|---|---|
N = 7 | N = 32 | ||
Infants with 15°–85° percentile for weight at six months age, % | 29 | 28 | 0.986 |
Infants with 15°–85° percentile for height at six months age, % | 43 | 44 | 0.978 |
Parameter | Smoking mothers | No-smoking mothers | p |
---|---|---|---|
N = 10 | N = 29 | ||
Infants with 15°–85° percentile for weight at six months age, % | 20 | 31 | 0.609 |
Infants with 15°–85° percentile for height at six months age, % | 50 | 41 | 0.770 |
This study showed that proper health education and information during pregnancy is essential to promote the most appropriate choices regarding lifestyles to be adopted.
Based on published data, our study confirmed that the lifestyle adopted during pregnancy can have an impact on obstetric, neonatal and infant outcomes. In particular, women who are obese at the end of pregnancy show a significantly increased incidence of major maternal pathologies and caesarean delivery compared with normal weight women. Moreover, smoking during pregnancy may be associated with lower neonatal weight and Apgar index, and higher BMI at the end of pregnancy. The physical activity seems to help spontaneous vaginal delivery.
Lifestyle can be defined as a set of behaviours that individuals engage in daily life that significantly influence quality of life and perceived well-being [1]. Various environmental, social, cultural, and individual factors can influence lifestyle and thus people’s quality of life, both positively and negatively.
The World Health Organization (WHO) identified several factors (e.g., smoking, hypertension, alcoholism, overweight, sedentary habit, and the use of drugs of abuse) that can negatively affect the quality of life of pregnant women, infants and children [1, 28, 29].
Regarding physical activity, it should be noted that these terms mean and bodily movement that requires energy expenditure, thus not only sports activities, but all daily movements, such as walking, dancing, walking the dog, etc. Some studies have reported that regular physical activity (i.e., at least 30 minutes a day) can improve health status and therefore thu individual well-being [30, 31].
Quitting smoking, is known to result in health benefits, such as improved physical resistance, breathing, and skin tone and elasticity, and reduced risk of developing cancer, cardiovascular and respiratory diseases [3, 32]. Quitting smoking also leads to improved fertility and reduction in pregnancy complications, risk of miscarriages and low birth weight [5, 33].
Moreover, giving up alcohol in pregnancy is important because of the negative consequences it may entail (e.g., risk of spontaneous abortion, pre-mature birth, intellectual deficit for the child) [34, 35].
Our study confirms the impact of lifestyles adopted during pregnancy on obstetric and neonatal outcomes. In particular, given the impact of BMI at the end of pregnancy, it seems crucial to provide information on the diet to be followed during pregnancy. Moreover, in agreement with other studies in the literature [5, 6, 7, 36], we found a significant reduction in neonatal weight and Apgar index in newborns of smoking mothers compared with those of non-smoking mothers. On the other hand, we found no significant differences in obstetric outcomes in women stratified by physical activity during pregnancy. Also, no significant differences were found in infant outcomes based on BMI, physical activity and smoking habit during pregnancy. However, despite an a priori defined study protocol, our results may be limited by a small sample size and a percentage of lost to follow-up higher than 5% in infants. This is a limitation of our study due to data collection problems.
Larger studies are needed to confirm and further investigate these findings.
The lifestyle adopted during pregnancy can have an impact obstetric and neonatal outcomes. In particular, a BMI in the obesity range at the end of pregnancy appears associated with major maternal morbidity and caesarean delivery. Furthermore, smoking during pregnancy seems related to lower neonatal weight and Apgar index, and higher BMI at the end of pregnancy. In addition, physical activity appears to be associated with an increased incidence of spontaneous vaginal delivery. No significant differences were found in infant outcomes. In conclusion, our data, in agreement with the literature, confirms that proper information and education about lifestyle changes, in particular regarding BMI and smoking during pregnancy can improve the health of women and their newborns.
Data are contained within the article.
MC, IS and RO designed the research study. MC, IS, DS and RO performed the research. IS, DS, RO, BS, DDP, CS, VDR and MF acquired data. MC, AR, VC, GC, BS, MBM, CS and VDR analyzed the data. AM and AF interpreted the data. MC, AR, VC, GC, BS, MBM, DDP, MF, AM and AF wrote the manuscript. MC, AR, VC, GC, AM and AF revised the manuscript. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.
We did not require ethics committee approval because of the retrospective observational design of our study. In our study, all patients gave their informed consent for the study participation, treatment, and publication of the personal data and the University hospital has also given the authorization to carry out the study. The study was conducted in accordance with the Declaration of Helsinki.
Not applicable.
This research received no external funding.
The authors declare no conflict of interest.
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