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      Women’s compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study

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          Abstract

          Objective To examine the extent to which women planning a pregnancy comply with recommendations for nutrition and lifestyle.

          Design Prospective cohort study.

          Setting Southampton, United Kingdom.

          Participants 12 445 non-pregnant women aged 20-34 recruited to the Southampton Women’s Survey through general practices, 238 of whom became pregnant within three months of being interviewed.

          Main outcome measures Folic acid supplement intake, alcohol consumption, smoking, diet, and physical activity before pregnancy.

          Results The 238 women who became pregnant within three months of the interview were only marginally more likely to comply with recommendations for those planning a pregnancy than those who did not become pregnant in this period. Among those who became pregnant, 2.9% (95% confidence interval 1.2% to 6.0%) were taking 400 μg or more of folic acid supplements a day and drinking four or fewer units of alcohol a week, compared with 0.66% (0.52% to 0.82%) of those who did not become pregnant. 74% of those who became pregnant were non-smokers compared with 69% of those who did not become pregnant (P=0.08). Women in both groups were equally likely to consume five or more portions of fruit and vegetables a day (53% in each group, P=1.0), but only 57% of those who became pregnant had taken any strenuous exercise in the past three months compared with 64% in those who did not become pregnant (P=0.03).

          Conclusion Only a small proportion of women planning a pregnancy follow the recommendations for nutrition and lifestyle. Greater publicity for the recommendations is needed, but as many pregnancies are unplanned, improved nutrition and lifestyles of women of childbearing age is also required.

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          Most cited references26

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          Impact of educational attainment on the quality of young women's diets.

          New findings, that relate poor foetal growth to long-term outcomes, highlight the need to understand more about the nature of women's diets before and during pregnancy. This study examines the influence of sociodemographic and anthropometric factors on the quality of the diets of young women in the UK. Diet was assessed by an interviewer-administered food frequency questionnaire. A single diet score was calculated for each woman using the first component defined by principal components analysis. Southampton, UK. A total of 6125 non pregnant women aged 20-34 y. The diets of women with low diet scores were characterised by low intakes of fruit and vegetables, wholemeal bread, rice and pasta, yogurt, and breakfast cereals, but high intakes of chips and roast potatoes, sugar, white bread, red, and processed meat and full-fat dairy products. Educational attainment was the most important factor related to the diet score. In all, 55% (95% CI 50-59%) of women with no educational qualifications had scores in the lowest quarter of the distribution, compared with only 3% (95% CI 2-4%) of those who had a degree. Smoking, watching television, lack of strenuous exercise, and living with children were also associated with lower diet scores. After taking these factors into account, no other factor including social class, the deprivation score of the neighbourhood, or receipt of benefits added more than 1% to the variance in the diet score. Poor achievement at school defines a substantial group of women in the UK who may be vulnerable. Many of these women have poor diets that are not simply a result of the level of deprivation in their neighbourhood, or of living at a level of poverty that entitles them to benefits. We suggest that it is a priority to identify and to address the barriers that prevent these women from improving the quality of their diets. The study was funded by the Dunhill Medical Trust, the University of Southampton and the Medical Research Council.
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            Unintended pregnancy and use of emergency contraception among a large cohort of women attending for antenatal care or abortion in Scotland.

            Unintended pregnancy is common. Although many unintended pregnancies end in induced abortion, up to a third of those proceeding to birth might be unplanned. Some of these pregnancies could be prevented by emergency contraception. We have sought to establish how many pregnancies ending in either childbirth or abortion are unintended, and what proportion of women use emergency contraception to try to prevent pregnancy. 2908 women who attended an Edinburgh hospital for antenatal care and 907 attending for abortion fully completed a self-administered questionnaire including a validated measure of pregnancy intention and questions about emergency contraceptive use. 814 (89.7%) of 907 pregnancies among women requesting abortion were unintended compared with only 250 (8.6%) among 2908 women who planned to continue pregnancy. However, only 1909 (65.6%) of continuing pregnancies were intended. The rest of the women were ambivalent about pregnancy intention. In women who continued with their pregnancies intendedness was related to age, with unintended pregnancy most probable in young women (p<0.0001). Emergency contraception was used by 113 (11.8%) of women who requested abortion but only 40 (1%) of those planning to continue pregnancy. In those whose pregnancy was continuing, the proportions reporting use of emergency contraception were higher in young women than in older women and in those who reported that their pregnancies were unintended than in those who meant to become pregnant (both p<0.0001). Unintended pregnancy is common, even among women planning to continue pregnancy. However, EC use is low even among women with no intention of conceiving, and is thus unlikely to reduce unintended pregnancy rates. Rather, we need to find ways to improve the use of regular contraception.
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              Alcohol use prior to pregnancy recognition.

              Frequent alcohol use during the first 8 weeks of pregnancy can result in spontaneous abortion and dysmorphologic changes in the developing organ systems of the embryo, including the heart, kidneys, and brain. However, few population-based studies are available that describe the prevalence of frequent drinking (6 or more drinks per week) among women prior to and during early pregnancy (the periconceptional period), and the sociodemographic and behavioral factors that characterize these women. Such knowledge is fundamental to the design of targeted interventions for the prevention of fetal alcohol syndrome (FAS) and other prenatal alcohol-related disorders. This cross-sectional study used survey data collected by the National Center for Health Statistics as part of the 1988 National Maternal and Infant Health Survey (NMIHS). Weighted prevalence estimates were calculated using SUDAAN, and multivariate analyses were used to determine risk factors for frequent drinking. Forty-five percent of all women surveyed reported consuming alcohol during the 3 months before finding out they were pregnant, and 5% reported consuming 6 or more drinks per week. Sixty percent of women who reported alcohol consumption also reported that they did not learn they were pregnant until after the fourth week of gestation. Risk factors for frequent drinking during the periconceptional period included 1 or more of the following: being unmarried, being a smoker, being white non-Hispanic, being 25 years of age or older, or being college educated. Half of all pregnant women in this study drank alcohol during the 3 months preceding pregnancy recognition, with 1 in 20 drinking at moderate to heavy levels. The majority did not know they were pregnant until after the fourth week of pregnancy, and many did not know until after the 6th week. Alcohol is a teratogen capable of producing a number of adverse reproductive and infant outcomes. Public health measures needed to reduce these potentially harmful exposures include alcohol assessment, education, and counseling for women of childbearing age, with referral sources for problem drinking, and family planning services for pregnancy postponement until problem drinking is resolved.
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                Author and article information

                Contributors
                Role: professor of statistical epidemiology
                Role: statistician
                Role: professor of epidemiology and human development
                Role: dietitian
                Role: professor of rheumatology and director
                Role: principal research fellow in nutrition
                Journal
                BMJ
                bmj
                BMJ : British Medical Journal
                BMJ Publishing Group Ltd.
                0959-8138
                1468-5833
                2009
                2009
                12 February 2009
                : 338
                : b481
                Affiliations
                [1 ]MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD
                Author notes
                Correspondence to: H M Inskip hmi@ 123456mrc.soton.ac.uk
                Article
                insh599795
                10.1136/bmj.b481
                2643441
                19213768
                ae5127bb-16a4-4b07-81de-b784add8f59e
                © Inskip et al 2009

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 November 2008
                Categories
                Research

                Medicine
                Medicine

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