Knowledge important but not necessarily enough to compel healthy lifestyle changes in women prior to conceiving
For those working in preconception lifestyle health, the importance of this time in a woman’s life is only growing in evidence, but what knowledge do women in general have of their preconception health and its role in preparing for pregnancy? What actions do they, or don’t they take to improve their preconception lifestyle health? CRE HiPP researcher and PhD candidate Pragya Kandel is making it her job to find out.
Ms Kandel recently published a systematic review where she explored research to date on the enablers and barriers of women’s lifestyle behaviour change during preconception.
The study took in 42 papers that explored the lifestyle behaviours of diet, physical activity, smoking, alcohol use, and supplement intake and what enabled or prevented women from modifying these during a preconception stage.
Ms Kandel prefaces an explanation of her research with a very simple: “we discovered more research is needed.”
“This systematic review highlighted that there is a significant gap in our understanding of what enables or prevents women from adopting healthy lifestyle behaviours during the preconception period and why,” Ms Kandel said.
“However, it did show that a woman’s knowledge was the most common enabler or barrier across all lifestyle behaviours. Worryingly, it also showed that for many of those who reported an understanding of the need for change, it still didn’t alter their behaviour prior to conception.”
Financial constraints, social support, motivation, beliefs around supplement intake and healthy food, not having control over food purchasing, family pressure, and unplanned pregnancy were some of the other identified enablers, barriers or both. However, Ms Kandel said further robust studies were required to understand the complex nuances of why these may or may not influence a women’s behaviour change.
“There is plenty of research to highlight the importance of a healthy lifestyle for positive pregnancy and newborn outcomes but not for the preconception period, so it is imperative that we work to bridge this gap in our understanding,” she said.
“Once we understand the enablers and barriers, we can begin to look at how the health system and society as a whole can better support women to make lifestyle health changes in a meaningful and sustainable way.”
Ms Kandel is a PhD student within Monash University’s Health and Social Care Unit, under the supervision of Unit Head Professor Helen Skouteris (Director of CRE HiPP), Deputy Head Dr Briony Hill and Dr Siew Lim.
A mother-of-one, she said her own life experience had highlighted to her just how little attention is paid to preparing women for a healthier lifestyle prior to conceiving.
“I’ve worked in maternal health and my husband and I both work in public health, so I like to think I am quite informed, but embarking on this research was my first experience of preconception and it was all new news, even to me,” she said.
“In my own experience of speaking to my health provider before pregnancy, they recommended taking a folic acid supplement but nothing further, and I’ve heard the similar stories anecdotally from many other women.
“I really believe this is a missed opportunity for the health system to empower and educate women on the benefits of simple healthy lifestyle changes before they embark on a pregnancy, which we know can create a multitude of challenges and often be too late in the piece to instigate meaningful change.”
Ms Kandel said she was concerned by findings that some women who reportedly understood how and why to change their lifestyle behaviours, were still not compelled to do so ahead of conceiving.
“The missing link is that we don’t know why women don’t change their behaviour or what will influence women to change behaviour,” she said.
Certain health behaviours, such as the need to take a daily folic acid supplement during the preconception period, were understood by as little as three percent of participants in some studies, to as great as 95 per cent in others.
The proportion of women who were aware of the benefits of preconception folic acid supplementation on pregnancy outcome also varied from 55-95 per cent, regardless of whether or not they were taking it.
Folic acid supplementation during the preconception period reduces the risk of neural tube defects, miscarriage, eclampsia, low birthweight, small for gestational age babies, stillbirth, and neonatal deaths.
Ms Kandel is now calling for participants for the next step of her research – surveying reproductive-aged women to determine enablers and barriers specifically for physical activity and diet during the preconception period.
She encourages women aged 18-45 years who are not currently pregnant to take part in her online survey.
Ms Kandel was also recently awarded one of two Feminist Fathers Bursaries by Graduate Women Victoria, awarded based on academic achievement and potential, balanced against the disadvantages experienced by the candidates.
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