{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:12:46Z","timestamp":1791915166388,"version":"4.3.4"},"reference-count":57,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006120","name":"Ministry of the Environment, Government of Japan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006120","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The Japan Environment and Children's Study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 79\u2009703 pregnant Japanese women without chronic disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Maternal lifestyle before pregnancy was assessed using a self\u2010administered questionnaire. A healthy lifestyle score (HLS, 0\u20135 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high\u2010quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log\u2010binomial regression model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Composite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small\u2010for\u2010gestational\u2010age, transcribed from medical records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 13\u2009894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose\u2013response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61\u20130.74) lower risk of APOs than those with the lowest HLS (0\u20131 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1\u2010point increase of HLS could have reduced APO cases by 6.6%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17994","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T09:29:37Z","timestamp":1731922177000},"page":"375-386","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Adherence to Healthy Prepregnancy Lifestyle and Risk of Adverse Pregnancy Outcomes: A Prospective Cohort 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