{"product_id":"can-lifestyle-programs-before-pregnancy-improve-fertility-and-health-a-comprehensive-review","title":"Can Lifestyle Programs Before Pregnancy Improve Fertility and Health? A Comprehensive Review","description":"\u003cp\u003eThis systematic review and meta-analysis examined 24 randomized controlled trials involving 7,795 women to determine which characteristics of preconception lifestyle interventions actually improve fertility and health outcomes. Overall, lifestyle interventions did not significantly increase clinical pregnancy or live birth rates. However, interventions delivered over 10 or more sessions and those that provided food or exercise equipment significantly improved clinical pregnancy odds. Lifestyle interventions did reduce weight by an average of 3.87 kg. Lifestyle interventions lowered fasting blood glucose by 0.15 mM. Greater weight loss was seen in programs that aimed for weight loss. Greater weight loss was also seen in programs delivered face-to-face.\u003c\/p\u003e\n\n\u003ch1\u003eCan Lifestyle Programs Before Pregnancy Improve Fertility and Health? A Comprehensive Review\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n\u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why Preconception Health Matters\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#results\"\u003eKey Findings: What the Studies Showed\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#interventions\"\u003eDetails of the Lifestyle Interventions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#outcomes\"\u003eDetailed Outcomes and Statistics\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#implications\"\u003eWhat These Findings Mean for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of the Research\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Women Planning Pregnancy\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eAcross 24 randomized trials of 7,795 women, preconception lifestyle interventions did not significantly increase clinical pregnancy or live birth overall.\u003c\/li\u003e\n\u003cli\u003eInterventions delivered over 10 or more sessions were associated with higher clinical pregnancy odds (odds ratio 2.17) than fewer sessions (0.88).\u003c\/li\u003e\n\u003cli\u003eProviding food or exercise equipment was associated with higher clinical pregnancy odds (odds ratio 3.51) than programs without it.\u003c\/li\u003e\n\u003cli\u003eLifestyle interventions reduced weight by about 3.87 kg on average, with greater loss in programs aiming for weight loss or delivered face-to-face.\u003c\/li\u003e\n\u003cli\u003eLifestyle interventions lowered fasting blood glucose by about 0.15 mM; subgroup findings are exploratory and need further investigation.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why Preconception Health Matters\u003c\/h2\u003e\n\n\u003cp\u003eThe time before conception is an important window of opportunity to improve a woman's health. Optimizing health during this period can reduce the risk of pregnancy complications and improve long-term health for both the mother and the child.\u003c\/p\u003e\n\n\u003cp\u003eMany countries have developed evidence-based preconception care guidelines. These guidelines recommend screening and management of risk factors that affect pregnancy outcomes. These risk factors include medical, lifestyle, social, and environmental factors.\u003c\/p\u003e\n\n\u003cp\u003eMaternal lifestyle recommendations within these guidelines include weight management and optimizing physical activity and diet. However, many women have suboptimal lifestyle behaviors during the preconception period. These behaviors include inadequate fruit and vegetable intake, excessive consumption of discretionary foods, and inadequate physical activity.\u003c\/p\u003e\n\n\u003cp\u003eThese behaviors increase the risk of infertility, pregnancy complications, and adverse neonatal outcomes. However, they are modifiable risk factors. This means that women can change these behaviors to improve their health.\u003c\/p\u003e\n\n\u003cp\u003ePrevious systematic reviews of preconception lifestyle interventions show no overall effect on live birth. These reviews also show mixed results on the effect on clinical pregnancy. Further research is therefore needed to characterize which interventions are effective at promoting fertility and health for preconceptional women.\u003c\/p\u003e\n\n\u003cp\u003eIntervention characteristics can be described using the Template for Intervention Description and Replication (TIDieR) framework. This framework covers features including materials, procedures, intervention providers, format, setting, and duration. This allows for replication and implementation of interventions.\u003c\/p\u003e\n\n\u003cp\u003eIn addition, behavior change techniques (BCTs) are the active ingredients used to bring about behavior change in interventions. It is important to understand which BCTs should be used within preconception lifestyle interventions.\u003c\/p\u003e\n\n\u003cp\u003ePrevious systematic reviews have used subgroup analysis by TIDieR characteristics and BCTs. These reviews examined the association of intervention characteristics with the effects of lifestyle interventions in various populations. These populations included postpartum women, adults at risk of type 2 diabetes, adults of reproductive age, and adults above a healthy weight.\u003c\/p\u003e\n\n\u003cp\u003eThe optimal intervention characteristics identified in these reviews differed according to the populations studied. There is therefore a need to evaluate the effect of intervention characteristics in lifestyle interventions specifically for preconceptional women.\u003c\/p\u003e\n\n\u003cp\u003eThe aims of this systematic review and meta-analysis were twofold. First, to assess the effects of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric, and metabolic outcomes in women planning a pregnancy. Second, to assess the association of intervention characteristics and BCTs with the effect of the intervention.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eThe study protocol for this systematic review was prospectively registered with PROSPERO. The registration number is CRD42022333066. The registration was amended before data analysis to add details on planned analysis. This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eSearch Strategy\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eBoth databases and clinical trials registers were searched to identify potentially relevant studies. For database searches, a comprehensive search strategy was developed. This strategy used relevant free text words and subject headings adapted for different databases.\u003c\/p\u003e\n\n\u003cp\u003eThe following databases were searched from inception to 6 December 2024:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eOvid MEDLINE\u003c\/li\u003e\n\u003cli\u003eOvid PsycINFO\u003c\/li\u003e\n\u003cli\u003eOvid Embase\u003c\/li\u003e\n\u003cli\u003eOvid Emcare\u003c\/li\u003e\n\u003cli\u003eScopus\u003c\/li\u003e\n\u003cli\u003eCochrane Central Register of Controlled Trials\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eCINAHL Plus was searched from inception to 31 May 2023. CINAHL Complete was searched from 31 May 2023 to 6 December 2024. This change occurred due to an upgrade in access to CINAHL.\u003c\/p\u003e\n\n\u003cp\u003eThe search strategy reflected three key concepts. These concepts were eligible populations (terms related to preconception and infertility), eligible interventions (terms related to lifestyle interventions, defined as diet and\/or physical activity), and eligible study designs. The study designs used the Cochrane Highly Sensitive Search Strategy for identifying randomized trials.\u003c\/p\u003e\n\n\u003cp\u003eSearch terms within the same concept were combined using the \"or\" Boolean operator. The three concepts were combined using the \"and\" Boolean operator. For the clinical trial register searches, both clinicaltrials.gov and WHO ICTRP were searched on 4 January 2023. Additional methods of study identification included expert referral and hand-searching of references of included studies and relevant systematic reviews.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEligibility Criteria\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe eligibility criteria were defined using the population, intervention, comparator, outcomes, and study design (PICOS) framework. Eligible participants were non-pregnant women of childbearing age with an intention to conceive.\u003c\/p\u003e\n\n\u003cp\u003eAnimal studies were excluded. Studies which included women with a body mass index (BMI) less than 18 kg\/m² were excluded. Studies which included women with a hereditary disorder in one or both parents were also excluded.\u003c\/p\u003e\n\n\u003cp\u003eEligible interventions were lifestyle modifications aiming to optimize nutritional and\/or physical activity status. Trials focusing solely on micronutrient supplementation, alcohol, smoking cessation or reduction, or diabetes control were ineligible.\u003c\/p\u003e\n\n\u003cp\u003eEligible comparators were no intervention or standard minimal care. Regarding concurrent medication use, studies were only eligible if medication use was consistent between groups. Studies were ineligible if medications were used in the intervention group but not the control group, or vice versa.\u003c\/p\u003e\n\n\u003cp\u003eThe primary outcomes were live birth, clinical pregnancy, anthropometric outcomes, and metabolic outcomes. Anthropometric outcomes were defined as those pertaining to the measurement of dimensions of the human body, such as body weight. Metabolic outcomes were defined as metabolic parameters that can indicate a participant's health status, such as blood glucose.\u003c\/p\u003e\n\n\u003cp\u003eThe secondary outcomes were fertility outcomes, obstetric outcomes, fetal outcomes, hormonal outcomes, quality of life, and maternal mortality. Fertility outcomes were defined as outcomes relating to ability to have offspring, such as time to pregnancy. Obstetric outcomes were defined as outcomes relating to maternal health before, during, and after parturition, such as gestational diabetes. Fetal outcomes were defined as outcomes relating to offspring health, such as low birth weight. Hormonal outcomes were defined as the level of hormones in the body, such as testosterone. Fertility outcomes were applicable to infertility populations only.\u003c\/p\u003e\n\n\u003cp\u003eEligible study designs were randomized controlled trials. Conference abstracts, clinical trial registrations, and protocols were excluded unless a full-text article reporting on the results was also available. There was no exclusion criterion based on language, and translations were sought for studies published in languages other than English.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eStudy Selection\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eFor title and abstract screening, all records were screened by two independent reviewers. For full-text screening, all English language records were screened by two independent reviewers. Two reports in full-text screening were published in Persian. For these, one reviewer assessed eligibility and provided a partial translation according to the eligibility criteria for verification of eligibility by another reviewer. Eligibility assessment was performed using Covidence systematic review software. Conflicts were resolved by discussion until consensus was achieved.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eData Extraction\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eFor all reports published in English, data were extracted by two independent reviewers in Microsoft Excel. One included study published one report in Persian; the data from this study were extracted by a translator.\u003c\/p\u003e\n\n\u003cp\u003eThe data extracted included author, year of publication, country, recruitment source, and participant demographic information. The data extracted also included participant inclusion and exclusion criteria, sample size, and attrition rates. The data extracted also included intervention characteristics according to the TIDieR framework, and outcomes. Data for all eligible outcomes were extracted. If outcome data were available for more than one time point, data were extracted for the latest time point in the primary study.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCoding of Behavior Change Techniques\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eBehavior Change Taxonomy Version 1 (BCTTv1) was used to identify BCTs utilized within the lifestyle interventions. This document provides definitions and examples of each of the 93 BCTs.\u003c\/p\u003e\n\n\u003cp\u003eFor each study, the intervention descriptions were reviewed, and the BCTs present were coded. In addition to the main text, the protocol paper and supplementary materials were reviewed where available for identification of BCTs. BCTs were only coded if the BCT was delivered with the purpose of changing diet, physical activity, and\/or body weight.\u003c\/p\u003e\n\n\u003cp\u003eBoth the intervention and control groups were coded. Only BCTs present in the intervention group but not the control group were included in the analysis. Before the start of coding, all coders completed the BCTTv1 online training course developed by the authors of BCTTv1. Each study was independently coded by two reviewers. Discrepancies were resolved by discussion among the three reviewers involved in BCT coding.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRisk of Bias and Trustworthiness Assessment\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eTwo reviewers independently reviewed the risk of bias in all included studies using version two of the Cochrane Risk of Bias tool (RoB 2.0). Any discrepancies were resolved by discussion. RoB 2.0 assesses bias arising from five domains:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eRandomization procedures\u003c\/li\u003e\n\u003cli\u003eDeviations from intended interventions\u003c\/li\u003e\n\u003cli\u003eMissing outcome data\u003c\/li\u003e\n\u003cli\u003eOutcome measurement\u003c\/li\u003e\n\u003cli\u003eSelective reporting of results\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eAdditionally, integrity assessment was performed using the Trustworthiness in RAndomised Controlled Trials (TRACT) checklist by two independent reviewers. Any discrepancies in ratings were resolved by discussion. The TRACT checklist evaluates seven domains: governance, author group, plausibility of intervention usage, timeframe, drop-out rates, baseline characteristics, and outcomes.\u003c\/p\u003e\n\n\u003cp\u003eThree authors discussed the completed checklists to determine which studies required further investigation regarding integrity. For any studies which were deemed as requiring further investigation regarding integrity, corresponding authors were emailed with a request for clarification. If no adequate explanation was provided or no response from the authors, the study was categorized as \"Awaiting Classification.\"\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eSynthesis Methods\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eRandom-effects meta-analyses using the Restricted Maximum-Likelihood method were performed using Stata 18. A random-effects model was used due to expected variations in treatment effect arising from between-study heterogeneity.\u003c\/p\u003e\n\n\u003cp\u003eEffect estimates were presented as odds ratio (OR) for categorical variables or mean difference (MD) for continuous variables with 95% confidence intervals (CI). The I² statistic was used to assess the proportion of variability due to heterogeneity.\u003c\/p\u003e\n\n\u003cp\u003eFor continuous outcomes that were reported as median and interquartile range, mean and standard deviation were estimated when appropriate. This was done in accordance with the Cochrane Handbook. Unit conversions were calculated as required. If studies reported a standard deviation of 0 for an outcome, the study was excluded from the analysis for this outcome.\u003c\/p\u003e\n\n\u003cp\u003eWhere 10 or more studies were included in a meta-analysis, subgroup analyses were performed. These subgroup analyses were based on population (women with and without infertility) and intervention characteristics according to the TIDieR framework. The TIDieR characteristics examined included use of a named theoretical framework, health professional delivery, and intervention duration. The TIDieR characteristics examined also included number of sessions, format, use of technology, and intervention type. The TIDieR characteristics examined also included whether weight loss was an aim and continuation of the intervention into pregnancy. The TIDieR characteristics examined also included tailoring and use of strategies to improve fidelity.\u003c\/p\u003e\n\n\u003cp\u003eSubgroup analyses were also performed based on BCTs. These included any BCT from BCTTv1 which appeared uniquely in the intervention of at least one study reporting the outcome. The analyses also examined whether the total number of BCTs uniquely in the intervention was less than 5 or 5 or more.\u003c\/p\u003e\n\n\u003cp\u003eFor primary outcomes, sensitivity analysis restricted to women with obesity (BMI ≥30 kg\/m²) was performed. For outcomes where 10 or more studies were included in a meta-analysis, a contour-enhanced funnel plot was used to evaluate small-study effect.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAssessment of Certainty of the Evidence\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe certainty of the evidence for the key outcomes (live birth, clinical pregnancy, weight, and waist circumference) was assessed using the GRADE criteria. The GRADE criteria assess the certainty of the evidence as very low, low, moderate, or high.\u003c\/p\u003e\n\n\u003cp\u003eThe GRADE criteria include:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eRisk of bias\u003c\/li\u003e\n\u003cli\u003eInconsistencies in results across studies\u003c\/li\u003e\n\u003cli\u003eIndirectness of the relationship of the evidence to the health care question\u003c\/li\u003e\n\u003cli\u003eImprecision in effect estimates\u003c\/li\u003e\n\u003cli\u003ePublication bias\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eCertainty assessments were conducted using GRADEpro by one reviewer with verification by another reviewer.\u003c\/p\u003e\n\n\u003ch2 id=\"results\"\u003eKey Findings: What the Studies Showed\u003c\/h2\u003e\n\n\u003cp\u003eThe database searches returned 18,854 records. The clinical trial register searches returned 116 records. Two additional records were identified via citation searching.\u003c\/p\u003e\n\n\u003cp\u003eAfter the removal of 6,613 duplicates, 12,089 records were screened based on titles and abstracts. Of these, 412 records were screened based on full text. After identifying two additional eligible reports via citation searching, 30 studies (99 reports) which met the eligibility criteria were identified.\u003c\/p\u003e\n\n\u003cp\u003eHowever, 6 studies (9 reports) were categorized as awaiting classification due to integrity concerns. The remaining 24 studies (90 reports) were included in the review.\u003c\/p\u003e\n\n\u003cp\u003eOf the included studies, 23 studies published all reports in English. One study published one report in English and one report in Persian.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCharacteristics of Included Studies\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe 24 included studies involved a total of 7,795 women. The majority of studies (79%) were conducted in high-income countries. Most studies (67%) studied women with infertility.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRisk of Bias of Included Studies\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eRisk of bias was low for seven studies. Risk of bias was some concerns for 15 studies. Risk of bias was high for two studies.\u003c\/p\u003e\n\n\u003cp\u003eRegarding specific domains of the RoB 2.0 assessment, some concerns were identified for two studies in the domain of outcome measurement. Some concerns were identified for 15 studies in the domain of selection of the reported result.\u003c\/p\u003e\n\n\u003ch2 id=\"interventions\"\u003eDetails of the Lifestyle Interventions\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eWhy: Theoretical Framework\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eSeven studies cited at least one theoretical framework to support the intervention. The most commonly reported theoretical frameworks were:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eSocial cognitive theory (5 studies)\u003c\/li\u003e\n\u003cli\u003eTranstheoretical model (3 studies)\u003c\/li\u003e\n\u003cli\u003eFogg's behavior model (2 studies)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eWhat: Intervention Type, Materials, and Procedures\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eSix studies reported on diet-only interventions. Three studies reported on physical activity-only interventions. Fifteen studies reported on combined diet and physical activity interventions.\u003c\/p\u003e\n\n\u003cp\u003eDietary strategies included:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eSodium restriction\u003c\/li\u003e\n\u003cli\u003eLow glycaemic index diets\u003c\/li\u003e\n\u003cli\u003eDietary Approaches to Stop Hypertension (DASH) diet\u003c\/li\u003e\n\u003cli\u003eAligning dietary intake with national\/regional guidelines\u003c\/li\u003e\n\u003cli\u003eMeal replacement programs\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003ePhysical activity strategies included:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eYoga\u003c\/li\u003e\n\u003cli\u003eHigh-intensity interval training\u003c\/li\u003e\n\u003cli\u003eAerobic exercise (e.g. walking or stationary bicycling)\u003c\/li\u003e\n\u003cli\u003eHome-based resistance training\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFourteen studies included weight loss as an aim of the intervention. This was either for all participants (11 studies) or only for those above a healthy weight (3 studies).\u003c\/p\u003e\n\n\u003cp\u003eTwenty-two studies reported on materials used. These materials included:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eWritten resources (e.g. menus, textbooks, and information cards)\u003c\/li\u003e\n\u003cli\u003eFood (e.g. olive oil and dried fruit)\u003c\/li\u003e\n\u003cli\u003eMeal replacement products\u003c\/li\u003e\n\u003cli\u003eCardiovascular exercise machines (e.g. treadmills, stationary bicycles, and elliptical trainers)\u003c\/li\u003e\n\u003cli\u003eSelf-monitoring tools (e.g. heart rate monitors, pedometers, body weight scales, food diaries, and physical activity diaries)\u003c\/li\u003e\n\u003cli\u003eMobile phone applications\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAll studies reported on procedures used. These procedures included lifestyle counselling pertaining to diet and\/or physical activity.\u003c\/p\u003e\n\n\u003ch2 id=\"outcomes\"\u003eDetailed Outcomes and Statistics\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eFertility Outcomes\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eOverall, there was no difference in clinical pregnancy with lifestyle intervention. The odds ratio was 1.06 with a 95% confidence interval of 0.84 to 1.35. The I² value was 24.22%.\u003c\/p\u003e\n\n\u003cp\u003eThere was also no difference in live birth with lifestyle intervention. The odds ratio was 1.17 with a 95% confidence interval of 0.82 to 1.67. The I² value was 48.73%.\u003c\/p\u003e\n\n\u003cp\u003eHowever, odds of clinical pregnancy were higher for interventions delivered over 10 or more sessions. The odds ratio was 2.17 with a 95% confidence interval of 1.21 to 3.86. This compared to an odds ratio of 0.88 with a 95% confidence interval of 0.72 to 1.07 for interventions with fewer sessions. The P-value for subgroup differences was 0.004.\u003c\/p\u003e\n\n\u003cp\u003eOdds of clinical pregnancy were also higher with the behavior change technique \"Adding objects to the environment.\" This technique includes provision of intervention-compliant food and\/or exercise equipment. The odds ratio was 3.51 with a 95% confidence interval of 1.70 to 7.23. This compared to an odds ratio of 0.90 with a 95% confidence interval of 0.75 to 1.08 for interventions without this technique. The P-value for subgroup differences was less than 0.001.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAnthropometric Outcomes\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eLifestyle interventions reduced weight. The mean difference was −3.87 kg with a 95% confidence interval of −5.76 to −1.97. The I² value was 95.03%.\u003c\/p\u003e\n\n\u003cp\u003eGreater weight loss was observed for interventions with a weight loss aim. The mean difference was −4.19 kg with a 95% confidence interval of −6.30 to −1.92. This compared to a mean difference of −0.81 kg with a 95% confidence interval of −1.48 to −0.14 for interventions without a weight loss aim. The P-value for subgroup differences was 0.003.\u003c\/p\u003e\n\n\u003cp\u003eGreater weight loss was also observed for interventions delivered solely via face-to-face. The mean difference was −6.02 kg with a 95% confidence interval of −8.96 to −3.07. This compared to a mean difference of −2.21 kg with a 95% confidence interval of −3.62 to −0.81 for interventions delivered via a combination of face-to-face and technology. The P-value for subgroup differences was 0.02.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eMetabolic Outcomes\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eLifestyle interventions reduced fasting blood glucose. The mean difference was −0.15 mM with a 95% confidence interval of −0.25 to −0.04. The I² value was 0%.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eWhat These Findings Mean for Patients\u003c\/h2\u003e\n\n\u003cp\u003eThe effectiveness of preconception lifestyle interventions aiming to enhance fertility may be improved by a structured, intensive approach. This means that programs with more sessions may be more likely to help women achieve pregnancy.\u003c\/p\u003e\n\n\u003cp\u003ePreconception lifestyle interventions reduce weight. This is particularly true for face-to-face interventions with a weight loss aim. Women who attend in-person programs focused on weight loss may experience greater weight reduction.\u003c\/p\u003e\n\n\u003cp\u003eHowever, these findings based on subgroup analyses should be interpreted with caution. They warrant further investigation due to the exploratory nature of the analysis. There was also a limited number of studies included. There is also potential aggregation bias of study-level subgroup effects.\u003c\/p\u003e\n\n\u003cp\u003eSelection of intervention characteristics for future preconception lifestyle interventions should consider patient preferences and practical considerations. This means that what works best for one woman may not work best for another.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of the Research\u003c\/h2\u003e\n\n\u003cp\u003eThis review has several limitations that patients and healthcare providers should consider.\u003c\/p\u003e\n\n\u003cp\u003eFirst, the subgroup analyses were exploratory in nature. This means they were designed to generate hypotheses rather than provide definitive answers. The findings from these analyses should be interpreted with caution.\u003c\/p\u003e\n\n\u003cp\u003eSecond, there was a limited number of studies included in some subgroup analyses. This reduces the reliability of the findings for those subgroups.\u003c\/p\u003e\n\n\u003cp\u003eThird, there is potential aggregation bias of study-level subgroup effects. This means that the way data were combined across studies could affect the results.\u003c\/p\u003e\n\n\u003cp\u003eFourth, the overall certainty of the evidence varied. The GRADE assessment categorized the certainty of evidence for key outcomes as very low, low, moderate, or high.\u003c\/p\u003e\n\n\u003cp\u003eFifth, six studies were categorized as awaiting classification due to integrity concerns. These studies were not included in the review. This could affect the completeness of the findings.\u003c\/p\u003e\n\n\u003cp\u003eSixth, most studies were conducted in high-income countries (79%). This limits how well the findings apply to women in other settings.\u003c\/p\u003e\n\n\u003cp\u003eSeventh, most studies (67%) studied women with infertility. This means the findings may not apply equally to women without infertility.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Women Planning Pregnancy\u003c\/h2\u003e\n\n\u003cp\u003eBased on this research, women planning a pregnancy may benefit from the following approaches:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eConsider participating in structured lifestyle programs with multiple sessions. Interventions delivered over 10 or more sessions were associated with higher odds of clinical pregnancy.\u003c\/li\u003e\n\u003cli\u003eLook for programs that provide food and\/or exercise equipment. This behavior change technique, called \"Adding objects to the environment,\" was associated with higher odds of clinical pregnancy.\u003c\/li\u003e\n\u003cli\u003eIf weight loss is a goal, choose programs that specifically aim for weight loss. These programs were associated with greater weight reduction.\u003c\/li\u003e\n\u003cli\u003eConsider face-to-face programs if weight loss is a priority. Face-to-face interventions were associated with greater weight loss compared to programs delivered via a combination of face-to-face and technology.\u003c\/li\u003e\n\u003cli\u003eDiscuss your individual preferences and practical considerations with your healthcare provider. What works best for one woman may not work best for another.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eIt is important to note that this research does not prove that these intervention characteristics cause improved outcomes. The findings are based on subgroup analyses, which are exploratory. Women should discuss their individual situation with their healthcare provider before making decisions about preconception lifestyle programs.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eCan a lifestyle program before pregnancy improve my chances of getting pregnant?\u003c\/h3\u003e\n\u003cp\u003eAcross 24 randomized trials of 7,795 women, preconception lifestyle programs did not significantly raise clinical pregnancy or live birth overall. However, programs delivered over 10 or more sessions, and those providing food or exercise equipment, were linked to higher clinical pregnancy odds. These subgroup findings are exploratory and need confirmation.\u003c\/p\u003e\n\u003ch3\u003eWill a preconception lifestyle program help me lose weight?\u003c\/h3\u003e\n\u003cp\u003eYes, on average. Across the included trials, lifestyle interventions reduced weight by about 3.87 kg. Greater weight loss was seen in programs that specifically aimed for weight loss (about 4.19 kg) and in programs delivered solely face-to-face (about 6.02 kg). These subgroup results are exploratory and should be interpreted with caution.\u003c\/p\u003e\n\u003ch3\u003eDoes a face-to-face program work better than one using technology?\u003c\/h3\u003e\n\u003cp\u003eFor weight loss, face-to-face-only programs were associated with greater reduction (about 6.02 kg) than programs combining face-to-face and technology (about 2.21 kg). This was a subgroup finding from an exploratory analysis, so it should be interpreted with caution and discussed with your healthcare provider.\u003c\/p\u003e\n\u003ch3\u003eDo these programs affect blood sugar or other health measures?\u003c\/h3\u003e\n\u003cp\u003eLifestyle interventions lowered fasting blood glucose by about 0.15 mM across the included trials. The review found no overall difference in clinical pregnancy or live birth. Effects on other outcomes were mixed, and the certainty of evidence for key outcomes ranged from very low to high.\u003c\/p\u003e\n\u003ch3\u003eWho was included in this research, and does it apply to me?\u003c\/h3\u003e\n\u003cp\u003eThe 24 trials involved 7,795 non-pregnant women of childbearing age intending to conceive. Most studies (67%) enrolled women with infertility, and 79% were conducted in high-income countries. Findings may not apply equally to women without infertility or to those in other settings. Discuss your situation with your healthcare provider.\u003c\/p\u003e\n\u003ch3\u003eWhen should a woman planning pregnancy seek a second opinion about a preconception lifestyle program?\u003c\/h3\u003e\n\u003cp\u003eA second opinion can help when deciding whether a structured preconception lifestyle program fits your situation. Programs delivered over 10 or more sessions were associated with higher odds of clinical pregnancy, and programs providing food or exercise equipment were also associated with higher odds. If weight loss is a goal, programs that specifically aim for weight loss and are delivered face-to-face were associated with greater weight reduction. These subgroup findings are exploratory and warrant further investigation, so discussing your individual preferences and practical considerations with your healthcare provider is important. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal Article Title:\u003c\/strong\u003e Preconception lifestyle interventions for women-a systematic review and meta-analysis of intervention characteristics and behaviour change techniques.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e Human reproduction update\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eLicense:\u003c\/strong\u003e CC BY (open access)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Torkel S, Mantzioris E, Villani A, Kellow NJ, Bhatnagar D, Osei-Safo EK, McGowan M, Abdul Jafar NK, Bogatzke N, Alesi S, Astarcioglu T, Mol BW, Norman RJ, Cowan S, Wang R, Moran L.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication:\u003c\/strong\u003e Human Reproduction Update, 2026, 32(1), 105–127\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e https:\/\/doi.org\/10.1093\/humupd\/dmaf021\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAdvance Access Publication Date:\u003c\/strong\u003e August 22, 2025\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRegistration:\u003c\/strong\u003e This review was prospectively registered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42022333066).\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eNote:\u003c\/strong\u003e This patient-friendly article is based on peer-reviewed research. The original article is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47876152230044,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/ddn-medical-article-can-lifestyle-programs-before-pregnancy-improve-fertility-and-health-a-comprehensive-review-hero.png?v=1793254912","url":"https:\/\/diagnosticdetectives.com\/zh\/products\/can-lifestyle-programs-before-pregnancy-improve-fertility-and-health-a-comprehensive-review","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}