Very few women of childbearing age are sticking to lifestyle and nutrition recommendations before becoming pregnant, new research from the UK shows.

Among 12,445 women 20 to 34 years old, the 238 who became pregnant within the next three months were only slightly more likely to be following guidelines on smoking, drinking and folic acid supplement use than were those who did not get pregnant, Dr. Hazel M. Inskip of the University of Southampton and her colleagues found.

In fact, just 2.9 percent of women were taking the recommended amount of folic acid and having not more than four alcoholic drinks each week three months before they conceived.

Encouraging women to take folic acid supplements (which reduce the risk of having a child with certain birth defects), get more exercise and eat better will be relatively easy, Inskip noted in an interview with Reuters Health; the real challenge is to help them avoid alcohol, given the current culture in the UK, where excessive drinking is common and widely accepted. “The social life of many young people involves getting drunk on a Friday and Saturday night,” she said.

At the time the women were surveyed, UK guidelines recommended women planning a pregnancy have no more than one or two units of alcohol, once or twice a week; in 2007, UK public health authorities changed their recommendation to urge women to completely avoid alcohol, Inskip and her team write. However, about a quarter of young women in the UK exceed the upper limit of 14 drinks per week recommended for women who aren’t planning a pregnancy.

Planning for pregnancy is “far from easy,” Inskeep and her team acknowledge, given that timing of conception can never be certain. Many women conceive without intending to do so, while many also may not know they are pregnant for weeks after conception has occurred, the researchers add. “Therefore promoting good health and nutrition before pregnancy may be at least as important as during pregnancy,” they write in the British Medical Journal.

Inskip and her team surveyed young women about their lifestyles, asking them at the close of the interview whether they were thinking of trying to become pregnant within the next 12 months. Among the women who became pregnant, 23 percent had told the researchers they were not planning to conceive within the next year.

Among the women who actually did get pregnant, 74 percent did not smoke, compared to 69 percent for the women who didn’t conceive. Just over half of the women in both groups reported eating five or more servings a day of fruit and vegetables.

Average alcohol consumption for women who became pregnant was about eight drinks a week, compared to nine drinks weekly for women who didn’t.

Just 5.5 percent of the women who got pregnant were taking the recommended 400 micrograms of folic acid daily, compared to 1.1 percent of women who didn’t get pregnant.

Sixty four percent of the women who did not become pregnant reported engaging in any strenuous exercise, compared to 57 percent of the women who did conceive.

The findings make it clear that public health messages on preconception health need to reach not just women, but their partners and society as a whole, Inskip said. “Yet more leaflets aren’t going to help,” she added. “It’s about embedding it in schools, embedding it in the culture.”

In an editorial accompanying the study, Dr. Anne-Marie Nybo Andersen of the University of Southern Denmark agreed that men should also be targeted in efforts to improve fetal health. “We think that a school based public health strategy aimed at all young people would have the advantage of reaching everybody, regardless of their sex or whether they take part in preventive health visits.”

SOURCE: British Medical Journal, Online First, February 13, 2009.