For couples who are or wish to get pregnant

Smarter Pregnancy is based on the latest scientific insights. The trans-theoretical model for behavioral change of Prochaska and Diclemente, the Attitude-Social-Efficacy model, the Healthy Nutrition guidelines of the Health Council and the recommendations of the Dutch Nutrition Center were used. The risk score is partly based on the Erasmus MC Rotterdam Reproduction Risk Score (R-3) and the Preconceptional Dietary Risk Score (PDR). Please refer to the sources below for proof of the importance of using

Scientific publications: 

Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod 1998; 13: 1532-9.

Bergen NE, Jaddoe VW, Timmermans S, Hofman A, Lindemans J, Russcher H, Raat H, Steegers-Theunissen RP, Steegers EA. Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: the Generation R Study. BJOG 2012;119:739-751.

Beurskens LW, de Jonge R, Schoonderwaldt EM, Tibboel D, Steegers-Theunissen RP. Biomarkers of the one-carbon pathway in association with congenital diaphragmatic hernia. Birth Defects Res A Clin Mol Teratol 2012;94:557-560.

Beurskens LW, Schrijver LH, Tibboel D, Wildhagen MF, Knapen MF, Lindemans J, de Vries J, Steegers-Theunissen RP. Dietary vitamin A intake below the recommended daily intake during pregnancy and the risk of congenital diaphragmatic hernia in the offspring. Birth Defects Res A Clin Mol Teratol. 2013 Jan;97(1):60-6.

Bouwland-Both MI, Steegers-Theunissen RP, Vujkovic M, Lesaffre EM, Mook-Kanamori DO, Hofman A, Lindemans J, Russcher H, Jaddoe VW, Steegers EA. A periconceptional energy-rich dietary pattern is associated with early fetal growth: the Generation R study. BJOG. 2013 Mar;120(4):435-45.

Bliek BJ, Guzel C, Klein de A, Stingl C, Luider TM, Lindemans J, Steegers EA, Steegers-Theunissen RP. Peptide fingerprinting of folate-responsive proteins in human B lymphoblasts and orofacial clefting. Eur J Clin Invest 2012;42:738-750.

Bliek BJ, Steegers-Theunissen RP, Douben H, Lindemans J, Steegers EA, de Klein A Comparable levels of folate-induced aneusomy in B-lymphoblasts from oral-cleft patients and controls. Mutat Res 2012;741:76-80.

Boxmeer JC, Smit M, Utomo E, Romijn JC, Eijkemans MJ, Lindemans J, Laven JS, Macklon NS, Steegers EA, Steegers-Theunissen RP. Low folate in seminal plasma is associated with increased sperm DNA damage. Fertil Steril 2009; 92: 548-56.

Cetin I, Berti C, Calabrese S. Role of micronutrients in the periconceptional period. Hum Reprod Update 2010; 16: 80-95.

Chavarro JE, Rich-Edwards JW, Rosner BA, Willet WC. Caffeinated and alcoholic beverage intake in relation to ovulatory disorder infertility. Epidemiology 2009; 20: 374-81.

Van Dijk MR, Huijgen NA, Willemsen SP, Laven JS, Steegers EA, Steegers-Theunissen RP. Impact of an mHealth Platform for Pregnancy on Nutrition and Lifestyle of the Reproductive Population: A Survey. JMIR Mhealth Uhealth. 2016 May 27;4(2):e53.

van Dijk MR, Koster MPH, Willemsen SP, Huijgen NA, Laven JSE, Steegers-Theunissen RPM. Healthy preconception nutrition and lifestyle using personalized mobile health coaching is associated with enhanced pregnancy chance. Reproductive Biomedicine Online. 2017 Oct;35(4):453-460

Van Dijk MR, Borggreven NV, Willemsen SP, Koning AHJ, Steegers-Theunissen RPM, Koster MPH. Maternal Lifestyle Impairs Embryonic Growth: The Rotterdam Periconception Cohort. Reproductive Science. 2018 Jun;25(6):916-922

Van Dijk MR, Koster MP, Rosman AN, Steegers-Theunissen RP. Opportunities of mHealth in Preconception Care: Preferences and Experiences of Patients and Health Care Providers and Other Involved Professionals. JMIR Mhealth Uhealth. 2017 Aug 17;5(8):e123

Donnelly GP, McClure N, Kennedy MS, Lewis SE. Direct effect of alcohol on the motility and morphology of human spermatozoa. Andrologia 1999; 31: 43-7.

Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med 2008; 359: 61-73.

Gootjes DV, van Dijk MR, Koster MP, Willemsen SP, Steegers EA, Steegers-Theunissen RP. Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands. JMIR Mhealth Uhealth. 2019 Apr 11;7(4):e11664

Hammiche F, Temel S, Laven JSE, Verhagen-vanden Graaf IMJ, Steegers EAP, Steegers-Theunissen RPM. Veel bezoekers speciaal preconceptiespreekuur leven ongezond: vruchtbare adviezen. Medisch Contact 2008: 63: 1672-5.

Hammiche F, Laven J, Twigt J, Boellaard W, Steegers E, Steegers-Theunissen R. Body mass index and central adiposity are associated with sperm quality in men of subfertile couples. Hum Reprod 2012; 27: 2365-72.

Sermondade N, Faure C, Fezeu L, Shayeb AG, Bonde JP, Jensen TK, Van Wely M, Cao J, Martini AC, Eskandar M, Chavarro JE, Koloszar S, Twigt JM, Ramlau-Hansen CH, Borges E Jr, Lotti F, Steegers-Theunissen RP, Zorn B, Polotsky AJ, La Vignera S, Eskenazi B, Tremellen K, Magnusdottir EV, Fejes I, Hercberg S, Lévy R, Czernichow S. BMI in relation to sperm count: an updated systematic review and collaborative meta-analysis. Hum Reprod Update. 2013;19; 221-231.

Herzog E, Galvez J, Roks A, Stolk L, Verbiest M, Cornelissen J, Steegers E, Steegers-Theunissen R. Tissue-specific DNA methylation profiles in newborns. Clin Epigenetics. 2013: 5(1): 8.

Lorente C,  Cordier S, Goujard J, Ayme S, Bianchi F, Calzolari E, de Walle HE, Knill-Jones R. Tobacco and alcohol use during pregnancy and risk of oral clefts. Occupational exposure and congenital malformation working group. Am J Public Health 2000: 90: 415-9.

Ludwig KU, Mangold E, Herms S, Nowak S, Reutter H, Paul A, Becker J, Herberz R, AlChawa T, Nasser E, Böhmer AC, Mattheisen M, Alblas MA, Barth S, Kluck N, Lauster C, Braumann B, Reich RH, Hemprich A, Pötzsch S, Blaumeiser B, Daratsianos N, Kreusch T, Murray JC, Marazita ML, Ruczinski I, Scott AF, Beaty TH, Kramer FJ, Wienker TF, Steegers-Theunissen RP, Rubini M, Mossey PA, Hoffmann P, Lange C, Cichon S, Propping P, Knapp M, Nöthen MM. Genome-wide meta-analyses of nonsyndromic cleft lip with or without cleft palate identify six new risk loci.Nat Genet 2012 Sep;44(9):968-71.

Lumley J, Watson L, Watson M, Bower C. Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Cochrane Database Syst Rev 2000; 2: CD001056.

Rasch V. Cigarette, alcohol, and caffeine consumption: risk factors for spontaneous abortion. Acta Obstet Gynecol Scand 2003; 82: 182-8.

Roo de LA, Wilcox AJ,DrevonCA, Lie RT. First-trimester maternal alcohol consumption and the risk of infant oral clefts inNorway: A population-based case-control study. Am J Epidemiol 2008; 168: 638-46.

Schuit AJ, van Loon AJ, Tijhuis M, Ocke M. Clustering of lifestyle risk factors in a general adult population. Prev Med 2002; 35: 219-24. 

Smedts HP, van Uitert EM, Valkenburg O, Laven JS, Eijkemans MJ, Lindemans J, Steegers EA, Steegers-Theunissen RP: A derangement of the maternal lipid profile is associated with an elevated risk of congenital heart disease in the offspring. Nutr Metab Cardiovasc Dis 2012; 22:477-485.

Snijder CA, Vlot IJ, Burdorf A, Obermann-Borst SA, Helbing WA, Wildhagen MF, Steegers EA, Steegers-Theunissen RP: Congenital heart defects and parental occupational exposure to chemicals. Hum Reprod 2012;27:1510-1517.

Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301: 636-50.

Steegers EAP. Begin bij ’t begin. (Inaugurale rede) Demmenie Grafimedia, Leiderdorp 2005.

Steegers-Theunissen RPM. Nieuw leven in een veranderende omgeving. (Inaugurale rede) Demmenie Grafimedia, Leiderdorp 2010.

Steegers-Theunissen RPM, Twigt J, Pestinger V, Sinclair KD. The periconceptional period, reproduction and long-term health of offspring: the importance of one-carbon metabolism. Hum Reprod Update 2013;1-16.

Stolk L, Bouwland-Both MI, van Mill NH, Verbiest MM, Eilers PH, Zhu H, Suarez L, Uitterlinden AG, Steegers-Theunissen RP. Epigenetic profiles in children with a neural tube defect; a case-control study in two populations.  PLoS One. 2013 Nov 5;8(11):e78462.

Timmermans S, Steegers-Theunissen RP, Vujkovic M, den Breeijen H, Russcher H, Lindemans J, Mackenbach J, Hofman A, Lesaffre EE, Jaddoe VV, Steegers EA. The Mediterranean diet and fetal size parameters: the Generation R Study. Br J Nutr 2012 28;108(8):1399-409.

Timmermans S, Bonsel GJ, Steegers-Theunissen RP, Mackenbach JP, Steyerberg EW, Raat H, Verbrugh HA, Tiemeier HW, Hofman A, Birnie E, Looman CW, Jaddoe VW, Steegers EA. Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods. Eur J Epidemiol. 2011; 26: 165-80.

Timmermans S, Steegers-Theunissen RP, Vujkovic M, den Breeijen H, Hofman A, Jaddoe VW, Steegers EA. The Mediterranean diet during early pregnancy is significantly associated with fetal growth and the risk of intrauterine growth restriction. Reprod Sci 2010: 17suppl: 160A.

Timmermans S, Jaddoe VW, Hofman A, Steegers-Theunissen RP, Steegers EA. Periconception folic acid supplementation, fetal growth and the risks of low birth weight and preterm birth: the Generation R Study. Br J Nutr 2009; 30: 1-9.

Twigt J, Steegers-Theunissen RP, Bezstarosti K, Demmers JA. Proteomic analysis of the microenvironment of developing oocytes. Proteomics. 2012;12(9):1463-71.

Twigt J, Bolhuis M, Steegers E, Hammiche F, vn Inzen W, Laven J, Steegers-Theunissen R. The preconception diet is associated with the chance of ongoing pregnancy in women undergoing IVF/ICSI treatment. Hum Reprod 2012; 27:2526-2531.

Venners SA, Wang X, Chen C, Wang L, Chen D, Guang W, Huang A, Ryan L, O'Connor J, Lasley B, Overstreet J, Wilcox A, Xu X. Paternal smoking and pregnancy loss: a prospective study using a biomarker of pregnancy. Am J Epidemiol 2004; 159: 993-1001.

van Mil NH, Steegers-Theunissen RP, Bongers-Schokking JJ, El Marroun H, Ghassabian A, Hofman A, Jaddoe VW, Visser TJ, Verhulst FC, de Rijke YB, Verhulst FC, de Rijke YB, Steegers EA, Tiemeier H. Maternal hypothyroxinemia during pregnancy and growth of the fetal and infant head. Reprod Sci 2012;19:1315-1322.

van Mil NH, Tiemeier H, Bongers-Schokking JJ, Ghassabian A, Hofman A, Hooijkaas H, Jaddoe VW, de Muinck Keizer-Schrama SM, Steegers EA, Visser TJ,Visser W, Ross HA, Verhulst FC, de Rijke YB, Steegers-Theunissen RP. Low urinary iodine excretion during early pregnancy is associated with alterations in executive functioning in children. J Nutr 2012;142:2167-2174.

van Uitert EM, Steegers-Theunissen RP. Influence of maternal folate status on human fetal growth parameters. Mol Nutr Food Res. 2013; 57(4):582-95.

van Uitert EM, van der Elst-Otte N, Wilbers JJ, Exalto N, Willemsen SP, Eilers PH, Koning AH, Steegers EA, Steegers-Theunissen RP. Periconception maternal characteristics and embryonic growth trajectories: the Rotterdam Predict study. Hum Reprod 2013 Dec;28(12):3188-96

van Uitert EM, Steegers-Theunissen RPM. Influence of maternal folate status on human fetal growth parameters. Mol Nutr Food Res. 2013; 57(4):582-95.

Vuijkovic M, de Vries JH, Lindemans J, Macklon NS, van der Spek PJ, Steegers EA, Steegers-Theunissen RP. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril 2010; 94: 2096-101.

Obermann-Borst SA, Vujkovic M, de Vries JH, Wildhagen MF, Looman CWN, de Jonge R, Steegers EAP, Steegers-Theunissen RPM. A maternal dietary pattern characterized by fish and seafood in association with congenital heart defects in the offspring. BJOG 2011; 118: 1205-15.

Vujkovic M, de Vries JH, Dohle GR, Bonsel GJ, Lindemans J, Macklon NS, van der Spek PJ, Steegers EA, Steegers-Theunissen RP. Associations between dietary patterns and semen quality in men undergoing IVF/ICSI treatment. Hum Reprod 2009; 24: 1304-12.

Vujkovic M, Steegers EA, Looman CW, Ocke MC, van der Spek PJ, Steegers-Theunissen RP. The maternal Mediterranean dietary pattern is associated with a reduced risk of spina bifida in the offspring. BJOG 2009; 116: 408-15.

Vujkovic M, Ocke MC, van der Spek PJ, Yazdanpanah N, Steegers EA, Steegers-Theunissen RP. Maternal western dietary patterns and the risk of developing a cleft lip with or without a cleft palate. Obstet Gynecol 2007; 110: 378-84.

Weerd de S, Thomas CMG, Cikot RJLM, Steegers-Theunissen RPM, De Boo TM, Steegers EAP. Preconception counseling improves folate status of women planning pregnancy. Obstet Gynecol 2002; 99: 45-50.

Wegner CC, CliffordAL, Jilbert PM, Henry MA, Gentry WL. Abnormally high body mass index and tobacco use are associated with poor sperm quality as revealed by reduced sperm binding to hyaluronan-coated slides. Fertil Steril 2010; 93: 332-4.

Wildschut HI, van Vliet-Lachotzki EH, Boon BM, Liefong S, Landkroon AP, Steegers EA. Preconceptiezorg: een onlosmakelijk onderdeel van de zorg voor moeder en kind. Ned Tijdschr Geneeskd 2006; 150: 1326-30.

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