# Utilizing the NHANES-Linked Medicaid Data to Understand the Role of Preconception Lifestyle Factors on Pregnancy Outcomes

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2024 · $451,214

## Abstract

PROJECT SUMMARY
Although lifestyle factors have been investigated for their potential to modify risk of adverse pregnancy
outcomes, initiating interventions during pregnancy may not have the greatest impact. Therefore, it is crucial to
focus on preconception interventions to support healthy placental development and reduce the risk of
metabolic conditions. However, there is a lack of data regarding the optimal timing and strategies for
preconception health to improve pregnancy outcomes. Physical activity, diet, and sleep play pivotal roles in
preconception care as they influence metabolic health and body weight regulation, which can impact the
subsequent risk of pregnancy complications. Existing preconception care often emphasizes weight loss, but
there is limited evidence on the most effective amounts and strategies for improving later pregnancy health.
Moreover, using body mass index as the primary measure for obesity classification may misidentify individuals
who would benefit the most from weight loss, as it fails to distinguish between lean mass, fat mass, and fat
distribution. Methodological challenges in studying preconception exposures have hindered the establishment
of a robust evidence base for optimizing pregnancy health. To address these gaps, we propose an innovative
approach utilizing the linkage between the National Health and Nutrition Survey (NHANES) and Medicaid data.
With this data examine pregnancy outcomes among low-income reproductive-aged women who become
pregnant and utilize Medicaid services following their NHANES assessment. Medicaid covers a substantial
portion of U.S. births, making studies of Medicaid-covered pregnancies highly generalizable. Leveraging the
NHANES-Medicaid data as a "preconception cohort," we will investigate the impact of preconception
exposures on pregnancy outcomes. Employing advanced epidemiological methods to minimize selection bias
and improve generalizability, we will apply a target trial framework to assess preconception strategies for
optimizing pregnancy outcomes. The comprehensive phenotyping data available in NHANES will enable robust
assessment of confounding variables, reducing the impact of unmeasured confounders and mimicking
randomized trials of lifestyle factors. Using NHANES-assessed exposures, we will evaluate the influence of
preconception dietary patterns, physical activity, sleep, body composition, and weight loss attempts and
strategies on adverse pregnancy outcomes. This analysis will provide the most extensive and generalizable
evidence to date on preconception health and its impact on adverse pregnancy outcomes, ultimately informing
the development of evidence-based preconception care guidelines.

## Key facts

- **NIH application ID:** 10855292
- **Project number:** 1R01HD114736-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Ellen Christina Caniglia
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $451,214
- **Award type:** 1
- **Project period:** 2024-09-15 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10855292

## Citation

> US National Institutes of Health, RePORTER application 10855292, Utilizing the NHANES-Linked Medicaid Data to Understand the Role of Preconception Lifestyle Factors on Pregnancy Outcomes (1R01HD114736-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10855292. Licensed CC0.

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