The Influence of Deficient Hygiene and Nutrition in Pregnancy Outcome

1. Introduction

Pregnancy represents a complex physiological time period in life, which is defined by anatomic, hormonal and immunological changes in the organism of a woman. In this specific time span, women are far more susceptible to certain infections and metabolic disorders, thus the need for adequate changes in hygiene and nutrition, for maintaining a proper evolution of the pregnancy. Promoting correct personal hygiene habits and a balanced diet are essential elements in preventing maternal-fetal complications and ensuring optimal fetal development [1].

According to World Health Organization recommendations on maternal health antenatal care should include clinical monitoring of pregnancy and education of the pregnant woman on personal hygiene, nutrition and infection prevention. Appropriate hygiene practices, such as proper hand washing, maintaining oral hygiene and intimate hygiene, contribute to reducing the risk of urinary, vaginal or systemic infections, which are frequently encountered during pregnancy. At the same time, appropriate nutritional supplementation and the adoption of balanced eating habits have an important role in preventing anemia, micronutrient deficiencies and other associated complications [2].

The physiological vaginal microbiota of pregnant women plays a crucial role in the natural defense against infections. Alterations in this microbiological balance have been shown to significantly influence pregnancy outcomes, being associated with complications such as premature rupture of membranes and preterm birth. Moreover, disruption of the maternal vaginal flora may contribute to an imbalance in the neonatal intestinal microbiome, which can have long-term effects on neurological, respiratory, metabolic, and immunological development, as well as potentially increasing neonatal morbidity and mortality. Preventing infectious infections during pregnancy should be prioritized above treating them, considering these consequences. Comprehensive medical history, ongoing immunization status monitoring and updating, and, when necessary, targeted serological studies to determine infectious status are all necessary for effective prophylaxis. The gynecologist might offer tailored advise regarding suitable preventive measures based on these evaluations. The current strategy emphasizes how crucial it is to put particular guidelines into practice for the management and prevention of infections that are essential to obstetrics during pregnancy. Maternal infections during pregnancy, such as urinary tract infections, vaginal candidiasis, toxoplasmosis or viral infections, can negatively influence the course of pregnancy and may be associated with premature birth, intrauterine growth restriction or other adverse obstetric outcomes. In this context, hygiene behaviors and lifestyle adopted by the pregnant woman become important factors that can contribute to reducing risks and improving maternal and fetal prognosis [3].

Essential vitamins and minerals are among the micronutrients that are crucial for sustaining maternal health and promoting fetal growth and development throughout pregnancy. Both the mother and the growing fetus may suffer from deficiencies in essential nutrients, which could result in a number of issues. Maternal anemia, which is frequently linked to iron deficiency, may raise the risk of death from hemorrhage after childbirth. Its precise effect on fetal development and pregnancy outcomes is still unknown, though. Although its relationship to other unfavorable birth outcomes is still up for question, folic acid deficiency is known to have significant hematological effects and has been connected to pregnancy problems and congenital abnormalities. Zinc deficiency has been correlated in certain studies with complications during pregnancy and delivery, as well as with intrauterine growth restriction, congenital anomalies, and delayed neurobehavioral and immunological development in the fetus, though findings are not entirely consistent across all research. Iodine deficiency during pregnancy represents a significant public health concern, as it may lead to severe outcomes such as cretinism, increased risk of fetal loss, and preterm birth. Additionally, insufficient levels of other minerals, including magnesium, selenium, copper, and calcium, have been associated with various complications related to pregnancy, labor, and fetal development. Deficiencies in vitamins other than folic acid may similarly contribute to adverse maternal and fetal outcomes, highlighting the importance of adequate micronutrient intake throughout pregnancy [4].

The aim of this study is to describe hygiene and nutrition behaviors among women aged 18 to 40 years in Romania and to evaluate the possible association between these behaviors and pregnancy outcome, including the occurrence of complications or infections during gestation. The study aims to highlight the importance of adopting adequate hygiene and nutrition measures during pregnancy, in order to maintain maternal and fetal health.

2. Materials and Methods

The present study is an observational, descriptive and analytical cross-sectional study, conducted based on an anonymous questionnaire applied to women in Romania. The aim of the study was to evaluate hygiene and nutrition behaviors during pregnancy and analyze their association with the evolution of pregnancy.

The questionnaire was distributed to women in their fertile period, aged between 18 and 40 years, who are currently pregnant or have had at least one pregnancy completed by birth or miscarriage. The inclusion criteria were represented by the age between 18 and 40 years, residence in Romania, the existence of a current or previous pregnancy and the expression of consent to participate. Participants who refused to participate or incompletely completed the questionnaire were excluded.

Data was collected through an online questionnaire developed by the author and distributed using the Google Forms platform. The questionnaire included questions regarding the participants socio-demographic characteristics, hygiene behaviors (hand, oral and intimate hygiene), nutritional supplementation during pregnancy, history of infections and pregnancy-related complications, and the outcome of the last pregnancy. Participation in the study was voluntary and anonymous, without the collection of personal data that could have allowed the identification of the respondents.

The sample size was aimed at approximately 50 to100 participants who completed the questionnaire in full. The variables analyzed included personal hygiene behaviors, the administration of dietary supplements during pregnancy, the presence of infections and complications, as well as the evolution of the pregnancy (term birth, premature, overcarriage or spontaneous abortion).

The data obtained were centralized and analyzed using the Microsoft Excel program. Frequencies and percentages were calculated for the variables studied, and the results were presented in the form of tables and graphical representations. The association between hygiene behaviors, nutrition and the evolution of pregnancy was evaluated by comparing the proportions obtained for the different categories analyzed. Chi-square tests were performed using the software Graphpad-instat to analyze the association between variables such as hands hygiene or intimate hygiene and urinary tract infections or vaginal candidiasis in pregnancy, nutrient supplementation and the outcomes of the pregnancy or complications during it.

The study respected the ethical principles of scientific research, and by completing the questionnaire, the participants expressed their consent for the use of the data for academic and scientific purposes.

3. Results

A total of 61 responses to the questionnaire were obtained during a 6-month period, between 01.08.2025 and 01.02.2026. All respondents expressed their consent and met the inclusion criteria thus were included in the study. The population analyzed consists exclusively of women in their fertile period between 18 and 40 years of age, that were grouped by age in categories from 18 to 25 years old, respectively 26 to 30, 31 to 35 and 36 to 40, the majority included in the second and fourth group. Tho thirds of the population reside in an urban environment. We assessed the level of education of the participants and more than 50% have finished university studies, one third did finish high school, while the rest had also post bachelor’s degrees. A number of 38 participants had at least one finalized pregnancy that resulted in birth of a live child, there were also 6 patients with only reported spontaneous miscarriages, while the rest were currently pregnant during the interview. 64% of the respondents affirm to never have had an abortion, and the rest had at least one. When analyzing the evolution of the patients’ last pregnancy, 75% gave birth at term, 8% had a miscarriage and the rest gave birth either prematurely or have overcarried. Among the 61 pregnant participants, the vast majority (72.1%) reported no infectious diagnoses. When infections did occur, urinary tract infections were most common (13.1%), followed by vaginal candidiasis (4.9%); 3.3% of individuals experienced both, and 6.6% reported other types of infection. Vaccination uptake during pregnancy was low, with 80.3% remaining unvaccinated and 13.1% unsure of their status. Only four individuals confirmed vaccination: three for influenza (4.9%) and one for COVID-19 (1.6%). Daily hygiene practices varied: while most participants (44.3%) washed their hands 3–5 times daily, 34.4% did so 6–10 times, and 21.3% fewer than three times. Oral care was largely consistent, with 67.2% brushing twice daily and 23.0% once daily, though 9.8% admitted to an irregular routine. Intimate hygiene was predominantly a daily (52.5%) or twice daily (32.8%) practice, with 14.8% reporting only occasional cleansing. Finally, regarding lifestyle perception, 39.3% of participants viewed their diet as balanced and 41.0% as relatively balanced, while 19.7% considered their nutritional intake to be unbalanced. The detailed data is presented in Table 1, Table 2 and Table 3.

The association between the frequency of intimate hygiene and the occurrence of vaginal candidiasis was analyzed using the Chi-square test. The statistical analysis revealed a significant association between the two variables (χ² = 8.92; df = 2; p = 0.011). Participants who reported occasional intimate hygiene showed a higher frequency of vaginal candidiasis compared to those who performed daily hygiene practices.

The association between the frequency of hand washing and the occurrence of urinary tract infections during pregnancy was analyzed using the Chi-square test. The statistical analysis did not reveal a significant association between the two variables (χ² = 2.32; df = 2; p = 0.314).

The association between perceived diet quality during pregnancy and the occurrence of pregnancy complications was analyzed using the Chi-square test. The statistical analysis revealed a significant association between the two variables (χ² = 8.81; df = 2; p = 0.012). Participants who reported an unbalanced diet showed a higher frequency of pregnancy complications compared to those who reported a balanced diet.

The association between the level of nutritional supplementation during pregnancy and pregnancy outcome was analyzed using the Chi-square test. Participants were classified into three categories: no supplementation, 1–2 supplements, and ≥3 supplements used during pregnancy. The statistical analysis revealed a significant association between the level of supplementation and pregnancy outcome (χ² = 28.29; df = 2; p < 0.001). Women who did not use supplements showed a higher frequency of unfavorable pregnancy outcomes, whereas most women who used three or more supplements had term deliveries.

4. Discussion

According to Sadaf Firdaus, Sayeed Ahmed and Dr. Ammar Ibne Anwar, Adequate nutrition is a key factor in maintaining the health of both the pregnant woman and the developing fetus. In addition to a balanced diet, proper hygiene practices play an essential role in reducing the risk of infections and supporting a healthy pregnancy outcome. Personal hygiene is particularly important during pregnancy, as it affects not only maternal health but also the well-being of the unborn child. Poor hygiene may increase the risk of maternal infections, some of which can also affect the baby. Therefore, maintaining healthy eating habits and appropriate hygiene measures contributes to better maternal-fetal health and may promote a more favorable pregnancy experience [1]. Karl Wehbe et al. performed a systematic review on 67 papers on the prevention of toxomplasmosis in pregnant women, which concluded that Hygiene measures are effective as primary prevention in reducing toxoplasmosis and avoiding congenital toxoplasmosis and its consequences [5]. Several socio-demographic factors were shown to be significantly associated with urinary tract infections during pregnancy, including maternal age of 30 years or older, illiteracy or low educational attainment, low socio-economic status, inadequate personal hygiene, and the use of non-cotton underwear. Significant associations were also observed among women with higher gravidity (four or more pregnancies), those with more than one child, and those with a prior history of urinary tract infections. Among these factors, low socio-economic status emerged as the only independent predictor of urinary tract infections. The study also showed that women who experienced urinary tract infections during pregnancy had a significantly greater likelihood of delivering prematurely and of giving birth to infants with low birth weight. Multivariate analysis further identified urinary tract infection as one of the major contributors to preterm delivery [6]. Accumulating evidence suggests that maternal systemic infections and the inflammatory responses they trigger may interfere with normal placental vasculogenesis and angiogenesis. These disturbances can alter placental blood flow and impair fetal development, thereby increasing the risk of adverse pregnancy outcomes such as preterm birth, small-for-gestational-age infants, stillbirth, and low birth weight [7]. Similarly, our study shows the significance of intimate hygiene practices and preventing vaginal infections such as candidiasis in our case. The data provided by the studies mentioned above, underlines the importance of maintaining appropriate hygiene practices, as precaution for adverse events or poor outcomes of pregnancy. Although the analysis on our population did not find a significant association between proper hand-washing conduit and the occurrence of urinary tract infections, studies on a bigger population may suggest different outcomes and should be performed in the future. Contrary to what was said before, a certain study suggests that a vaginal microbiome characterized by reduced Lactobacillus species has been associated with several unfavorable gynecological and obstetrical outcomes, including preterm birth, bacterial vaginosis, and a higher susceptibility to sexually transmitted infections. Both bacterial vaginosis and sexually transmitted infections have also been linked to certain feminine intimate hygiene practices, many of which are performed despite limited or absent evidence of clinical benefit. Among these practices, vaginal douching has been the most thoroughly investigated and has been shown to disturb the normal vaginal microbiota, thereby increasing the risk of bacterial vaginosis, pelvic inflammatory disease, and preterm birth. Nevertheless, the broader effects of intimate hygiene behaviors and the products used for this purpose on the vaginal microbiome remain insufficiently understood [8]. Therefore, our studied topic should remain a mainstream interest for further analysis and review.

Regarding the influence of nutrition and micronutrients supplementation in pregnancy, Qosain Suriya et al. conducted a study on 500 pregnant women, which revealed that micronutrient deficiencies were common among the participants, with vitamin D deficiency affecting 45.6% of women, followed by anemia in 38.2%, calcium deficiency in 30.1%, iron deficiency in 25.7%, and folic acid deficiency in 18.3%. Dietary assessment further revealed insufficient intake of several key nutrients, including protein, iron, and folic acid, all of which were below the recommended levels for pregnancy. Adverse perinatal outcomes were also reported, including preterm birth in 12.8% of cases, low birth weight in 9.5%, macrosomia in 8.7%, and neonatal intensive care unit admission in 14.3%. In addition, 28.5% of women were overweight and 11.4% were obese before pregnancy, factors that were associated with higher rates of gestational diabetes and hypertensive disorders. Overall, the findings emphasize the substantial burden of inadequate nutrition and micronutrient deficiencies during pregnancy and their relationship with unfavorable maternal and neonatal outcomes. These results support the need for routine micronutrient screening, nutritional counseling, and appropriate supplementation as part of antenatal care, together with stronger public health strategies focused on nutrition education and food fortification to improve long-term health outcomes for both mothers and children [9]. Micronutrient deficiencies in pregnancy, particularly in low-income settings, can exacerbate health issues for both mother and fetus. Effective interventions include single micronutrient supplements like folic acid and iron, as well as multiple micronutrient supplements to reduce risks of low birth weight and stillbirth per Gernand, Alison D., Kerry J. Schulze et al. [10]. In addition our findings present a significant statistical associations between an unbalanced diet and the lack of supplementation, and unfavorable pregnancy outcomes. The continuous evolvement in the nutrition field makes it easier and more affordable for all patients to receive proper nutritional supplementation, thus the need for educating pregnant women in this direction.

5. Conclusions

The findings of the present study highlight the importance of hygiene and nutritional behaviors during pregnancy in relation to maternal and pregnancy outcomes. Most participants reported favorable hygiene practices, including regular hand washing, daily intimate hygiene, and twice-daily oral hygiene. In addition, the majority of women described their diet as relatively balanced or balanced, and a considerable proportion reported the use of multiple nutritional supplements during pregnancy.

The statistical analysis showed a significant association between the frequency of intimate hygiene and the occurrence of vaginal candidiasis, with occasional intimate hygiene being associated with a higher frequency of infection. A significant relationship was also identified between dietary habits during pregnancy and the occurrence of complications, as women who reported an unbalanced diet presented a higher frequency of pregnancy-related complications. Furthermore, the level of nutritional supplementation was significantly associated with pregnancy outcome, with women who used three or more supplements showing a higher frequency of term deliveries, while unfavorable outcomes were more common among those who did not use supplements. In contrast, no statistically significant association was found between the frequency of hand washing and urinary tract infections.

Overall, these results suggest that adequate intimate hygiene, balanced nutrition, and appropriate supplementation during pregnancy may contribute to more favorable maternal and fetal outcomes. The study supports the importance of prenatal education and preventive strategies focused on hygiene and nutrition in order to improve pregnancy evolution and reduce the risk of complications. Further studies on larger populations are needed to confirm these findings and to better define the impact of individual behavioral factors on pregnancy outcomes.