Dear Dr. Papageorghiou, Adverse pregnancy outcomes, such as gestational diabetes, pregnancy-induced hypertension and preterm birth, are major global public health concerns with significant effects on maternal and infant health and long-term chronic disease risks [1]. Although pre-pregnancy healthy lifestyles are crucial for improving pregnancy outcomes, most studies focus on single factors and are primarily based on European and North American populations [2]. Research on the combined effects of multiple lifestyle factors, especially in Asian populations, remains limited [3]. Therefore, investigating the association between prepregnancy healthy lifestyles and adverse pregnancy outcomes in different populations is of great public health significance.