Findings of a series of three papers published in The Lancet have substantial societal and public health implications, and point to a new emphasis on preparing for conception.

To help improve health in future generations, the authors call for a joint focus, including better guidance and support for individuals planning pregnancy, and increased public health measures to reduce obesity and improve nutrition.

Behavioural change

The experts suggest that behaviour change interventions, supplementation and fortification could lead to preconception health improvements.

Professor John Mathers, Human Nutrition Research Centre, Newcastle University, is a co-author of the studies along with the University's Professor Falko Sniehotta, Dr Miguel Velazquez and Dr Nicola Heslehurst.

Professor Mathers said: “How well we are nourished during early development in the womb affects health and wellbeing for the rest of our lives.

“Waiting until you know that you are pregnant may be too late to benefit from improving your diet, stopping smoking and becoming more active.

“For the health of the next generation, prospective mothers and fathers should start early, eat a healthier diet with lots of vegetables and fruit and avoid putting on weight.”

The Series draws on existing evidence from around the world to redefine the preconception period, outlines how preconception risk factors affect the unborn baby and lifelong health risks, and proposes interventions to help improve preconception health.

The authors present two new analyses of the diets and health of women of reproductive age (18-42 years old) in the UK and Australia.

Lead author of the Series, Professor Judith Stephenson, University College London, said: “The preconception period is a critical time when parental health – including weight, metabolism, and diet – can influence the risk of future chronic disease in children, and we must now re-examine public health policy to help reduce this risk.

“While the current focus on risk factors, such as smoking and excess alcohol intake, is important, we also need new drives to prepare nutritionally for pregnancy for both parents. Raising awareness of preconception health, and increasing availability of support to improve health before conception will be crucial.”

Professor Stephenson also stressed: “This isn’t about provoking fear or blaming individuals – our analysis establishes the importance of health of the next generation, stresses societal responsibility, and demands strong local, national and international leadership."

Defining the preconception period

Previous research has defined the preconception period as the three months before conception, as this is the average time it takes for fertile couples to become pregnant.

However, this is imprecise, and ignores the time taken to achieve preconception health improvements – with some taking less than a month (such as achieving adequate folate concentrations through supplements) and others taking months or years, such as achieving a healthy weight.

Taking this into account, the Series authors redefine the preconception period biologically – as the days to weeks before and after fertilisation; individually – as the weeks or months when a woman or couple decides to have a child; and at a public health level – as the months or years needed to address preconception risk factors, such as diet and obesity, before pregnancy.

Evidence suggests that smoking, high alcohol and caffeine intake, diet, obesity and malnutrition potentially cause genetic, cellular, metabolic and physiological changes during the development of the unborn baby, which have lasting consequences into adulthood and increase the child’s lifelong risk of cardiovascular, metabolic, immune, and neurological diseases.

In particular, maternal obesity, which is also linked to poorer birth outcomes, is thought to increase levels of inflammation, hormones and metabolites, which may directly alter the development of the egg and embryo to increase the risk of chronic disease in later life.

Male obesity is also important, and is associated with poor sperm quality, quantity and motility, which could increase the risk of chronic disease in later life. However, it is uncertain whether paternal diet and obesity have as strong an influence as maternal preconception health.

The authors also note that there could be more risk factors associated that have not yet been identified.

In a new analysis, the authors calculate the proportion of women of reproductive age (18-42 years old) in the UK who are nutritionally prepared for pregnancy, using data from 509 women of reproductive age in the UK National Diet and Nutrition Survey.

The experts estimate that many UK women are not nutritionally prepared for pregnancy, and almost all women of reproductive age (96%) have iron and folate dietary intakes below the recommendation for pregnancy (14.8mg per day, and 400µg per day, respectively).

Based on these associations and the proportion of women likely to be nutritionally unprepared, the authors call for interventions that start years before pregnancy. They reinforce the importance of improving everyone’s health from an early age as a way to avoid poor preconception health, and improve the health of future generations.

Improving preconception health

Some studies suggest that dietary influences from a number of years before conception may have effects. With 2012 estimates suggesting that 40% of global pregnancies were unplanned, efforts to improve nutrition and health behaviour at a population level are needed to support individual efforts among those planning ahead for pregnancy.

To do this, the authors recommend interventions that span the lifetime. They say that these interventions should understand and harness people’s reasons to engage with preconception health at different stages in their lives to support people to change.

Starting in adolescence, the authors propose that schools need to help young adults prepare for parenthood in the future. Support for improving nutrition before conception needs to be offered in ways that engage adolescents in thinking about their diets and health, and the implications of this in later life, in pregnancy, and for future generations.

Building on this, in adults with no immediate plans to become pregnant, they call for social change that supports improved public awareness of preconception health. Lastly, in adults planning to become pregnant, they call for improved support and practical tools for preconception health.

The authors also suggest that the food industry and food retailers should be part of the solution, working alongside government organisations, non-governmental organisations, and research institutions to form advocacy coalitions to create more demand for preconception health support.

References

For access to the Series, visit:

http://www.thelancet-press.com/embargo/preconception1.pdf 

http://www.thelancet-press.com/embargo/preconception2.pdf 

http://www.thelancet-press.com/embargo/preconception3.pdf 

Press release adapted with thanks to The Lancet.