Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health

Abstract

A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.

Dietary guideline adherence during preconception and pregnancy: A systematic review

“…This sociocultural context can exert considerable influence on a diet at different stages of life; in particular, during conception and pregnancy (Withers, Kharazmi, & Lim, ). Poor adherence to dietary guidelines or nutritional recommendations during the preconception period (i.e., the weeks to months before pregnancy occurs) and throughout pregnancy can have a negative impact on fertility, pregnancy and birth outcomes, as well as the future health of the offspring (Craig, Jenkins, Carrell, & Hotaling, ; Lane, Robker, & Robertson, ; Stephenson et al, ). For example, in women, adequate intake of folate during the preconception period may help to prevent neural tube defects in the foetus (De‐Regil, Peña‐Rosas, Fernández‐Gaxiola, & Rayco‐Solon, ; WHO, 2017).…”

Knowledge about the Developmental Origins of Health and Disease is independently associated with variation in diet quality during pregnancy

“…The DOHaD hypothesis offers a powerful set of explanations accounting for much of the epidemiology of NCDs related to metabolic function (Godfrey et al, ; Hanson & Gluckman, ). Furthermore, models derived from the DOHaD hypothesis indicate that strategies for reducing the burden of metabolic disease should focus on intervening in the earliest stages of life (Garmendia, Corvalan, & Uauy, ; Godfrey et al, ; Hanson & Gluckman, ; Low, Gluckman, & Hanson, ; Stephenson et al, ; Victora et al, ). As such, over the last decade, there has been an increasing push to translate key findings from DOHaD‐related research into social and public health policy and guidelines as well as into clinical practice (Anon., ; Barker et al, ; Mckerracher, Moffat, Barker, Williams, & Sloboda, ).…”

Childhood abuse and unplanned pregnancies: a cross‐sectional study of women in the Norwegian Mother and Child Cohort Study

“…Unplanned pregnancies preclude preconception actions (e.g. abstaining from alcohol, quitting smoking and reaching a healthy weight) that improve pregnancy‐related health . Hence, providing exposed women with adequate contraceptive counselling may have positive effects on maternal and child health outcomes.…”