Preconception health in England: a proposal for annual reporting with core metrics

Stephenson, Judith; Vogel, Christina; Hall, Jennifer; Hutchinson, Jayne; Mann, Sue; Duncan, Helen; Woods-Townsend, Kathryn; Lusignan, Simon de; Poston, Lucilla; Cade, Janet; Godfrey, Keith M.; Hanson, Mark A.; Barrett, Geraldine; Barker, Mary; Conti, Gabriella; Shannon, Geordan; Colbourn, Tim

doi:10.1016/s0140-6736(19)30954-7

Cited by 64 publications

(83 citation statements)

References 22 publications

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“…Sociodemographic disparities are also documented in the Infant Feeding survey and an analysis of the MSDS data which reports strong associations across the UK between smoking, age, and socioeconomic status, remaining broadly similar across all countries in the UK (8,24). They report younger, unemployed mothers tending to be the least likely to quit smoking before or during pregnancy.…”

Section: Findings In Relation To Other Studiesmentioning

confidence: 93%

Alcohol, smoking, folic acid and multivitamin use among women attending maternity care in London: A cross-sectional study

Jawad¹,

Patel

Brima

et al. 2019

Sexual & Reproductive Healthcare

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Section: Findings In Relation To Other Studiesmentioning

confidence: 93%

Alcohol, smoking, folic acid and multivitamin use among women attending maternity care in London: A cross-sectional study

Jawad¹,

Patel

Brima

et al. 2019

Sexual & Reproductive Healthcare

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“…The potential for heightened social and medical surveillance of bodies and individual reproductive decisions seems obvious, and is indeed reflected in reports such as the recent proposal for monitoring core metrics of preconception health in the UK, published in The Lancet (Stephenson et al, 2019). In this article, the authors argue for a "dual intervention strategy at both the public health level (e.g., by improving the food environment) and at the individual level (e.g., by better identification of those planning a pregnancy who would benefit from support to optimize health before conception) in order to raise awareness of preconception health and to normalize the notion of planning and preparing for pregnancy" (Stephenson et al, 2019: 2,262, our emphasis).…”

Section: Anticipating New Normsmentioning

confidence: 99%

“…At a population level, strategies include food fortification with folate, embedding preconception health in school curricula and in other policies related to maternal and child health, and broadly improving food environments . At the individual level, proposed strategies include "normalizing conversations about pregnancy intention" during clinic visits, providing online tools to promote behavior change, and training health care workers about preconception care Stephenson et al, 2019. This is more than detecting the presence of a faulty gene or highlighting risky alleles that may render the individual particularly susceptible to disease in a given environment.…”

Section: Anticipating New Normsmentioning

confidence: 99%

“…At the individual level, the recommendation is for a "reorientation of the health services and health-care professionals to normalize conversations about planning for pregnancy during routine visits" (our emphasis). The measurement of core metrics, as a set of preconception health indicators, is framed as a means for the state and relevant organizations to account for the improvement of preconception health (Stephenson et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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“It's Never Too Early”: Preconception Care and Postgenomic Models of Life

Pentecost

Meloni

2020

Front. Sociol.

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In this article, we are concerned with the expanded public health interest in the "preconception period" as a window of opportunity for intervention to improve long-term population health outcomes. While definitions of the "preconception period" remain vague, new classifications and categories of life are becoming formalized as biomedicine begins to conduct research on, and suggest intervention in, this undefined and potentially unlimited time before conception. In particular, we focus on the burgeoning epidemiological interest in epigenetics and Developmental Origins of Health and Disease (DOHaD) research as simultaneously a theoretical spyglass into postgenomic biology and a catalyst toward a public health focus on preconception care. We historicize the notion that there are long-term implications of parental behaviors before conception, illustrating how, as Han and Das have noted, "newness comes to be embedded in older forms even as it transforms them" (Han and Das, 2015, p. 2). We then consider how DOHaD frameworks justify a number of fragmented claims about preconception by making novel evidentiary assertions. Engaging with the philosophy of Georges Canguilhem, we examine the relationship between reproductive risk and revised understandings of biological permeability, and discuss some of the epistemic and political implications of emerging claims in postgenomics.

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“…Stephenson and colleagues recently proposed an annual report card on preconception health in the UK which should serve to hold governments and other relevant agencies accountable for delivering interventions to improve preconception health. Maybe, next to its research purposes, the PrePARED consortium can also serve to act as a forum for receiving preconception health, education, and care on the top of the agenda of all responsible health care and governmental agencies.…”

mentioning

confidence: 99%

Understanding preconception health for early life course medicine

Steegers

2019

Paediatric Perinatal Epid

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A promising future life starts with a healthy fetal development and birth. Being born healthy is not granted to everyone; however, large disparities exist in perinatal mortality and morbidity. Premature birth and being born small for gestational age, which is observed in over 15% of all births, reflect a cascade of health complications which impact not only the newborn but also the health and well-being in infancy, childhood, and later life. Therefore, the guiding beacon for prioritising research, and also for policymaking in health care, should be to aim for equal chances of healthy birth, thereby reducing inequalities in population health. What is needed to achieve this?Better care starts with new knowledge. One of the most profound contributions of academic scholarship to the field of reproductive medicine has been the knowledge that fetal development is a key determinant of health in later life with intergenerational effects. 1 We are also increasingly aware of differences in early pregnancy embryonic growth that are related to maternal preconception health. 2 Furthermore, being relatively small as an embryo is associated with increased risks of pregnancy complications like miscarriage, low birthweight, and preterm birth, as well as an adverse cardiovascular risk profile at 6 years of age. 3 Embryonic health is therefore paramount to future health.Prevailing antenatal care systems, however, do not optimise early development. They generally start around the eighth gestational week or later, especially in socially vulnerable populations.Early pregnancy care should start before conception. Preconception care can be defined as "a set of interventions and/or programmes that aims to identify and enable informed decision making to modify biomedical, behavioural, and psychosocial risks to parental health and the health of their future child through counselling, prevention, and management; emphasising on factors that must be acted on before conception and in early pregnancy to have maximal impact and/or choice". 4 Preconception care constitutes an essential preventive strategy to combat adverse pregnancy and child outcomes, as well as provides a window of opportunity to improve parental health beyond the reproductive age. General individual preconception care in the community provides opportunities for risk analysis, health information, and interventions like vaccinations and life style changes to improve nutrition and stop substance abuse. Specialist individual preconception care and counselling should be provided in hospitals in case of chronic conditions, complicated obstetric history, or genetic issues. Not only in care, but also in research the "Developmental Origins of Health and Disease" (DOHaD) paradigm is increasingly shifting to the periconception period. A better understanding of the type of relevant preconception exposures will improve the efficacy of preconception care. Harville and colleagues 5 in this issue of Paediatric and Perinatal Epidemiology describe a new initiative to create knowledge on preconc...

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Preconception health in England: a proposal for annual reporting with core metrics

Cited by 64 publications

References 22 publications

Alcohol, smoking, folic acid and multivitamin use among women attending maternity care in London: A cross-sectional study

Alcohol, smoking, folic acid and multivitamin use among women attending maternity care in London: A cross-sectional study

“It's Never Too Early”: Preconception Care and Postgenomic Models of Life

Understanding preconception health for early life course medicine

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