Understanding preconception health for early life course medicine

Abstract

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...