The Importance of Preconceptional Health – Monash Lens

Optimizing pre-pregnancy health can improve health outcomes for both the mother and newborn baby.

However, not everyone is aware of the need for good health before pregnancy – they generally start thinking about it during pregnancy.

Modifiable risk factors, including smoking and excessive alcohol consumption during the preconception period, affect the reproductive health of both women and men, and the quality of the reproductive cells – sperm and eggs.

Preconception care includes education about preconception risk factors and recommendations such as taking folic acid before conception, making sure any medications taken are safe for a future pregnancy, and addressing risk factors such as smoking and weight.

These can reduce the occurrence of adverse pregnancy outcomes such as low birth weight, spontaneous abortion and premature birth.

As the first point of contact in healthcare, primary care providers are ideally suited to provide preconception care. But while there is evidence that preconception care interventions in community and hospital settings are known for reducing risk factors and improving pregnancy outcomes, their effectiveness is unclear.

Low priority and aimed at women

Preconception care is often a low priority and not routine practice in primary care in many countries, and almost all preconception care primary care interventions are targeted at women.

Our new SPHERE study (co-authored with GP Dr Sonia Srinivasan and Professor Kirsten Black from the University of Sydney) has underlined the importance of good health before conception.

The Monash University-led systematic review, published in the British Journal of Family Medicineexamined how effective preconception care interventions in primary care, including education, adjunctive medication, and dietary modification, were in reducing risk factors and improving health.

Of the 28 studies eligible for inclusion in the review, only one involved men. Our sheet says:

“Almost all primary care-based PCC interventions target women…Since modifiable risk factors, including smoking and alcohol consumption, can also affect men’s reproductive health and sperm quality, PCC targeting men of reproductive age may also improve pregnancy outcomes.”

Read more: Breaking birth control barriers to empower all women

We found that primary care preconception care – including short and intensive education, additional medication and dietary modification – is effective in improving health knowledge and reducing risk factors for preconception, such as alcohol consumption and smoking in women, even when delivered by trained untrained women. healthcare professionals, but there was little evidence for the effect of preconception care on pregnancy outcomes.

With regard to nutrition, four articles reported that dietary modifications were effective. In one, snacks made by a health professional — green leafy vegetables, fruits and milk — eaten more than three months before conception increased the baby’s birth weight.

As our paper says, “… this may be due to higher micronutrient, energy and/or protein levels in the snack provided to the intervention group compared to the control group.”

Also, a diet containing at least 100 g of mushrooms per day from preconception to the 20th week of pregnancy reduced gestational hypertension, preeclampsia, weight gain during pregnancy, excessive weight gain during pregnancy and gestational diabetes.

In the other two articles, non-healthcare, professionally trained facilitators delivered macronutrient supplementation from preconception to term. This increased maternal protein, iron, zinc, folic acid, vitamins A and B12. However, it did not affect birth weight or growth in babies up to 24 months old.

A seated man with hands folded with a doctor, also sitting, holding an iPad and a stylus

Important for both men and women

This is the first review to consider the role of caregivers and the importance of preconception care for both women and men.

The findings highlight the need for more research to determine whether primary care-based preconception care can improve pregnancy outcomes, and to gain more evidence about its potential benefits for men.

We hope that this new review will help primary care providers in general practice (general practitioners, nurses) to increase their understanding of the effectiveness of preconception care and their potential role in supporting women to optimize their pre-pregnancy health.

We also hope that this research will raise awareness among women and men of reproductive age about the importance of optimal health during the preconception period.

We urge pregnancy plans to talk to their GP about preconception health.

We think it is very important that women and men of childbearing age enter into the discussion about preconception care when they visit their GP and ask for resources to improve their knowledge.

The Importance of Preconceptional Health – Monash Lens

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