Advancing Preconception Health Globally: A Way Forward

Preconception Women’s Health and Pediatrics: An Opportunity to Address Infant Mortality and Family Health

Where is the “W”oman in MCH?

Eliminating disparities in preconception health can potentially reduce disparities in two of the leading causes of death in early and middle adulthood (i.e., heart disease and diabetes). Public health officials can use this information to provide a baseline against which to evaluate state efforts to improve preconception health.

As part of the federal multi-agency conference on Paternal Involvement in Pregnancy Outcomes, the existing Fatherhood paradigm was expanded to include a new focus on Men's Preconception Health. This concept grew out of the women's preconception health movement and the maternal and child health (MCH) life course perspective, as well as pioneering research from the child development, public health data and family planning fields. It encourages a new examination of how men's preconception health impacts both reproductive outcomes and men's own subsequent health and development. This essay introduces the concept of men's preconception health and health care; examines its historical development; notes the challenges of its inclusion into fatherhood and reproductive health programs; and situates it within a longer men's reproductive health life course. We then briefly explore six ways men's preconception health and health care can have positive direct and indirect impacts-planned and wanted pregnancies (family planning); enhanced paternal biologic and genetic contributions; improved reproductive health biology for women; improved reproductive health practices and outcomes for women; improved capacity for parenthood and fatherhood (psychological development); and enhanced male health through access to primary health care. Research on men's preconception health and health care is very limited and siloed. We propose a research agenda to advance this topic in three broad domains: increasing the basic epidemiology and risk factor knowledge base; implementing and evaluating men's preconception health/fatherhood interventions (addressing clinical health care, psychological resiliency/maturation, and social determinants of health); and fostering more fatherhood health policy and advocacy research.

A roadmap toward equitable, coordinated, quality reproductive care for women with chronic conditions.

BackgroundThe preconception period allows couples to plan and prepare for pregnancy. However, males can often consider this integral public health topic as a female domain. To better understand and support behaviour change for males before conception, this study aimed to identify and explore the preconception and pregnancy planning health beliefs and intentions of expectant male reproductive partners of pregnant women in Australia.MethodsAn online cross-sectional survey [2020–2021] among males aged 18–49 years who were the reproductive partner (expectant partner) of a pregnant female. Recruitment occurred via social media. The 80-item survey consisted of five sections. Survey items regarding beliefs and intentions were formulated using the Theory of Planned Behaviour. Associations between participants’ beliefs, subjective norms, perceived behavioural control, and intentions related to three outcomes (regular exercise, healthy diet, and alcohol avoidance) were estimated using Structural Equation Modelling.ResultsExpectant partners’ (n = 136) had a mean age of 31 years. Their beliefs toward regular exercise and their perceived behavioural control to exercise regularly were associated with a greater intention to exercise regularly (Standardised estimate β = 0.54; p = 0.0087 and β = 0.43; p = 0.02, respectively). The beliefs of expectant partners toward alcohol avoidance and their perceived behavioural control toward alcohol avoidance were associated with a greater intention to avoid alcohol (β = 0.43; p < 0.001 and β = 0.36; p < 0.001, respectively). For the healthy diet outcome, subjective norms of expectant partners, and perceived behavioural control to adopt a healthy diet were associated with an intention to adopt a healthy diet (β = 0.23; p = 0.04 and β = 0.47; p < 0.001, respectively). Intention was in turn associated with behaviour for all three outcomes.ConclusionOur study demonstrated that the preconception intentions of expectant partners were associated with their preconception behaviours; especially for the intention to exercise regularly or to avoid alcohol. Further studies examining paternal preconception health beliefs, and intentions and the motivations behind health behaviours for males are needed to help develop targeted preconception health promotion messages and interventions that support males to optimise their preconception health.

Preconception health

Overweight and obesity (body mass index (BMI) ≥ 25.0 to 29.9 kg/m(2) and BMI ≥ 30 kg/m(2,) respectively are increasingly common among women of reproductive age. Overweight and obesity are known to be associated with many adverse health conditions in the preconception period, during pregnancy and during the labour and postpartum period. There are no current guidelines to suggest which preconception health programs and interventions are of benefit to these women and their infants. It is important to evaluate the available evidence to establish which preconception interventions are of value to this population of women. To evaluate the effectiveness of preconception health programs and interventions for improving pregnancy outcomes in overweight and obese women. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2014) and reference lists of retrieved studies. Randomised controlled trials (including those using a cluster-randomised design), comparing health programs and interventions with routine care in women of reproductive age and a BMI greater then or equal to 25 kg/m(2). Studies published in abstract form only, were not eligible for inclusion. Quasi-randomised trials or randomised trials using a cross-over design were not eligible for inclusion in this review. The intervention in such studies would involve an assessment of preconception health and lead to an individualised preconception program addressing any areas of concern for that particular woman.Preconception interventions could involve any or all of: provision of specific information, screening for and treating obesity-related health problems, customised or general dietary and exercise advice, medical or surgical interventions. Medical interventions may include treatment of pre-existing hypertension, impaired glucose tolerance or sleep apnoea. Surgical interventions may include interventions such as bariatric surgery. The comparator was prespecified to be standard preconception advice or no advice/interventions. We identified no studies that met the inclusion criteria for this review. The search identified one study (published in four trial reports) which was independently assessed by two review authors and subsequently excluded. There are no included trials. We found no randomised controlled trials that assessed the effect of preconception health programs and interventions in overweight and obese women with the aim of improving pregnancy outcomes. Until the effectiveness of preconception health programs and interventions can be established, no practice recommendations can be made. Further research is required in this area.

The clinical content of preconception care: preconception care for men

Men's engagement in maternal and child health care in the preconception health forum is essential because it allows primary prevention of maternal and infant mortality and morbidity. This review aimed to identify strategies to engage men in preconception health. This scoping review was conducted from August to September 2022. The database searches included PubMed, EBSCO, and ProQuest from 2012 to 2022, related to men's involvement in reproductive health, preconception health, family planning, maternity, and infant care; articles written in English; national (Indonesia) and international articles; and appropriate thesis. The searched keywords were man/male role, premarital, preconception, reproductive health, and fertility. The electronic searches turned to 1969 articles, 16 of which met the inclusion criteria and were selected for study analysis. This review identified three themes: identifying programs that are sensitive to the limitations of men; developing community outreach strategies; and engaging management principles, policy, and legislation. Efforts to engage men in preconception health can be complicated, but several strategic programs have demonstrated some success. Subsequent programs that require men's participation in preconception health services must be sensitive to the identified barriers.

Background Women's health prior to pregnancy is an increasing area of public health focus. Lifestyle interventions in preconception may be an ideal to target lifestyle behaviours that impact preconception and pregnancy health. However, there are limited interventions initiated prior to pregnancy. This study assesses the feasibility, acceptability and preliminary effectiveness of a digital healthy lifestyle behaviours intervention in women planning a pregnancy. Methods Participants were provided digital health and lifestyle information, health checklist, goal setting tools and virtual health coaching (telephone or video conference). Feasibility was defined as 1) recruitment of eligible participants who expressed interest, 2) retention from baseline through delivery (attending both preconception coaching sessions), and 3) adherence, based on attending one health coaching session, using the digital goal setting tool and accessing at least one information article. Acceptability was based on program components evaluated as helpful/very helpful. Preliminary intervention efficacy was based on participants attending a preconception consultation with a genera l practitioner (GP). Results Women (n = 298) planning a pregnancy within 12 months were recruited. Feasibility objectives were met, with 60% (n = 298/494) recruitment, 76% (n = 227/298) retention and 85% (n = 252/298) adherence. Evaluation demonstrated high levels of acceptability: digital module (95% n = 205/216), physical activity/diet information (90% n = 195/216), preconception health information (91% n = 195/215), coaching (92% n = 198/216), lifestyle SMSs (72% n = 153/213) and self-weighing (74% n = 159/215). Since the intervention, 73% (n = 159/217) had visited their GP in preparation for pregnancy. Conclusions The OptimalMe preconception intervention demonstrated feasibility, high acceptability and efficacy in women planning a pregnancy. This supports future digital health interventions in preconception; pregnancy results pending. Key messages • Interventions prior to pregnancy are limited, yet women’s health prior to pregnancy is an increasing area of public health focus. • Digital health interventions are feasible and acceptable for preconception health and lifestyle health promotion for women planning a pregnancy.

The development and publication of this supplement of the American Journal of Health Promotion have provided an opportunity to connect with new partners in the field of preconception health education, assess the current state of the science on this topic, and note gaps in research that we hope readers will consider filling. As guest editors, we appreciate our colleagues who submitted articles for consideration, the guest reviewers for their time and willingness to serve, and the journal staff for their flexibility and support throughout the process. This supplement serves as a platform to elevate contributions made in the context of preconception health promotion since 2006 as well as to issue a call to action to expand the work being done in this important arena. Six years ago, in partnership with over 35 national organizations and hundreds of partners, a select panel of experts on preconception health issued a series of 4 goals, 10 recommendations, and over 40 action steps focused on improving the health and well-being of women and men of childbearing age. The recommendations addressed a number of domains, including consumer education, clinical care, advocacy and policy, research, and public health and community interventions. A complete list of the recommendations and action steps is included in the online version of this article (http://www.cdc.gov/mmwR/preview/ mmwrhtml/rr5506a1.htm). Four national workgroups were created to move this agenda forward based on these different domains. To catalyze action in the context of consumer education and health promotion, the National Preconception Health Consumer Workgroup was formed. A main charge of the consumer workgroup continues to be to improve the knowledge, attitudes, and behaviors of men and women related to preconception health by using information that is relevant across various age groups, literacy levels, and cultural and ethnic groups. This journal issue on preconception health focuses mainly on women’s preconception health and is one example of the consumer workgroup’s efforts. In the context of women, preconception health refers to the health of a woman of childbearing age prior to or between pregnancies. The purpose of preconception care is to identify and modify biomedical, behavioral, and social risks to a woman’s health in order to maximize her health as well as that of any babies she may have in the future. Increasing awareness, knowledge, and engagement in preconception health practices among women and their partners are important objectives. Data suggest that pregnancy intentions can improve birth outcomes. Given the high infant mortality rates in the United States, particularly as compared to 28 other countries with better birth outcomes, this work is essential. Preconception health is unique as it is comprised of numerous components, including lifestyle (i.e., healthy weight, physical activity, smoking, drinking, substance use), screenings and vaccination (i.e., sexually transmitted infections, human immunodeficiency virus, rubella), and chronic disease management (i.e., diabetes, hypertension), along with family planning and exposure to teratogens, to name a few. Mass communication and clinician intervention about preconception health are challenging because of the volume of health topics within this issue and in light of the fact that half of all pregnancies are unplanned. Ultimately, a key task of the preconception health movement is to change social norms about the importance of the health of women and men and the impact it can have on their future reproductive goals. Formative research, education campaigns, and interventions on single health topics among women of childbearing age are well documented in the literature. However, less is known about how to effectively bundle and deliver a preconception health ‘‘package’’ to consumers in a way that resonates with them and motivates them to take action. One goal of this supplement is to inform this dialogue. In soliciting the content for this issue, we were particularly interested in preconception health audience research, advances in message development and dissemination strategies, and innovations in public and private partnerships, as well as insight into improving the preconception health of at-risk populations. A critical step in the process of developing and disseminating health promotion messages is to conduct audience Elizabeth W. Mitchell, PhD, is with the National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Developmental Disabilities, Prevention Research Branch, National, Atlanta, Georgia. Sarah Verbiest, DrPH, MSW, MPH, is with the Center for Maternal and Infant Health, University of North Carolina at Chapel Hill.

The preconception period is an opportunity to address health-related behaviours to optimise pregnancy and child health outcomes. However, preconception health research and practice are primarily focused on females while similar attention on males remains underdeveloped. To address evidence gaps and inform effective paternal preconception health support, the aim of this systematic review was to identify the health beliefs, attitudes, and intentions of males toward pregnancy planning and preconception health and care. A literature search was conducted in seven databases: Medline, Embase, PubMed, CINAHL, PsycINFO, Scopus, and Web of Science to identify original research regarding pregnancy planning or preconception health beliefs, attitudes, and/or intentions among generally healthy adult males. Methodological rigour of included studies was assessed using the Newcastle Ottawa Scale (NOS) and the Critical Appraisal Skills Programme (CASP) Qualitative Studies checklist. Nine studies were included; cross sectional studies (n=6); a qualitative exploratory case study (n=1); a mixed method study (n=1) and a study incorporating qualitative and quantitative surveys (n=1). Analysis identified three broad themes: 1) Importance of Preconception Health and Care; 2) Paternal Preconception Behaviours; and 3) Inequalities in Preconception Health and Preconception Care. Findings reveal 1) Many males did not attend a preconception care consultation and believed it was not needed, or they already knew enough about a healthy pregnancy. 2) Males often agreed that smoking and alcohol consumption can affect the quality of their sperm and sometimes agreed it is important to consume a healthy preconception diet and to be physically active to achieve a healthy weight before conception. 3) For many males, there was a tendency to direct a greater level of responsibility to the female than to themselves regarding preconception health. African American males can feel marginalised. Males do not always opt for a preconception consultation and many believe they are adequately prepared for a healthy pregnancy. Further, many males place a greater level of responsibility for planning and preparing for pregnancy on their partners rather than themselves. Further research focused upon male experiences and perspectives around preconception health is needed to inform targeted preconception health education, policy and care.

Preconception health care interventions: A scoping review

IntroductionThe preconception period is an opportunity to address health-related behaviours to optimise pregnancy and child health outcomes. However, preconception health research and practice are primarily focused on females while similar attention on males remains underdeveloped. To address evidence gaps and inform effective paternal preconception health support, the aim of this systematic review was to identify the health beliefs, attitudes, and intentions of males toward pregnancy planning and preconception health and care.MethodsA literature search was conducted in seven databases: Medline, Embase, PubMed, CINAHL, PsycINFO, Scopus, and Web of Science to identify original research regarding pregnancy planning or preconception health beliefs, attitudes, and/or intentions among generally healthy adult males. Methodological rigour of included studies was assessed using the Newcastle Ottawa Scale (NOS) and the Critical Appraisal Skills Programme (CASP) Qualitative Studies checklist.ResultsNine studies were included; cross sectional studies (n=6); a qualitative exploratory case study (n=1); a mixed method study (n=1) and a study incorporating qualitative and quantitative surveys (n=1). Analysis identified three broad themes: 1)Importance of Preconception Health and Care; 2)Paternal Preconception Behaviours; and 3)Inequalities in Preconception Health and Preconception Ca.reFindings reveal 1) Many males did not attend a preconception care consultation and believed it was not needed, or they already knew enough about a healthy pregnancy. 2) Males often agreed that smoking and alcohol consumption can affect the quality of their sperm and sometimes agreed it is important to consume a healthy preconception diet and to be physically active to achieve a healthy weight before conception. 3) For many males, there was a tendency to direct a greater level of responsibility to the female than to themselves regarding preconception health. African American males can feel marginalised.ConclusionMales do not always opt for a preconception consultation and many believe they are adequately prepared for a healthy pregnancy. Further, many males place a greater level of responsibility for planning and preparing for pregnancy on their partners rather than themselves. Further research focused upon male experiences and perspectives around preconception health is needed to inform targeted preconception health education, policy and care.