Abstract
Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infections; mental health, physical health; medication and genetic risk. Sixty-five of the 66 indicators were reported in at least one national routine health data set, survey or cohort study. A measure of preconception health assessment and care was not identified in any current national data source. Perspectives from three (healthcare) professionals described how indicator assessment and monitoring may influence patient care and inform awareness campaign development. This review forms the foundation for developing a national surveillance system for preconception health in England. The identified indicators can be assessed using national data sources to determine the population's preconception needs, improve patient care, inform and evaluate new campaigns and interventions and enhance accountability from responsible agencies to improve preconception health.
Highlights
The health and health behaviours of women and men prior to pregnancy are key determinants of a successful pregnancy and the health of women, men and their offspring in the short- and long-term.[1,2] There is ample evidence from developmental biology and epidemiological studies that improving preconception health represents an opportunity to reduce maternal and infant mortality and morbidity, prevent non-communicable disease in parents themselves and their offspring and improve the overall health of at least two generations
International guidance related to preconception health that reported additional indicators not described in documents relating to England included clinical preconception care recommendations from the USA and Canada, a position statement from Australia and a policy brief from the World Health Organization (WHO) (Supplementary Table S1)
We present an extension to these existing surveillance efforts based on indicators that are relevant to people of reproductive age and that are recommended as indicators of optimal preconception health and care based on clinical guidance and policy reports
Summary
The health and health behaviours of women and men prior to pregnancy are key determinants of a successful pregnancy and the health of women, men and their offspring in the short- and long-term.[1,2] There is ample evidence from developmental biology and epidemiological studies that improving preconception health represents an opportunity to reduce maternal and infant mortality and morbidity, prevent non-communicable disease in parents themselves and their offspring and improve the overall health of at least two generations. The importance of optimal preconception health has been recognised in many national and international guidelines, position statements and policy reports. These provide clinical guidance on providing preconception care (PCC) to individuals planning pregnancy,[3,4,5,6,7,8,9] outline how primary care, maternity and community services may integrate PCC into existing services[5,6,9,10,11,12] and call for continued efforts to improve the health of the population more broadly.[4,5,6,9,10,12,13]. Examples include a focus on the health of girls and women during the adolescent and reproductive years in the United Nations 2030 Agenda for Sustainable Development[14] and in the Global Strategy for Women’s, Children’s and Adolescent’s
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