Abstract
The preconception period is a key public health and clinical opportunity for obesity prevention. This paper describes the development of international preconception priorities to guide research and translation activities for maternal obesity prevention and improve clinical pregnancy outcomes. Stakeholders of international standing in preconception and pregnancy health formed the multidisciplinary Health in Preconception, Pregnancy, and Postpartum (HiPPP) Global Alliance. The Alliance undertook a priority setting process including three rounds of priority ranking and facilitated group discussion using Modified Delphi and Nominal Group Techniques to determine key research areas. Initial priority areas were based on a systematic review of international and national clinical practice guidelines, World Health Organization recommendations on preconception and pregnancy care, and consumer and expert input from HiPPP members. Five preconception research priorities and four overarching principles were identified. The priorities were: healthy diet and nutrition; weight management; physical activity; planned pregnancy; and physical, mental and psychosocial health. The principles were: operating in the context of broader preconception/antenatal priorities; social determinants; family health; and cultural considerations. These priorities provide a road map to progress research and translation activities in preconception health with future efforts required to advance evidence-translation and implementation to impact clinical outcomes.
Highlights
Obesity is a leading public health problem, with childbearing a key driver of obesity development in women [1]
International preconception research and translation priorities for healthy lifestyle and the prevention of maternal obesity and related pregnancy and long-term complications were identified by the multidisciplinary HiPPP Global Alliance
Folic acid supplementation and food security were mentioned within this priority, notwithstanding other important factors associated with diet and nutrition preconception, including advancing our understanding of the dietary intakes of preconception populations, and exploring how preconception improvements in diet can impact on pregnancy outcomes and beyond
Summary
Obesity is a leading public health problem, with childbearing a key driver of obesity development in women [1]. High preconception body mass index (BMI), alongside excess gestational weight gain and postpartum weight retention, are significant and independent contributors to rising maternal obesity and associated health risks [2,3]. Long-term lifestyle and medical treatment of obesity is largely ineffective and unable to curb associated adverse health outcomes; prevention is essential. A recent Lancet series highlighted the importance of health and wellbeing on preconception health, with actions required varying across the lifecourse and most targeted when actively planning a pregnancy [4]. Planning pregnancy allows for more time to take actions to improve health, protect fertility, and increase the chance for healthy maternal and birth outcomes [4]. Pregnancy planning varies significantly; 30 to 50% of pregnancies are unintended in high-income countries and even more in middle- and low-income countries [8]
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