Optimising Preconception Care

Abstract

Women with PCOS are at an increased risk of infertility and a range of pregnancy complications. It is therefore important to understand how to optimise preconception care to reduce these risks. A reproductive life plan and age-appropriate education on optimising reproductive health is recommended in adolescents and women with PCOS. This should occur across the domains of appropriate nutritional intake (dietary and supplement sources), optimising physical activity, considering the effects of excess weight on fertility and being aware of the effects of substances on fertility. Dietary intake should be consistent with population guidelines for healthy eating with appropriate intake of core food groups and limited intake of discretionary foods high in added sugar, sodium, trans and saturated fats. Recommendations exist for preconception micronutrient supplementation including folic acid and iodine (in the Australian context) with others (e.g., vitamin D, iron, calcium and B12) as per deficiencies or other country specific guidelines. Recommendations for physical activity should also be consistent with general population guidelines comprising moderate intensity physical activity of >150 minutes/week or vigorous intensity physical activity of 75 minutes/week or a combination of both, engaging in muscle strengthening activities [Formula: see text]2 days/week and minimising the amount of time spent in prolonged sitting. The association of excess weight on reduced fertility are recognised from epidemiological literature and current guidelines highlight strategies of modest weight loss at higher BMIs. This is an important and emerging field of literature where future research can elucidate efficacy in randomised controlled trials across different interventions and populations. When working with all women preconception, and in particular women with PCOS, it is important to consider weight stigma, disordered eating and eating disorders when discussing the relationship of infertility and weight and potential modification of weight. Substance use can be considered across limiting high intake of caffeine and avoiding alcohol and illicit substance intake and smoking.