Preconception health in the well woman

Abstract

Key content It is important to focus on preconception care in the well woman because prevention is better than treatment, and interventions commenced in pregnancy may have limited benefit. A lower socioeconomic status is associated with poorer maternal and neonatal outcomes, including gestational diabetes mellitus (GDM), preterm birth (PTB), pre‐eclampsia (PET), and small‐for‐gestational‐age babies. Poor nutrition contributes to epigenetic dysregulation, which can alter gene expression and effect phenotypic change. A healthy diet during pregnancy, high in grains and vegetables, may help to reduce the risk of obesity, GDM, cardiovascular disease, hypertension, PET, and maternal anaemia; the benefits to the fetus include the prevention of low birthweight, macrosomia, PTB and stillbirth. The minimum amount of aerobic activity recommended during the preconception and pregnancy period is either 150 minutes of moderate intensity activity per week, or 30 minutes of activity per day, or 75 minutes of intense activity per week. Alcohol is a teratogen that can cause fetal growth restriction and facial malformations, learning and behavioural challenges and impairment to the central nervous system. Smoking in pregnancy can lead to impaired fetal growth and adverse effects on the immune system. Learning objectives To understand the importance of the preconception period. To evaluate key nutritional requirements in the preconception period. To critically evaluate the benefits and disadvantages of vaccination in the preconception period.