Preconception Health Research Articles

Preconception care.

Preconception care (PCC) entails a comprehensive suite of interventions to improve the health of potential parents, their babies and future generations. PCC is not limited to a first pregnancy, and addressing health and wellbeing is equally important in the interconception period. The aims of this paper are to discuss the evidence for and components of PCC, as well as the role of the general practitioner in the delivery of PCC. It is estimated that 90% of women and over 50% of men have preconception health issues to address. Although all people stand to benefit from PCC, certain population groups experience increased risk of adverse outcomes and require more targeted attention. Although most do not present for a dedicated PCC consultation, asking about pregnancy intention can start the conversation. Evidence shows that interventions delivered in primary care can improve preconception health knowledge and reduce preconception risk factors.

The Effect of Preconception Counseling According to the Theory of Planned Behavior with the Presence of the Spouse on Preconception Health Behaviors – A Training Trial Study

Background and Objective: Preconception care consists of biomedical, behavioral, and social services, along with health interventions, for women and couples before conception to improve their health status and reduce individual and environmental high-risk behaviors. This study aimed to assess to preconception counseling according to the theory of planned behavior with the presence of the spouse on preconception care behaviors. Materials and Methods: This study was an educational trial. The researcher randomly divided women into two intervention and control groups. The control group only received routine preconception care in the presence of the spouse. The intervention group, according to the theory of planned behavior, received 60-minute face-to-face counseling weekly sessions. The main outcomes of behavior were divided into two categories: screening tests and vaccinations and individual lifestyle (exercise, nutrition, and smoking). The questions also focused on men’s check-up tests. The data normality was analyzed by group, variable type, and measurement stage using the Shapiro-Wilk test and the skewness and kurtosis results. Levene's and Mochli's tests were used to check the homogeneity of variances and assumption of sphericity, respectively. Data were analyzed using independent t-tests, chi-square, repeated measures test, and SPSS 26 software. Result: The previous lifestyle behaviors were respectively 15.22 + 2.836, 15.49 + 2.769, and 16.84 + 1.894 before, immediately, and 4 weeks after the intervention in control, and 12.70 + 3.69, 15.53 + 3.02, and 16.60 + 2.73 in the intervention group, indicating no significant differences (p=0.08). However, the two groups significantly increased healthy lifestyles over time(p=0.001). The results also showed that the mean of test and vaccination was respectively 4.44 ± 2.99, 2.75 ± 6.42, and 2.49 ± 8.31 before, immediately, and 4 weeks after the intervention in control, and 4.09 + 3, 6.74 + 2.87, and 8.35 + 2.37 in the intervention group, indicating no significant differences(p=0.99). Conclusion: Since the presence of the husband during the training of women's pre-pregnancy care can affect their health behaviors regardless of the type of intervention, men are suggested to attend prepregnancy training and consultations for at least one session.

Perinatal Health Insurance And Health Care Use By Immigration Status In 6 US States, 2020-22.

Some noncitizens in the US are not eligible for public health insurance, potentially reducing access to preconception, prenatal, and postpartum care. We compared insurance coverage and health care use from the preconception period to the postpartum period by immigration status, using representative survey data collected from six US states between 2020 and 2022. Respondents were surveyed at two to six months postpartum and at twelve to fourteen months postpartum. Immigration status was classified in three categories: US citizen, permanent resident, and people who were neither citizens nor permanent residents. Compared with US citizens, fewer permanent residents had late postpartum insurance coverage, but coverage rates were otherwise similar. Coverage was lower among noncitizens/non-permanent residents compared with US citizens at every time point except pregnancy, with the largest differences at preconception (50.5percent and 90.5percent, respectively) and late postpartum (53.2percent and 95.1percent, respectively). Fewer permanent residents had health care visits before pregnancy compared with US citizens, but health care use was otherwise similar. Noncitizens/non-permanent residents had substantially lower rates of preconception health care, early and adequate prenatal care, postpartum visits, and having a usual source of care at one year postpartum. Expansion of public insurance to cover immigrants is needed to reduce large inequities in perinatal health insurance and health care use by immigration status.

Determinants of appetite in the first year of life: Results from a prospective study of infants

Abstract Childhood obesity, a growing public health problem, was shown to be associated with appetite traits (ATs) in infancy but little research exists on the determinants of early appetite. We aimed to examine the association between parental, pregnancy and infant variables on ATs during the first year of life. We followed up 450 healthy term infants assessing Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE), using the Baby (at 2-4 weeks (wk) & 6m) and the Child (at 12m) Eating Behaviour Questionnaires. Associations between parental sociodemographic and lifestyle, pregnancy, infant feeding and anthropometric factors, and these ATs were investigated. Multivariable linear regression models were built for each AT, incorporating statistically significant variables from minimally adjusted models (sex, gestational age, and ethnicity). Results primarily focus on ATs at 2-4wks, as later ATs were largely influenced by these values. Higher father’s BMI (β = 0.013, p = 0.022) was associated with increased EF at 2-4wks. Later gestational age (β = 0.106, p = 0.032), and gestational diabetes (β = 0.538, p = 0.002) were associated with higher FR 2-4wk while mixed feeding compared to exclusively breast feeding (β =-0.281, p = 0.013) with lower FR 2-4wk. Female sex (β = 0.174, p = 0.009) was positively, while gestational age (β=-0.076, 0.022), father’s educational attainment (β=-0.199, p = 0.003), father habitual smoking (β=-0.167, p = 0.020) and 4wk WFA z-score (β = 0.087, p = 0.037) were negatively associated with SR 2-4wk. Lastly, higher 4wk WFA z-score (β=-0.151, p = 0.012) and bottle feeding (β=-0.378, p = 0.003) were associated with decreased SE 2-4wk. Acknowledging that a causal association cannot be established in an observational study, this data suggests that parental lifestyle and pregnancy factors could influence infant ATs and hence risk of later obesity, highlighting the importance of preconception health in mitigating the problem of childhood obesity. Key messages • Appetite traits in early infancy are influenced by infant feeding and anthropometric variables, but also by parental and pregnancy characteristics. • The importance of preconception health is paramount in mitigating the problem of childhood obesity.

Preconception Health Education is Provided to Healthy Childbearing Couples in The Preconception Phase

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Several biological, behavioral, and social preventative strategies can improve the chances of having a healthy baby during pregnancy. Preconception health care spans the entire reproductive life cycle. Early preconception counseling should attempt to improve both women's and men's sexual and reproductive health. It should begin with early instruction on healthy lifestyle behaviors, safe sex, and pregnancy planning for childbearing couples. This research aims to develop preconception health education for family-based childbearing age couples planning a healthy pregnancy in Deli Serdang district. The Equivalent Time Series Samples approach was employed in this study as a quasi-experimental approach. The total sample size was 90 couples of reproductive age. </em><em>The analysis in this study was carried out descriptively to see the characteristics of each variable studied and to measure the effect of providing health education during the preconception period on the knowledge and perception of Couples of Childbearing Age about preconception health using a paired sample T test. The intervention provided is health education about preconception health provided to couples of childbearing age. The implementation of the research has received approval from the Health Research Ethics Committee of the Medan Health Polytechnic with the number: 01.25.174 /KEPK/POLTEKKES KEMENKES MEDAN 2023. </em><em>There is a difference in the average variable knowledge of couples of childbearing age at pretest and posttest with an increase of 5, 2778, and there is also an increase in the perception variable with an increase of 0.8889, and the results of statistical tests using the Paired Samples Test obtained show differences in respondents' knowledge and perceptions before and after the intervention. Family-based preconception health education has been effective in raising the awareness and attitudes of childbearing couples regarding the planning and preparation of a healthy pregnancy as well as in motivating them to seek a check-up at a health care facility.</em><em> </em><em></em></p><p class="TableParagraph"><strong><em> </em></strong></p></td></tr></tbody></table></div><strong><em>Keywords: Health Behavior, Health Services, Preconception Care, Pregnancy</em></strong>

Tackling inequalities in preconception health and care: barriers, facilitators and recommendations for action from the 2023 UK preconception EMCR network conference.

Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total n = 69). Interactive discussions explored barriers to achieving optimal preconception health, driving influences of inequalities and recommendations. The Socio-Ecological Model framed the identified themes, with recommendations structured at interpersonal (e.g. community engagement), institutional (e.g. integration of preconception care within existing services) and environmental/societal levels (e.g. education in schools). The co-developed recommendations provide a framework for addressing inequalities in preconception health, emphasising the importance of a whole-systems approach. Further research and evidence-based interventions are now needed to advance the advocacy and implementation of our recommendations.

Early Life Energy Balance: The Development of Infant Energy Expenditure and Intake in the Context of Obesity.

This review aims to provide a summary of the current knowledge on measurement tools and most recent evidence for prenatal and postnatal modulators of energy balance in young infants. The prevention of pediatric obesity depends upon curating the perfect imbalance of energy intake to energy expenditure, taking into consideration the energy needs for healthy growth. We summarize the recent evidence for the programming of fetal and infant metabolism influenced by maternal preconception health, prenatal metabolic milieu, and physical activity behaviors. In the early postnatal environment, caregiver feeding behaviors shape the extent of energy imbalance through dictating quantity and modality of infant energy intake. There are biological and behavioral contributors to improper infant energy imbalance. Furthermore, caregiver and clinician education on overfeeding and clinical tools to prescribe and monitor infant overgrowth are absent. Ultimately, the lack of high-quality and modern research of infant energy expenditure underpins the lack of advancement in clinical guidelines and the needed prevention of pediatric obesity.

Association between low-calorie sweetener consumption during pregnancy and child health: A systematic review and meta-analysis.

We examined the association between low-calorie sweeteners (LCS) consumption during preconception, pregnancy, and breastfeeding and child health outcomes. A systematic search of electronic databases in PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature, the Cochrane Library, Scopus, Web of Science, PsycINFO, ProQuest Health and Medical, ClinicalTrials.gov, and Google Scholar was conducted up to 21 September 2023. A random effects model with restricted maximum likelihood estimation was used for the meta-analysis. Seventeen eligible studies were included. The standardised mean difference (SMD) and 95% confidence interval (CI) in birth weight between those who frequently consumed LCS (≥1 serve/day) during pregnancy and those who did not consume LCS was 0.04 (0.00, 0.08) (four cohort studies). Any LCS consumption during pregnancy compared with no consumption was not associated with birth weight [SMD (95% CI) = 0.03 (-0.03, 0.08)] (four cohort studies). Any LCS consumption during pregnancy was not associated with body mass index z-scores. The weighted mean difference (95% CI) was 0.00 (-0.05, 0.06) at birth, 0.06 (-0.29, 0.40) at 6 months, -0.04 (-0.19, 0.10) at 1 year, 0.00 (-0.16, 0.17) at 3 years, and 0.10 (-0.15, 0.34) at 7 years of the child age, compared with no intake (five cohort studies). The odds of being overweight at 1 year among children exposed to LCS during pregnancy was 1.19 (OR [95% CI]: 1.19 [0.81, 1.58]) compared with unexposed children (two cohort studies). The effect sizes were not precise for all the outcomes as the 95% CI indicated the effect estimates could range from small protective to a higher risk. The effect of LCS consumption on child behaviour and cognition was inconsistent. There is not enough evidence to confirm LCS consumption during pregnancy affects birth weight and risk of overweight in children. However, frequent consumption increased birth weight and the risk of overweight at different ages, though the effects were imprecise. More robust research evidence is required as the quality of evidence is low.

General practice preconception care invitations: a qualitative study of women’s acceptability and preferences

BackgroundIn general practice, primary care providers can potentially use electronic medical records (EMRs) to identify and invite reproductive-aged women with preconception health risk factors to increase their engagement in preconception...

A development and implementation of a preconception counseling program for black women and men in the southeastern United States: a pilot protocol.

Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States. This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities. Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

Precision Interventions Targeting the Maternal Metabolic Milieu for Healthy Pregnancies in Obesity.

Entering pregnancy with obesity increases the risk of adverse health outcomes for parent and child. As such, research interventions are largely focused on limiting excess gestational weight gain during pregnancy, especially in those with obesity. Yet, while many lifestyle interventions are successful in reducing GWG, few affect pregnancy outcomes. Here we review work targeting the metabolic milieu instead of focusing solely on weight. Work done in non-pregnant populations suggests that specifically targeting glucose, triglyceride, and leptin levels or inflammatory makers improves the metabolic milieu and overall health. We posit that precision interventions that include strategies such as time restricted eating, following the 24h movement guidelines, or reducing sedentary behavior during pregnancy can be successful approaches benefiting the maternal metabolic milieu and minimize the risk of adverse pregnancy outcomes. Personalized tools such as continuous glucose monitors or community-based approaches play an important role in pre-conception health and should be extrapolated to pregnancy interventions to directly benefit the metabolic milieu optimizing health outcomes for both parent and child.

Advancing geospatial preconception health research in primary care through medical informatics and artificial intelligence

Established life course approaches suggest that health status in adulthood can be influenced by events that occurred during the prenatal developmental period. Yet, interventions such as diet and lifestyle changes performed during pregnancy have had a small impact on both maternal and offspring health outcomes. Currently, there is a growing body of literature that highlights the importance of maternal health before conception (months or years before pregnancy occurs) for the future health of offspring. While some studies have explored factors such as maternal body composition, nutrition, and lifestyle in this area, location-based environmental and socioeconomic exposures before conception may also contribute to future offspring health. In this line, the study of a patient's geographic history presents a promising avenue. To foster research in this direction, the integration of geospatial health, medical informatics and artificial intelligence techniques offers great potential. Importantly, novel sources of big health data sets such as electronic health records registered at the primary care level provide a unique framework due to its inherent longitudinal nature. Nonetheless, a number of privacy, ethical, and technical challenges need to be overcome for this kind of longitudinal analysis to mature and succeed. In the long-term, we support the vision of incorporating a patient's geographic history into her clinical history to equip clinicians with useful contextual information to explore.

Understanding the Experiences of Women Seeking Preconception Health Information

Understanding women’s information seeking behaviours before conception is important for the development of interventions to enhance preconception health. This project explored barriers, facilitators, and motivators towards engagement with preconception advice in women undergoing assisted reproductive technology, across BMI classifications. Twenty interviews were conducted with women attending the fertility clinic, Repromed, in South Australia. Barriers to behaviour change included challenges finding reputable information, lack of social and health provider support, and desire for secrecy. Women reported a preference for receiving health information from the internet, social media, complementary and allied health professionals. Women living with overweight reported similar behaviours and interactions.

Innovations in Preconception Care: Optimizing Health for All Individuals.

Optimizing the overall health of individuals prior to pregnancy can improve both pregnancy and lifelong health outcomes. Despite extremely high financial expenditure on birth in the United States, maternal and infant mortality rates continue to rise. Moreover, significant racial and ethnic disparities persist in perinatal health outcomes. Preconception care, or health care provided before or between pregnancies, has the capacity to meet these challenges. Preconception care can be integrated into every health care visit, including visits with primary care, reproductive health, and mental health care clinicians. Increasing awareness among clinicians of the benefits of preconception care and equipping them with innovative strategies to implement this care into practice, the number of people receiving optimal care could be increased. Recent innovations in preconception care include group care, health applications (apps), reminders in electronic health records, social marketing campaigns, social media movements, community-based partnerships, health care policy and access, and improving public and clinician education on preconception health topics. Ultimately, improving preconception health is best done in partnership between the consumer and clinician. Midwives, whose care is person-centered and partnership-focused, are well positioned to champion the innovation and implementation of equitable preconception care. The purpose of this State of the Science review, therefore, is to synthesize the literature on recent evidence-based innovations that may be used to improve preconception health and counseling.

What Does 'Preconception Health' Mean to People? A Public Consultation on Awareness and Use of Language.

There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health. A public consultation was undertaken with people of any gender aged 18-50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers. Fifty-fourpeople joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18-30 years, 30% 31-40 years, 15% 41-50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender-sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well-being during the childbearing years', 'health and well-being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School-based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness. This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co-development of public awareness campaigns and guidance for healthcare professionals. This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co-authors of the paper.

Low Pre-Conception Health Among Iraqi College Women Linked to Age and Socioeconomic Status

This study explores pre-conception health behaviors among female college students at the University of Baghdad, highlighting a critical gap in non-Western contexts. Conducted from October 2023 to March 2024 with 144 participants, the cross-sectional study assessed pre-pregnancy health behaviors using a validated 5-point Likert scale. Results showed that 74.4% of students exhibited low pre-conception health behaviors, with significant predictors being age (p = 0.008), academic grade (p = 0.041), and socioeconomic status (p = 0.035). The average participant age was 20.63 years, with most in their first academic year and living with parents. The findings emphasize the need for targeted interventions and educational programs to improve pre-pregnancy health awareness and behaviors in this demographic. Highlights: High Prevalence: 74.4% exhibited low pre-conception health behaviors. Influential Factors: Age, grade, and socioeconomic status significantly impacted behaviors. Intervention Needed: Educational programs essential for improving pre-conception health awareness. Keywords: pre-conception health, female college students, predictive factors, socioeconomic status, health behaviors

P-732 Analysis of health and lifestyle behaviour data from 300,065 UK-based women to analyse preconception lifestyle choices in the context of the broader female population

Abstract Study question Do health and lifestyle behaviours from 300,065 UK-based women indicate preconception choices exceeding national recommended limits? Summary answer The majority indulged in lifestyle behaviour(s) that negatively impact fertility despite actively trying to conceive or wanting to start a family in the future. What is known already Existing knowledge underscores the impact of alcohol consumption, drug use, smoking, and vaping on preconception health and fertility. Understanding the associated risks is crucial for optimising reproductive outcomes. Awareness regarding limits of exposure and intake also remains low, hindering informed decision-making. This study, examining data from 300,065 UK-based women, aims to bridge this gap by shedding light on the prevalence of lifestyle choices and their potential implications for fertility. Emphasising the need for heightened awareness, the findings can contribute to informed preconception counselling, promoting healthier lifestyle choices and empowering individuals with the knowledge needed for optimal reproductive well-being. Study design, size, duration A cross-sectional study was conducted on 300,065 women aged 18-58 who used an at-home hormone testing service between September 2020 and January 2024. Users were asked to complete an online health assessment (OHA) assessing demographics, menstrual cycle history, lifestyle and medical history and asked to select one or more categories that best described them - planning for the future (PFF), actively Trying to Conceive (TTC), just curious about their reproductive health, concerned only about symptoms. Participants/materials, setting, methods Among the 300,065 users, 133,682 were PFF, 76,692 were TTC, 81,257 were just curious, and 42,966 were only concerned about symptoms. We analysed the lifestyle habits of users including alcohol consumption, smoking, vaping and recreational drug use. Only users who were PFF, TTC or just curious were included in the analysis. Counts, means and percentages of completed VHAs were calculated using R software. Main results and the role of chance For those TTC, the mean age was 30.7, 39.53% (n = 30,317), consumed 1-14 units of alcohol weekly, 3.95% (n = 3,028) exceeded 14 units, 21.95% (n = 16,834) regularly or occasionally smoked, 22.40% (n = 9,436) regularly or occasionally vaped, and 7.06% (n = 5,415) used recreational drugs regularly or occasionally. Among those PFF, the mean age was 28.3, 57.27% (n = 76,556) consumed 1-14 units of alcohol weekly, 5.31% (n = 7,095) exceeded 14 units, 22.86% (n = 30,566) regularly or occasionally smoked, 27.29% (n = 21,002) regularly or occasionally vaped, and 13.52% (n = 18,071) used recreational drugs regularly or occasionally. For those who were just curious, the mean age was 27.9, 58.10% (n = 30,602) consumed 1-14 units of alcohol weekly, 5.70% (n = 3,010) exceeded 14 units, 21.17% (n = 11,143) regularly or occasionally smoked, 28.53% (n = 15,018) regularly or occasionally vaped, and 14.63% (n = 7,701) used recreational drugs regularly or occasionally. Limitations, reasons for caution As all data was self-reported, there is a risk of recall bias and inaccurate reporting. As the users who completed the OHA were seeking a reproductive healthcare service, there is likely a bias in the selection criteria of study participants. Wider implications of the findings Although those TTC demonstrated fewer adverse lifestyle behaviours our data demonstrates that a significant number were still not following national recommendations. This highlights the need for tailored preconception education to improve fertility awareness and uptake of practices to improve preconception health and pregnancy outcomes. Trial registration number NA

O-135 The consequences of paternal pre-conceptional health for offspring health and pregnancy outcomes: involvement of the germ-cell epigenome and non-germ cell factors

Abstract Study question Paternal health at conception is important for offspring health. The susceptibility windows within the male reproductive tract and the molecular mechanisms are not completely understood. Summary answer Using mouse genetics, (epi)genomics and in-depth phenotyping, we show that the germ-cell epigenome and components of the seminal fluid are critical for paternal intergenerational effects. What is known already Paternal intergenerational effects are highly conserved across mammals and lower organisms including flies and nematodes. In mammals, the sperm epigenome, as well as the composition of the seminal fluid are sensitive to environmental challenges and influence offspring development and adult phenotypic trajectories. The best known of these mechanisms are DNA methylation and small non-coding RNAs in spermatozoa and the balance between inflammatory and tolerogenic cytokines in the seminal fluid. Small non-coding RNAs are mostly acquired by maturing spermatozoa during the epididymal transit from extracellular vesicle of epididymal epithelial origin, and have the potential to influence embryonic development and offspring health. Study design, size, duration We use two paternal paradigms of pre-conceptional challenge in wild-type C57BL6 mice: high-fat diet feeding for 2 weeks and circadian disruption for 4 weeks before conception. The duration of the environmental challenges has been chosen to meet timing of sperm maturation in the mouse (high-fat diet) or to be the minimum sufficient to induce circadian disruption without overt side effects. Exposed males and their offspring have undergone deep metabolic and molecular phenotyping. Participants/materials, setting, methods We used both bulk and single cell (epi)genomics on exposed males as well as male and female offspring. The molecular phenotyping has been instructed by the results of the metabolic phenotyping performed in collaboration with the German Mouse Clinic, the biggest mouse clinic in Europe, using highly standardized and robust procedures. Importantly, we have used a family-based approach for the data analysis, according to which the experimental n is the exposed father. Main results and the role of chance Paternal circadian disruption achieved by four weeks of day-restricted feeding (food only during the light phase), leads to hyperphagia, hyperglycemia, hypercorticosteronemia and partial circadian disruption in unexposed male offspring. The phenotypes are gender-specific and the females feature partial protection from the paternal effects. Mechanistically, mouse seminal fluid contains corticosterone, whose appearance dynamic follows the organismal circadian rhythm and is blunted upon circadian disruption. Offspring phenotypes are sensitive to the levels of corticosterone in the seminal fluid and consequential to impaired placentation, reduced placental efficiency and fetal growth restriction. Paternal exposure to an acute high-fat diet challenge, instead, leads to a 30% penetrant glucose intolerance phenotype exclusively in male offspring. Mechanistically, this is linked to diet-induced mitochondrial dysfunction in somatic and germ cells and a compensatory burst of mitochondrial DNA transcription in spermatozoa. Mitochondrial DNA encoded small non-coding RNAs accumulate in spermatozoa, are inherited at fertilization, and reprogram early embryo transcription towards premature activation of oxidative metabolism, a predisposing factor to adult-onset glucose intolerance. Importantly, phenotypes and mechanisms are conserved across highly characterized human cohorts. These studies strengthen the importance of paternal health at conception for pregnancy and offspring health and identify germ-cell and non-germ cell factors as potential mechanistic mediators. Limitations, reasons for caution Although we have shown for the first time that stress hormones are present in the seminal fluid and relay paternal stress to the offspring and provided the first example of epigenetic inheritance of sperm small non-coding RNAs, mechanisms are still to be completely uncovered. Complementary mechanisms cannot be excluded. Wider implications of the findings Our findings strengthen the importance of paternal health at conception for pregnancy and offspring health. They also provide potential male tract biomarkers and novel strategies to monitor paternal health at conception and preconception lifestyle interventions aimed at improving pregnancy outcomes and preventing the spread of metabolic disorders through epigenetic inheritance. Trial registration number not applicable

Preconception indicators and associations with health outcomes reported in UK routine primary care data: a systematic review.

Routine primary care data may be a valuable resource for preconception health research and informing provision of preconception care. To review how primary care data could provide information on the prevalence of preconception indicators and examine associations with maternal and offspring health outcomes. Systematic review of observational studies using UK routine primary care data. Literature searches were conducted in five databases (March 2023) to identify observational studies that used national primary care data from individuals aged 15-49 years. Preconception indicators were defined as medical, behavioural and social factors that may impact future pregnancies. Health outcomes included those that may occur during and after pregnancy. Screening, data extraction and quality assessment were conducted by two reviewers. From 5,259 records screened, 42 articles were included. The prevalence of 30 preconception indicators was described for female patients, ranging from 0.01% for sickle cell disease to >20% for each of advanced maternal age, previous caesarean section (among those with a recorded pregnancy), overweight, obesity, smoking, depression and anxiety (irrespective of pregnancy). Few studies reported indicators for male patients (n=3) or associations with outcomes (n=5). Most studies had low risk of bias, but missing data may limit generalisability. Findings demonstrate that routinely collected UK primary care data can be used to identify patients preconception care needs. Linking primary care data with health outcomes collected in other datasets is underutilised but could help quantify how optimising preconception health and care can reduce adverse outcomes for mothers and children.

Healthcare professional perspectives on improving inter-pregnancy care after a baby loss for women with type 1 and type 2 diabetes.

Women with diabetes (WWD) (type 1 and type 2) are around four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death or termination of pregnancy for medical reasons. Many WWD become pregnant again soon after loss. This study aimed to explore healthcare professional perspectives on improving inter-pregnancy care for WWD after baby loss, as they play a crucial role in facilitating access to support for WWD to prepare for subsequent pregnancy. Eighteen healthcare professionals recruited through social media and professional networks between November 2020 and July 2021 participated in a semi-structured remote interview. Data were analysed using thematic analysis. Three main themes were identified: (1) supporting WWD who want to become pregnant again after baby loss; (2) recognising multiple hidden burdens in the inter-pregnancy interval after loss; (3) discontinuities and constraints in inter-pregnancy care. Most participants tended to assume WWD wanted time and space before thinking about pregnancy after loss, so they did not routinely broach the subject. Participants reported receiving little or no training on managing sensitive conversations. Care provision varied across providers, and unclear referral pathways were challenging to navigate. Participants reported concerns that not all healthcare professionals knew how to mitigate pregnancy risks. It is unclear who is responsible for supporting WWDs preconception health between baby loss and subsequent pregnancy. Healthcare professionals may be reticent to initiate conversations about pregnancy for fear of causing upset or distress. Future research is required to scope out ways to raise awareness among healthcare professionals and practical tips on sensitively raising the topic of subsequent pregnancy.