There are always decision points when writing a book about what to include and what not to include. Given that there were over 200 references, I think we covered a lot of ground! But there is always more. Certain things didn’t quite make their way into the book and I thought I’d highlight a few of them over the coming weeks.
This first one is a graphic from Preconception Health in England. It shows just how interconnected the preconception, prenatal and postpartum periods are with the lifelong development of that child. In particular, preconception health “...is a critical period for influencing not only pregnancy outcomes, but also future maternal and child health and prevention of long term conditions.”
The study explores the premise that the health, behavioral and environmental exposures during the preconception period can have far-reaching consequences not only for pregnancy outcomes but also for health across generations. In essence, preconception exposures contribute to the developmental origins of health and disease.
Because of this, the UK developed The Preconception Partnership to figure out how to implement preconception health measures into policy and practice. The Partnership proposed an annual report to assess the status of preconception health.
Making preconception health a priority involves both providers and patients.
How can we prepare our providers?
How can we prepare our population?
The goal here is to increase preconception awareness; from there, we can encourage people to plan and prepare for pregnancy.
“Awareness refers to recognition at any age that health before conception affects the chances of a healthy pregnancy and baby, as well as disease risk in later life.” In particular, it’s important to educate people on why health is something to consider before, rather than after, a pregnancy occurs.
From there, “planning implies a conscious intention to become pregnant in the near-to-medium future.”
Finally, “Preparation means taking action to improve health before pregnancy.”
How do we track these initiatives?
The study proposed a variety of measures to track progress, including but not limited to:
- Monitoring household expenditures, among those of childbearing years, “...on food categories that are markers of healthy or unhealthy preconception diet including fruit and vegetables, wholemeal versus white bread, takeaway foods and sugar sweetened drinks”
- Monitoring supplement sales
- Leveraging national surveys regarding smoking, alcohol, BMI, physical activity and fruit and vegetable consumption, as well as biomarkers (such as blood pressure, cholesterol and glycated hemoglobin) and vaccination coverage
We understand the fundamental link between preconception health and developmental origins of disease; however, there is still much more to discover. They acknowledge the importance of being able to collect this data and tie it to outcomes to refine the approach even further. “The ability to link big data across high quality datasets is particularly exciting; it brings new opportunities to track individual reproductive health trajectories - from preconception to first pregnancy, interconception and subsequent pregnancies at scale. It means we can go beyond a national picture of preconception health to examine associations between preconception exposure and outcomes, spanning, for example, maternal obesity or diabetes to preterm and still births, child health and cognitive development. We can also explore evidence for the effectiveness of preconception interventions in improving such outcomes.”
I’m impressed by the comprehensiveness of this approach and the efforts to establish data transparency with an annual report card. I hope to see this proactive and comprehensive approach adopted more broadly around the world.
Source (including image):
Stephenson, J, Vogel, C, Hall, J et al. (14 more authors) (2019) Preconception health in England: a proposal for annual reporting with core metrics. The Lancet, 393 (10187). pp. 2262-2271. ISSN 0140-6736
https://doi.org/10.1016/S0140-6736(19)30954-7