The Vital Importance of Preconception Health

A greater focus on preconception could improve the health of generations to come

Chayene Rafaela from Unsplash

Inspiration for this post came in part from the work of Prof. Judith Stephensen

If you’d like to reach out you can find my contact details here. I work with a number of companies as a medical advisor.

Preconception health is incredibly important but, unfortunately, is often overlooked. Studies have shown strong links between the health of would-be parents before pregnancy and maternal and child health outcomes, with consequences that can extend across generations.

Awareness of this connection is generally low and efforts to improve preconception health are often implemented too late to have a significant impact leading to worse overall outcomes for mothers and children.

In this post we discuss the opportunity and the need for a sharper focus on preconception health to improve maternal and child health.

The Preconception Window of Opportunity

Studies show that while the majority of pregnancies are planned, the awareness of the importance of preconception health is generally low. This means there is a significant opportunity for positive interventions in the preconception period if these women and couples can be reached at the right time.

One study found that 73% of women had planned their pregnancy, yet of those 37% weren’t taking folic acid, an essential supplement in the preconception period to help prevent birth defects.

The preconception period may represent a time of unusually high levels of motivation therefore represents an opportune time for health interventions. One study found that 51% of those that received preconception health advice made lifestyle improvements.

In another study, 65% of obese women that attended a family planning clinic to come off long-term contraception to become pregnant were willing to improve their preconception health by deferring removal of contraception for 6 months while they followed an intensive weight loss plan.

Why Preconception Health Matters

To put it simply, the healthier you are at the time of pregnancy, the healthier you, your pregnancy and your child are likely to be. And this isn’t just in the early years of the child’s life. Data suggests that the impact could extend across generations. That means your preconception health could impact your future grandchildren!

A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child

Here are some possible impacts of poor preconception health:

1. Birth Defects: Certain nutritional deficiencies, such as a lack of folic acid, can increase the risk of birth defects. Similarly, uncontrolled diabetes in the mother can increase the risk of congenital heart defects and other organ malformations in the baby.
2. Preterm Birth and Low Birth Weight: Conditions like hypertension, obesity, and diabetes, if not well-managed before and during pregnancy, can increase the risk of preterm birth and low birth weight. These conditions can have long-term impacts on a child’s health and development.
3. Developmental Problems: Exposure to alcohol, tobacco or illicit drugs before and during pregnancy can lead to a range of developmental problems in children. These can include cognitive impairments, behavioural problems and physical development issues.
4. Chronic Health Conditions: Emerging research suggests that a mother’s health and nutritional status before and during pregnancy can influence the child’s risk of chronic health conditions later in life, such as obesity, diabetes, and heart disease. This is known as the “Developmental Origins of Health and Disease” (DOHaD) hypothesis.

Timing matters

To have a positive impact on the health of your child, timing is crucial. Studies that have looked at the effect of women improving their nutrition and lifestyle once they knew they were pregnant have been disappointing from a child health perspective.

Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but the effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Interventions need to happen weeks or months prior to conception to confer benefit to the child.

Since no-one knows how long it will take to become pregnant and many women become pregnant within the first few cycles, it is important we reframe the preconception window from the days and weeks leading up to conception, to months and even years before conception. This is because some health improvements can take time, such as reaching a healthy weight.

Taking a Broader View of Preconception Health

The typical advice to take folic acid and stop smoking, drinking and taking drugs is important but does not achieve optimal outcomes. For those that want to maximise their preconception health there are other things to consider:

Optimal Nutrition

Micronutrient deficiencies (a lack of essential vitamins and minerals) are incredibly common. In fact the World Health Organisation (WHO) estimates 2 billion people (or 25% of the global population) have a micronutrient deficiency with women being particularly at risk due to menstruation and the nutritional and metabolic demands of pregnancies.

This is not just a problem faced in developing countries. In the UK the vast majority of women of reproductive age are not nutritionally prepared for a pregnancy.

A study found that 96% of young women did not meet the daily recommendations for pregnancy for iron and folate and 77% of women did not meet even the lower reference nutrient intake (RNI) amounts for iodine. Other common dietary deficiencies include vitamin b12 (especially important for vegans), calcium, potassium, selenium and zinc.

Deficiencies in these key nutrients can have a major impact on the future health of a child. Folate deficiency increases the likelihood of neural tube defects (a type of birth defect) and even a mild degree of iodine deficiency has been linked to lower intelligence in offspring. Iron is also important for a number of factors in child health.

Healthy Weight

There are substantial risks for maternal and child health associated with mothers who are underweight or overweight.

Although the proportion of women who are underweight has decreased, global levels for overweight and obesity are climbing rapidly. The World Obesity Atlas estimates over 4 billion people may be affected by 2035, compared with over 2.6 billion in 2020. This reflects an increase from 38% of the world’s population in 2020 to over 50% by 2035!

Possible consequences of obesity include difficulty conceiving; complications of pregnancy, including pre-eclampsia and gestational diabetes, and delivery; congenital anomalies; stillbirth and low birthweight.

Several studies have proposed that maternal and paternal obesity increases the risk of obesity in future generations hence achieving a health weight in the preconception period could be an important tool in managing rising global obesity rates.

Hormone Balance & Endocrine Disrupting Chemicals

As well as optimal nutrition and a health weight, hormonal health and exposure to endocrine disrupting chemicals (EDCs) play an important part in preconception health. I’ve written previously about EDCs here.

There is a hypothesis that for women with hormonal imbalances such as those seen in polycystic ovary syndrome (PCOS) this can impact the fetus’ endocrine system in a process called ‘fetal programming’. Some evidence points to this in human studies and experimental animal studies have also shown a strong connection. PCOS is a strongly lifestyle driven condition and lifestyle interventions can improve overall hormonal balance however this takes time to achieve. For women with conditions relating to hormonal imbalance, taking steps to improve their hormone health may lead to better outcomes.

Endocrine disruptors are chemicals that can interfere with the body’s endocrine system, which regulates hormones. These chemicals are found in many everyday products, including plastics, cosmetics, and pesticides. Increasingly, research is highlighting the potential impact of these disruptors on preconception health and the health of future generations. Taking steps to minimise exposure in the preconception phase and in early pregnancy can be beneficial.

Preconception Health for Men

Preconception Health is important for men as well as women. For example paternal obesity has been linked to impaired fertility by affecting sperm quality and quantity and is associated with increased chronic disease risk in offspring.

A growing number of animal studies and a limited number of epidemiological studies show that paternal environmental exposures before conception, including EDC exposures, can influence the health of offspring. Recent research has shown that paternal phthalate exposure specifically before conception can affect offspring birthweight and behaviour.

Conclusion

The preconception period represents a key time for child health. Interventions made during pregnancy have shown disappointing results when it comes to child health outcomes. Given no-one knows how long it will take to become pregnant and many women become pregnant in the few cycles, waiting until the point of actively trying to conceive is too late.

To have a positive impact, nutritional deficiencies need to be corrected months before conception. Additionally a healthy weight can take time to achieve therefore preconception weight loss advice may need to be given months or years prior to the point of conceiving.

Given this, the preconception period needs to shift to be a lot longer in the minds of would-be parents and healthcare providers. A sharper focus on this crucial period could help reduce the burden of non-communicable diseases, such as obesity, in future generations which are becoming rife.

Practical Advice

If you’re interested in improving your preconception health, I invite you to consider the following:

• Follow the NHS guidance at a minimum
• Try to ensure you’re meeting the minimum intake requirements for vitamins and minerals, especially folate, iron, iodine, potassium, zinc, selenium and vitamin B12 (especially important for vegans)
• Take folic acid and vitamin D as per the NHS guidance
• Try to maintain a healthy weight
• Optimise any long-term health conditions — visiting your GP can help

If you have thoughts on the above I’d love to hear from you in the comments. If you’re a founder or investor in the space I’d love to chat with you. You can find my contact details here. I work with a number of companies as a medical advisor.

References

• Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018 May 5;391(10132):1830–1841. doi: 10.1016/S0140–6736(18)30311–8. Epub 2018 Apr 16. Erratum in: Lancet. 2018 May 5;391(10132):1774. PMID: 29673873; PMCID: PMC6075697.
• Stephenson J, Patel D, Barrett G, Howden B, Copas A, Ojukwu O, Pandya P, Shawe J. How do women prepare for pregnancy? Preconception experiences of women attending antenatal services and views of health professionals. PLoS One. 2014 Jul 24;9(7):e103085. doi: 10.1371/journal.pone.0103085. PMID: 25058333; PMCID: PMC4109981.
• World Obesity Atlas 2023. Link
• Godfrey KM, Gluckman PD, Hanson MA. Developmental origins of metabolic disease: life course and intergenerational perspectives. Trends Endocrinol Metab. 2010 Apr;21(4):199–205. doi: 10.1016/j.tem.2009.12.008. Epub 2010 Jan 14. PMID: 20080045.
• Braun JM. Early-life exposure to EDCs: role in childhood obesity and neurodevelopment. Nat Rev Endocrinol. 2017 Mar;13(3):161–173. doi: 10.1038/nrendo.2016.186. Epub 2016 Nov 18. PMID: 27857130; PMCID: PMC5322271.
• Hamra GB, Lyall K, Windham GC, Calafat AM, Sjödin A, Volk H, Croen LA. Prenatal Exposure to Endocrine-disrupting Chemicals in Relation to Autism Spectrum Disorder and Intellectual Disability. Epidemiology. 2019 May;30(3):418–426. doi: 10.1097/EDE.0000000000000983. PMID: 30789431; PMCID: PMC6456403.
• Braun JM. Pre-conception susceptibility to endocrine disruptors. Nat Rev Endocrinol. 2018 Sep;14(9):505–506. doi: 10.1038/s41574–018–0057–6. PMID: 29970916.