• Amy Cuthbertson

The importance of lifestyle and health optimisation in preconception “ground zero trimester”

Care before pregnancy can increase the health and well-being of couples and improve subsequent pregnancy and child health outcomes. There is however a risk of medicalising reproduction and of intruding into the privacy of couples and controlling their bodies, so communication about preconception should be done with care.

Preconception care is the provision of biomedical, social and behavioural interventions to couples, aimed at improving their health and reducing behaviours, individual and environmental risk factors that could contribute to poor maternal and child health outcomes. Its ultimate aim is improved parental and child health outcomes, in both the short and long term. It also provides a window to include interventions not traditionally included post-conception, such as reduction in use of and exposure to tobacco smoke.

Preconception, couples should allow plenty of time for planning and care before trying to get pregnant. They should both make sure their lifestyle is as healthy as possible. It increases their chances of conceiving if they are both in good health. A bad diet, alcohol consumption, and unhealthy working conditions can affect the quality of sperm. Sufficient nutrient intake and a good nutritional status of the mother are important for optimal development of the foetus. Therefore a healthy varied diet, regular exercise and managing stress is really important before conception as well as during pregnancy. Too much or too little body fat can make women have irregular periods or stop them completely, which can affect ability to conceive. Women are advised to take folic acid supplements before conception (and during pregnancy) to lower the risk of neural tube defects in the foetus. Women who are planning a pregnancy are also advised to stop drinking alcohol and smoking. It is also important to check all your vaccines are current as certain infections are dangerous to the foetus. It is also worth doing preconception screening for sexually transmitted infections which can pose risks to the mother and foetus. A preconception assessment of any family history of specific medical conditions is recommended if such genetic conditions are a concern.

Preconception care in the short term helps reduce pregnancies that are unplanned, too early or that are too close together. It contributes to reducing the risk of genetic disorders, environmental exposure, maternal and childhood mortality. It can also improve health in other areas such as nutrition, infertility and subfertility, mental health, intimate partner relations and sexual violence, and substance use. In the long term, it can contribute to improving the health of children as they grow into adolescence and beyond. One study found that suboptimal heart health in pregnant mothers is associated with poorer heart health in their childrens' adolescence between 10-14 years of age. The gut microbiome during pregnancy is associated with the future health of babies as well. Gut dysbiosis can lead to overweight, obesity, neurodevelopmental and chronic gut disorders in babies.

By supporting couples in making well-informed decisions about their fertility and health, preconception care can contribute to the social and economic development of families and communities. By promoting male involvement, it also has the additional benefit of creating greater awareness of the importance of men’s health and men’s behaviours on maternal and child health outcomes.

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