Relation of preconception eating behaviours to dietary pattern trajectories and gestational weight gain from preconception to late pregnancy

Studies examining preconception eating behaviours with longitudinal dietary patterns from preconception to late pregnancy as well as gestational weight gain (GWG) are limited. We derived dietary pattern trajectories from preconception to late-pregnancy, and related preconception eating behaviours to these trajectories and GWG. Preconception eating behaviours were assessed using the Three-Factor Eating Questionnaire measuring cognitive restraint (CR) - conscious restriction of food intake, emotional eating (EE) - overeating in response to negative emotions, and uncontrolled eating (UE) - overeating with a feeling of lack of control. Dietary intakes were measured at preconception, 20-21 and 34-36 weeks' gestation with food frequency questionnaires. Dietary patterns were determined using factor analysis, and trajectories derived using group-based trajectory modelling. Inadequate and excessive GWG were defined according to Institute of Medicine guidelines based on weights at preconception and the last antenatal visit (median: 38 weeks' gestation). Two dietary patterns were derived: 'Fast Food, Fried Snacks and Desserts (FFD)' and 'Soup, Fish and Vegetables (SFV)'. Adherence trajectories from preconception to late-pregnancy were characterised as consistently high ("stable-high") and low ("stable-low"). Women with higher UE scores had higher odds of being in the "stable-high" trajectory (n = 34) of the FFD pattern [Odds Ratio (OR): 1.25, 95% Confidence Interval (CI): 1.03, 1.51], compared to "stable-low" (n = 260). Percentages of women with inadequate, adequate or excessive GWG were 21.7% (n = 70), 25.8% (n = 83), and 52.5% (n = 169), respectively; women with higher EE scores had a higher likelihood of excessive GWG [Relative Risk Ratio (RRR): 1.35, 95% CI: 1.02, 1.80], but this association was attenuated after adjusting for preconception body mass index. Eating behaviour interventions to improve dietary patterns among pregnant women may need to start as early as preconception, incorporating strategies to manage UE.

The preferences of people in Australia to respond and engage with advertisements to promote reproductive health: Results of a discrete choice experiment

Objectives

The health of people prior to pregnancy impacts pregnancy outcomes and childhood health, making the preconception period an important time to optimise health behaviours. Low awareness of the importance of this issue is a recognised barrier to achieving good preconception health. Public health messaging can help to address this barrier.

Methods

A discrete choice experiment to assess the preferences of people of reproductive age for a health promotion advertisement for preconception health was conducted. Attributes of the advertisement image, title, additional text content and positioning, and the location of advertisement were assessed by fitting a mixed logit model to the choices made.

Results

Three hundred and thirty-four responses were obtained, from people of reproductive age, both planning and not planning a pregnancy, in Australia. Participants placed most importance on the image, and the location in which they saw the advertisement. An image of adult and baby hands was preferred to adult hands only, and healthcare settings were preferred to more general media locations such as advertising online or on public transport. Preference was also given to the advertisement title of "Healthy you, Healthy baby", closely followed by "Are you ready for pregnancy?". The location and content of additional text did not significantly impact engagement with the advertisement.

Conclusion

The image and title on the advertisement, and the locations in which they are placed were the most significant features to impact engagement with a health promotion advertisement for preconception health. This can inform health promotion efforts for preconception health.

Assessing preconception exposure to environmental chemicals and fecundity: Strategies, challenges, and research priorities

In 2022, approximately one out of six people globally experienced infertility at some point in their life. Environmental chemicals, particularly those with endocrine disrupting activity, may contribute to impaired fecundity and infertility. We review existing prospective cohort studies of environmental chemicals and fecundity, identify methodological challenges and biases, and outline future research priorities. Studies of preconception environmental chemical exposures and fecundity have occurred in US, Singapore, China and Denmark with recruitment as early as 1982-1986, as recent as 2015-2017 and sample sizes ranging from 99 to 936. Higher exposure to certain chemicals (e.g. heavy metals, perfluoroalkyl substances) was associated with longer time to pregnancy; yet the literature is scarce or nonexistent for many chemicals. Furthermore, prospective studies face challenges and potential biases related to recruiting participants prior to conception, measuring environmental chemicals during critical windows of exposure, and ascertaining when pregnancy occurred. Research priorities include expanding the scope of biomonitoring data collected during the preconception period, continuing to develop and validate analytic methods for self-sampled biospecimens in traditional and novel matrices, collecting data in male partners and investigating etiologic associations according to indicators of marginalization.

Preconception Non-criteria Antiphospholipid Antibodies and Risk of Subsequent Early Pregnancy Loss: a Retrospective Study

The aim of this study was to investigate the subsequent early pregnancy outcomes in women positive for non-criteria antiphospholipid antibodies (NC-aPLs) before pregnancy. A total of 273 patients who had experienced sporadic or recurrent pregnancy loss and had been screened for 13 NC-aPLs at preconception were recruited in this study from September 2019 to February 2022. Serum levels of NC-aPLs were measured by ELISA using specific kits. The primary outcome was early pregnancy loss, and the secondary outcomes were biochemical pregnancy, clinically confirmed pregnancy loss, and ongoing pregnancy. Among these subjects, 56 patients had one previous pregnancy loss, and 217 had recurrent pregnancy loss (RPL). The NC-aPLs (+) and NC-aPLs (-) groups had similar rates of early pregnancy loss (EPL) after adjustment, regardless of the number of positive NC-aPLs (aOR = 1.054, 95% CI 0.602-1.846). Other outcomes were comparable in both groups, including the rates of biochemical pregnancy (aOR = 1.344, 95% CI 0.427-4.236), clinically confirmed pregnancy loss (aOR = 0.744, 95% CI 0.236-2.344), and ongoing pregnancy (aOR = 0.949, 95% CI 0.542-1.660). Based on sensitivity analysis, the NC-aPLs (+) were not associated with adverse early pregnancy outcomes in women with RPL. Furthermore, the difference in gestational weeks of pregnancy loss between the two groups was also insignificant. This study found no evidence linking preconception NC-aPL positivity to early pregnancy outcomes but offers a reference for future research to clarify NC-aPLs' potential clinical impact.

Micronutrient supplement recommendations in pregnancy vary across a geographically diverse range of countries: a narrative review

Specific food supplements are essential during preconception and pregnancy to ensure adequate intake of vitamins and minerals to support fetal growth and development and metabolic changes in the maternal body. Our objective was to identify food supplement recommendations, particularly those of folic acid, iron, Vitamin D, and iodine, during preconception and/or pregnancy across a geographically diverse range of countries. Further, we investigated whether country location and income-level related to the recommendations. We performed an electronic search and identified country-specific preconception and pregnancy food supplement recommendations, policy documents, and official guidelines of national organizations informing recommendations. To ensure the data were as accurate as possible, country-specific experts were contacted. Data were collected in 2017 and reevaluated in 2022. Country income level was determined by the World Bank classification. Each inspected country (n = 43) recommended folic acid supplementation, typically 400 µg/day, before and during pregnancy. About half of the countries recommended an iron supplement (dose range, 16-195 mg/day) and one quarter Vitamin D (typically 10 µg/d in higher latitudes) and iodine (150-200 µg/day). Country location and income level had some influence on the recommendations. Vitamin D was more often recommended in higher latitude, high-income countries. Almost all upper-middle and lower-middle income countries recommended iron supplementation, whereas less than one third of high-income countries had a corresponding recommendation. Findings suggest that food supplement recommendations for pregnant women vary across countries, likely influenced by geographic location as well as income level. These data may be used in the harmonization of food supplement recommendations.

Part 1: Preconception and pregnancy

Midwifery services play an important role in healthcare provision, birth preparation and prevention. Knowledge on women's expectations, preferences and needs regarding midwifery care is crucial not only for clinical care during preconception and pregnancy and research, but also for educational purposes. This descriptive qualitative study aimed to investigate the expectations, preferences and the needs of women concerning midwifery care in Germany. Experienced researcher team conducted interviews with women who have the desire to get pregnant and online focus groups with women in early and late pregnancy. A purposeful recruitment strategy with maximum variation sampling was applied to reach diversity in the sample regarding age, previous children and socioeconomic background. A total of 26 women participated. In the qualitative content analysis according to Mayring, seven main categories were developed for both preconceptional phase and pregnancy: (a) care by midwife, (b) care by obstetrician, (c) involvement of family, (d) need for information, (e) physical aspects, (f) psychological aspects and (g) orientation in healthcare system. One additional category referenced (h) organisation and bureaucracy in pregnant women. Women appreciated the personalised experience provided by midwives leading to trust and empowerment. Women's experiences with midwifery care varied. They reported contradictory information they received about services and care options. They valued interprofessional cooperation, continuity of care, structured information and personalised counselling. Midwives play an important role in healthcare provision, birth preparation and prevention. In order to depict the care situation quantitatively, to personalise care and to optimise healthcare models, a tool to assess the quality of healthcare and to evaluate women's needs and benefits of midwifery care will be developed based on the findings of this study. From the public health perspective, deficits in the German healthcare system concerning insufficient intra-sectoral communication, time pressure and low remuneration should be resolved in further research steps and policy action.

Association of maternal preconception blood pressure with preterm birth: a population-based cohort study

The association between maternal preconception blood pressure (BP) and preterm birth (PTB) is still unclear. The purpose of this study was to investigate the association between maternal preconception BP and PTB. This population-based cohort study included 715 984 Chinese women aged 20-49 years who participated in the National Free Preconception Health Examination Project and successfully had a singleton livebirth during 2014-2019 in Guangdong Province, China. Maternal preconception BP were measured by trained health workers. Multivariate logistic regression models and restricted cubic spline regressions were used to examine the association and dose-response relationship between maternal preconception BP and PTB, respectively. Maternal preconception hypertension was associated with the increased risk of PTB (adjusted odds ratios (aOR): 1.24; 95% CI: 1.14-1.34). Compared to women with normal preconception BP, the aORs for PTB were 1.09 (95% CI: 1.06-1.12), 1.24 (95% CI: 1.13-1.36), and 1.43 (95% CI: 1.15-1.79) for women with preconception elevated BP (120-139/ 80-89 mmHg, stage-1 hypertension (140-159/ 90-99 mmHg, and stage-2 hypertension (160-179/100-109 mmHg), respectively. According to the 2017 American College of Cardiology/American Heart Association criteria, maternal preconception elevated BP and hypertension were also significantly associated with an increased risk of PTB. Preconception systolic and diastolic BP showed a U-shaped (χ2 = 40.54; nonlinear P < 0.001) and linear (χ2 = 6.62; nonlinear P = 0.085) dose-response relationship with PTB, respectively. The association was modified by maternal age and preconception body mass index. These findings identify maternal preconception elevated BP and hypertension as a modifiable risk factor for PTB, providing evidence for future research studies, public health and clinical interventions.

Unlocking the Path to Healthier Families: The Untapped Potential of Men's Preconception Health

This debate paper explores the necessity of introducing a comprehensive primary care model for men's preconception health. It highlights the importance of a holistic approach that includes risk assessment, health promotion, and clinical and psychological interventions. Despite the current limited focus on male preconception health in primary care, there is evidence suggesting a growing awareness among men about the importance of optimizing their health before conception. The paper stresses the importance of such a model in addressing various aspects of men's well-being, family dynamics, and overall reproductive health outcomes. It also acknowledges potential limitations and considerations related to implementing this crucial healthcare approach.

Impact of preconception and antenatal supplementation with myo-inositol, probiotics, and micronutrients on offspring BMI and weight gain over the first 2 years

BACKGROUND

Nutritional intervention preconception and throughout pregnancy has been proposed as an approach to promoting healthy postnatal weight gain in the offspring but few randomised trials have examined this.

METHODS

Measurements of weight and length were obtained at multiple time points from birth to 2 years among 576 offspring of women randomised to receive preconception and antenatally either a supplement containing myo-inositol, probiotics, and additional micronutrients (intervention) or a standard micronutrient supplement (control). We examined the influence on age- and sex-standardised BMI at 2 years (WHO standards, adjusting for study site, sex, maternal parity, smoking and pre-pregnancy BMI, and gestational age), together with the change in weight, length, BMI from birth, and weight gain trajectories using latent class growth analysis.

RESULTS

At 2 years, there was a trend towards lower mean BMI among intervention offspring (adjusted mean difference [aMD] - 0.14 SD [95% CI 0.30, 0.02], p = 0.09), and fewer had a BMI > 95th percentile (i.e. > 1.65 SD, 9.2% vs 18.0%, adjusted risk ratio [aRR] 0.51 [95% CI 0.31, 0.82], p = 0.006). Longitudinal data revealed that intervention offspring had a 24% reduced risk of experiencing rapid weight gain > 0.67 SD in the first year of life (21.9% vs 31.1%, aRR 0.76 [95% CI 0.58, 1.00], p = 0.047). The risk was likewise decreased for sustained weight gain > 1.34 SD in the first 2 years of life (7.7% vs 17.1%, aRR 0.55 [95% CI 0.34, 0.88], p = 0.014). From five weight gain trajectories identified, there were more intervention offspring in the "normal" weight gain trajectory characterised by stable weight SDS around 0 SD from birth to 2 years (38.8% vs 30.1%, RR 1.29 [95% CI 1.03, 1.62], p = 0.029).

CONCLUSIONS

Supplementation with myo-inositol, probiotics, and additional micronutrients preconception and in pregnancy reduced the incidence of rapid weight gain and obesity at 2 years among offspring. Previous reports suggest these effects will likely translate to health benefits, but longer-term follow-up is needed to evaluate this.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02509988 (Universal Trial Number U1111-1171-8056). Registered on 16 July 2015.

Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Women at risk of gestational diabetes mellitus (GDM) need preventative interventions.

OBJECTIVE

To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM.

METHODS

Systematic review and meta-analysis conducted following PRISMA guidelines. MEDLINE, EMBASE and the Cochrane Library in addition to reference and citation lists were searched to identify eligible randomised controlled trials (RCTs) utilising risk stratification during the preconception period or in the first/early second trimester. Screening and data extraction were carried out by the authors independently. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Random effects meta-analysis and narrative synthesis were performed.

RESULTS

Eighty-four RCTs were included: two during preconception and 82 in pregnancy, with a pooled sample of 22,568 women. Interventions were behavioural (n = 54), dietary supplementation (n = 19) and pharmacological (n = 11). Predictive factors for risk assessment varied; only one study utilised a validated prediction model. Gestational diabetes was reduced in diet and physical activity interventions (risk difference - 0.03, 95% CI 0.06, - 0.01; I2 58.69%), inositol (risk difference - 0.19, 95% CI 0.33, - 0.06; I2 92.19%), and vitamin D supplements (risk difference - 0.16, 95% CI 0.25, - 0.06; I2 32.27%). Subgroup analysis showed that diet and physical activity interventions were beneficial in women with ≥ 2 GDM risk factors (risk difference - 0.16, 95% CI 0.25, - 0.07; I2 11.23%) while inositol supplementation was effective in women with overweight or obesity (risk difference - 0.17, 95% CI 0.22, - 0.11; I2 0.01%). Effectiveness of all other interventions were not statistically significant.

CONCLUSIONS

This review provides evidence that interventions targeted at women at risk of GDM may be an effective strategy for prevention. Further studies using validated prediction tools or multiple risk factors to target high-risk women for intervention before and during pregnancy are warranted.

Influence of preconception body mass index on perinatal outcomes after metabolic and bariatric surgery

INTRODUCTION

Metabolic and bariatric surgery (MBS) is a very effective weight loss intervention, although does not invariably reverses the obesity status. Our aim was to evaluate whether despite successful weight loss after MBS, persistence of obesity at time of conception still carries additional risks of adverse perinatal pregnancy outcomes.

METHODS

Retrospective study comparing pregnancy outcomes of women previously submitted to MBS with a preconception (PC) body mass index BMI < 30 kg/m2 or PC BMI ≥ 30 kg/m2.

RESULTS

Eighty pregnancies (n = 80) were included, 49 from women with a PC BMI < 30 kg/m2 and 31 with a PC BMI ≥ 30 kg/m2. Gestational weight gain was significantly lower (9.72 ± 7.10 vs. 13.81 ± 7.16 respectively; p = 0.01) and neonatal intensive care unit admissions were significantly higher (5% vs. 0% respectively; p = 0.02) in women with PC BMI ≥ 30 kg/m2 as compared to those with PC BMI < 30 kg/m2. There were no statistically significant differences in gestational diabetes, anemia, fetal growth restriction, prematurity rate, mode of delivery or birth weight between groups.

CONCLUSION

Perinatal outcomes of pregnancies after MBS may be significantly influenced by PC BMI. The benefits of MBS induced weight loss on obesity-associated adverse pregnancy outcomes can be maximized if the obesity status can be reverted before pregnancy.

Current preconception care practice in the Netherlands - An evaluation study among birth care professionals

OBJECTIVE

To evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care.

METHODS

We have developed a digital questionnaire and conducted a cross-sectional study by distributing the questionnaire among 102 organisations: 90 primary care midwifery practices and obstetric departments of 12 hospitals in the Southwest region of the Netherlands between December 2020 and March 2021. One birth care professional per organization was asked to complete the questionnaire. Descriptive statistics were used to present the results.

FINDINGS

Respondents of eighty-three organisations (81.4 %) filled in the questionnaire, of whom 74 respondents were independent primary care midwives and 9 respondents were obstetricians. Preconception care mostly consisted of an individual consultation in which personalized health and lifestyle advice was given. Among the respondents, 44.4 % reported that the organization had a preconception care protocol. The way in which the consultation was carried out, as well as the health and lifestyle related questions asked, differed between respondents. More than 85 % of the respondents inquire about the following possible risk factors for complications: maternal illnesses, obstetric history, folic acid supplement intake, alcohol intake, smoking, substance abuse, hereditary disease, prescription medication, dietary habits, overweight, and birth defects in the family. The respondents acknowledged that preconception care should be offered to all couples who wish to become pregnant, as opposed to offering preconception care only to those with an increased risk of complications. Still, respondents do not receive many questions regarding the preconception period or requests for preconception care consultations.

KEY CONCLUSION

Birth care professionals acknowledge the need for preconception care for all couples. In the Netherlands, preconception care consists mostly of an individual consultation with recommendations for health and lifestyle advice. However, the identification of risk factors varies between birth care professionals and less than half of the respondents indicate that they have a protocol available in their practice. Furthermore, the demand of parents-to-be for preconception care is low. More research, that includes more obstetricians, is necessary to investigate if there is a difference between the care provided by primary care midwives and obstetricians.

IMPLICATIONS FOR PRACTICE

To increase the awareness and uptake of preconception care, it would be prudent to emphasize its importance to parents-to-be and professionals, and actively promote the use of widespread, standardized protocols for birth care professionals.

Real-world practices for the care of women with epilepsy during pregnancy: A Canadian perspective

OBJECTIVE

Approximately 150,000 Canadian women live with epilepsy, a population that presents with unique challenges. Our objective was to capture demographic and real-world practice characteristics of Canadian healthcare professionals providing care for women with epilepsy (WWE) with specific focus on reproductive considerations to identify potential gaps in knowledge and care.

METHODS

A questionnaire developed by the Canadian League Against Epilepsy WWE workgroup was distributed to Canadian healthcare professionals from February 2021 to October 2022 to capture participant demographic characteristics and practice patterns in key areas of the reproductive cycle in WWE.

RESULTS

A total of 156 participants completed the questionnaire, most being physicians (81.4%), epilepsy specialists (69.0%), and those who cared for adult patients (86.5%), with a significant proportion based at an academic center (65.4%). The majority of participants counselled on folic acid supplementation (89.7%). Participants selected lamotrigine and levetiracetam most frequently for either focal or generalized epilepsies during pregnancy. Additionally, 85.9% performed therapeutic drug monitoring during pregnancy. Almost all practitioners always or often counseled WWE on valproic acid on the benefits of switching to a less teratogenic medication (96.2%). Some geographic variability in practice patterns was noted with valproic acid being one of the top three medications selected for patients with generalized epilepsies in Western regions, although participants in Eastern regions had brivaracetam more commonly included as one of their top three agents for this population.

SIGNIFICANCE

This is the first report of real-world Canadian practices in epilepsy care for women in pregnancy. Overall, our study reports that Canadian practice patterns conform well to current evidence and best-practice guidelines. Important variations in antiseizure medication selection across different regions were identified.

Looking Back, Visioning Forward: Preconception Health in the US 2005 to 2023

Preconception health has always been about preventative health care, ensuring the overall wellbeing of people of reproductive age before they have children. However, just as public health and health care have shifted to prioritize equity and include ideas about how social determinants of health influence health outcomes, the field of preconception health has experienced a similar transition. The purpose of this paper is to provide an overview of the evolution of preconception health in the United States after 2005, highlighting the key tensions that have shaped the field. We provide an overview of the early history of the movement and describe how four phases of ideological tensions overtime have led to changes across seven categories of preconception health: definitions and frameworks, surveillance and measurement, messaging and education, strategic convenings and collaborations, clinical practice, and reproductive life planning. We also describe the historic and emerging challenges that affect preconception care, including limited sustained investment and ongoing threats to reproductive health. The vision of preconception health care we outline has been created by a diversity of voices calling for wellness, equity, and reproductive justice to be the foundation to all preconception health work. This requires a focus on preconception health education that prioritizes bodily autonomy, not just pregnancy intentions; national surveillance and data measures that center equity; attention to mental health and overall well-being; and the inclusion of transgender and non-binary people of reproductive age.

Identifying critical windows of air pollution exposure during preconception and gestational period on birthweight: a prospective cohort study

BACKGROUND

Few studies have assessed air pollution exposure association with birthweight during both preconception and gestational periods.

METHODS

Leveraging a preconception cohort consisting of 14220 pregnant women and newborn children in Shanghai, China during 2016-2018, we aim to assess associations of NO2 and PM2.5 exposure, derived from high-resolution spatial-temporal models, during preconception and gestational periods with outcomes including term birthweight, birthweight Z-score, small-for-gestational age (SGA) and large-for-gestational age (LGA). Linear and logistic regressions were used to estimate 3-month preconception and trimester-averaged air pollution exposure associations; and distributed lag models (DLM) were used to identify critical exposure windows at the weekly resolution from preconception to delivery. Two-pollutant models and children's sex-specific associations were explored.

RESULTS

After controlling for covariates, one standard deviation (SD) (11.5 μg/m3, equivalent to 6.1 ppb) increase in NO2 exposure during the second and the third trimester was associated with 13% (95% confidence interval: 2 - 26%) and 14% (95% CI: 1 - 29%) increase in SGA, respectively; and one SD (9.6 μg/m3) increase in PM2.5 exposure during the third trimester was associated with 15% (95% CI: 1 - 31%) increase in SGA. No association have been found for outcomes of birthweight, birthweight Z-score and LGA. DLM found that gestational weeks 22-32 were a critical window, when NO2 exposure had strongest associations with SGA. The associations of air pollution exposure tended to be stronger in female newborns than in male newborns. However, no significant associations of air pollution exposure during preconception period on birthweight outcomes were found.

CONCLUSION

Consistent with previous studies, we found that air pollution exposure during mid-to-late pregnancy was associated with adverse birthweight outcomes.

A pre-conception clinical trial to reduce intergenerational obesity and diabetes risks: The NDPP-NextGen trial protocol

BACKGROUND

Intrauterine exposure to maternal overweight/obesity or diabetes transmits risks to offspring, perpetuating a disease cycle across generations. Prenatal interventions to reduce maternal weight or dysglycemia have limited impact, while postpartum interventions can alter the intrauterine environment only if child-bearing continues. Efficacious preconception interventions are needed, especially for underserved populations, and with the potential to be scaled up sustainably. Research is also needed to assess intervention effects at conception, throughout pregnancy, and among offspring.

METHODS

This two-arm, parallel randomized clinical trial will include 360 biological females with overweight/obesity and moderate-to-high likelihood of pregnancy within 24 months. Participants will be randomized 1:1 to a yearlong pre-conception lifestyle intervention based on the National Diabetes Prevention Program (NDPP-NextGen) or usual care. Data collection will occur at enrollment (before conception), post-conception (<8 weeks gestation), late pregnancy (28-32 weeks gestation), and delivery (before discharge) for participants who become pregnant within 24 months of enrollment. Main outcomes are post-conception body mass index (<8 weeks gestation; primary outcome), post-conception fasting glucose (<8 weeks gestation; secondary outcome), and neonatal adiposity (<2 days post-birth). Additional clinical, behavioral, perinatal and offspring data will be collected, and biospecimens (blood, urine, stool, cord blood) will be banked for future ancillary studies.

CONCLUSION

This clinical trial will evaluate an intervention model (NDPP-NextGen) with potential to improve maternal health among the >50% of US females with overweight/obesity or diabetes risks in pregnancy. If successful, it can be scaled among >1800 organizations delivering NDPP in the United States to benefit the health of future generations.

Preconception knowledge, beliefs and behaviours among people of reproductive age: A systematic review of qualitative studies

BACKGROUND

The health of parents before pregnancy influences the short- and long-term health of their offspring. This systematic review explored the preconception knowledge, beliefs and behaviours held by women and men of childbearing age.

METHODS

Databases were searched from 2009 to 2022 (MEDLINE, CINAHL Full-text, PsycINFO, EMBASE). Inclusion criteria specified qualitative research papers which recruited individuals of reproductive age (16-45 years) without existing chronic illnesses. Data were quality assessed and analysed using thematic synthesis.

RESULTS

Twelve papers met inclusion criteria. Six themes were identified (cultural context, pregnancy planning, knowledge, gender roles and responsibility, information seeking, prior health behaviours) which relate to individual, social, psychological and cultural factors. Cultural context was related to all other themes. Pregnancy planners had greater motivation to optimise their health whereas those not actively planning were focused more on becoming financially stable. Women and men's knowledge of how and why to engage in health protective behaviours was limited, with health risks and behaviour change discussed in the context of pregnancy rather than preconception. Gender roles influenced individual responsibility for preparation for pregnancy, which in turn influenced information seeking behaviours and engagement in health behaviours. Online sources of support and information were seen as desirable, regardless of pregnancy planning stage.

CONCLUSIONS

Our findings indicate that behaviour change interventions designed to support people to optimise health before conception should address cultural, individual, social and psychological factors to facilitate behaviour change. Development of online resources may help to increase accessibility for people across different cultural contexts and stages of pregnancy planning.

Spermatozoa, acts as an external cue and alters the cargo and production of the extracellular vesicles derived from oviductal epithelial cells in vitro

The oviduct provides optimum physiological and biochemical milieu essential for successful fertilization, early embryo development and facilitates functional maturation of spermatozoa. A study has revealed that spermatozoa alters the gene expression in bovine oviductal epithelial cells (BOECs) remotely via bio-active particles, thus acting as a cue to the oviduct prior to their arrival. However, very little attention has been paid to the question of whether spermatozoa could alter the cargo of extracellular vesicles (EVs) derived from BOECs. Therefore, the aim of this study was to investigate the alterations in small non-coding RNAs in EVs cargo derived from BOECs when incubated with spermatozoa in contact and non-contact co-culture models. After 4 h of incubation the EVs were isolated from the conditioned media, followed by small non-coding sequencing of the BOEC derived EVs. Our results revealed that EVs from both co-culture models contained distinct cargo in form of miRNA, fragmented mRNA versus control. The pathway enrichment analysis revealed that EV miRNA from direct co-culture were involved in the biological processes associated with phagocytosis, macroautophagy, placenta development, cellular responses to TNF and FGF. The mRNA fragments also varied within the different groups and mapped to the exonic regions of the transcriptome providing vital insights regarding the changes in cellular transcriptome on the arrival of spermatozoa. The findings of this study suggest that spermatozoa, in contact as well as remotely, alter the EV cargo of female reproductive tract epithelial cells which might be playing an essential role in pre and post-fertilization events.

Optimizing preconception care and interventions for improved population health

There is growing literature indicating that optimal preconception health is associated with improved reproductive, perinatal, and pediatric outcomes. Given that preconception care is recommended for all individuals planning a pregnancy, medical providers and public health practitioners have a unique opportunity to optimize care and improve health outcomes for reproductive-aged individuals. Knowledge of the determinants of preconception health is important for all types of health professionals, including policy makers. Although some evidence-based recommendations have already been implemented, additional research is needed to identify factors associated with favorable health outcomes and to ensure that effective interventions are made in a timely fashion. Given the largely clinical readership of this journal, this piece is primarily focused on clinical care. However, we acknowledge that optimizing preconception health for the entire population at risk of pregnancy requires broadening our strategies to include population-health interventions that consider the larger social systems, structures, and policies that shape individual health outcomes.

Preconception use of antibiotics and fecundability: a Danish prospective cohort study

OBJECTIVE

To assess the association between preconception antibiotic use and fecundability, the per menstrual cycle probability of conception.

DESIGN

SnartForaeldre.dk, a Danish prospective cohort study of women trying to conceive (2007-2020).

SETTING

Not applicable.

SUBJECT(S)

9462 female participants, median age 29 years at enrollment.

EXPOSURE

Antibiotic use was defined by filled prescriptions retrieved from the Danish National Prescription Registry, using Anatomical Therapeutic Chemical codes, and modeled as time-varying (menstrual cycle-varying) exposure.

MAIN OUTCOME MEASURE(S)

Pregnancy status was reported on female follow-up questionnaires every 8 weeks for up to 12 months or until conception. Fecundability ratios (FR) and 95% confidence intervals (CI) were computed using proportional probabilities regression models, with adjustment for age, partner age, education, smoking, folic acid supplementation, body mass index, parity, cycle regularity, timing of intercourse, and sexually transmitted infections.

RESULT(S)

During all cycles of observation, the percentage of participants filing at least 1 antibiotic prescription was 11.9%; 8.6% had a prescription for penicillins, 2.1% for sulfonamides, and 1.8% for macrolides. Based on life-table methods, 86.5% of participants conceived within 12 cycles of follow-up. Recent preconception antibiotic use was associated with reduced fecundability (≥1 prescription vs. none: adjusted FR = 0.86; 95% CI, 0.76-0.99). For participants using penicillins, sulfonamides, or macrolides, the adjusted FRs were 0.97 (95% CI, 0.83-1.12), 0.68 (95% CI, 0.47-0.98), and 0.59 (95% CI, 0.37-0.93), respectively.

CONCLUSION(S)

Preconception use of antibiotics, specifically sulfonamides and macrolides, was associated with decreased fecundability compared with no use. The observed associations may be explained plausibly by confounding by indication, as we lacked data on indications for the prescribed antibiotics. Consequently, we cannot separate the effect of the medication from the effect of the underlying infection.

Fathers' preconception smoking and offspring DNA methylation

BACKGROUND

Experimental studies suggest that exposures may impact respiratory health across generations via epigenetic changes transmitted specifically through male germ cells. Studies in humans are, however, limited. We aim to identify epigenetic marks in offspring associated with father's preconception smoking.

METHODS

We conducted epigenome-wide association studies (EWAS) in the RHINESSA cohort (7-50 years) on father's any preconception smoking (n = 875 offspring) and father's pubertal onset smoking < 15 years (n = 304), using Infinium MethylationEPIC Beadchip arrays, adjusting for offspring age, own smoking and maternal smoking. EWAS of maternal and offspring personal smoking were performed for comparison. Father's smoking-associated dmCpGs were checked in subpopulations of offspring who reported no personal smoking and no maternal smoking exposure.

RESULTS

Father's smoking commencing preconception was associated with methylation of blood DNA in offspring at two cytosine-phosphate-guanine sites (CpGs) (false discovery rate (FDR) < 0.05) in PRR5 and CENPP. Father's pubertal onset smoking was associated with 19 CpGs (FDR < 0.05) mapped to 14 genes (TLR9, DNTT, FAM53B, NCAPG2, PSTPIP2, MBIP, C2orf39, NTRK2, DNAJC14, CDO1, PRAP1, TPCN1, IRS1 and CSF1R). These differentially methylated sites were hypermethylated and associated with promoter regions capable of gene silencing. Some of these sites were associated with offspring outcomes in this cohort including ever-asthma (NTRK2), ever-wheezing (DNAJC14, TPCN1), weight (FAM53B, NTRK2) and BMI (FAM53B, NTRK2) (p < 0.05). Pathway analysis showed enrichment for gene ontology pathways including regulation of gene expression, inflammation and innate immune responses. Father's smoking-associated sites did not overlap with dmCpGs identified in EWAS of personal and maternal smoking (FDR < 0.05), and all sites remained significant (p < 0.05) in analyses of offspring with no personal smoking and no maternal smoking exposure.

CONCLUSION

Father's preconception smoking, particularly in puberty, is associated with offspring DNA methylation, providing evidence that epigenetic mechanisms may underlie epidemiological observations that pubertal paternal smoking increases risk of offspring asthma, low lung function and obesity.

Belgian Fertility Clinic Staff Value Healthy Lifestyle Promotion but Lack Access to a Structured Lifestyle Modification Programme: An Observational Study

OBJECTIVES

Guidelines advise promoting a healthy lifestyle among patients with fertility problems as the lifestyle of women and men proved to be associated with their fertility. Australian fertility nurses were shown to lack access to structured lifestyle modification programmes, although they value healthy lifestyle promotion. This study aimed to examine whether gynaecologists also value promoting a healthy lifestyle and whether structured lifestyle modification programmes are available in Belgian fertility clinics.

DESIGN

An observational study was conducted among health care professionals (HCPs) working in Belgian fertility clinics.

PARTICIPANTS/MATERIALS, SETTING, METHODS

An Australian questionnaire on attitudes and practices related to promoting a healthy lifestyle among patients with fertility problems was reciprocally back-to-back translated and three open-ended questions were added. All HCPs of Belgian fertility clinics, including gynaecologists, fertility nurses/midwives, psychologists, and embryologists, were invited by e-mail to complete the questionnaire online. Responses to closed and open-ended questions were analysed with, respectively, descriptive statistics and qualitative thematic analysis. Finally, differences in perspectives between different groups of HCPs were explored.

RESULTS

A total of 50 fertility nurses/midwives, 42 gynaecologists, and 19 other HCPs completed the survey (n = 111). Regarding attitudes, all respondents valued informing patients about the impact of lifestyle on fertility. The vast majority of HCPs (n = 96; 86%) stated that fertility clinics have the responsibility to address unhealthy lifestyles prior to offering fertility treatment. Fertility nurses/midwives were significantly more likely than gynaecologists to state that fertility clinics have this responsibility (p = 0.040). Regarding practices, the patient's lifestyle was most commonly discussed by the gynaecologist (n = 107; 96%) during the first appointment (n = 105; 95%). The lifestyle factors that were being addressed, according to the vast majority of respondents, were smoking, weight, age, alcohol, and recreational drugs. Only three HCPs (from three different clinics) stated that their clinic offered a structured lifestyle modification programme. HCPs explained that they lacked the resources and expertise for offering a structured lifestyle modification programme.

LIMITATIONS

Response rates were limited, but the responding Belgian gynaecologists and fertility nurses/midwives confirmed the findings of the previous study in Australian fertility nurses.

CONCLUSIONS

HCPs working in Belgian fertility clinics value healthy lifestyle promotion but lack access to structured lifestyle modification programmes to implement in their daily clinical practice. Future studies should focus on developing and evaluating structured lifestyle modification programmes for patients with fertility problems.

Association of hypothyroidism during pregnancy with preconception and early pregnancy exposure to ambient particulate matter

BACKGROUND

Limited research has been conducted on the association between preconception exposure to ambient particulate matter (PM) and hypothyroidism. This study aimed to investigate the relationship between preconception PM exposure and hypothyroidism.

METHODS

A retrospective case-control study at China-Japan Friendship Hospital was performed. Fine particulate matter (PM2.5) and inhalable particulate matter (PM10) were obtained from the China High Air Pollution Dataset. Buffer analysis methods were used to calculate the exposure of pregnant women to PM in a circular area of 250, 500, and 750 m in diameter at preconception and in early pregnancy. Logistic regression models were used to assess the relationship between PM and hypothyroidism. Odd ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the effect of PM on the risk of hypothyroidism.

RESULTS

A total of 3,180 participants were studied, and they comprised 795 hypothyroid patients and 2,385 matched controls. The mean age was 31.01 years (standard deviation: 3.66) in the control group and 31.16 years (standard deviation: 3.71) in the case group. Logistic regression analysis showed that exposure to PM2.5 and PM10 in the 60-day period before the last menstrual period month (LMPM), 30-day period before the LMPM, and LMP, across all distance buffers, was associated with an increased risk of hypothyroidism (all P < 0.05). The most pronounced effect was observed during the LMPM, with PM2.5 (OR: 1.137, 95% CI: 1.096-1.180) and PM10 (OR: 1.098, 95% CI: 1.067-1.130) in the 250-m buffer. Subgroup analysis in the Changping District yielded consistent results with the main analysis.

CONCLUSION

Our study shows that preconception PM2.5 and PM10 exposure increases the risk of hypothyroidism during pregnancy.

Maternal preconception thyroid autoimmunity is associated with neonatal birth weight conceived by PCOS women undergoing their first in vitro fertilization/intracytoplasmic sperm injection

BACKGROUND

Thyroid autoimmunity and polycystic ovary syndrome (PCOS) are the most common endocrinopathies and have close relationships based on common etiology and pathogenesis, including genetic susceptibility, metabolic disorders, hormonal dysregulation, immune response, and inflammatory activation. The co-occurrence of both diseases is associated with adverse reproductive outcomes, but its effect on neonatal outcomes remains largely unknown. We aim to explore the effect of thyroid autoimmunity on neonatal birth weight in PCOS women undergoing IVF/ICSI.

METHODS

This is a retrospective analysis of 486 PCOS women who underwent the first IVF/ICSI cycles and gave birth to 361 singletons and 125 twins during 2018 - 2020 at a reproductive center. The associations between maternal preconception serum thyroid function and autoimmunity indicators and birth weights of the singleton and twin groups were evaluated using generalized linear models (GLMs) and generalized estimate equations (GEEs), respectively. Analyses were further stratified by neonatal sex, maternal age, and maternal preconception BMI to assess the possible interaction effects.

RESULTS

Maternal preconception serum TPOAb had a significant negative association with singleton birth weight (P for trends = 0.03). Compared with women in the first tertile of TPOAb, women in the third tertile had a change in singleton birth weight of - 119.72 g (95% CI: - 222.68 g, - 16.70 g). Maternal preconception serum TPOAb had a significant positive association with twin birth weight (P for trends = 0.01). Compared with women in the first tertile of TPOAb, women in the third tertile had a change in twin birth weight of 138.62 g (95% CI: 33.96 g, 243.30 g). Besides, maternal preconception serum TPOAb had a specific association with increased twin birth weight for female neonates, a specific association with decreased singleton birth weight for PCOS women under 35 years, and a specific association with decreased twin birth weight for overweight PCOS women (all P for interactions < 0.05).

CONCLUSIONS

Maternal preconception thyroid autoimmunity may affect the birth weights of both singleton and twin neonates. Further large cohorts and experimental studies are required to confirm these findings and explore the underlying mechanisms.

The association between preconception cannabis use and depression and anxiety during pregnancy

OBJECTIVE

Cannabis use among individuals of reproductive age has increased with cannabis legalization and heightened stress during the COVID-19 pandemic. Our study provides data on preconception cannabis use and cannabis use disorder (CUD) during the pandemic and models the association between preconception cannabis use and depression and anxiety during pregnancy.

METHODS

Data on substance use and depression and anxiety symptoms were collected from questionnaires and the Structured Clinical Interview for DSM-5 (SCID-5) from pregnant individuals in Oregon in 2019-2022. Linear regression was used to model the association between the frequency of preconception cannabis use and scores on the Center for Epidemiological Studies of Depression-Revised (CESD-R) and Beck Anxiety Inventory (BAI).

RESULTS

The prevalence of preconception cannabis use was 27.8% among 227 study participants. CUD was diagnosed in 19% of cannabis users, or 5.3% of the overall sample. Daily cannabis use, compared to rare/never use, was associated with increases in CESD-R (β = 6.22, p 0.029) and BAI (β = 4.71, p 0.045) scores.

CONCLUSIONS

Cannabis use and CUD are common among individuals of reproductive age. Given the association between preconception cannabis use and depression and anxiety during pregnancy, more attention is needed on screening and counseling of cannabis use among people of reproductive age.

Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion

Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.

Experiences in the delivery of preconception and pregnancy care for LGBTIQA+ people: A systematic review and thematic synthesis of patient and healthcare provider perspectives

BACKGROUND

The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care.

AIM

The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement.

METHOD

Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research.

FINDINGS

A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.

Preconception sleep quality moderates the association between preconception hair cortisol levels and mental health in pregnant women

BACKGROUND

Poor sleep quality may elevate cortisol levels and affect prenatal mental health through altered HPA axis functioning. This study aims to examine whether subjective sleep quality during preconception moderates the association between preconception hair cortisol levels and mental health from preconception to pregnancy trimesters.

METHODS

Women from a prospective cohort study completed the Pittsburgh Sleep Quality Index (PSQI), the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI) questionnaires during preconception (T0) and at each pregnancy trimesters (T1, T2, and T3). We analyzed 266 of these women who conceived and had fully completed measures at preconception for hair cortisol, sleep quality and either EPDS or STAI-state. Changes in EPDS and STAI-state scores were derived (i.e., T1-T0, T2-T0, T3-T0). Johnson-Neyman technique identified PSQI scores with significant moderation of cortisol on mental health.

RESULTS

After adjusting for potential covariates, there was a significant positive correlation between preconception hair cortisol levels and depressive symptom at the second trimester (r_s (144) = 0.22, p = 0.008), but not the first and third trimesters (all p_s > 0.05). The positive association between preconception hair cortisol and change in depressive symptoms between third trimester and preconception was significant only among women with poor preconception sleep quality (PSQI ≥ 7).

LIMITATIONS

Sleep quality and prenatal mood were derived from self-reported questionnaires, which may be more susceptible to bias.

CONCLUSIONS

The positive association between preconception hair cortisol and change in prenatal depressive symptoms is significant among women who reported poor sleep quality during preconception. Improving preconception sleep quality can potentially mitigate the association between preconception hair cortisol and depressive symptoms during pregnancy.

Exploring body dissatisfaction in pregnancy and the association with gestational weight gain, obesity, and weight stigma

OBJECTIVE

Body dissatisfaction in pregnancy has been associated with negative psychological maternal outcomes, including increased risk of postpartum depression. This study aimed to explore weight-related factors that influence body dissatisfaction in pregnancy, including gestational weight gain (GWG), weight stigma, obesity, and weight loss attempts before pregnancy.

DESIGN

Secondary analysis of a larger cross-sectional study.

SETTING

Online survey administered via Qualtrics.

PARTICIPANTS

≥12 weeks pregnant, ≥18 years of age, having a singleton pregnancy and residing in Canada.

MEASUREMENTS AND FINDINGS

A battery of questionnaires were completed, including the Body Image in Pregnancy Scale (BIPS) sub-scale. The BIPS scores were compared based on experiences of weight stigma in pregnancy, perception towards their GWG, weight loss attempts before pregnancy, obesity, and GWG category classified as excessive or not referring to Institute of Medicine (2009) guidelines. Significant differences were entered into a linear regression model with BIPS scores as the dependent variable. Significance was accepted as p<0.05. A total of 182 participants completed the survey. There were no differences in BIPS scores based on GWG category (p = 0.160), or obesity (p = 0.230). Poorer BIPS scores were reported by those who felt they had gained 'too much' pregnancy weight than 'appropriate' (p<0.001), and among those who were trying to lose weight before pregnancy compared to those who were not (p = 0.002). Poorer BIPS scores were also reported by individuals who indicated they had experienced weight stigma during pregnancy compared to those who had not (p<0.001). Regression results showed that significant variables were perceptions towards GWG (p = 0.003) and experiencing weight stigma in pregnancy (p = 0.011).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Perceptions towards GWG and experiencing weight stigma can influence body dissatisfaction in pregnancy. Given the detrimental physical and psychological consequences of body dissatisfaction, effective strategies to reduce prenatal weight stigma are needed, such as training maternal healthcare providers to offer sensitive preconception and prenatal weight counselling.

A Network Analysis of Multiple Preconception Health Behaviors in Chinese Women

BACKGROUND

A healthy preconception lifestyle, consisting of multiple health behaviors, is crucial for preventing adverse health outcomes in mothers and offspring. Although knowledge about the pattern of inter-behavior relations may provide insights for nudging multiple health behavior changes, this has not been adequately explored in the existing literature. Adopting a network perspective, the present study conceptualized multiple health behaviors as a behavior network (i.e., behaviors as nodes, inter-behavior relations as edges) and utilized network analysis to investigate the pattern of interrelations of preconception health behaviors in a large sample of Chinese women.

METHOD

We used the data of a population-based cohort study in China to estimate the behavior network. An analytic sample included 41,127 Chinese women who were surveyed about their adoptions of multiple health behaviors during the preconception period.

RESULTS

Network analysis revealed a relatively dense behavior network and visualized the network structure of multiple preconception health behaviors. Subsequent centrality analysis identified three central behaviors (i.e., avoiding second- or third-hand smoke, reducing psychosocial stress, and reducing alcohol) that had distinctively stronger connections to other behaviors.

CONCLUSIONS

Preconception health behaviors were strongly interconnected, and certain behaviors had stronger influences than others within the behavior network. Our findings highlight the strong inter-relatedness of preconception health behaviors. This study also encourages targeting the three central behaviors in preconception lifestyle promotions because this may bring more secondary improvements on other non-targeted behaviors and thereby achieve comprehensive lifestyle change.

Paternal preconception modifiable risk factors for adverse pregnancy and offspring outcomes: a review of contemporary evidence from observational studies

BACKGROUND

The preconception period represents transgenerational opportunities to optimize modifiable risk factors associated with both short and long-term adverse health outcomes for women, men, and children. As such, preconception care is recommended to couples during this time to enable them to optimise their health in preparation for pregnancy. Historically, preconception research predominately focuses on maternal modifiable risks and health behaviours associated with pregnancy and offspring outcomes; limited attention has been given to inform paternal preconception health risks and outcomes. This systematic review aims to advance paternal preconception research by synthesising the current evidence on modifiable paternal preconception health behaviours and risk factors to identify associations with pregnancy and/or offspring outcomes.

METHODS

Medline, Embase, Maternity and Infant care, CINAHL, PsycINFO, Scopus, and ISI Proceedings were searched on the 5^th of January 2023, a date limit was set [2012-2023] in each database. A Google Scholar search was also conducted identifying all other relevant papers. Studies were included if they were observational, reporting associations of modifiable risk factors in the preconception period among males (e.g., identified as reproductive partners of pregnant women and/or fathers of offspring for which outcomes were reported) with adverse pregnancy and offspring outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Exposure and outcome heterogeneity precluded meta-analysis, and results were summarised in tables.

RESULTS

This review identified 56 cohort and nine case control studies. Studies reported on a range of risk factors and/or health behaviours including paternal body composition (n = 25), alcohol intake (n = 6), cannabis use (n = 5), physical activity (n = 2), smoking (n = 20), stress (n = 3) and nutrition (n = 13). Outcomes included fecundability, IVF/ISCI live birth, offspring weight, body composition/BMI, asthma, lung function, leukemia, preterm birth, and behavioural issues. Despite the limited number of studies and substantial heterogeneity in reporting, results of studies assessed as good quality showed that paternal smoking may increase the risk of birth defects and higher paternal BMI was associated with higher offspring birthweight.

CONCLUSION

The current evidence demonstrates a role of paternal preconception health in influencing outcomes related to pregnancy success and offspring health. The evidence is however limited and heterogenous, and further high-quality research is needed to inform clinical preconception care guidelines to support men and couples to prepare for a health pregnancy and child.

Exploring preconception signatures of metabolites in mothers with gestational diabetes mellitus using a non-targeted approach

BACKGROUND

Metabolomic changes during pregnancy have been suggested to underlie the etiology of gestational diabetes mellitus (GDM). However, research on metabolites during preconception is lacking. Therefore, this study aimed to investigate distinctive metabolites during the preconception phase between GDM and non-GDM controls in a nested case-control study in Singapore.

METHODS

Within a Singapore preconception cohort, we included 33 Chinese pregnant women diagnosed with GDM according to the IADPSG criteria between 24 and 28 weeks of gestation. We then matched them with 33 non-GDM Chinese women by age and pre-pregnancy body mass index (ppBMI) within the same cohort. We performed a non-targeted metabolomics approach using fasting serum samples collected within 12 months prior to conception. We used generalized linear mixed model to identify metabolites associated with GDM at preconception after adjusting for maternal age and ppBMI. After annotation and multiple testing, we explored the additional predictive value of novel signatures of preconception metabolites in terms of GDM diagnosis.

RESULTS

A total of 57 metabolites were significantly associated with GDM, and eight phosphatidylethanolamines were annotated using HMDB. After multiple testing corrections and sensitivity analysis, phosphatidylethanolamines 36:4 (mean difference β: 0.07; 95% CI: 0.02, 0.11) and 38:6 (β: 0.06; 0.004, 0.11) remained significantly higher in GDM subjects, compared with non-GDM controls. With all preconception signals of phosphatidylethanolamines in addition to traditional risk factors (e.g., maternal age and ppBMI), the predictive value measured by area under the curve (AUC) increased from 0.620 to 0.843.

CONCLUSIONS

Our data identified distinctive signatures of GDM-associated preconception phosphatidylethanolamines, which is of potential value to understand the etiology of GDM as early as in the preconception phase. Future studies with larger sample sizes among alternative populations are warranted to validate the associations of these signatures of metabolites and their predictive value in GDM.

Investigating continuation of folic acid supplementation during peri-conceptional period: a community-based cross-sectional study

BACKGROUND

Maternal folate may not reach an optimal level to prevent neural tube defects if supplementation commenced post-conception or took place pre-conception only. Our study aimed to investigate the continuation of folic acid (FA) supplementation from pre-conception to post-conception during peri-conceptional period and to examine its differences in FA supplementation between the subgroups taking the initiation timing into consideration.

METHODS

This study was conducted in two community health service centers in Jing-an District of Shanghai. Women accompanying their children to pediatric health clinics of the centers were recruited and asked to recall information concerning their socioeconomic and previous obstetric characteristics, utilization of healthcare and FA supplementation before and/or during pregnancy. The continuation of FA supplementation during peri-conceptional period were categorized into three subgroups: Supplementing with FA pre- and post-conception; supplementing with FA preconception only or post-conception only; no FA supplements pre-conception and post-conception. The relationship between FA continuation and couples' characteristics were examined as setting the first subgroup as the base reference.

RESULTS

Three hundred and ninety-six women were recruited. Over 40% of the women started FA supplementation after conception and 30.3% of them supplemented with FA from pre-conception to the first trimester of their pregnancy. Compared to this one-third of participants, women who didn't supplemented with any FA during peri-conceptional period were more likely to have no utilization of pre-conception healthcare ([Formula: see text]= 2.47, 95% [Formula: see text]: 1.33-4.61) or antenatal care ([Formula: see text]= 4.05, 95% [Formula: see text]: 1.76-9.34), or who had a lower family socioeconomic status ([Formula: see text]= 4.36, 95% [Formula: see text]: 1.79-10.64). Women who supplemented with FA pre-conception only or post-conception only were more likely to have no utilization of pre-conception healthcare ([Formula: see text]= 2.94, 95% [Formula: see text]: 1.79-4.82), or to have no previous pregnancy complication ([Formula: see text]=1.80, 95% [Formula: see text]: 0.99-3.28).

CONCLUSION

Over two-fifth of the women started FA supplementation and only one-third of them had an optimal supplementation from pre-conception to the first trimester. Maternal utilization of healthcare before or during pregnancy together with maternal and paternal socioeconomic status may play a role in the continuation to FA supplementation pre- and post-conception.

Plasma lipidomic profiling reveals metabolic adaptations to pregnancy and signatures of cardiometabolic risk: a preconception and longitudinal cohort study

BACKGROUND

Adaptations in lipid metabolism are essential to meet the physiological demands of pregnancy and any aberration may result in adverse outcomes for both mother and offspring. However, there is a lack of population-level studies to define the longitudinal changes of maternal circulating lipids from preconception to postpartum in relation to cardiometabolic risk factors.

METHODS

LC-MS/MS-based quantification of 689 lipid species was performed on 1595 plasma samples collected at three time points in a preconception and longitudinal cohort, Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO). We mapped maternal plasma lipidomic profiles at preconception (N = 976), 26-28 weeks' pregnancy (N = 337) and 3 months postpartum (N = 282) to study longitudinal lipid changes and their associations with cardiometabolic risk factors including pre-pregnancy body mass index, body weight changes and glycaemic traits.

RESULTS

Around 56% of the lipids increased and 24% decreased in concentration in pregnancy before returning to the preconception concentration at postpartum, whereas around 11% of the lipids went through significant changes in pregnancy and their concentrations did not revert to the preconception concentrations. We observed a significant association of body weight changes with lipid changes across different physiological states, and lower circulating concentrations of phospholipids and sphingomyelins in pregnant mothers with higher pre-pregnancy BMI. Fasting plasma glucose and glycated haemoglobin (HbA1c) concentrations were lower whereas the homeostatic model assessment of insulin resistance (HOMA-IR), 2-h post-load glucose and fasting insulin concentrations were higher in pregnancy as compared to both preconception and postpartum. Association studies of lipidomic profiles with these glycaemic traits revealed their respective lipid signatures at three physiological states. Assessment of glycaemic traits in relation to the circulating lipids at preconception with a large sample size (n = 936) provided an integrated view of the effects of hyperglycaemia on plasma lipidomic profiles. We observed a distinct relationship of lipidomic profiles with different measures, with the highest percentage of significant lipids associated with HOMA-IR (58.9%), followed by fasting insulin concentration (56.9%), 2-h post-load glucose concentration (41.8%), HbA1c (36.7%), impaired glucose tolerance status (31.6%) and fasting glucose concentration (30.8%).

CONCLUSIONS

We describe the longitudinal landscape of maternal circulating lipids from preconception to postpartum, and a comprehensive view of trends and magnitude of pregnancy-induced changes in lipidomic profiles. We identified lipid signatures linked with cardiometabolic risk traits with potential implications both in pregnancy and postpartum life. Our findings provide insights into the metabolic adaptations and potential biomarkers of modifiable risk factors in childbearing women that may help in better assessment of cardiometabolic health, and early intervention at the preconception period.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03531658.

Harmonization of maternal balanced energy-protein supplementation studies for individual participant data (IPD) meta-analyses - finding and creating similarities in variables and data collection

BACKGROUND

Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems.

METHODS

We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendations for a BEP product for use among pregnant and lactating women in low- and middle-income countries. The initiative goal is to harmonize variables across studies to facilitate IPD meta-analyses on closely aligned data, commonly called prospective meta-analysis. Our objective here is to describe the process of harmonizing variable definitions and prioritizing research questions. A two-day workshop of investigators, content experts, and advisors was held in February 2020 and harmonization activities continued thereafter. Efforts included a range of activities from examining protocols and data collection plans to discussing best practices within field constraints. Prior to harmonization, there were many similar outcomes and variables across studies, such as newborn anthropometry, gestational age, and stillbirth, however, definitions and protocols differed. As well, some measurements were being conducted in several but not all studies, such as food insecurity. Through the harmonization process, we came to consensus on important shared variables, particularly outcomes, added new measurements, and improved protocols across studies.

DISCUSSION

We have fostered extensive communication between investigators from different studies, and importantly, created a large set of harmonized variable definitions within a prospective meta-analysis framework. We expect this initiative will improve reporting within each study in addition to providing opportunities for a series of IPD meta-analyses.

A systematic review of evidence for maternal preconception exposure to outdoor air pollution on Children's health

The preconception period is a critical window for gametogenesis, therefore preconception exposure to air pollutants may have long-term effects on children. We systematically reviewed epidemiological evidence concerning the effects of preconception ambient air pollution exposure on children's health outcomes and identified research gaps for future investigations. We searched PubMed and Web of Science from journal inception up to October 2022 based on an established protocol (PROSPERO: CRD42022277608). We then identified 162 articles based on searching strategy, 22 of which met the inclusion criteria. Studies covered a wide range of health outcomes including birth defects, preterm birth, birthweight, respiratory outcomes, and developmental outcomes. Findings suggested that exposure to outdoor air pollutants during maternal preconception period were associated with various health outcomes, of which birth defects has the most consistent findings. A meta-analysis revealed that during 3-month preconception period, a 10 μg/m3 increase in PM10 and PM2.5 was associated with relative risk (RR) of birth defects of 1.06 (95% confidence interval (CI): 1.00, 1.02) and 1.14 (95% CI: 0.82, 1.59), respectively. Preterm birth, low birthweight, and autism have also been associated with maternal preconception exposure to PM2.5, PM10, O3 and SO2. However, the significance of associations and effect sizes varied substantially across studies, partly due to the heterogeneity in exposure and outcome assessments. Future studies should use more accurate exposure assessment methods to obtain individual-level exposures with high temporal resolution. This will allow the exploration of which specific time window (weeks or months) during the preconception period has the strongest effect. In future epidemiologic studies, integrating pathophysiologic biomarkers relevant to clinical outcomes may help improve the causal inference of associations between preconception exposure and health outcomes suggested by the current limited literature. Additionally, potential effects of paternal preconception exposure need to be studied.

Trimester-specific ambient PM2.5 exposures and risk of intellectual disability in Utah

Prenatal fine particulate matter (PM2.5) exposure is an understudied risk factor for neurodevelopmental outcomes, including intellectual disability (ID). Associations among prenatal exposures and neurodevelopmental outcomes may vary depending on the timing of exposure. Limited numbers of studies examining PM2.5 and neurodevelopmental outcomes have considered exposures occurring during the preconception period. To address these gaps, we conducted a case-control study of children born in Utah between 2002 and 2008 (n = 1032). Cases were identified using methods developed by the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network and matched with controls on birth year, sex, and birth county. We estimated the daily average PM2.5 concentration during a period spanning 12 weeks before the estimated conception date, as well as during each of the three trimesters at the maternal residential address listed on the child's birth certificate. In a multivariable model, the third (OR: 2.119, CI: 1.123-3.998, p = .021) and fourth (OR: 2.631, CI: 1.750-3.956, p < .001) quartiles for preconception average PM2.5 demonstrated significantly increased risk of ID relative to the first quartile. Second quartile preconception exposure was also associated with increased risk, though it did not reach significance (OR: 1.385, CI: 0.979-1.959, p = .07). The fourth quartile of first trimester average PM2.5 was positive and significant (OR: 2.278, CI: 1.522-3.411, p < .001); the third quartile was positive, but not significant (OR: 1.159, CI: 0.870-1.544, p = .312). Quartiles of second and third trimester were not associated with higher risk of ID. These findings from Utah, which were robust to a variety of sensitivity analyses, provide initial evidence that preconception and prenatal PM2.5 exposure may be associated with ID. Future studies are needed across other geographic locations and populations.

Piloting a complex intervention to promote a tobacco and alcohol-free pregnancy: the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study

BACKGROUND

Tobacco smoking and alcohol consumption before and during pregnancy increase the risk of adverse health outcomes for mother and child. Interventions to address smoking and drinking before and during pregnancy have the potential to reduce early-life health inequalities. In the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pilot study we aimed to evaluate the acceptability, feasibility and effectiveness of a complex intervention supporting women in smoking and alcohol cessation before and during pregnancy.

METHODS

From February 2019 till March 2021, we piloted the SAFER pregnancy intervention among pregnant women and women planning pregnancy in South-West Netherlands in an uncontrolled before-after study. Participants were supported in smoking and alcohol cessation via up to six group sessions and an online platform. In addition, biochemically validated cessation was rewarded with incentives (i.e. shopping vouchers) amounting up to 185 euros. We aimed to include 66 women. The primary outcome was smoking and/or alcohol cessation at 34-38 weeks of gestation (if pregnant) or after six group sessions (if not pregnant). Quantitative data were analysed using descriptive statistics. Focus group interviews among those involved in the study were conducted at the end of the study to explore their experiences. Qualitative data was analysed using thematic analysis.

RESULTS

Thirty-nine women who smoked were included; no women who consumed alcohol were referred to the study. Unemployment (51%), financial problems (36%) and a smoking partner (72%) were common. Thirteen women (33%) dropped out, often due to other problems impeding smoking cessation or 'being too busy' to participate in the group sessions. Eleven women (28%) had quit smoking at the study's endpoint. The personal and positive approach was highly valued and biochemical validation was felt to be helpful.

CONCLUSION

The SAFER pregnancy intervention seems appropriate for women in need of extra support for smoking cessation before and during pregnancy. Its impact on alcohol cessation could not be studied due to recruitment issues. Recruitment and prevention of early dropout need attention in further development of this intervention.

TRIAL REGISTRATION

Netherlands Trial Register: NL7493. Date registered: 04/02/2019.

Addressing Obesity in Preconception, Pregnancy, and Postpartum: A Review of the Literature

PURPOSE OF REVIEW

Reproductive-aged women (aged 19 to 50 years) are a key population warranting focused research for the prevention of overweight and obesity. This review highlights the importance of addressing weight before, during and after pregnancy.

RECENT FINDINGS

Obesity decreases fertility during the preconception period; increases the risk of adverse pregnancy outcomes including gestational diabetes, pre-eclampsia and caesarean section and postpartum weight retention; and increases the long-term health risks for both the mother and offspring. Despite overwhelming efficacy evidence on solutions, there are significant implementation gaps in translating this evidence into pragmatic models of care and real-world solutions. Interventions during preconception, pregnancy and postpartum are likely to be cost-effective or cost-saving, with future investigation needed in the preconception and postpartum period. International clinical guidelines and public health policies are needed for a concerted effort to prevent unhealthy weight gain in these life stages and to reverse the significant adverse health outcomes for women and the next generation.

Pertussis, diphtheria, and tetanus antibodies seroprevalence in pregnant women and neonates, as a preliminary data for introduction of preconception or prenatal DTaP vaccination among Japanese society

An increasing number of countries have been introducing acellular pertussis vaccination during pregnancy for the prevention of neonatal pertussis. In response to the fact that infantile pertussis cases of 0-5 months age groups remained unchanged despite the universal vaccination program, prenatal pertussis vaccination has been a rising issue in Japan. Hence, we investigated the seroprevalence of pertussis, diphtheria, and tetanus antibodies in Japanese pregnant women and neonates, and evaluated the necessity of diphtheria-tetanus-acellular pertussis (DTaP) vaccination during the preconception or prenatal period. Maternal PT-IgG (EIA) and FHA-IgG (EIA) for the first trimester, within 1 week after delivery, and cord blood were collected, along with colostrum pertussis-IgA (ELISA), diphtheria-IgG (EIA), tetanus-IgG (EIA), and blood samples from the first trimester. The maternal seroprevalence of PT-IgG and FHA-IgG was 69 % and 75 %, respectively. All tested participants were positive for diphtheria-IgG and tetanus-IgG (100 %). First trimester PT-IgG/FHA-IgG antibody titers were significantly associated with cord blood PT-IgG/FHA-IgG titers (P < 0.001). We found that pertussis seroprevalence among pregnant Japanese women was approximately 70 %. The antibody seropositivity rate of pertussis was lower than that of diphtheria and tetanus. Fetal acquired passive immunity against pertussis is higher when the level of maternal antibody in the first trimester is sufficient. At least 30 % of study population did not reach to the threshold value to provide sufficient pertussis immunity for the neonates and themselves. The acellular pertussis vaccine (DTaP) approved in Japan lacks safety information for pregnancy, hence, a solution for prompt administration of prenatal acellular pertussis vaccination might be introducing DTaP in the preconception period.

The effectiveness of implementation strategies in improving preconception and antenatal preventive care: a systematic review

BACKGROUND

Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the effectiveness of implementation strategies in improving health professional provision of preconception and antenatal care addressing tobacco smoking, weight management and alcohol consumption.

METHODS

A systematic review of randomised and non-randomised studies with a parallel comparison group was conducted. Eligible studies used implementation strategy/ies targeted at health professionals to improve at least one element of preconception and/or antenatal care (smoking: ask, advise, assess, assist, arrange; weight/alcohol: assess, advise, refer) compared to usual practice/control or alternative strategies. Eligible studies were identified via CENTRAL, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL and other sources. Random-effects meta-analyses were conducted where appropriate, with other findings summarised using the direction of effect. The certainty of the pooled evidence was assessed using the GRADE approach.

RESULTS

Fourteen studies were included in the review. Thirteen were in the antenatal period and 12 tested multiple implementation strategies (median: three). Meta-analyses of RCTs found that implementation strategies compared to usual practice/control probably increase asking (OR: 2.52; 95% CI: 1.13, 5.59; 3 studies; moderate-certainty evidence) and advising (OR: 4.32; 95% CI: 3.06, 6.11; 4 studies; moderate-certainty evidence) about smoking and assessing weight gain (OR: 57.56; 95% CI: 41.78, 79.29; 2 studies; moderate-certainty evidence), and may increase assessing (OR: 2.55; 95% CI: 0.24, 27.06; 2 studies; low-certainty evidence), assisting (OR: 6.34; 95% CI: 1.51, 26.63; 3 studies; low-certainty evidence) and arranging support (OR: 3.55; 95% CI: 0.50, 25.34; 2 studies; low-certainty evidence) for smoking. The true effect of implementation strategies in increasing advice about weight gain (OR: 3.37; 95% CI: 2.34, 4.84; 2 non-randomised studies; very low-certainty evidence) and alcohol consumption (OR: 10.36; 95% CI: 2.37, 41.20; 2 non-randomised studies; very low-certainty evidence) is uncertain due to the quality of evidence to date.

CONCLUSIONS

Review findings provide some evidence to support the effectiveness of implementation strategies in improving health professional delivery of antenatal care addressing smoking and weight management. Rigorous research is needed to build certainty in the evidence for improving alcohol and weight gain advice, and in preconception care.

TRIAL REGISTRATION

PROSPERO-CRD42019131691.

Effect of preconceptional, prenatal and postnatal exposure to home environmental factors on childhood pneumonia: A key role in early life exposure

BACKGROUND

Increasing evidence have associated pneumonia with early exposure to ambient air pollution. However, the role of indoor environmental factors exposure in early life on childhood pneumonia remains unclear.

OBJECTIVE

To examine the association between indoor environmental factors exposure during different timing windows and childhood pneumonia, and to identify the key indoor factor(s) in different critical window(s).

METHODS

A retrospective cohort study of 8689 pre-schoolers was performed in Changsha, China during 2019-2020. Our questionnaire survey was designed to collect information on pre-schooler's outcome and residential environmental exposure containing indoor pollution and allergens during 1 year before pregnancy, pregnancy, first year, and past year. The associations were further estimated stratified by personal exposure level of outdoor NO₂, CO, temperature (T) and different covariates. Associations were assessed by multiple logistic regression model in terms of odds ratio (OR) of 95% confidence interval (CI).

RESULTS

Pre-schooler's pneumonia was significantly related with exposure of new furniture, redecoration, mold/damp stains, and mold or damp clothing or bedding exposure during the four periods, with the strongest associations observed during 1 year before pregnancy based on multi-window model, with ORs (95% CI) of 1.27 (1.12-1.44), 1.26 (1.09-1.46), 1.34 (1.14-1.57), and 1.28 (1.05-1.56) respectively. Environmental tobacco smoke (ETS) including both parental and grandparental smoking were significantly related with increased risk of pre-schooler's pneumonia, and ETS played a more important role in early life, with ORs (95% CI) of 1.17 (1.01-1.36) and 1.19 (1.02-1.39) in pregnancy and first year. Indoor plants particularly nonflowering plants significantly elevated pneumonia risk but only in past year, with ORs (95% CI) of 1.17 (1.05-1.30) and 1.14 (1.03-1.26). Higher pneumonia risk was observed for renovation exposure in pre-birth compared to post-birth, while mold/dampness exerted an accumulative effect with the highest risk for exposure during both pre- and post-birth. Living near traffic road and exposure to high level of traffic-related air pollution and high temperature significantly increased pneumonia risk. Sensitivity analysis found that some sub-groups were more susceptible to pneumonia risk of home environment exposure.

CONCLUSION

Early life exposure to indoor environmental factors plays an important role in pneumonia development, supporting the hypothesis of "Preconceptional and Fetal Origin of Childhood Pneumonia" and "Developmental Origins of Health and Pneumonia".

The acceptability of asking women to delay removal of a long-acting reversible contraceptive to take part in a preconception weight loss programme: a mixed methods study using qualitative and routine data (Plan-it)

Background

Having a body mass index (BMI) which is classified as overweight (BMI ≥ 25) or obese (BMI ≥ 30) increases the risk of complications during pregnancy and labour. Weight-management interventions which target excess gestational weight gain during pregnancy have had limited success. Women who use long-acting reversible contraception (LARC) are in contact with services as part of their preparation for conception, creating a potential opportunity to offer a preconception weight-loss intervention.

The aims of this mixed methods study were to assess the acceptability and practicability of a weight-loss intervention which asked people to delay LARC removal in order to lose weight before conceiving.

Methods

Routine UK NHS data were analysed to identify pathways from LARC removal to pregnancy. Qualitative surveys and advisory group discussions with service providers and LARC users with experience of being overweight were conducted and analysed thematically.

Results

Three hundred fifteen thousand seven hundred fifty-five UK women aged 16–48 years between 2009–2018 had at least one LARC-related event (e.g. insertion, removal) and 1.7% of those events were recorded as related to planning a pregnancy. BMI was included in 62% of women’s records, with 54% of those BMI being classified as overweight or obese. Online surveys were completed by 100 healthcare practitioners and 243 LARC users. Stakeholders identified facilitators and barriers associated with the proposed intervention including sensitivities of discussing weight, service-user past experiences, practitioner skills, the setting and ethical implications of the proposed intervention.

Conclusions

Although women and service providers recognised potential benefits, a preconception weight-loss intervention asking people to delay LARC removal posed many barriers, due mainly to the acceptability of such an intervention to women and healthcare practitioners. Weight-loss interventions that target the general population, together with a focus on improving public knowledge of preconception health, may be more acceptable than interventions which solely focus on LARC users. Many of the barriers identified, including communication, understanding and beliefs about weight and risk, appointment systems and the limitations of routine datasets also have relevance for any preconception weight-loss intervention. Work to improve routine datasets and reducing communication barriers to discussing weight are priorities.

Trial registration

ISRCTN14733020 registered 10.05.2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05077-0.

Changes in dietary patterns from preconception to during pregnancy and its association with socio-demographic and lifestyle factors

OBJECTIVE

To examine dietary patterns changes from preconception to during pregnancy and their associations with socio-demographic and lifestyle factors.

DESIGN

This study used data from the Australian Longitudinal Study on Women's Health (ALSWH), a population-based prospective cohort study. Women's dietary patterns were assessed using Healthy Eating Index-2015 (HEI-2015) score and the four patterns were obtained from the factor analysis (Western diets, vegetable and grains, traditional vegetable and fruit patterns). Multi-variable linear regression and repeated measures mixed-effect models were used.

SETTING

A national representative survey which covers all Australian citizens and permanent residents in Australia.

PARTICIPANTS

621 women were included from the ALSWH.

RESULTS

Women's scores increased on the 'HEI-2015', 'traditional vegetable' and 'fruit' patterns while the 'vegetable and grains' decreased from preconception to during pregnancy. Women with higher education were more likely to increase their HEI-2015 score and fruit consumption from preconception to during pregnancy, respectively (β = 2·31, (95 % CI 0·02, 4·60)) and (β = 23·78, (95 % CI 4·58, 42·97)), than those with lower educational status. Single women were more likely to increase the consumption of vegetables and grains compared to married women (β = 76·08, (95 % CI 20·83, 131·32)). Women with higher income had a greater increase in the HEI-2015 score than those with lower income (β = 3·02, (95 % CI 0·21, 5·83)).

CONCLUSION

The findings indicate that there have been marked dietary changes from preconception to during pregnancy. Changes in healthy dietary patterns were influenced by education, marital status and income.

Empowerment for behaviour change through social connections: a qualitative exploration of women's preferences in preconception health promotion in the state of Victoria, Australia

BACKGROUND

Health behaviours in the preconception period have the potential to impact on fertility and pregnancy outcomes, and the health of all women regardless of pregnancy intention. Public awareness of this is low and interventions that promote behaviour change have not been integrated into real-world settings. Aims were to explore women's understandings of health and health behaviours and what supports are important to promote behaviour change in the preconception period.

METHODS

This qualitative study is the first phase of a broader co-design project set in the state of Victoria, Australia. Over 3 months, a series of in-depth interviews were conducted with female participants who were intending to become pregnant in the next 2 years (n = 6) and participants who were not intending to become pregnant in the next 2 years (n = 6). Community advisors (n = 8) aged 18-45 years provided feedback throughout the process. Coding of transcripts from interviews and meetings was undertaken by two researchers before a deductive process identified themes mapped to the COM-B framework.

RESULTS

Nine themes and eight sub-themes were identified. Participants had a holistic view of health with nutrition, physical activity and sleep being most valued. Social connections were considered as being important for overall health and wellbeing and for promoting health behaviours. The only difference between groups was that pregnancy was an additional motivator for women who were planning to become pregnant in the next 2 years. A range of health information is available from health professionals and other sources. Unlimited access to information was empowering but sometimes overwhelming. Being listened to and shared experiences were aspects of social connections that validated participants and guided them in their decision-making.

CONCLUSIONS

Women valued their health and had a holistic view that includes physical, mental and social dimensions. Women viewed social connections with others as an opportunity to be listened to and to gain support that empowers behaviour change. Future interventions to promote behaviour change in preconception women should consider the importance all women placed on social connections and leverage off existing resources to connect women.

Maternal depressive symptom trajectories from preconception through postpartum: Associations with offspring developmental outcomes in early childhood

BACKGROUND

Two theoretical frameworks, the cumulative stress and match-mismatch model, propose that patterns of maternal depressive symptoms over early periods of offspring development predict outcomes in opposing ways. Studies have yet to test these theories across the preconception, prenatal, and early postnatal period. Study 1 identified trajectories of maternal depressive symptoms from preconception to postpartum. Study 2 examined associations of these trajectories with offspring developmental outcomes in early childhood.

METHODS

In Study 1, women (n = 362) enrolled in a longitudinal study were assessed prior to conception and through a subsequent pregnancy and postpartum. In Study 2, a subsample of 125 mother-child pairs completed home visits in early childhood. Mothers reported on child temperament at age 4. Children completed assessments of executive function at age 5.

RESULTS

Four trajectories of maternal depressive symptoms were identified: low-stable, increasing, decreasing, persistent. In controlled analyses, children of women with decreasing symptoms were lower in maternal ratings of effortful control at age four (β = -0.24, p = .003). Children of women with increasing symptoms scored lower on an inhibitory control task at age five (β = -0.35, p = .001).

CONCLUSIONS

Changes in maternal depressive symptoms, but not stable symptoms, were associated with lower maternal ratings of effortful control and poorer performance on an inhibitory control task. Results are consistent with the match-mismatch model. Assessment of preconception depressive symptoms in women and changes in symptoms may be beneficial for early intervention for women and children.

Preconception reproductive tract infections status and adverse pregnancy outcomes: a population-based retrospective cohort study

Background

Reproductive tract infections can cause serious adverse outcomes for pregnant women such as spontaneous abortion and preterm birth. However, it is unclear whether maternal reproductive tract infection before pregnancy would also be related to any adverse pregnancy outcomes. This study aims to investigate the association of maternal preconception reproductive tract infections with subsequent adverse pregnancy outcomes.

Methods

A retrospective cohort study was conducted in the Chongqing Municipality of China between April 2010 and December 2016. A total of 57,586 women (57,708 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project were included. They all took preconception examinations for gonorrhea, chlamydia, trichomoniasis, syphilis, bacterial vaginosis and candidiasis before pregnancy within one year. Primary outcomes included spontaneous abortion (< 28 weeks gestation), preterm birth (< 37 weeks gestation), macrosomia and low birthweight.

Results

Of the 57,708 pregnancies, 2438 (4.22%) had at least one type of reproductive tract infections. Compared with women who were not infected with any reproductive tract infection before pregnancy, women with reproductive tract infections had a higher rate of spontaneous abortion (7.88% vs. 5.62%, p < 0.001). After analyzing by each infection, there were few significant associations between pre-pregnancy infections and adverse outcomes. Preconception syphilis infection was significantly associated with increased odds of spontaneous abortion (aOR = 2.07, 95%CI 1.50–2.85), induced abortion/labour due to medical reasons (aOR = 1.60, 95%CI 1.01–2.54) and preterm birth (aOR = 1.60, 95%CI 1.12–2.30) after adjusting for potential confounders. Preconception trichomoniasis was intended to relate to a higher risk of spontaneous abortion (aOR = 1.65, 95%CI 1.01–2.71), but its impact seemed to be attributed to its co-infection with other RTIs. Women who were chlamydia or bacterial vaginosis positive before pregnancy showed higher odds of macrosomia (aOR = 2.00, 95% CI 1.07–3.74 for chlamydia; aOR = 1.58, 95% CI 1.06–2.34 for bacterial vaginosis). Preconception bacterial vaginosis might also be associated with higher risks of very preterm birth (aOR = 2.16, 95%CI 1.23–3.78) and large for gestational age (aOR = 1.36, 95%CI 1.02–1.81).

Conclusions

Women with infections of the genital tract before pregnancy might also have increased risks of subsequent adverse outcomes including spontaneous abortion, preterm birth and macrosomia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04836-3.

Preconception Counseling and Care for Pregnant Women with Thyroid Disease

Thyroid disease is associated with adverse maternal and fetal outcomes. Appropriate reference ranges should be used for the interpretation of test results, although universal screening for thyroid dysfunction is not warranted. Overt thyroid dysfunction requires careful consideration of medication adjustments and close monitoring. Mild thyroid hypofunction has been linked to adverse pregnancy outcomes including preterm delivery, and poor neurocognition in the offspring. This review summarizes the most recent evidence on the counseling and management of women with thyroid disease before and during pregnancy and highlights the areas of controversy in need of further research.

Modes of cannabis administration in the year prior to conception among patients in Northern California

Cannabis use among individuals before and during pregnancy is increasing alongside the proliferation of new products with various modes of administration. Preconception cannabis use is a strong predictor of prenatal cannabis use. Yet little is known about how individuals administer cannabis during the preconception period, particularly in socioeconomically vulnerable populations. This study examined the prevalence and correlates of modes of cannabis administration (smoke, vape, blunts, edible/oral, dabs/wax, lotion/topical) during the year before conception, among patients who self-reported preconception cannabis use during universal screening in prenatal care. Descriptive statistics included sociodemographic characteristics, preconception cannabis use frequency, and modes of administration. Chi-square tests examined whether mode was associated with sociodemographic characteristics and use frequency. The sample (N = 11,936, screened from February 2020-May 2021) was 59.8% non-White and 26.1% were < 26 years old; 50.7% reported monthly or less, 21.8% weekly, and 27.4% daily preconception cannabis use; 69.7% smoked (any method), 34.5% smoked blunts, 53.4% used edibles/oral, 28.2% vaped, 9.9% used lotion/topical; 54.2% reported 1 mode, 30.4% reported 2 modes, 15.4% reported 3+ modes. Smoking was more common among daily users, younger patients, those with greater neighborhood deprivation, and Black and Hispanic patients, while edibles/oral were more common among ≤ monthly users, older patients, those with less neighborhood deprivation, and Asian patients. Use of other modes also varied by sociodemographic characteristics and use frequency. Research is needed to understand preconception cannabis use in vulnerable subpopulations, continuation of use during pregnancy, and whether health risks associated with preconception and prenatal cannabis use differ by administration mode.

Diagnostic and Treatment Considerations for Thyroid Cancer in Women of Reproductive Age and the Perinatal Period

Thyroid cancer is one of the most common cancers diagnosed in women of reproductive age and during pregnancy. This leads to important questions about thyroid cancer prognosis and treatment, but also fertility and risk for adverse obstetric and/or fetal and neonatal outcomes. The benefits of thyroid cancer treatment should be weighed against its harms, as various options may adversely impact maternal and fetal health. In the current review, the authors focus on perinatal-specific clinical considerations related to the care of patients with thyroid cancer.