Intervention strategies to improve nutrition and health behaviours before conception

Abstract

The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.

Poor maternal anthropometric status before conception is associated with a deleterious infant growth during the first year of life: a longitudinal preconceptional cohort

“…Studies in Taiwan and the United States have found an increased birthweight in subsequent babies from mothers that were supplemented in micronutrients/macronutrients for several months after the birth of their first baby. Our results support preventive interventions started prior to conception or even early in pregnancy to improve nutritional status of women such as supplementation or preventive strategies against malaria and helminthic diseases, which could influence nutritional status …”

“…According to WHO standards, 22% of infants were affected by stunting at 12 months of age with a higher risk in infants born from mothers with underweight before conception. These results reinforce the need for improving maternal nutritional conditions as early as in the preconception period …”

“…Our results support preventive interventions started prior to conception or even early in pregnancy to improve nutritional status of women such as supplementation or preventive strategies against malaria and helminthic diseases, which could influence nutritional status. 46 Our study has some limitations that should be considered. First, we…”

The impact of maternal supplementation during pregnancy and the first 6 months postpartum on the growth status of the next child born after the intervention period: Follow‐up results from Bangladesh and Ghana

“…For this reason, many nutrition interventions focus on improving maternal nutrition during pregnancy and/or child nutrition during the first 2 years. More recently, the preconception period has received increasing attention as another critical, and generally overlooked, window for improving maternal nutrition and child outcomes (Barker et al, 2018;De-Regil, Harding, & Roche, 2016;Stephenson et al, 2018).…”

The Preconception Period analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium

“…“Preconception” can be construed narrowly, for instance, as the time period when pregnancy is planned, or broadly, as any point in the life span prior to pregnancy . Exposures from both time periods have been found to affect pregnancy and infant health (eg folic acid supplementation or adverse childhood experiences).…”