A wake-up call for preconception health: a clinical review.

Preparing for a healthy pregnancy, preconception care, should be the norm and a more actively managed step in primary care. Decades of improvement in the quality of maternity care have greatly reduced the risks associated with pregnancy and childbirth, but improvements in preconception care have lagged behind. The health of women as they enter pregnancy remains a major challenge to maternity services, and two-thirds of maternal deaths in the UK are now in women with pre-existing medical conditions.1 Animal and human research show clear links between preconception influences and offspring health extending across two or more generations.2 In the UK and most other countries, preconception health is frequently compromised by maternal and paternal obesity, dietary deficiencies, smoking, excessive alcohol consumption, mental health issues, and recreational drug use, all of which are associated with poorer pregnancy outcomes and frequently rooted in social and economic deprivation. The rise in obesity among women of reproductive age has been the most pressing ‘wake-up call’ to improve preconception health. Obesity (body mass index [BMI] ≥30 kg/m2), which affects over one in five (21.6%) pregnant women in the UK,3 is strongly linked to almost all adverse pregnancy and birth outcomes, notably pre-eclampsia, gestational diabetes, and stillbirth, and has lasting consequences for the health of the offspring.4 Unfortunately, attempts to tackle the problem through diet and physical activity interventions starting in pregnancy have had negligible effect on immediate and later outcomes.5,6 Together, these findings call for a new focus on improving health before conception. This article draws on comprehensive recent reviews of clinical care from the National Institute for Health and Care Excellence (NICE),7 research evidence from the National Institute for Health Research (NIHR),8 the scientific rationale,9 the 2018 Lancet series on preconception health,2, …