This chapter should be cited as follows:
Devlieger R, Miserez L, Glob Libr Women's Med
ISSN: 1756-2228; DOI 10.3843/GLOWM.421533

Nutrition in the Periconceptional, Pregnancy and Postpartum Periods

Volume Editor:
DOI 10.3843/GLOWM.00000

Chapter

Reproductive and periconceptional period: opportunity for better health and pregnancy outcomes

VIDEO 1

AUTHOR(S)

Roland Devlieger, MD, PhD

Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium

Leonie Miserez, MSc, RMW

REALIFE Research Group, Department of Development and Regeneration, KU Leuven, Leuven, Belgium

While the potential adverse outcomes of prenatal exposure to unhealthy lifestyle are well-established, little is known about the impact of these exposures in the reproductive and periconceptional periods. The associations between lifestyle behaviors and adverse pregnancy outcomes are highlighted.

INTRODUCTION

Preconception care encompasses health services, interventions and counseling aimed at individuals planning to conceive, focusing on optimizing maternal health, supporting fetal development, and ensuring positive outcomes for both mother and child. This proactive, preventive approach addresses various factors affecting pregnancy prior to conception¹. This chapter provides a brief overview of preconception care, its importance, and the emerging insight into the short- and long-term benefits for both mother and offspring.

PRECONCEPTION CARE

Preconception care is a comprehensive process that encompasses various medical, behavioral and environmental aspects². To assist healthcare providers in delivering high-quality clinical care in this field, various clinical practice guidelines have been published. The content of preconception care can be categorized into several key areas, according to current guidelines³.

Health assessment and risk factor identification
A thorough health assessment is the cornerstone of preconception care. Healthcare providers should evaluate the mother’s physical health status, medical history and lifestyle factors that could affect pregnancy outcomes. For example, identification and management of chronic diseases, screening for alcohol or tobacco/vaping use⁴ and identifying mental health issues⁵.
Screening for infections and immunizations
Infections can pose significant risks to both maternal and fetal health. Therefore, preconception care includes screening for sexually transmitted infections, assessment of immunization status, and provision of necessary vaccinations if the woman is not up-to-date. Additionally, guidance is offered on preventing infections that could harm the developing fetus, such as cytomegalovirus⁶.
Genetic counseling and family history
Genetic screening can detect inherited conditions or potential genetic risks within the family (e.g. cystic fibrosis). The evaluation of family history can guide future reproductive decisions and inform the couple about potential risks during pregnancy⁷.
Reproductive health education
Educating individuals about fertility and reproductive health is essential for both achieving and avoiding pregnancy. This includes understanding ovulation cycles, the timing of conception and lifestyle factors that impact fertility. Couples may also receive guidance on contraceptive use if they do not desire to have children in the future⁸.
Supplements and nutrition counseling
Folate supplementation is a well-known key component of preconception care. Adequate folate intake before conception reduces the risk of neural tube defects in the offspring by more than 50%⁹. Additional supplementation is advised in some high-risk populations (e.g. history of metabolic bariatric surgery). In addition, counseling about eating and weight management to achieve a healthy prepregnancy body mass index (BMI) is part of preconception care.
Environmental and occupational health
Preconception care includes addressing environmental exposures that may harm pregnancy outcomes, such as exposure to heavy metals or radiation. Occupational health risks are assessed to ensure the working environment does not pose harm to pregnancy. Additionally, given the proven impact on fertility, it is increasingly important to raise awareness about endocrine-disrupting chemicals and provide individuals with guidance on how to minimize their exposure¹⁰^,¹¹.

IMPORTANCE OF PRECONCEPTION CARE: SHORT- AND LONG-TERM BENEFITS

The importance of preconception care lies in its preventive nature. Presented below is an overview of the short- and long-term effects¹²^,¹³.

Short-term benefits

Improved pregnancy outcomes
Preconception care directly influences the likelihood of a successful pregnancy by addressing modifiable risk factors, such as poor nutrition, obesity, smoking and alcohol consumption. Research shows that women who become pregnant when in optimal health are less likely to experience complications like pre-eclampsia, gestational diabetes and preterm birth.
Enhanced fertility
A healthy preconception state improves fertility rates in both women and men. For women, a balanced diet rich in micronutrients can enhance the chances of conception. Men’s fertility also benefits from a healthy diet and regular physical activity, as it improves sperm quality¹⁴. For instance, among couples assessed prior to their first IVF cycle, those in which both partners consumed at least four drinks per week had a 21% lower likelihood of achieving a live birth compared to couples in which both partners drank fewer than four drinks per week¹⁵.
Reduced risk of maternal complications
Preconception interventions lower the risk of maternal complications. The following are some examples. (1) Achieving a healthy weight before pregnancy reduces the likelihood of gestational diabetes and hypertensive disorders¹²^,¹³. (2) Women living with obesity have an increased likelihood of undergoing a Cesarean section¹⁶. (3) Cessation of smoking before conception significantly decreases the risk of pregnancy loss and congenital anomalies in the baby¹⁷^,¹⁸

Long-term benefits for the offspring

Reduced risk of chronic disease
The Developmental Origins of Health and Disease (DOHaD) hypothesis underscores the lasting impact of early-life exposures on long-term health. Nutritional deficiencies or toxic exposures during the preconception period can program the child’s susceptibility to chronic diseases such as type 2 diabetes, cardiovascular disease and obesity. Conversely, optimal maternal nutrition and health behaviors before conception establish a foundation for lifelong health.
Cognitive and developmental benefits
Maternal health such as nutrition status and stress levels before conception and during pregnancy have an impact on the child’s cognitive and neurodevelopmental outcomes. Good maternal nutrition, including adequate intake of omega-3 fatty acids and essential micronutrients, supports brain development and improves long-term cognitive abilities in the child. In addition, a sufficient level of vitamin D supports skeletal growth¹⁹.
Intergenerational health
The benefits of preconception care extend beyond the individual mother. Women who receive preconception care are more likely to adopt healthy behaviors that they pass on to their children, breaking the cycle of poor maternal health²⁰. For example, maternal undernutrition during the preconception period has been linked to altered DNA methylation patterns in key growth-regulating genes, which persist in adulthood and can predispose the child to metabolic dysfunction.

Long-term benefits for the mother

Prevention of chronic diseases
Preconception care helps manage chronic conditions, reducing the long-term burden on the mother’s health. By addressing diseases associated with obesity, women may be able to avoid long-term complications, such as cardiovascular disease, stroke and kidney problems.
Improved postpartum recovery
Becoming pregnant when in an optimal health state increases the likelihood of experiencing a smoother postpartum recovery. Preconception weight management, for instance, reduces the risk of excessive weight retention postpartum, facilitating a quicker return to prepregnancy BMI.

CONCLUSION

Preconception care plays a critical role in ensuring healthy pregnancy and promoting the wellbeing of both mothers and their offspring. There is substantial evidence highlighting the importance of preconception care. Optimizing maternal and paternal health before pregnancy can help prevent chronic diseases in the future for both the mother and her children. With the increasing burden of deaths caused by conditions such as cardiovascular disease, preconception care is a valuable, socially relevant and cost-effective strategy.

Table 1¹²^,¹³ highlights the various components of preconception care and the short- and long-term benefits for both mother and offspring.

Short- and long-term benefits of different aspects of preconception care.

Area	Description	Short-term benefits for mother	Long-term benefits for mother	Short-term benefits for offspring	Long-term benefits for offspring
Health assessment and risk factor identification	Evaluating maternal health, chronic conditions (e.g. diabetes, hypertension), and lifestyle factors.	Improved control of chronic conditions (e.g. diabetes, hypertension). Improved management of risk factors (e.g. obesity)	Prevention of chronic diseases (e.g. heart disease, stroke). Improved overall health and fertility.	Reduced risk of birth defects (e.g. neural tube defects) and complications.	Reduced risk of chronic diseases (e.g. obesity, type 2 diabetes). Healthier immune and metabolic function.
Screening for infections and immunizations	Identifying infections (e.g. STIs, rubella) and updating vaccinations (e.g. flu, hepatitis B).	Prevention of infectious diseases during pregnancy. Protection from preventable diseases (e.g. rubella, influenza).	Lower risk of infectious diseases and associated long-term health complications.	Reduced risk of fetal infections and birth defects. Lower risk of neonatal infections.	Lower incidence of long-term infections and related complications.
Genetic counseling and family history	Screening for inherited conditions and assessing family history for potential risks.	Informed decision-making regarding pregnancy. Early identification of genetic risks.	Prevention of passing on hereditary conditions.	Lower risk of genetic disorders in offspring.	Better long-term health outcomes due to reduced genetic risks.
Nutrition and supplementation	Addressing nutritional needs (e.g. folate, omega-3 fatty acids) and advising on weight management.	Reduced risk of deficiencies that affect maternal health and fertility. Optimized nutrient intake for pregnancy.	Prevention of long-term health conditions due to poor nutrition (e.g. osteoporosis, heart disease).	Reduced risk of birth defects and developmental issues. Healthier fetal growth and development.	Improved cognitive development and academic performance due to better prenatal nutrition.
Mental health and stress management	Identifying and addressing mental health issues (e.g. depression, anxiety) and stress.	Improved emotional wellbeing, leading to better coping with pregnancy.	Reduced risk of postpartum depression. Better long-term mental health.	Reduced risk of developmental and behavioral issues in infants.	Healthier emotional and cognitive development in children.
Reproductive health education	Educating on fertility, conception timing, and reproductive health practices.	Enhanced fertility awareness and healthier conception.	Greater awareness of reproductive health, leading to informed decisions for future pregnancies.	Lower risk of preterm birth and pregnancy complications.	Improved long-term health outcomes, including reduced risk of infertility or reproductive health issues.
Environmental and occupational health	Addressing environmental and occupational exposures that could harm pregnancy (e.g. chemicals, radiation).	Minimization of harmful exposures.	Long-term protection from harmful environmental factors, contributing to overall health.	Reduced risk of birth defects related to environmental toxins.	Lower risk of chronic health conditions due to early avoidance of environmental hazards.

STI, sexually transmitted infection.

CONFLICTS OF INTEREST

Author(s) statement awaited.

REFERENCES

1	Jacob CM, Killeen SL, McAuliffe FM, Stephenson J, Hod M, Yamal ID, et al. Prevention of noncommunicable diseases by interventions in the preconception period: A FIGO position paper for action by healthcare practitioners. International Journal of Gynecology & Obstetrics [Internet]. 2020 Sep 1;151(S1):6–15. Available from: https://doi.org/10.1002/ijgo.13331
2	Maternal, Newborn, Child & Adolescent Health & Ageing (MCA). Preconception care: Maximizing the gains for maternal and child health – Policy brief [Internet]. 2013. Available from: https://www.who.int/publications/i/item/WHO-FWC-MCA-13.02
3	Dorney E, Boyle JA, Walker R, Hammarberg K, Musgrave L, Schoenaker D, et al. A Systematic Review of Clinical Guidelines for Preconception care. Seminars in Reproductive Medicine [Internet]. 2022 May 16;40(03/04):157–69. Available from: https://doi.org/10.1055/s-0042-1748190
4	Bowsher R, Marczylo TH, Gooch K, Bailey A, Wright MD, Marczylo EL. Smoking and vaping alter genes related to mechanisms of SARS-CoV-2 susceptibility and severity. European Respiratory Journal [Internet]. 2024 Jul 1;64(1):2400133. Available from: https://doi.org/10.1183/13993003.00133-2024
5	Van Haeken S, Braeken M a. KA, Nuyts T, Franck E, Timmermans O, Bogaerts A. Perinatal resilience for the first 1,000 days of life. Concept Analysis and Delphi survey. Frontiers in Psychology [Internet]. 2020 Nov 3;11. Available from: https://doi.org/10.3389/fpsyg.2020.563432
6	Kilby MD, Ville Y, Acharya G. Screening for cytomegalovirus infection in pregnancy. BMJ [Internet]. 2019 Nov 19;l6507. Available from: https://doi.org/10.1136/bmj.l6507
7	Wille MC, Weitz B, Kerper P, Frazier S. Advances in preconception genetic counseling. The Journal of Perinatal & Neonatal Nursing [Internet]. 2004 Jan 1;18(1):28–40. Available from: https://doi.org/10.1097/00005237-200401000-00004
8	Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building. Human Reproduction [Internet]. 2022 Feb 21;37(5):988–96. Available from: https://doi.org/10.1093/humrep/deac036
9	De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Library [Internet]. 2015 Dec 14;2015(12). Available from: https://doi.org/10.1002/14651858.cd007950.pub3
10	Martin L, Zhang Y, First O, Mustieles V, Dodson R, Rosa G, et al. Lifestyle interventions to reduce endocrine-disrupting phthalate and phenol exposures among reproductive age men and women: A review and future steps. Environment International [Internet]. 2022 Oct 14;170:107576. Available from: https://doi.org/10.1016/j.envint.2022.107576
11	Smarr MM, Salehabadi SM, Barr DB, Louis GMB, Sundaram R. A multi-pollutant assessment of preconception persistent endocrine disrupting chemicals and incident pregnancy loss. Environment International [Internet]. 2021 Jul 28;157:106788. Available from: https://doi.org/10.1016/j.envint.2021.106788
12	Stephenson J, Heslehurst N, Hall J, Schoenaker D a JM, Hutchinson J, Cade JE, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. The Lancet [Internet]. 2018 Apr 16;391(10132):1830–41. Available from: https://doi.org/10.1016/s0140-6736(18)30311-8
13	Fleming TP, Watkins AJ, Velazquez MA, Mathers JC, Prentice AM, Stephenson J, et al. Origins of lifetime health around the time of conception: causes and consequences. The Lancet [Internet]. 2018 Apr 16;391(10132):1842–52. Available from: https://doi.org/10.1016/s0140-6736(18)30312-x
14	Salas-Huetos A, Rosique-Esteban N, Becerra-Tomás N, Vizmanos B, Bulló M, Salas-Salvadó J. The Effect of nutrients and dietary supplements on sperm quality Parameters: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Advances in Nutrition [Internet]. 2018 Jul 14;9(6):833–48. Available from: https://doi.org/10.1093/advances/nmy057
15	Rossi BV, Berry KF, Hornstein MD, Cramer DW, Ehrlich S, Missmer SA. Effect of alcohol consumption on in vitro fertilization. Obstetrics and Gynecology [Internet]. 2010 Dec 22;117(1):136–42. Available from: https://doi.org/10.1097/aog.0b013e31820090e1
16	Wuytack F, Devlieger R, Ameye L, Corcoran P, Fitzgerald AP, Ombelet W, et al. Impact of female obesity and assisted reproduction on uncomplicated pregnancies and healthy births: a study of 428 336 births in Flanders. Human Reproduction [Internet]. 2022 Oct 18;38(1):156–67. Available from: https://doi.org/10.1093/humrep/deac221
17	Lassi ZS, Imam AM, Dean SV, Bhutta ZA. Preconception care: caffeine, smoking, alcohol, drugs and other environmental chemical/radiation exposure. Reproductive Health [Internet]. 2014 Sep 26;11(S3). Available from: https://doi.org/10.1186/1742-4755-11-s3-s6
18	Penzias A, Bendikson K, Butts S, Coutifaris C, Falcone T, Gitlin S, et al. Smoking and infertility: a committee opinion. Fertility and Sterility [Internet]. 2018 Sep 1;110(4):611–8. Available from: https://doi.org/10.1016/j.fertnstert.2018.06.016
19	Pilz S, Zittermann A, Obeid R, Hahn A, Pludowski P, Trummer C, et al. The Role of Vitamin D in Fertility and during Pregnancy and Lactation: A Review of Clinical Data. International Journal of Environmental Research and Public Health [Internet]. 2018 Oct 12;15(10):2241. Available from: https://doi.org/10.3390/ijerph15102241
20	Roseboom T. De eerste 1000 dagen. Het fundamentele belang van een goed begin vanuit biologisch, medisch en maatschappelijk perspectief. Tijdstroom D, editor. Utrecht 2018.

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