The Critical Importance of Pre-pregnancy Care

Written by Clare Carrick ANutr BHSc (Nutrition and Health Promotion)

Scientifically reviewed by Dr Fathalla Ali, PHD Paediatrics

03/08/2022

What does pre-pregnancy care mean to you?

Is ‘pre-pregnancy care’ cutting out those Friday night work drinks… which often carry into the wee hours of the morning? Maybe you’ve started a weekly yoga class to get you into that zen zone for the birth, or perhaps you’ve thrown that last packet of ciggies in the bin…

If you’re someone who’s thought at all about your health and preparation prior to getting pregnant, you’re in the minority (go you!)! Most people tend to wait until they’re pregnant, or until they’ve been trying unsuccessfully to get pregnant, before they think about making diet and lifestyle changes to support their fertility.

The data, however, is clear: you AND your partner’s health in the lead-up to conception is strongly linked to the outcome of the pregnancy, and the health of the future generation (1)!

 

Pre-pregnancy Care Matters!

As a society, we’ve come a long way in terms of healthcare during pregnancy and birth, but our pre-pregnancy care is lagging behind (2). When you think about the high school PD/PE lessons on pregnancy, most of the focus was probably on how NOT to get pregnant, not on how to prepare your body for a healthy pregnancy. But, the evidence has shown direct associations between pre-pregnancy influences and the health of your baby, and even your baby’s baby (2)! The importance of good nutrition and health, for both men and women in the lead up to conception, has been highlighted in the literature, for improving chances of successful conception, pregnancy outcomes, and the health of mum and bub during birth and long into their future (1). 

 

Population Level Action

“But up to 40% of pregnancies aren’t planned, so what’s the point of putting effort into pre-pregnancy care?” (2). This is a common objection to focusing more attention towards pre-pregnancy care, but all it really does is highlight the additional need for focusing our healthcare beyond the individual, and more towards the population as a whole (2). Although most teenagers probably aren’t thinking much about making babies, the type of healthy dietary and lifestyle advice that can have a positive impact on pregnancy and bub’s health outcomes, also just-so-happen to reduce unwanted weight gain, prevent nutrient deficiencies, improve gut health etc…all things teenagers might be a tad more interested in…so there are many different ways to ‘sell’ the ‘healthy life’!

 

Caring for the Microbiome

We already know that the human microbiome plays a large role in human health, but what does this have to do with pre-pregnancy care (3)? A lot, as it turns out! Up until fairly recently, the general consensus was that the uterine environment was sterile, but it turns out that non-pathogenic bacteria can be found in the amniotic fluid and placentas of healthy babies, which indicates that there is a transfer of microbes between mum and bub before the actual birth (3). Why is this important? Because the microbiome of the mum during pregnancy will direct the development of the baby’s own microbiome, and therefore may also influence their immune system development and future health (3). We know that the microbiome is modifiable through changes in diet and lifestyle, so this knowledge highlights the importance of those months leading into pregnancy as a prime time to optimise your own microbiome so that you’re passing on the best possible version to your bub.

 

The Golden Window – When does the ‘Pre-pregnancy’ Period Start?

Is it 3 months? 6 months? 1 year? Whilst there is much discussion surrounding the exact definition of the ‘pre-pregnancy period’, there is evidence to show that the earlier the care starts, the better! In fact, targeting the health of adolescents through diet and lifestyle could represent an ideal time for intervention, as this is often the time when less beneficial lifestyle habits trickle in, becoming habits that frequently last into adulthood (1). Poor diet and nutrition pre-pregnancy may have an impact on the health of the baby because of high BMI or nutrient deficiencies (1). Whilst motivation is often higher during pregnancy to make healthy changes to aid with weight-loss or nutrition deficiencies, the evidence shows that this is often too late to make much of an impact on birth outcomes, again underscoring the importance of getting in early (1, 4)! 

 

The Way Forward

Healthy mums and dads make healthy babies. In general, as individuals we leave it too late to make healthy changes when planning a pregnancy, but substantial benefits may be seen if we get in a bit earlier. Obesity, malnutrition (over- or undernutrition), and our microbiome all play a role in the health of our pregnancies and the future health of our babies. On the population level, more needs to be done to prevent detrimental lifestyle habits setting in during adolescence, which can lead on to negatively impact the health of our babies. Overall, we need to get ahead of the game. Supporting healthy lifestyle and dietary habits as early as possible in life will help create healthy mums- and dads-to-be…long before they’ve even decided they want to be parents! 

References

  1. The Lancet. Campaigning for pre-pregnancy health. The Lancet, 2018. 391(10132): p. 1749.
  2. Stephenson J, Schoenaker DA, Hinton W, Poston L, Barker M, Alwan NA, Godfrey K, Hanson M, de Lusignan S. A wake-up call for pre-pregnancy health: a clinical review. British Journal of General Practice. 2021 May 1;71(706):233-6.
  3. Stiemsma LT, Michels KB. The role of the microbiome in the developmental origins of health and disease. Pediatrics. 2018 Apr 1;141(4).
  4. Stephenson J, Heslehurst N, Hall J, Schoenaker DA, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K. Before the beginning: nutrition and lifestyle in the pre-pregnancy period and its importance for future health. The Lancet. 2018 May 5;391(10132):1830-41.

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