Routine pre-pregnancy health promotion for improving pregnancy outcomes
Open accessAbstract
BACKGROUND: A number of potentially modifiable risk factors are known to be associated with poor pregnancy outcomes. These include smoking, drinking excess alcohol, and poor nutrition. Routine health promotion (encompassing education, advice and general health assessment) in the pre-pregnancy period has been proposed for improving pregnancy outcomes by encouraging behavioural change, or allowing early identification of risk factors. While results from observational studies have been encouraging, this review examines evidence from randomised controlled trials of preconception health promotion. OBJECTIVES: To assess the effectiveness of routine pre-pregnancy health promotion for improving pregnancy outcomes when compared with no pre-pregnancy care or usual care. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2009). SELECTION CRITERIA: Randomised and quasi-randomised trials examining health promotion interventions which aim to identify and modify risk factors before pregnancy. The review focuses on all women of childbearing age rather than those in high-risk groups. We have excluded trials where interventions are aimed specifically at women with established medical, obstetric or genetic risks or already receiving treatment as part of programmes for high-risk groups. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility and carried out data extraction. MAIN RESULTS: Four trials (2300 women) are included. The interventions ranged from brief advice through to education on health and lifestyle over several sessions. For most outcomes, data were only available from individual studies. Only one study followed up through pregnancy and there was no strong evidence of a difference between groups for preterm birth, congenital anomalies or weight for gestational age; only one finding (mean birthweight) reached statistical significance (mean difference -97.00, 95% confidence interval (CI) -168.05 to -25.95). This finding needs to be interpreted with caution as pregnancy outcome data were available for only half of the women randomised. There was some evidence that health promotion interventions were associated with positive maternal behavioural change including lower rates of binge drinking (risk ratio 1.24, 95% CI 1.06 to 1.44). Overall, there has been little research in this area and there is a lack of evidence on the effects of pre-pregnancy health promotion on pregnancy outcomes. AUTHORS' CONCLUSIONS: There is little evidence on the effects of pre-pregnancy health promotion and much more research is needed in this area. There is currently insufficient evidence to recommend the widespread implementation of routine pre-pregnancy health promotion for women of childbearing age, either in the general population or between pregnancies.
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Health promotion activities, such as education, advice and a general health assessment, are likely to improve pregnancy outcomes, by early identification of risk factors encouraging behavioural change.
“Health promotion activities, such as education, advice and a general health assessment, are likely to improve pregnancy outcomes, by early identification of risk factors encouraging behavioural change [15–17].”
From Associations between periconceptional lifestyle behaviours and adverse pregnancy outcomes (2021) · cites this paper as [15]
The Background (‘Description of the intervention’) describes education, advice and health assessment as a proposed way to improve pregnancy outcomes through behavioural change or early identification of risk factors. But the Abstract (‘Main results’) says there is a lack of evidence on effects on pregnancy outcomes, so ‘likely to improve’ is stronger than this review supports. Page numbers are not available in the supplied passages. (LLM, conf=0.88)
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“However, there is a lack of evidence of the success of such health promotion pre-pregnancy, and often women do not present to health care professionals until after conception [28].”
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“…to control pre-existing comorbidities (such as diabetes, hypertension, or autoimmune disease) and regulate environmental interventions such as vitamin intake, smoking cessation, and increasing the chance of breastfeeding post-delivery (Dorney & Black, 2018; Simon, 2019; Whitworth & Dowswell, 2009).”
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“We are purposefully not just targeting pregnancy planners as we speculate that those who need behavioural change interventions are less likely to plan pregnancy [41].”
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Botchway, S., Quigley, M. A., & Gray, R. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005468 · Cited by 11 · see citing works
“Smoking during pregnancy can lead to poor outcomes for mothers as well as for babies.(16) Low birth weight is associated with worse childhood, and worse adult health and social outcomes, and is thought to be influenced by biological as well as social factors.”
Results of a Dutch national and subsequent international expert meeting on interconception care
Sijpkens, M., van den Hazel, C. Z., Delbaere, I., Tydén, T., Mogilevkina, I., Steegers, E., Shawe, J., & Rosman, A. (2019) · Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2018.1547375 · Cited by 10 · see citing works
“Few studies have specifically assessed the effectiveness of an ICC intervention on improved pregnancy outcomes or proxy outcomes such as behavior change (see Supplementary addendum table) [17].”
Harden, S., Ramalingam, N., Wilson, K. E., & Evans-Hoeker, E. (2017) · BMC Obesity · doi:10.1186/s40608-017-0144-6 · Cited by 10 · see citing works
“However, there is little evidence on the effects of preconception health promotion or its existence in practice, despite recommendations for routinized population-level preconception health promotion [3, 4].”
BackgroundDilworth, S., Doherty, E., Mallise, C., Licata, M., Hollis, J. L., Wynne, O., Lane, C., Wolfenden, L., Wiggers, J., & Kingsland, M. (2024) · Implementation Science Communications · doi:10.1186/s43058-024-00655-z · Cited by 9 · see citing works
“Internationally, it is estimated that 10% of pregnant people smoke tobacco [13–15], 10% consume alcohol [16], and 68% gain weight outside of recommended ranges [1, 2, 17, 18].”
BackgroundEffectiveness of preconception care interventions in primary care: a systematic review protocol
Withanage, N., Botfield, J. R., Srinivasan, S., Black, K., & Mazza, D. (2022) · BJGP open · doi:10.3399/bjgpo.2021.0191 · Cited by 9 · see citing works
“Furthermore, most primary carebased PCC interventions have primarily focused on women.(8,9,13,30,31) Lifestyle factors such as alcohol consumption and smoking may cause deoxyribonucleic acid (DNA) damage to the sperm, however, which may result in birth defects.”
BackgroundPromoting preconception health in primary care.
Fuehrer, L., Buckler, E., Bowman, E., Gregory, T., & Mcdaniel, J. (2015) · JAAPA : official journal of the American Academy of Physician Assistants · doi:10.1097/01.jaa.0000469436.52325.cb · Cited by 9 · see citing works
Acceptability of stem cell therapy by pregnant women.
Hodges, R., Bardien, N., & Wallace, E. (2012) · Birth · doi:10.1111/j.1523-536x.2012.00527.x · Cited by 9
Maisonneuve, E. (2016) · Journal de gynecologie, obstetrique et biologie de la reproduction · doi:10.1016/j.jgyn.2016.09.019 · Cited by 8 · see citing works
Maas, V. Y. F., Koster, M. P. H., Ista, E., Auweele, K. V., de Bie, R. W. A., de Smit, D. J., Visser, B. C., van Vliet‐Lachotzki, E. H., Franx, A., & Poels, M. (2020) · BMC Public Health · doi:10.1186/s12889-020-8329-1 · Cited by 17 · see citing works
Yngyknd, S. G., Mohammad-Alizadeh-Charandabi, S., Babapour, J., & Mirghafourvand, M. (2018) · Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2017.1346605 · Cited by 8 · see citing works
Family-Centred Perinatal Care: Improving Pregnancy, Birth and Postpartum Care
Chalmers, B. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316809662 · Cited by 8 · see citing works
Ingersoll, K., Hettema, J., Cropsey, K., & Jackson, J. (2011) · Journal of Women's Health · doi:10.1089/jwh.2010.2633 · Cited by 8 · see citing works
“associated with positive maternal behavioral change, including lower rates of binge drinking.(36)”
BackgroundThe management of pregnant women with epilepsy: a multidisciplinary collaborative approach to care
Bhatia, M., Adcock, J., & Mackillop, L. (2017) · doi:10.1111/tog.12413 · Cited by 7
Goeckenjan, M., Brückner, A., & Vetter, K. (2021) · Der Gynäkologe · doi:10.1007/s00129-021-04821-5 · Cited by 6 · see citing works
“Dazu gehören die Beratung zu Lebensstilfaktoren, eine gezielte und sinnvolle Diagnostik angepasst an Ressourcen und Bedürf- 580 Der Gynäkologe 8 · 2021 CM E Überleben der Mutter Mütterliche Mortalität 1890 1950 Optimales Überleben der Mutter Mütterliche Morbidität Überleben des Kindes 1970 Perinatale Mortalität Kind m…”
BackgroundInfluentialPreconception tests at advanced maternal age.
Chronopoulou, E., Raperport, C., Serhal, P., Saab, W., & Seshadri, S. (2020) · Best Practice & Research: Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2020.11.003 · Cited by 6 · see citing works
Tieu, J., Bain, E., Middleton, P., & Crowther, C. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010211.pub2 · Cited by 6 · see citing works
Ravula, P., Kasala, K., & Das, A. (2024) · SAGE Open · doi:10.1177/21582440241266695 · Cited by 5
“This, in turn, contributes to enhancing maternal well-being and birth outcomes (Mulliner et al., 1995; Popa et al., 2013; Whitworth & Dowswell, 2009).”
Doherty, E., Kingsland, M., Wolfenden, L., Wiggers, J., Dray, J., Hollis, J., Elliott, E., Daly, J., Bailey, K., Attia, J., et al. (2019) · Systematic Reviews · doi:10.1186/s13643-019-1193-3 · Cited by 5 · see citing works
“Preconception care may also be effective in improving risk factors prior to pregnancy [8], including lowering rates of risky alcohol consumption [29].”
BackgroundImproving maternal and reproductive health in South Asia : drivers and enablers
El-Saharty, S., Chowdhury, S., Ohno, N., & Sarker, I. (2016) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0963-7 · Cited by 5 · see citing works
Can an Electronic Health Record System be Used for Preconception Health Optimization?
Straub, H. L., Adams, M. G., & Silver, R. (2014) · Maternal and Child Health Journal · doi:10.1007/s10995-014-1461-8 · Cited by 5 · see citing works
“Potential interventions could include communicating with the patients’ primary care providers via electronic physician alerts or computer-based decision tools, which have been shown to improve compliance with clinical protocols [30] and decrease teratogenic medication exposures in women without documented contraceptio…”
BackgroundDoe, P., Hormenu, T., & Enyan, N. I. E. (2022) · Journal of Family and Reproductive Health · doi:10.18502/jfrh.v16i1.8593 · Cited by 4 · see citing works
“Additionally, there is insufficient evidence to guide the comprehensive implementation of routine PCH interventions (26, 27).”
BackgroundUpStart Parent Survey-Prenatal: A New Tool for Evaluating Prenatal Education Programs.
Benzies, K., Barker, L., Churchill, J., Smith, J., & Horn, S. (2016) · Public Health Nursing · doi:10.1111/phn.12269 · Cited by 4 · see citing works
“While prenatal education is frequently recommended by health care providers (Gagnon & Sandall, 2007), evidence of its effectiveness is lacking (Whitworth & Dowswell, 2009).”
BackgroundThe Impact of Pregnancy Readiness on Lupus Activity, Maternal Mental Health, and Pregnancy Outcomes
Harding, C. C., Eudy, A., Sims, C. A., Edens, C., Talabi, M., Ramsey-Goldman, R., Neil, L., & Clowse, M. (2024) · Arthritis care & research · doi:10.1002/acr.25430 · Cited by 3 · see citing works
“3,31,32 Among preparatory health behaviors, these individuals also reported not having sought medical advice, which underscores the importance of provider-initiated discussions around pregnancy planning.”
Improving Conceptual Clarity of Antenatal Interventions: A Scoping Review
Buultjens, M. (2016) · doi:10.23937/2469-5793/1510043 · Cited by 3
“smoking, poor nutrition, and alcohol abuse [7].”
Preconception counselling for women with epilepsy
Winterbottom, J., Pulman, J., Greenhalgh, J., Smyth, R., & Marson, A. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011007 · Cited by 3 · see citing works
Preterm birth: prediction, prevention, care
Alleman, B. W. (2014) · doi:10.17077/etd.4eor65oi · Cited by 3 · see citing works
“Categorical Variables Total Cholesterol OR (95% CI) P Total Cholesterol OR (95% CI) P Q4 (193-359) 1.”
BackgroundPublic Health Aspects of Child Well-Being
Brinkman, S., & Stanley, F. (2014) · doi:10.1007/978-90-481-9063-8_16 · Cited by 3
Sharper focus on uncomplicated pregnancy
Knight, M. (2013) · British medical journal · doi:10.1136/bmj.f6470 · Cited by 2 · see citing works
Lanssens, D., Vandenberk, T., Lodewijckx, J., Peeters, T., Storms, V., Inge, M., Grieten, L., & Gyselaers, W. (2018) · doi:10.2196/preprints.10887 · Cited by 2
Eriksson, L., Olsson, K., Hasson, H., Bergström, A., Costea, V. A., Holm, E., & Bäck, A. (2026) · BMC Primary Care · doi:10.1186/s12875-026-03337-y · Cited by 1 · see citing works
Pregnancy, risk behaviors and adverse reproductive outcomes: Is preconception care working in Italy?
Bortolus, R., Filippini, F., Cipriani, S., Morassutti, F. R., Marchetto, L., Rigotti, E., Cesari, E., Trevisanuto, D., & Parazzini, F. (2025) · Midwifery · doi:10.1016/j.midw.2025.104404 · Cited by 1 · see citing works
Clay, S., Woodson, M. J., Makelarski, J. A., Cheng, W., Alston, R., Trask, J. T., & Hodges, T. (2022) · Journal of Ethnic & Cultural Diversity in Social Work · doi:10.1080/15313204.2022.2094520 · Cited by 1
“In an article assessing routine pre-pregnancy health education and the impact on pregnancy outcomes, Whitworth and Dowswell (2009) found that health promotion activities were positively associated with behavior change in women who were pregnant.”
BackgroundNair, D. B., & Morgan, M. (2015) · BJOG: an International Journal of Obstetrics and Gynaecology · doi:10.1111/1471-0528.13563 · Cited by 1
The Scope of Pre-Pregnancy Care Conducted at Health Centers of Tabriz, Iran: Women's Viewpoints.
Kamalifard, M., Ebrahim, H., & Rahmat, M. (2013) · Journal of Caring Sciences · doi:10.5681/jcs.2013.020 · Cited by 1 · see citing works
Aruda, M. M. (2010) · Evidence-Based Nursing · doi:10.1136/ebn1028 · Cited by 1
Associations Between Periconceptional Lifestyle Behaviour Change and Adverse Pregnancy Outcomes
Maas, V., Poels, M., Ruiter, M. D., Kwee, A., Bekker, M., Franx, A., & Koster, M. P. (2021) · doi:10.21203/rs.3.rs-156592/v1
“Health promotion activities, such as education, advice and a general health assessment, are likely to improve pregnancy outcomes, by early identi cation of risk factors encouraging behavioural change (14, 15).”
BackgroundPreconception care for women with epilepsy: a mixed methods review
Winterbottom, J., Marson, A., Noble, A. J., Smith, C. T., & Mathieson, A. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011007.pub2
Preconception Lifestyle Status and Its Predictors in Women Contemplating Pregnancy
Ghasemi, S., Mohammad-Alizadeh-Charandabi, S., & Mirghafourvand, M. (2018) · doi:10.22038/ebcj.2018.30921.1767
“According to a Cochrane review, preconception lifestyle risk factors are associated with undesirable pregnancy outcomes; accordingly, preconception lifestyle counselling is effective in the induction of behavioral changes (3, 4).”
BackgroundLevandowski, D. C., Pereira, M., Moura-Ramos, M., & Canavarro, M. C. (2018) · Psychologica · doi:10.14195/1647-8606_61-2_5
“This strategy is important for improving obstetric outcomes by encouraging women to adopt healthy behaviours (including changes in lifestyle habits) as well as for early identification of risk factors for adverse pregnancy outcomes (Whitworth & Dowswell, 2009).”
BackgroundKinderwunschtherapie in der gynäkologischen Praxis
Goeckenjan, M., & Reisenbüchler, C. (2016) · Gynäkologische Endokrinologie · doi:10.1007/s10304-016-0069-z
“So gibt es in Deutschland bislang keine abrechenbare Ziffer für eine präkonzeptionelle Beratung, obwohl Studien gezeigt haben, dass diese die Schwangerschaftsplanung und den Schwangerschaftseintritt positiv beeinflusst [4].”
La consultation préconceptionnelle : pourquoi des adhésions diverses malgré un concept excellent ?
Ceysens, G., Mauroy, M., Zhang, W.-H., & Alexander, S. (2012) · Revue de médecine périnatale · doi:10.1007/s12611-012-0190-8
Preventing Congenital Anomalies Through Existing Maternal and Child Health Services in India
Kar, A., Bhide, P., & Gund, P. (2021) · Birth Defects in India · doi:10.1007/978-981-16-1554-2_9
Preventing Ectopic Pregnancy and its Complications - What Next?
Knight, M. (2017) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.12334
- Authors
- Whitworth, M., & Dowswell, T.
- Affiliations
- St Mary's Hospital (GB)
- University of Liverpool (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2009-10-07
- Volume
- 2010
- Issue
- 1
- Pages
- CD007536-CD007536
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC4164828
- OpenAlex
- W2137447904
- Cited by
- 92
- References
- 26
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 8 · 2021: 2 · 2020: 4 · 2019: 6 · 2018: 6 · 2017: 11 · 2016: 9 · 2015: 7 · 2014: 10 · 2013: 6 · 2012: 6
- FWCI
- 9.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- pregnancy outcomes, preconception care, binge drinking, smoking, alcohol consumption, nutrition, birth weight, preterm birth, congenital malformations, weight for gestational age, women of reproductive age, risk factor control, health education, brief advice, lifestyle counseling, usual care comparison, intervention effectiveness
- MeSH terms
- Adult, Female, Health Education, Health Promotion, Humans, Maternal Behavior, Pregnancy, Pregnancy Outcome, Risk Factors, Health Behavior, Randomized Controlled Trials as Topic, Preconception Care, Young Adult
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