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Cited by 1,222Maternal and Neonatal HealthcareBirth, Development, and HealthPublic Health and Nutrition

Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health

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Stephenson, Judith, Heslehurst, Nicola, Hall, Jennifer, Schoenaker, Danielle A J M, Hutchinson, Jayne, Cade, Janet E, Poston, Lucilla, Barrett, Geraldine +6 more·2018·The Lancet
DOI 10.1016/s0140-6736(18)30311-8PMC PMC6075697
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Abstract

A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.

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Authors
Stephenson, J., Heslehurst, N., Hall, J., Schoenaker, D. A. J. M., Hutchinson, J., Cade, J. E., Poston, L., Barrett, G., Crozier, S. R., Barker, M., Kumaran, K., Yajnik, C. S., Baird, J., & Mishra, G. D.
Affiliations
  • University College London (GB)
  • Newcastle University (GB)
  • The University of Queensland (AU)
  • University of Leeds (GB)
  • St Thomas' Hospital (GB)
  • Southampton General Hospital (GB)
  • King Edward Memorial Hospital Research Centre (IN)
Corresponding author
Stephenson, Judith
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2018-05
Volume
391
Issue
10132
Pages
1830-1841
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(18)30311-8
PMC
PMC6075697
OpenAlex
W2800419398
Cited by
1,222
References
10
Citations by year
2026: 119 · 2025: 152 · 2024: 153 · 2023: 195 · 2022: 155 · 2021: 144 · 2020: 166 · 2019: 100 · 2018: 34
FWCI
20.21
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Research Online (University of Wollongong) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Funders
  • National Institute for Health and Care Research (PDF-2011-04-034, NF-SI-0513-10099)
  • British Heart Foundation (PG/14/33/30827)
  • Medical Research Council (MR/K02325X/1, MR/J000094/1, MC_UU_12011/4, MC_UU_12011/3, MR/N011848/1)
Topics
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
Keywords
preconception health, maternal nutrition, pregnancy planning, maternal and child health, micronutrient supplementation, maternal obesity, adolescent nutrition, non-communicable diseases, lifestyle habits, low-income countries, high-income countries
MeSH terms
Diet, Healthy, Female, Humans, Life Style, Nutritional Status, Pregnancy, Pregnancy Complications, Health Behavior, Preconception Care

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