Cited by 377Public Health and NutritionMaternal and Neonatal HealthcareGlobal Maternal and Child Health

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Intervention strategies to improve nutrition and health behaviours before conception

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Barker, Mary, Dombrowski, Stephan U, Colbourn, Tim, Fall, Caroline H D, Kriznik, Natasha M, Lawrence, Wendy T, Norris, Shane A, Ngaiza, Gloria, Patel, Dilisha, Skordis-Worrall, Jolene, Sniehotta, Falko F, Steegers-Theunissen, Régine, Vogel, Christina, Woods-Townsend, Kathryn, Stephenson, Judith·2018·The Lancet

DOI 10.1016/s0140-6736(18)30313-1PMC PMC6075694

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Abstract

The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.

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Authors: Barker, M., Dombrowski, S. U., Colbourn, T., Fall, C. H. D., Kriznik, N. M., Lawrence, W. T., Norris, S. A., Ngaiza, G., Patel, D., Skordis-Worrall, J., Sniehotta, F. F., Steegers-Theunissen, R., Vogel, C., Woods-Townsend, K., & Stephenson, J.
Affiliations: Southampton General Hospital (GB)
University of Stirling (GB)
University College London (GB)
University of Cambridge (GB)
University of the Witwatersrand (ZA)
United Kingdom Clinical Research Collaboration (GB)
Corresponding author: Stephenson, Judith
ORCID: Barker, Mary
Dombrowski, Stephan U
Colbourn, Tim
Fall, Caroline H D
Kriznik, Natasha M
Lawrence, Wendy T
Norris, Shane A
Ngaiza, Gloria
Patel, Dilisha
Sniehotta, Falko F
Vogel, Christina
Stephenson, Judith
Venue: The Lancet
Publisher: Elsevier BV
Published: 2018-05
Volume: 391
Issue: 10132
Pages: 1853-1864
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(18)30313-1
PMC: PMC6075694
OpenAlex: W2794603072
Cited by: 377
References: 95
Citations by year: 2026: 23 · 2025: 43 · 2024: 40 · 2023: 51 · 2022: 57 · 2021: 48 · 2020: 56 · 2019: 44 · 2018: 13
FWCI: 7.69
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
ePrints Soton (University of Southampton) (acceptedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by-nc-nd)
UCL Discovery (University College London) (submittedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Apollo (University of Cambridge) (submittedVersion, cc-by-nc-nd)
Apollo
Funders: Wellcome Trust (097899/A/11/Z, 097899/Z/11/Z)
National Institute for Health and Care Research (DRF-2011-04-015, NF-SI-0513-10099)
British Heart Foundation (PG/14/33/30827)
Academy of Medical Sciences (HOP001\1067)
Kementerian Kesihatan Malaysia
Medical Research Council (MC_PC_MR/R018545/1, MR/K02325X/1, MR/J000094/1, MC_UU_12011/4, MC_UU_12011/3, MR/N011848/1)
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords: preconception health, maternal nutrition, preconception interventions, behaviour change interventions, life course framework, social determinants of health, gender inequality, social movements, advocacy coalitions, private sector participation, health policy, offspring outcomes
MeSH terms: Female, Financial Support, Humans, Pregnancy, Public Health, Public Policy, Health Behavior, Preconception Care, Prenatal Nutritional Physiological Phenomena

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