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

Authors: Stephenson J, Heslehurst N, Hall J, et al

Reference: Lancet 2018; 391:1830-41

Summarised on: 14 June 2018

This is the first in a series of articles that make the case for preconception health as a key determinant of pregnancy success and next generation health.

The authors reviewed published evidence from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health.

The authors acknowledge studies showing that micronutrient supplementation, which is started in pregnancy, can correct important maternal nutrient deficiencies and have modest effects on increasing birthweight. However, it is not sufficient to fundamentally improve child health. Furthermore, dietary interventions in pregnancy can lead to modest reductions in gestational weight gain, but are also insufficient in improving pregnancy outcomes.

The authors point to a growing consensus that the greatest gain will be achieved through a life-course approach or continuum of improved nutrition in children, adolescents, and young women. A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. Accordingly, the preconception period presents a special opportunity for intervention.

Observational studies have shown strong links between maternal health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations.

Achieving a healthy weight can take longer than dietary changes and should ideally be established during adolescence when most women will not be planning pregnancy – this intervention requires a population-level approach.

Generally, however, a degree of pregnancy planning is common in low and middle-income countries and high-income countries, offering considerable scope for intervention before pregnancy.

The authors say that alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, there is heightened awareness of preconception health, particularly regarding diet and nutrition.

Importantly, health professionals should be alerted to ways of identifying women contemplating pregnancy to improve health before conception, while population-level initiatives to reduce the determinants of preconception risks (eg obesity and smoking) irrespective of pregnancy planning, are essential to improve outcomes.


Welcome to the RNZCGP Digest. Here, we summarise recent New Zealand and overseas journal articles and publications that are of interest to general practice and those working in the primary care sector, such as those about clinical issues, health workforce, education, quality improvement, or cross-cultural care.

Some articles are available in open-access journals, some require an online subscription.

We welcome your suggestions and comments. Please contact the College's policy team at

More RNZCGP Digest articles