What do we mean by preconception health and preconception care in research and policy? A systematic review.

Abstract

Background Preconception health (PCH) is a globally accepted strategy to reduce preventable adverse pregnancy outcomes and ultimately improve the health of the unborn child. Optimal PCH can be achieved through preconception care (PCC), which encompasses the behavioural, biomedical, and social interventions women and couples undertake and/or receive before conception. However, there is a lack of clarity on various aspects of PCH and PCC, such as what constitutes preconception risk factors, what the optimal interventions are, when the preconception period is, and who the overall target population is. Additionally, marginalised groups such as sexual and racial or ethnic minority individuals are routinely excluded from PCH research and PCC interventions. PCH and PCC are topical issues given changing societal norms worldwide, such as delayed childbirth, exponential rises in fertility treatments, and the growing trend of unplanned pregnancies. We hypothesised that the ambiguity surrounding the definition of PCH and PCC may limit their understanding and application to improve pregnancy and childhood outcomes.

Objective and rationale This is a systematic review of existing definitions of PCH and PCC to understand the commonalities and disparities in definitions and critical components of PCH and PCC, to aid in the development of a comprehensive and globally standardised definition. Search methods MEDLINE, PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar, PsychINFO, and Google were searched to identify published studies, guidelines, and public health websites containing definitions of PCH and PCC published between January 1993 and October 2024. No restrictions were placed on language. We searched academic databases, organisational reports, and policy documents to capture the full range of definitions across clinical, health, and policy contexts. Outcomes The narrative synthesis of 176 publications showed heterogeneity in the definitions of PCH and PCC. The themes developed from the thematic analysis showed that PCC is preventative care which identifies and utilises interventions to manage individuals' preconception risk factors and aims to improve pregnancy outcomes by optimising the short- and long-term health of potential parents and their children. The analysis also showed that PCH is relevant across the entire reproductive lifespan. PCC was described as a continuum of care that occurs before conception and encompasses the health of all potential parents, not just women. Wider implications This systematic review found there is a lack of universality in the definitions of PCH and PCC. Current definitions often narrowly focus on women planning pregnancy, which may exclude important demographics such as unintended pregnancies and fathers, and aligned health needs such as contraception in the preconception period. We propose that there is a need for a definition that captures various demographics and emphasises a life-course approach to reproductive health, acknowledging that the preconception period is much wider than only the period in which couples are actively trying to conceive. Congruence between policymakers, researchers, and public health professionals on the definition of PCH and PCC may address research operationalisation and clinical implementation to better assess global uptake and impact. Registration number CRD42023480536.