Preconception care, as defined by WHO, is the provision of biomedical, behavioral, and social health interventions to women and couples before conception occurs. With the significant advancements in maternal-fetal medicine, new evidence has shown that environmental factors are the major etiological determinants of most chronic diseases, obstetric complications, and genetic mutations. Hence, preconception care emphasizes providing adequate nutritional requirements and avoiding toxicity in the gestational phase to improve maternal and child health, in both the short and long term.
One of the requirements of a healthy pregnancy and infant is adequate nutrition. Ensuring proper and adequate nutrition is vital since nutritional deficiencies can have dramatic effects on the incidence of illness in the mother's offspring. One of the well-known examples of nutrient deficiency is folate deficiency which has been linked to risks of open neural tube defects, miscarriage, and Down’s syndrome. In addition, three of the most common micronutrient deficiencies are vitamin D, magnesium, and Docosahexaenoic Acid (DHA) insufficiency. Vitamin D deficiency has been associated with short- and long-term adverse gestational complications. Short-term complications include first-trimester pregnancy loss, gestational diabetes, preeclampsia, preterm birth, higher rates of primary and emergency Caesarean delivery, small for gestational age infants, and maternal postpartum depression. In the long run, it has been associated with impaired lung development among 6-year-old offspring, neurocognitive difficulties at age 10, increased risk of eating disorders in adolescence, and lower peak bone mass at 20 years. Fetal hypomagnesemia, on the other hand, maybe associated with metabolic syndrome later in life. Lastly, DHA insufficiency has been associated with preterm labor, pregnancy-induced hypertension, postpartum depression and increases the risk of children for central nervous system disturbances, poor sleep patterns, lower IQs, and impaired blood pressure control later in life. Other micronutrient deficiencies include gestational iron deficiency linked to cognitive and immune impairment in offspring, iodine deficiency which can lead to pediatric hypothyroidism and intellectual disabilities, maternal biotin deficiency linked to potential fetal sequelae, and low maternal vitamin B12 which can increase the risk for neural tube defects. However, it is worth mentioning that healthy foods should still be the main source of most nutrients rather than relying solely on supplements.
A healthy biome is also an important determinant of gestational and pediatric outcomes. The use of antibiotics during pregnancy may alter the maternal-offspring microbiota exchange which can lead to antisocial behavior and anxiety in offspring and higher offspring risk of childhood obesity. The association of pediatric outcomes and mode of delivery also verifies the correlation of microbiome and pediatric health and disease. Children who were delivered by Caesarean delivery had an increased risk of asthma, systemic connective tissue disorders, juvenile arthritis, inflammatory bowel disease, immune deficiencies, and leukemia.
Another foundation and objective of good preconception and prenatal care is the avoidance of toxicity in the gestational phase. Exposure to toxic chemicals has been associated with a wide range of health problems from autism to mental illness, to cancer, and can have negative impacts on human metabolism including hormone disruption, epigenetic alteration, immune dysregulation, direct cytotoxicity, carcinogenesis, mitochondrial impairment, and oxidative damage. Household and vehicle exposures from common sources of airborne exposure such as furniture, mattresses, personal care products, electronic equipment, etc. have been associated with myriad adverse outcomes like pediatric allergy, decreased IQ, infectious disease, pediatric endocrine disorders, respiratory illness, autism, childhood cancers, increased hyperactivity scores, congenital birth defects, and various other childhood health problems. Maternal occupational exposures have also been linked to adverse outcomes in children. Maternal exposure to solvents, paints, and petroleum products has been strongly associated with childhood leukemia. Food choices, having a direct relationship to insecticide and herbicide exposure, can also create negative impacts on pregnancy such as neurological and cardiovascular problems and increased rates of various cancers. Prenatal supplement contamination can also pose adverse fetal outcomes. A recent study has found out that many prenatal supplements are contaminated with several toxic elements, particularly lead, which can have an adverse impact on the development and enduring well-being of the child.
Electrical exposure, often unrecognized, can have serious impacts on pregnancy outcomes. Recent evidence has shown that regular prenatal cellphone exposure to expectant mothers was linked to elevated risk for pediatric behavioral disorders and hyperactivity. EMR exposure from mobile phones can also lead to an increased fetal heart rate, decreased cardiac output, and increased risk of miscarriage and development of asthma in offspring.
Considering all of these, preconception care must be promoted to all women of reproductive age and all expecting couples. Informed preconception and gestational choices on nutrition and dietary measures, toxicant avoidance, supplement use, and other lifestyle interventions would help in preventing the development of several maternal or fetal problems which in turn ensures the creation of a healthy family with well and happy members.
References:
Genuis, S., & Genuis, R. (2016). Preconception Care: A New Standard of Care within Maternal Health Services. Biomed Research International, 2016. https://doi.org/10.1155/2016/6150976
WHO (2013). Preconception care: Maximizing the gains for maternal and child health. who.int. Retrieved March 14, 2022 from https://www.who.int/maternal_child_adolescent/documents/preconception_care_policy_brief.pdf