Preconception health policy, health promotion, and health services to achieve health in current and future generations: a narrative review

Abstract

Non-communicable diseases (NCDs) represent the leading cause of death and disability worldwide, and those NCDs contributing most burden – cardiometabolic illness, diabetes, cancer, chronic respiratory disease – can be largely prevented through improvements in health behaviours such as tobacco use, harmful use of alcohol, exposure to environmental hazards, unhealthy dietary habits, and physical inactivity. Despite concerted efforts at all levels of health care provision and policy, population-level health behaviour change still presents an ongoing challenge to primary care clinicians, public health practitioners, health promotion specialists and government agencies around the world. An individual’s age can influence their health behaviour decision-making as younger people often perceive the potential implications of their current poor health behaviours as remote in time and possibility, which may significantly limit their motivation to make a positive health behaviour change in the present. Yet public health researchers and practitioners recognise that a lifecourse approach to public health policies and interventions has the potential to reduce the risk of NCDs developing before conception and throughout life, as well as impacting the transmission of the benefits of health improvement from one generation to the next. Given the growing awareness of the benefits of a lifecourse approach to public health, a focus on improving preconception health at a population-level provides a unique opportunity for behaviour change motivation, NCD prevention and reducing inequalities across generations. Through this narrative review, we describe how three main public health strategies – health policy, health promotion and health services – may address the challenge of improving preconception health. We also explore the potential value of leveraging parental motivation in the preconception period to achieve positive health behaviour change and, in doing so, meet broader public health goals. We set out a framework for drawing on established public health methods and priorities to address structural inequalities and harness parental motivation and concern for their offspring to build and enable new and positive health behaviours that benefit current and future generations.

Background

Non-communicable diseases (NCDs) represent the leading cause of death and disability worldwide, causing an estimated 42 million deaths in 2019 and 63.8% of total disability-adjusted life years (DALYs) globally [1, 2]. The cost of continued worldwide underinvestment in NCD prevention has been estimated at US$47 trillion in lost gross domestic product from 2011 to 2025 [3]. Importantly, those NCDs contributing most burden – cardiometabolic illness, diabetes, cancer, chronic respiratory disease – can be largely prevented through improvements in health behaviours such as tobacco use, harmful use of alcohol, exposure to environmental hazards, unhealthy dietary habits, and physical inactivity [4, 5]. Despite concerted efforts at all levels of health care provision and policy, population-level health behaviour change still presents an ongoing challenge to primary care clinicians, public health practitioners, health promotion specialists and government agencies around the world [6].

An individual’s age can influence their health behaviour decision-making as younger people often perceive the potential implications of their current poor health behaviours as remote in time and possibility, which may significantly limit their motivation to make a positive health behaviour change in the present [7]. Yet, the ideal intervention strategy for NCDs is primary prevention – whereby individuals engage in positive health behaviours that prevent the onset of an NCD in the first place [8]. As an individual’s risk of developing NCDs accumulates over their lifecourse, researchers from basic sciences through to public health have directed attention to understand and prevent the risk factors for NCDs throughout an individual’s life, starting as early as possible [9, 10]. A lifecourse approach has the potential to reduce the risk of NCDs developing before conception, through foetal life, infancy, childhood, adolescence, adulthood, and into older age. A lifecourse approach also recognises the transmission of the benefits of health improvement from one generation to the next [9, 11], and the critical role of broader public health policies to support and enable individuals to make positive health choices through their life including before conception [12, 13].

The preconception period is one stage in the lifecourse receiving increasing academic interest [14]. The 2018 Lancet Series on preconception health emphasised the far-reaching consequences across the lifecourse and the need for potential solutions and interventions [15–17]. From a public health perspective, the preconception period relates to the months to years prior to conception needed to address risk factors for parents – here defined as the male and female reproductive partners contributing genetic material to the pregnancy irrespective of their personal relationship with each other or the child—and optimize health behaviours that may affect a future pregnancy and child [16]. Most commonly, preconception health is supported by interventions aimed at improving the health status, health behaviours and their wider determinants of female and male reproductive partners before conception occurs, known as preconception care [18] and delivered as primary care or public health interventions. Either way, a focus on improving preconception health at a population-level provides a unique opportunity for behaviour change motivation, NCD prevention and reducing inequalities across generations. In this narrative review we draw on selected seminal articles and frameworks within preconception health and public health peer-reviewed research, and examples from established health policies and initiatives to propose the need for and potential of a ‘whole of system approach’ to preconception health interventions. We describe how three main public health strategies – health policy, health promotion and health services – may address the challenge of improving preconception health and narrowing health inequalities in the community. While there is a recognised need to address preconception health in unplanned pregnancies, we explicitly focus on pregnancies that occur with some level of forethought, intention, or planning. We take this approach as planned or intended pregnancies – representing a substantial proportion if not the majority of pregnancies [19–23] – may provide an untapped and overlooked opportunity to explore the potential value of leveraging parental motivation in the preconception period to achieve positive health behaviour change and, in doing so, meet broader public health goals.

Utilising the preconception period to maximise likelihood of preventing NCDs throughout life

Over the last 20 years, accumulating evidence of the developmental origins of health and disease (DOHaD) suggests the health of an individual’s parents prior to their conception contributes to the risk of developing an NCD [14]. Based on evidence from epidemiology and developmental biology, this relationship between preconception health and lifecourse health can be explained by underlying biological mechanisms, including epigenetic, cellular, physiological and metabolic processes [17]. Several behavioural risk factors in the preconception period—including weight, nutrition, smoking and alcohol consumption—have been linked to long-term offspring health outcomes such as cardiometabolic disorders, neuro-developmental issues, and type 2 diabetes [14, 17, 24, 25]. These health behaviours during the preconception period, can increase the likelihood of their offspring developing NCDs in later life [24, 26, 27]. Furthermore, parental exposure to environmental risk factors, such as phthalates [28], air pollution [29] and pesticides [30, 31] have been found to increase risk of congenital defects [29], behavioural issues [28] and cancer [30, 31] in the child. While the current list of known risks may further change and grow as the evidence-base regarding preconception health exposures evolves, improvements in preconception health behaviours and environmental exposures bring a double benefit: they improve the lifecourse health of the child and provide primary and secondary NCD risk reduction to the parents [32–34].

The compelling evidence for the links between preconception health behaviours and environmental exposures, and lifetime health, illustrates the need for understanding how to best support health in the preconception period. Existing research in expectant parents suggests individuals may be more likely to make positive health behaviour choices if these will benefit the health and development of their unborn child compared to, or in addition to, their own health [35]. Particular examples of this includes smoking cessation [36], avoidance of substance abuse [37], alcohol abstinence [38], dietary choices [39], and dietary supplementation [40]. However, this previous research primarily focuses on health behaviour change during pregnancy, while less research has explored health behaviour change and its motivation during the preconception period [38, 41, 42].

A recent review of health behaviour interventions before conception proposed a strategy of aligning intervention to individual motivation and receptiveness at different Preconception Action Phases over the lifecourse, and adopting a dual strategy of targeting health improvement in both men and women planning a pregnancy and in the general population [15]. The Preconception Action Phases distinguish four phases characterised by overarching biological and psychological goals and intentions in relation to parenthood: 1) Children and adolescents (forming); 2) Adults with no immediate intention to become pregnant (refining); 3) Adults with the intention to become pregnant (activated); and 4) adults with the intention to become pregnant again (re-activated). The model proposes that the intention to become parents begins to form in childhood and develops as individuals mature until they have the adaptive capacity to pursue the goal of parenthood as young adults. This theoretical framework builds on psychological models that have been empirically investigated, such as the Rubicon model of action phases and the Action phase model of developmental regulation, and applied to preconception motivations and interventions [43, 44]. Even though the model describes a linear progression through both developmental and intention states, it is important to note that adults can move between intentions states in nonlinear ways.

It should be noted that parenthood intention varies for individuals across a spectrum which includes individuals who do not have children and do not want children in the future [45]. For those that do desire children, motivation to become a parent is the driver of relevant preconception behaviours. The goal of becoming a parent is, however, nested within other facilitating and conflicting goals and wider circumstances and translating intention into pregnancy outcomes is therefore not necessarily straightforward. Nonetheless, the motivation of individuals to become a parent and provide the best health outcomes for their offspring, we argue, is an untapped opportunity to promote and improve population health for the benefit of individuals across their lifecourse, and the health of the next generation.

Tapping into parental motivation to engender healthy behaviours in individuals planning a family now or in the future

Our approach—proposed in line with the Preconception Action Phases through the lens of public health scholarship—is a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Pregnancies can be defined in relation to the degree to which they are ‘planned’ or ‘intended’ although these terms are highly subjective and fraught with complexity [46, 47]. In this instance, planned pregnancies are characterized by the parents displaying thoughts and behaviours specifically aimed at preparing for or becoming pregnant (e.g. stopping contraceptive use, discussing pregnancy with a partner, initiating health behaviour changes prior to conception) [48]. The time given to pregnancy planning can vary widely, as changing some health behaviours (such as optimising weight or modifying teratogenic medication use) and circumstances (stable housing) may take time, and reproductive partners may also not become pregnant immediately after they start trying. On the other hand, intended pregnancies can be defined as pregnancies that occur at a time when they are wanted. An individual may identify as intending to become pregnant at present or soon, or to have a family at some future time but not at the present (refining stage) [15]. It is also possible to have unintended pregnancies – whereby the individuals never intended nor planned to become pregnant—but these individuals are beyond the scope of our focus here [15]. The position of any pregnancy across a spectrum of planning or intention has direct impacts on the intervention needed to achieve the desired outcome in the population [15].

Targeted preconception health interventions can be developed to motivate reproductive partners intending or planning to conceive. The preconception life phase is characterised by an increase in thinking about and actively taking steps towards becoming pregnant, and potential increases in an individual’s willingness to engage in interventions to support health related to pregnancy and parenthood. Screening for pregnancy intention may enable effective targeting of suitable strategies and support, which enhances the likelihood of interventions being translated into behaviour change. Interventions targeting specific individuals or sub-populations and delivered through one-on-one encounters can include managing long term health conditions and providing support for healthy behaviour change [49]. Given between 40 and 85% of pregnancies may be classified as ‘intended’ or ‘planned’ [19–23], expanding the focus of public health and health promotion practitioners to explicitly encompass individuals intending or planning a pregnancy has much potential to improve population health. It can be argued that only reproductive partners experiencing unintended pregnancies may fail to benefit from targeted preconception-specific health interventions.

Individuals in-between pregnancies will experience a re-activation of their goal to become a parent, and may therefore also benefit from preconception care – or interconception care – that may require adapted preconception interventions to meet their current health needs and respond to their current motivations [50]. Adults at this life stage are likely taking action that is based on their previous preconception experiences, if the previous pregnancy was uncomplicated, they may not feel the need for preconception input [51–53]. Alternatively, reproductive partners with previous complicated pregnancies may have different interconception priorities and motivations to other reproductive partners. Individuals with previous pregnancies are also likely to have multiple barriers to engaging with interventions, such as increased family responsibilities, little spare time, sleep deprivation and stress.

Alongside giving attention to adult reproductive partners—the first phase of Preconception Action—childhood and adolescence is only recently emerging as a focus in preconception health. It is rarely included in considerations for preconception interventions because children and adolescents are not yet in a life stage where becoming a parent is a key motivation, yet they are laying foundations for a healthy life. Given the low level of awareness of the concept of healthy preparation for pregnancy, awareness-raising is needed from an early age in the form of health education covering preconception topics within school curriculum [49, 54].

Overall, these various target populations need public health interventions that direct preconception health and care to improve health outcomes for current and future generations. However, there are also serious challenges to preconception health and care in line with broader fundamental challenges to public health as a field, particularly as it relates to social equity [55]. This concurrently sets immediate limits upon preconception health and care, in terms of what it can achieve and how easy it is to achieve it, while also providing an opportunity for preconception public health research to be a new, complementary field of study and practice that ultimately contributes to reducing inequities and promoting social justice around health.

Public health interventions targeting preconception health and care

While there are some countries that have identified the need for a public health focus on preconception health and care (United Kingdom [UK], Canada, Australia, Netherlands [32, 56–58]), and initiated national recommendations (Netherlands [59]), guidelines (Canada [57]), or an action plan (United States [US] [60]), this commitment to improved preconception health and care at the population level is not consistently evident internationally. This gap may be due to numerous factors such as: poor knowledge translation of the growing research evidence documenting the importance of the preconception period [61]; a focus on chronic illness populations (e.g. women with obesity or diabetes) [62]; and prioritizing short-term outcomes (e.g. fetal abnormalities) [18] while overlooking wider population benefit and long term implications [11]. There is undoubtedly a need to prioritise specific populations and to develop initiatives that improve short- and long-term benefits to reproductive partners and their offspring, but the public health approach should aim to benefit the whole population and all populations globally. There are further limitations in the public health research and policy on this topic, such as limited attention towards preconception health and care in low- and middle-income countries where it is arguably most needed and despite this being a global issue that needs public health interventions in all communities. Such interventions need to be developed in a manner which reflects contemporary priorities around co-design [63, 64] and responds to known predictors of public health activity effectiveness such as health literacy, socioeconomic status, and ethnicity among others [65, 66].

This need is amplified due to the greater prevalence of unhealthy behaviours such as poor diet, substance use and low physical activity, and exposure to environmental risks, among some populations, such as low socioeconomic communities [13]. Furthermore, other specific populations such as youth, men, ethnic minority, gender and sexually diverse, and culturally and linguistically diverse communities may have unique needs and motivations which must be considered. The broader public health community are already working to find ways to meet the diverse needs of these and other populations [55], and the lessons learnt from such experiences must be adapted and applied to preconception health and care activities as well. In doing so, plans to improve preconception health and care should also account for other barriers to using available services and implementing change in health behaviours and environmental risks, such as an individual’s capability and opportunity for change [67], health literacy [55], and access to services. Solutions to these challenges may be found by co-designing interventions with different target populations to ensure approaches are tailored to their motivations and needs [63, 64].

When considering a public health approach to preconception health and care it is also essential we consider the gendered nature of preconception care as it is currently framed and experienced [68, 69]. The documented risks of incursions on women’s human rights and wellbeing to prioritise protection of their foetus can result in significant pressures on pregnant women to submit to unwanted health-related interventions and activities [70]. Compared to maternal health, there is less evidence related to the effects of paternal preconception health on the short and long-term outcomes of their offspring, which is arguably the result of researcher oversight and very limited relevant data as opposed to being evidence of lesser importance [71]. Such imbalance in the literature may also reveal a deep-rooted broader gender bias that allocates familial and reproductive responsibility to women rather than men [68, 72]. Furthermore, the role of men in preconception health extends beyond the health of the sperm in the preconception period and has long term implications for the psychosocial health of the offspring which should also be considered [73, 74]. As such, any population-level preconception health initiatives must be developed through a lens of equity to ensure the broadest possible reach and widest possible benefit.

The gains achieved in the few countries prioritizing preconception health and care, such as decreases in the prevalence of birth defects and incidence of anaemia following introduction of the National Free Preconception Health Examination Project in China [29], present an opportunity to public health and health promotion practitioners and policy makers to learn from previous successes. National preconception care programs implemented in China and the Netherlands have also reported challenges, such as uptake in hard-to-reach regions and communities, full implementation in the everyday practice of professionals working across medical and social sectors, and the need to improve cost-effectiveness [29, 75]. These lessons can be used to further co-develop programs of preconception health care that can meet the needs of the whole population via targeted initiatives and approaches that align with the local community’s needs, experiences, and perspectives. However, despite these pockets of potentially innovative public health solutions, the absence of detailed evaluations of their contributions presents challenges to adapting or adopting their work to new settings. Preconception health indicators to monitor progress in preconception health and care (i.e. medical, behavioural and social factors as well as their wider determinants that may impact potential future pregnancies among people of reproductive age) have been developed in the Netherlands, England and the USA, and implementation and ongoing surveillance using these indicators is now needed to evaluate the benefits of national and regional preconception care programs [76–78].

The complexities involved in changing individual and population health behaviours are well recognised. Successful behaviour change requires the target population to: engage with the need to change; sustain the motivation to maintain the change; and be supported by contexts (services, society, social networks, and environments). With this in mind, we describe a framework (see Fig. 1) that encompasses three domains of public health – health policy, health promotion and health services – and that prioritises a ‘whole of population’, and ‘whole of system’ approach to addressing the challenge of improving preconception health and narrowing health inequalities in the community in a manner that reflects the diverse needs in different populations.

Fig. 1.

Proposed public health opportunities to address population health issues through preconception health interventions. N.B. We refer to ‘men’ and ‘women’ which also includes people who do not identify as such but may be able and intend to have children

Health policy

Most of the preconception exposures that adversely impact the health of mother and child disproportionately affect individuals based on social, economic, and cultural characteristics. Reduction of preconception risks will therefore rely heavily on structural and policy change to improve health equity in the community. Social determinants which have been linked with preconception health outcomes include race/ethnicity [79] and income [80]. There are also recognised commercial-determinants of health that are known to directly impact on healthy nutrition, environmental exposures, smoking and alcohol use and other health risks [81]. While the public health implications of social and commercial determinants of health are widely accepted and global efforts have continued over many years to improve health equity, the lens that preconception health offers to reimagine health policy should incentivize policymakers to address these issues with greater urgency than is currently seen.

To enhance efforts to address the growing global burden of NCDs, the 66th World Health Assembly endorsed the World Health Organisation (WHO) Global Action Plan for the Prevention and Control of NCDs (Action Plan) and NCD Global Monitoring Framework in 2013 [82]. The Action Plan recognises the key role of governments in responding to the growing challenge of NCDs and highlights the links between poor diet, physical inactivity and NCDs, and highlights the importance of enhancing maternal and child health. All of which are central to the preconception health agenda. The Action Plan sets out a range of policy options that governments at all levels can adopt and provides an international standard against which government action can be assessed. The policy options target: 1) individual-level behaviour change (e.g. smoking cessation, increased physical activity), 2) organisational-level determinants including social and physical settings (e.g. access to health care, housing) and 3) macroenvironmental-level determinants including fiscal policy, infrastructure, and environmental considerations (e.g. systematic racism, poverty, universal health care, climate change, marketing, supply chains). Multicomponent policy action that works across these levels has shown to be more effective at improving lifestyle behaviours than action at a single level [82]. It is important to note, however, that the order with which these changes are made, and the specific policies implemented to achieve these policy targets will be greatly influenced by each jurisdiction’s local context and must account for the variability in health care system, social and cultural norms, and prevailing infrastructure and capacity.

The success of preconception public health initiatives in terms of improving preconception health and reducing inequalities will need to be monitored at a population-level. This will require health systems and policymakers to collect and report on data relevant to improved preconception health and health care outcomes. A list of such preconception health indicators has been developed in the Netherlands, England and the US [76–78]. Differences across countries in availability of preconception care, policy priorities and in sources and methods of routine data collection mean that priority indicators are likely to differ internationally. However, indicators identified both in the UK and US cover a wide range of factors (domains), including: social determinants of health; health care; reproductive health and family planning; health behaviours; pre-existing mental health and physical health conditions; emotional and social support; and infections and immunizations [77, 78]. Similar work is also underway in Australia [83]. Further efforts are still required internationally to develop and build robust national surveillance infrastructures that monitor and annually report on a set of prioritised indicators based on high-quality data that is, or should be, routinely recorded at a national level. Such international surveillance of preconception health using a core set of indicators can be used to support advocacy for international adoption of successful preconception care programs and policies, and inform the development of new initiatives. It is also important that development and prioritization of indicators consider the impact of parental preconception exposures and risk factors on offspring health across the lifecourse, in line with the established and growing evidence in the DOHaD and broader public health fields.

Health promotion

Health promotion related to preconception health and care is an approach that is applicable at all life stages and involves raising awareness about the impact of preconception health on mother, father, baby, and later life. Studies have found that even among people who have planned their pregnancies, only around 50% of women acquire information about preconception health behaviours or receive information from their health care professional [51, 84] and fewer than half of men with pregnant partners receive preconception advice, make any health behaviour changes prior to pregnancy, or feel able to discuss preconception health with their peers due to male stigma around this being female-dominated and female-relevant territory [85]. Rates of awareness of preconception health and care are even lower in low- and middle-income countries, around 21% [86]. These findings highlight an urgent need to disseminate the available research knowledge regarding preconception exposures and the resulting health outcomes among the community. It also emphasises the need to tap into the deep cultural understandings and experiences of marginalised/priority sub-groups within a country as well as differences between countries themselves. This can be achieved through population-level health education campaigns such as have been widely used for other public health messages (e.g. tobacco and alcohol warning labels [87, 88], sun safety campaigns [89]). Examples of such efforts related to preconception health include social media campaigns, which have been developed in the Netherlands [90] and UK [91], and were identified by diverse groups of people of reproductive age as appropriate and relevant to them. As the term ‘preconception health’ means very little to the general public, meaningful public health messages need to be developed together with the target audience [54]. Moreover, preconception health education content can be integrated into existing sexual and reproductive health content within school curricula and preliminary efforts to undertake this type of work in adolescent populations have improved their preconception health knowledge [92, 93].

Health professionals can contribute to community education by screening patients’ pregnancy intentions and providing information about important preconception health exposures and corresponding outcomes. Unfortunately, this option is currently constrained by poor preconception health knowledge and confidence among health professionals [94, 95], and as such requires further attention. In particular, health professional literacy and competence regarding preconception health and care must be improved [94], as must funding and collaborative care pathways to enable health professionals to spend the required consultation time educating patients about preconception health options and opportunities [96]. While preconception-focused clinical practice guidelines and recommendations are in place in some countries [97], the gap between recommendations and practice must still be closed.

However, it is also worth noting that informing the community alone is not enough to ensure positive and lasting changes in preconception health behaviours [88]. Secondary school students in Sweden are reported to recognise the importance of preconception health but find it difficult to relate to preconception health on a personal or behavioural level [98]. Access to online information, community and school-based education, and public health campaigns can raise awareness and stimulate conversations about the importance of preconception health and, in doing so, shift social norms to reduce risks [88, 99]. For this reason, education-based interventions should be supported by system-level approaches such as supplementation or food fortification and targeted behaviour change interventions [15].

Health services

Preconception health also requires clinical interventions aimed at supporting individuals to improve health behaviours prior to pregnancy. Despite the evidence describing preconception health risks and outcomes, and perhaps in parallel to the poor implementation of preconception care in the community, a relatively small number of studies have examined the effectiveness of preconception health interventions and the majority of these used change in health behaviour or improved maternal health as the primary outcome [100]. Yet one of the most important impacts of preconception care is improved short- and long-term health of the child. Unfortunately, there is limited evidence to inform the design of clinical services to improve preconception health in the community.

Strategies are specifically needed to address psychological and practical barriers that hinder the translation of health promotion into actual and sustained behaviour change. For example, one psychological barrier which exacerbates the lack of information is a reluctance to visit a doctor to discuss preconception health because it is seen as “wasting an appointment” (in the UK with universal healthcare) or because they did not believe their doctor would have the specialist knowledge to deal with preconception health [101]. Such barriers are likely further amplified in marginalised populations, despite them potentially having greater health needs [102]. Health promotion therefore needs to highlight the importance of preconception health, how to access preconception care and what health care professionals can do, in a manner which reaches and impacts all groups and communities within a population.

Preconception health service delivery is also limited, as mentioned previously, by knowledge and confidence gaps among health professionals. A recent study of maternal and child health nurses found only 13% felt confident that they knew as much as they needed to promote preconception health [95]. Similarly, research examining GP attitudes towards preconception care suggests they acknowledge its value but do not believe they have the time or that it is their role to deliver it [94, 103], a perception which perhaps contributes to the view shared by individuals, described above, that doctors are not the right sources for preconception information and support. While primary care providers already play an important role in disease prevention and health promotion services, for example through immunization and screening and treatment of infectious diseases and NCDs, all health professionals working with young people in the community must be equipped with the knowledge, skills and resources needed to provide coordinated, holistic and effective preconception care to the community [104, 105]. Beyond giving health promotion information, health care professionals have a unique role in one-to-one settings for empowering individuals to improve their health, behaviours and wider circumstances. In order to seek advice and support, and to engage with the need for health behaviour change, individuals need to have a critical level of trust in their health professional which can be created by feeling listened to and that their problems are taken seriously [106, 107]. Achieving this demands a particular style of communication to be adopted by health care professionals to effectively build rapport, trust and commitment to a shared agenda; an approach which must be tailored to respond to the unique needs of all groups including marginalised populations [102]. There is currently little training and support for health care professionals to enable them to achieve these outcomes in the context of preconception health, which could greatly enhance the health promotion in relation to preconception care.

Conclusions

Preconception health has significant implications for public health research, practice and policy, however the value of addressing preconception health is largely overlooked in most countries. Through this paper we have set out a framework for drawing on established public health methods and priorities to improve preconception health and care and reduce inequalities in the community. By engaging with the opportunities we have outlined, the public health community can harness parental motivation and concern for their offspring to build and enable new and positive health behaviours to benefit current and future generations.

Abbreviations

NCD/s

Non-communicable disease/s

DOHaD

Developmental origins of health and disease

LGBTQ

Lesbian, gay, bisexual, trans and queer

CALD

Culturally and linguistically diverse

WHO

World Health Organization

UK

United Kingdom

US

United States

Biographies

Amie Steel

is co-convenor of the Women’s Health Special Interest Group of the Public Health Association of Australia.

is member of the Health in Preconception, Pregnancy and Postpartum Early and Mid-career Researcher Collaborative.

Danielle Schoenaker

is member of the Health in Preconception, Pregnancy and Postpartum Early and Mid-career Researcher Collaborative.

Authors’ contributions

The concept for this article was developed by AS and DS. All authors contributed to drafting the manuscript and read and approved the final version.

Funding

DS is supported by the National Institute for Health and Care Research (NIHR) through an NIHR Advanced Fellowship (NIHR302955) and the NIHR Southampton Biomedical Research Centre (NIHR203319). AS is supported by the Australian Research Council through a Future Fellowship (FT220100610).

Data availability

Not applicable.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.