Preconception Care: A Concept Analysis of an Evolving Paradigm

ABSTRACT

Aim(s)

To clarify the concept of preconception care and develop a precise and inclusive definition to improve its implementation and impact on reproductive health outcomes.

Design

This concept analysis paper employs Rodgers' evolutionary method to analyse the concept of preconception care, examining its historical evolution, attributes, antecedents and consequences.

Methods

A comprehensive literature review was conducted using databases such as Cumulative Index to Nursing and Allied Health Literature, Scopus, MEDLINE and Google Scholar, covering publications from 2012 to 2024. Data extraction involved identifying surrogate and related terms, attributes, antecedents and consequences of preconception care. A total of 1520 publications were retrieved, with 166 meeting eligibility criteria. Using systematic random sampling, 40 articles were selected for in‐depth analysis.

Results

The analysis revealed that preconception care encompasses several attributes: period‐related (biological, individual, public health and intergenerational), target population‐related (individual, public and intergenerational) and pathway‐related (universal, targeted and comprehensive). Antecedents include desires for a healthy baby and family planning decisions. Consequently, it improves pregnancy outcomes and health equity and enhances community and intergenerational health. The proposed operational definition highlights preconception care as a proactive strategy to optimise health before pregnancy through targeted and inclusive interventions.

Conclusion

Preconception care is a dynamic and multifaceted process that extends from immediate preconception periods to long‐term health considerations. Addressing diverse needs and effectively improving health outcomes requires a tailored approach considering individual, public and intergenerational perspectives.

Implications for Professions and Patient Care

A transparent and inclusive definition of preconception care will enable healthcare professionals, particularly nurses, to deliver more effective, culturally sensitive and equitable care. It will support advocacy for policy changes, resource allocation and educational initiatives to enhance preconception health.

Impact

Addressing preconception care's complexities and diverse needs will foster a more comprehensive understanding and implementation of preconception care, ultimately improving reproductive health outcomes and promoting health equity across generations.

Patient or Public Contribution

As this concept analysis was derived from published articles, patients or the public were not involved in the study's design, conduct or reporting.

1. Introduction

Preconception care (PCC) is a foundational concept in reproductive health, with its definition and application evolving significantly over time due to historical practices and various contextual influences (Khekade et al. 2023). As Rodgers (2000) explains, concepts are not static; they adapt and are reshaped by the environments in which they are applied. The roots of PCC can be traced back to ancient practices, such as Spartan exercise regimens for women and dietary guidance from the Old Testament (Judges 13:3–4, New International Version), emphasising the importance of preconception health. PCC has evolved from these traditional practices into modern, proactive healthcare strategies to improve health outcomes for couples and their children (WHO 2013). Historical evidence suggests that ancient civilizations like Egypt, Greece and Rome prepared couples for pregnancy through rituals and health practices to support positive pregnancy outcomes (Gentry 2009). Religious texts, including the Old Testament, also recognised the importance of preconception health, advising women to avoid alcohol and certain foods (Judges 13:3–4, New International Version). Similarly, Islamic teachings emphasise balanced nutrition, physical activity and medical guidance as essential for preconception and prenatal health (Bahri 2015; Shoaib 2024a, 2024b).

With societal progress, especially by the mid‐20th century, PCC became more formalised through public health movements and maternal and child health programs (Dean et al. 2013; Warren and Kavanagh 2023). This shift brought a growing awareness of the impact of preconception health on pregnancy outcomes, leading to targeted interventions and establishing a foundation for global maternal health initiatives. Today, the World Health Organisation (WHO) defines PCC as a set of interventions designed to optimise the health and well‐being of women, couples and their future children before pregnancy (WHO 2013). The modern understanding of PCC underscores its importance, as research links suboptimal pre‐pregnancy lifestyle choices with increased risks of infertility and adverse health outcomes for both current and future generations (Stephenson et al. 2018). For example, pre‐pregnancy weight gain is associated with persistent weight issues and infertility, though it may result from a complex interplay of factors, including genetic predispositions, metabolic conditions and hormonal imbalances (Dean et al. 2013; Hill et al. 2020; Stephenson et al. 2018). With global rates of overweight and obesity projected to rise to 70% by 2034, the implications for reproductive health are significant (WHO 2013). These findings highlight the urgent need for comprehensive PCC that addresses various influencing factors—lifestyle, genetics and metabolic health—to improve maternal and child health outcomes (Chen et al. 2024).

Despite advances in healthcare, suboptimal birth outcomes remain a pressing issue (Hill et al. 2020). Unplanned and teenage pregnancies account for 45% and 12% of all pregnancies, respectively, and teenage pregnancies are associated with a 56% higher risk of infant mortality (Mansfield 2017; Ross et al. 2017). This persistence of poor outcomes partly points to a gap in the effective implementation of PCC. Comprehensive PCC has the potential to address these issues by promoting healthier lifestyle choices and engaging preventative measures before conception, thereby reducing the risk of non‐communicable diseases in offspring (Dean et al. 2013; Stephenson et al. 2018). This period offers an exceptional opportunity for intervention based on evidence from life course epidemiology, developmental programming around the time of conception and maternal motivation (Dean et al. 2013; Stephenson et al. 2018).

The international relevance of concept analysis in PCC is profound, as this evolving concept addresses global reproductive health challenges and aligns with efforts to improve maternal and child health worldwide (Stephenson et al. 2018; Habte, Dessu, and Haile 2021). Recognising PCC as a dynamic and context‐dependent concept is essential for developing interventions that effectively respond to the diverse needs of populations across different regions and healthcare systems (Alemu et al. 2021; Dean et al. 2013). As PCC's definition and application shift in response to emerging health trends and social determinants, this concept analysis offers a methodical approach to refining its scope and ensuring its inclusivity and applicability in varied cultural and healthcare contexts (Mansfield 2017; Ross et al. 2017). Given the global challenges of rising non‐communicable diseases, fertility issues and health disparities, a precise and adaptable understanding of PCC is crucial (Chen et al. 2024). This analysis contributes to international public health strategies by emphasising preconception health as a critical foundation for improving health outcomes across generations and promoting equitable access to quality reproductive health services.

However, various stakeholders and researchers interpret the concept of PCC differently, leading to inconsistencies in its application and understanding (Ross et al. 2017). This variability extends to excluding individuals who may become pregnant but do not identify as female, highlighting a significant gap in the inclusivity of PCC guidelines (Dehlendorf et al. 2021; Thompson et al. 2017). To address these disparities and refine the concept for contemporary application, it is crucial to undertake a thorough concept analysis. This will ensure a precise and inclusive understanding of PCC that can be consistently used across diverse populations and periods.

This paper undertakes such an exercise, structured into four key sections: a comprehensive review of the available literature on PCC; identification of attributes, antecedents and consequences of the concept; a presentation of results and discussion of the findings and the implications for advancing knowledge in the field. Drawing on the existing literature and current healthcare practices, we propose a framework for an attribute‐based working definition of PCC, offering a more precise and inclusive understanding of the concept. This refined definition aims to reflect the dynamic and evolving nature of reproductive health today, ensuring that all individuals who may become pregnant receive the support they need to achieve optimal health outcomes before, during and after pregnancy (Berglund and Lindmark 2016; Johnson et al. 2006).

1.1. Significance

Clarifying the concept of PCC through the conduct of a concept analysis is crucial because it directly impacts the health outcomes of women, couples and children. A clear definition allows for the development of more effective interventions to improve preconception health and prevent adverse birth outcomes. In addition, it helps address disparities in healthcare access, ensuring equitable support for individuals regardless of gender identity or socioeconomic status (Sijpkens et al. 2020; Stephenson et al. 2018). For nursing practice, a clear understanding of PCC enables nurses to meet preconception health needs better, advocate for equitable care access and enhance outcomes for women, families and children. Upon closer examination, the current definition of PCC needs to be expanded to encompass intergenerational processes, special populations and paternal factors (Barker et al. 2018; Halfon and Forrest 2018).

Further conceptualisation and clarification of PCC are essential to promoting inclusive care and research (Sijpkens et al. 2020; Stephenson et al. 2018). By using Rodgers's concept analysis method, we can identify attributes that facilitate effective targeting of the PCC population, period and care pathway (Gunawan, Aungsuroch, and Marzilli 2023; Halfon and Forrest 2018; Rodgers 2000). This conceptual work is vital for fostering a healthier generation, advancing nursing knowledge and establishing a more robust theoretical framework for future PCC research (Halfon and Forrest 2018; Rodgers 2000; Sijpkens et al. 2020; Stephenson et al. 2018).

2. Methods

An inductive evolutionary method (Rodgers 2000) was employed to analyse the concept as it has developed over time. This method supports a contemporary approach in which tasks may come simultaneously, only sometimes chronologically, as in the current presentation. Following the structured approach described by Rodgers (2000), we applied the six stages of Rodgers' evolutionary concept analysis across three key phases to develop a comprehensive understanding of our selected concept. In the initial phase, we chose the concept central to our study, defined its context and gathered relevant literature to ground our analysis in current and relevant material (Rodgers 2000). This foundational work ensured that our concept analysis would be well‐supported by a thorough review of related studies and theoretical frameworks. The core analysis phase involved identifying surrogate and related terms, attributes, antecedents and consequences associated with the concept (Rodgers 2000). Surrogate and related terms clarified the concept's boundaries and relationships with similar ideas, while core attributes highlighted essential qualities across various contexts (Rodgers 2000). Antecedents identified the necessary conditions preceding the concept, and consequences outlined the potential outcomes of its application, enabling us to capture both the internal characteristics and broader implications of the concept. Finally, we synthesised our findings in the concluding phase and discussed the concept's significance and implications. We integrated insights from our analysis to form a coherent understanding of the concept's role and potential impact within the field, ending with recommendations for practical applications and future research directions. This structured approach aligns with Rodgers's (2000) insights, underscoring the value of Rodgers' evolutionary method in developing adaptable and dynamic concepts essential for advancing nursing science.

2.1. Collection of Material for Concept Analysis

Following Rodgers' guidelines, we conducted a literature search as one of the initial phases of concept analysis (Rodgers 2000). We utilised several databases, including CINAHL, Scopus, MEDLINE and Google Scholar, which are the most representative and commonly used for the selected disciplines in this study. We employed Boolean operators and Medical Subject Heading (Mesh) to search for terms such as ‘preconception population’ or ‘before conception care,’ ‘preconception care’ or ‘pre‐pregnancy care’ and ‘preconception period,’ among other possible similar terms. We included only full‐text reports published in English between 2012 and 2024 in nursing, midwifery, medicine, public health, genetics and other disciplines. This time frame was selected to focus on recent developments in the understanding and application of PCC. This timeframe allows for analysing current perspectives, practices and research findings, reflecting recent shifts in healthcare policies, guidelines and parental and child health research advancements. We excluded findings from inaccessible full texts. We noted attributes, antecedents, consequences and related and surrogate terms for each item reviewed using a disciplinary coding form for each discipline.

2.2. Data Extraction, Screening and Analysis

We extracted the data using a piloted extraction form by Excel, and each disciplinary coding form noted attributes, antecedents, consequences and related and surrogate terms for each item reviewed. Next, we combined this data to form a working concept definition per Rodgers' method. One reviewer independently performed the data screening and extraction process. The second, third, fourth and fifth senior reviewers conducted an intensive review of the screening and extraction outcomes. These senior reviewers collaboratively discussed and resolved disagreements or uncertainties, ensuring accuracy and consistency. A total of 1520 publications and reports were retrieved, and after removing duplicates with EndNote software, 166 findings fulfilled the eligibility as presented in the PRISMA diagram in Figure 1 (Selçuk 2019). Rodgers' concept analysis approach emphasises a process‐oriented selection to capture a comprehensive and representative understanding of the concept rather than prescribing a fixed sample size (Rodgers 2000). The sample size is determined by achieving thematic saturation, including enough studies to reflect diverse perspectives and critical attributes without redundancy (Rodgers 2000). For large datasets, Rodgers recommends systematic random sampling to distribute selected studies across the dataset evenly, maintaining proportionality to the literature volume and minimising bias. A manageable sample size, typically 20–50 studies, is advised for detailed yet feasible analysis (Rodgers 2000). For this study, we selected a sample of 40 studies from the 166 eligible findings by choosing every fourth study from a randomly chosen starting point. This ensured a balanced subset for analysis, capturing a range of perspectives, and the selected articles are listed in Supporting Information S1. In Supporting Information S2, we also presented a detailed protocol for the comprehensive literature review conducted for this concept analysis to support transparency and facilitate replication.

FIGURE 1.

PRISMA flow diagram.

3. Results

Based on Rodgers' evolutionary method, every finding is first examined for the concept's context, surrogate and related terms, antecedents, attributes and consequences (Rodgers 2000). So, the result of the core analysis phase of the current findings is presented based on the categories of surrogate and related terms, attributes, antecedents and consequences (Figure 2). Table 1 also summarises the 40 selected articles detailing the surrogate terms, attributes, antecedents and consequences of PCC.

FIGURE 2.

Conceptual framework of preconception care.

TABLE 1.

Summary of selected articles: Surrogate terms, attributes, antecedents, and consequences.

Sr. no	Authors and year	Surrogate and related terms	Attributes	Antecedents	Consequences
1	Barker et al. (2018)	Health behaviours before conception Preconception health, maternal health, nutrition	Period‐Related Attributes: Preconception health interventions focused on nutrition and lifestyle behaviours; Target Population Attributes: Individuals planning to conceive or of reproductive age; Pathway Attributes: Nutritional status and health behaviours directly impact pregnancy outcomes and long‐term health	Nutritional deficiencies, lifestyle risk factors (e.g., smoking, alcohol), existing chronic health conditions Decide to have pregnancy	Improved maternal and child health, reduced pregnancy complications risk, and long‐term health benefits for offspring
2	Berglund and Lindmark (2016)	Preconception health (PH), maternal and child health strategy	Period‐Related Attributes: Comprehensive health care before conception; Target Population Attributes: Women of childbearing age; Pathway Attributes: Integrating preconception care into regular health care to improve maternal and child health outcomes Treating chronic disease before pregnancy	Health care access, health education for pregnancy, societal awareness of preconception care, wishing to have a child	Reduced maternal and child morbidity and mortality, healthier pregnancies, and improved public health outcomes
3	Chen et al. (2024)		Period‐Related Attributes: The preconception period as a critical window for addressing obesity; Target Population Attributes: Populations with high body mass index (BMI), reproductive age individuals; Pathway Attributes: Interventions targeting BMI before conception to prevent obesity‐related complications	Decided to have a pregnancy; with rising global obesity rates and inadequate public health measures addressing preconception obesity	Decreased prevalence of obesity‐related pregnancy complications, lower global burden of obesity, improved maternal and child health
4	Dean et al. (2013)	Care before and between pregnancies, preterm birth prevention	Period‐Related Attributes: Focus on inter‐pregnancy intervals to prevent preterm births; Target Population Attributes: Women with previous preterm births, reproductive age individuals; Pathway Attributes: Optimised health and care during preconception and inter‐pregnancy periods to prevent adverse outcomes Continuous care, evidence‐based interventions, interdisciplinary approach	Previous preterm birth, inadequate inter‐pregnancy care, insufficient health resources	Reduction in preterm births, improved neonatal outcomes, enhanced maternal health Tailored care to individual preferences and circumstances
5	Dehlendorf et al. (2021)		Period‐Related Attributes: Expansion of the preconception health framework to include reproductive and sexual health equity; Target Population Attributes: Marginalised and underserved populations, individuals of reproductive age; Pathway Attributes: Addressing social determinants of health to improve preconception care outcomes	Social determinants of health, inequities (sexual minority groups) in health care access, reproductive justice	Enhanced health equity, improved access to preconception care, and reduction of health disparities
6	Dennis et al. (2022)	Pre‐pregnancy mental health screening, reproductive health for individuals with mental illness, preconception mental health care, mental health risk assessment, maternal and paternal mental health planning, and psychosocial support	Period‐Related: Biological, individual preference, public health, intergenerational Target Population: Individual, public, intergenerational Pathway: Universal, targeted, both	Mental health awareness, access to mental and reproductive health services, supportive healthcare policies, collaboration among providers, societal support, patient readiness	Improved mental health outcomes, reduced adverse pregnancy outcomes, enhanced parental resilience, lower intergenerational mental health risks, better family stability, and long‐term child health benefits
7	Halfon and Forrest (2018)	Postnatal care, prenatal care	Period‐Related Attributes: Life course approach to health development, including preconception; Target Population Attributes: Individuals across the lifespan, particularly during critical developmental periods; Pathway Attributes: Integration of life course theory into health care practices to improve outcomes across generations	Lifespan health risks, intergenerational transmission of health outcomes, advanced age	Improved long‐term health outcomes and a better understanding of the impact of preconception care across generations Health promotion throughout the lifespan and support for future pregnancy planning
8	Hieronimus and Ensenauer (2021)	Maternal and paternal preconception overweight/obesity, offspring outcomes, prevention strategies	Period‐Related: Biological, individual preference, public health, intergenerational	Influence of parental overweight/obesity, need for targeted prevention strategies	Improved offspring outcomes through addressing parental preconception of overweight/obesity, better prevention strategies
9	Hill et al. (2020)		Period‐Related Attributes: Exploration of the preconception period as a critical time for health interventions; Target Population Attributes: Individuals planning pregnancy of reproductive age; Pathway Attributes: Identification and intervention during the preconception period to improve health outcomes
10	Jacob et al. (2019)		Period‐Related Attributes: Preconception as part of the life course approach to health; Target Population Attributes: Reproductive age individuals, populations at risk for chronic conditions; Pathway Attributes: Understanding and addressing health risks from a life course perspective to prevent disease	Early life exposures, intergenerational transmission of health risks, chronic disease prevention, wishing to have a healthy baby	Improved chronic disease prevention, better maternal and child health outcomes, integration of life course theory into health care practices
11	Khekade et al. (2023)		Period‐Related Attributes: Strategic interventions before conception to prevent neonatal and birth disorders; Target Population Attributes: Women of reproductive age, at‐risk populations; Pathway Attributes: Focus on early interventions to reduce the risk of birth disorders and improve neonatal health	High prevalence of neonatal and birth disorders, inadequate early intervention strategies (childhood, puberty)	Reduction in neonatal and birth disorders, healthier pregnancies, and improved maternal and neonatal outcomes
12	Kim et al. (2017)	Pre‐pregnancy care Reproductive health care Preconception health counselling Family planning Maternal health interventions Preventive reproductive care	Period‐Related: Partnership and planning for pregnancy, patient readiness and willingness for lifestyle modification	Inconsistent preconception care practices, gaps in public health policy, becoming sexually active	Improved maternal and fetal health outcomes, higher rates of healthy pregnancy and delivery and enhanced awareness of prenatal health practices
			Population‐Related: Reproductive age individuals
			Path‐Related: Trained healthcare providers in maternal and reproductive health, access to healthcare services
13	Lassi et al. (2019)	Preconception care, preconception interventions, maternal nutritional status, birth outcomes	Period‐Related: Partnership and planning for pregnancy, patient readiness, and willingness for lifestyle modification Population‐Related: Reproductive age individuals Path‐Related: Trained healthcare providers in maternal and reproductive health, Access to healthcare services	Inconsistent preconception care practices, gaps in public health policy, becoming sexually active	Improved maternal nutritional status and enhanced birth outcomes through targeted preconception and preconception interventions in low‐ and middle‐income countries
14	Lewis (2018)	Reproductive justice, surrogacy, poly maternalism	Period‐Related Attributes: Exploration of reproductive justice in the context of surrogacy and polymaternalism; Target Population Attributes: Marginalised communities, individuals seeking reproductive assistance; Pathway Attributes: Advocacy for reproductive rights and inclusive practices in preconception care		Enhanced reproductive justice, better access to reproductive services for marginalised communities, and inclusive preconception care practices
15	Mansfield (2017)		Period‐Related Attributes: Exploration of the impact of preconception health on epigenetic outcomes; Target Population Attributes: Individuals planning pregnancy, at‐risk populations; Pathway Attributes: Understanding the epigenetic implications of preconception health for fetal development	Advances in epigenetics, growing understanding of fetal development, increased awareness of preconception health's impact on epigenetics	Improved fetal health outcomes, better integration of epigenetics into preconception care and reduced risk of developmental disorders
16	Meloni (2018)		Period‐Related Attribute: Intergenerational perspective	Lack of understanding of genomic factors, gaps in preconception care interventions, becoming sexually active	Informed preconception care practices improved health outcomes through genomic research integration
17	Marmot (2013)		Period‐Related Attributes: Emphasis on health equity and social determinants in preconception care; Target Population Attributes: Marginalised communities, individuals of reproductive age; Pathway Attributes: Addressing social inequities to improve preconception health outcomes		Enhanced health equity, reduced health disparities, and better access to preconception care for marginalised populations
18	Mattson and Smith (2015)		Period‐Related Attributes: Inclusion of preconception care concepts in nursing curricula; Target Population Attributes: Nursing students and educators; Pathway Attributes: Development of core competencies related to maternal‐newborn nursing and preconception care		Improved nursing education, better nurses' preparedness to provide preconception care, and enhanced patient outcomes in maternal‐newborn health
19	McDougall et al. (2021)	Health behaviours, preconception health, pregnancy planning	Period‐Related: Biological, individual preference, public health, intergenerational		Improved health behaviours in pregnancy planning, enhanced preconception care strategies
20	Moss and Harris (2015)	Paternal preconception health	Period‐Related: Biological, individual preference, public health, intergenerational Target Population: Individual, public, intergenerational Pathway: Universal, targeted, both		Improved birth outcomes through addressing both maternal and paternal preconception health enhanced prospective data usage
21	Näsman, Nyqvist, and Nygård (2022)	End‐of‐pregnancy care	Public perspective	Well‐being in old age/Advanced family age	Time and setting independent care
22	Ross et al. (2017)		Target Population Attributes: Individuals using IVF or assisted reproductive technologies, at‐risk populations; Pathway Attributes: Impact of reproductive technologies on preconception health and pregnancy outcomes	Reproductive technologies, growing use of IVF and other technologies (assisted human reproduction)	Improved understanding of the implications of reproductive technologies, better health outcomes for individuals using these technologies and informed ethical practices in preconception care Assist
23	St. Fleur, Damus, and Jack (2016)	Gender equality, transformative health care, preconception health	Period‐Related Attributes: Gender‐sensitive approaches to preconception health; Target Population Attributes: Individuals of reproductive age, gender‐diverse populations; Pathway Attributes: Transformative health care practices that promote gender equality and improve preconception health outcomes		Improved gender equality in health care, better preconception health outcomes and more inclusive health care practices
24	Schofield and Kapoor (2019)	Pre‐existing mental health disorders (preconception health), pregnancy	Impact of pre‐existing mental health disorders on pregnancy, strategies for management Period‐Related: Biological, individual preference, public health, intergenerational Target Population: Individual, public, intergenerational Pathway: Universal, targeted, both	Wishing to have a healthy baby, becoming sexually active	Improved management of pre‐existing mental health disorders during pregnancy and enhanced maternal and fetal outcomes
25	Segal and Giudice (2019)		Period‐Related Attributes: Impact of environmental exposures before conception; Target Population Attributes: Individuals exposed to environmental risks, reproductive age individuals; Pathway Attributes: Environmental factors influencing reproductive and obstetrical outcomes		Improved understanding of environmental impacts on reproductive health (Holistic care), better preconception care strategies (decentralised care)
26	Shawe et al. (2015)	Inter‐conception care, inter‐pregnancy care	Period‐Related Attributes: Biological
27	Shoaib (2024a, 2024b)	Preconception, prenatal, and perinatal counselling	Period‐Related: Biological, individual preference, public health, intergenerational Target Population: Individual, public, intergenerational	Lack of integration of Islamic perspectives in preconception and prenatal care, gaps in culturally competent counselling, minority groups	Enhanced preconception and prenatal care through culturally relevant counselling, improved health outcomes in diverse populations
28	Stephenson et al. (2018)	Inter‐conception care, inter‐pregnancy cares Related Terms: Prenatal care, end‐of‐pregnancy care	Period‐Related Attributes: Biological (days to weeks before pregnancy), individual preference, intergenerational
29	Sijpkens et al. (2020)	Before‐conception care Inter‐pregnancy care	Period‐Related Attributes: Individual preference
30	Daly et al. (2022)		Target Population Attributes: Gender‐diverse populations, individuals of reproductive age; Pathway Attributes: Addressing the intersections of gender, race, and other identities in health care to improve outcomes	Health disparities based on gender, race and other intersecting identities, lack of inclusive healthcare practices, puberty	Improved reproductive health outcomes, enhanced understanding of the impact of intersectionality on health and more inclusive and equitable healthcare practices (decentralised Care)
31	Tieu et al. (2017)	Pre‐pregnancy care	Period‐Related Attributes: Individual preference
32	Thompson et al. (2017)	Inter‐conception care, preconception care	Period‐Related Attributes: Focus on the periods before and between pregnancies for optimal reproductive outcomes; Target Population Attributes: Reproductive age individuals, women with previous pregnancy complications; Pathway Attributes: Comprehensive health interventions during preconception and inter‐conception periods to improve outcomes	Inadequate health care during preconception and inter‐conception periods, lack of awareness of the importance of these periods	Improved reproductive outcomes, reduced pregnancy complications, and better health outcomes, optimising reproductive outcomes for mothers and children
33	Ukoha, Mtshali, and Adepeju (2022)	Reproductive health services, pre‐pregnancy health care, maternal and child health services, family planning and counselling, preventive reproductive care, and women's health promotion	Historical overview and current focus on epigenetic mechanisms in health and disease (Intergenerational) Period‐Related: Biological, individual preference, public health, intergenerational Target Population: Individual, public, intergenerational Pathway: Universal, targeted, both		Improved understanding of developmental origins of health and disease (healthy generation, enhanced focus on epigenetic mechanisms in research and practice, holistic care)
34	Van Der Zee et al. (2012)		Period‐Related Attributes: Emphasis on preconception care as a preventive strategy; Target Population Attributes: Women and children; Pathway Attributes: Integrating preconception care into public health strategies to enhance health outcomes. Begin at the early age of childhood		Improved health outcomes for women and children, enhanced preventive care strategies, and better integration of preconception care into public health policy
35	Verbiest (2020)	Preconception period, preconception health, end of pregnancy care	Period‐Related Attributes: Individual Preference Public Health Intergenerational
36	Waggoner (2013)	Preconception health initiative, motherhood, health care Inter‐conception care	Emergence and development of the preconception health initiative (Intergenerational)		Development of preconception health initiatives (life span health, healthy generation, increased awareness and integration of preconception health in healthcare practices)
37	Wang et al. (2020)	Preconception health	Period‐related attributes: Early 2 weeks to pregnancy; target population attributes are reproductive age individuals, populations at risk for adverse health outcomes; and pathway attributes are the application of data‐driven interventions to improve preconception health and pregnancy outcomes		Improved precision in public health interventions, better pregnancy outcomes, enhanced use of data in preconception care Growing need for personalised health interventions, public health policy changes
38	Warin et al. (2016)		Exploration of how habitus and social environments influence epigenetics and obesity/Intergenerational		Reproduction of obesity‐related behaviours and health outcomes need holistic preconception care approaches that address social and biological factors
39	Wilson et al. (2019)	Postnatal care, prenatal care, conception care, end‐of‐pregnancy care	Period‐Related Attributes: Focus on mental health during the preconception period; Target Population Attributes: Individuals of reproductive age, populations at risk for mental health issues; Pathway Attributes: Integrating mental health care into preconception health practices to improve overall well‐being		Improved mental health outcomes, better integration of mental health care into preconception services, enhanced overall well‐being of individuals planning pregnancy
40	Withanage et al. (2022)			Decided to have a pregnancy	Enhanced preconception care boosts integration into primary care, improves pregnancy outcomes and supports family‐centred care

3.1. Surrogate and Related Terms

The first step in the concept analysis phase involves identifying surrogate terms used in the concept development process (Rodgers 2000). This step focuses on recognising terms often incorrectly used instead of the intended terms that more accurately express the concept (Näsman, Nyqvist, and Nygård 2022). Inter‐conception care, inter‐pregnancy care, pre‐pregnancy care, before‐conception care, preconception period and preconception health are surrogate terms used (Lassi et al. 2019; Schofield and Kapoor 2019). The literature search in various disciplines shows that inter‐conception care is a set of care from the end of one pregnancy to the conception of the subsequent pregnancy (Hieronimus and Ensenauer 2021; Shawe et al. 2015; Stephenson et al. 2018; Tieu et al. 2017). Similarly, inter‐pregnancy care starts from the end of one pregnancy to the conception of the subsequent pregnancy, and pre‐pregnancy care is the care that a woman gets before she becomes pregnant. Related terms are words with something in common with the concept but not the same characteristics (Rodgers 2000). In the literature search, postnatal care (care for both mothers and newborns after delivery to the last 6 weeks), prenatal care (care during pregnancy), conception care (care during pregnancy) and end‐of‐pregnancy care (care given at the end of pregnancy and then after) were also identified as the related terms (Hieronimus and Ensenauer 2021; Wang et al. 2020; Wilson 2019).

3.2. Attributes

According to Rodgers (2000), the researcher is required to identify the characteristics of the concept that constitute true definition and enable the identification of situations that fall under it. Therefore, based on the synthesised evidence, we have categorised the concept's attributes as follows: (1) period‐related, (2) target population‐related and (3) preconception pathway perspective attributes.

3.2.1. Period‐Related Attributes

The preconception period is one of the earliest sensitive periods of human development. Therefore, it can potentially affect not only pregnancy but also long‐term outcomes as well. The synthesised evidence from the different sources revealed that focusing on the period between prenatal care and childbirth needs to be revised. However, the life course attributes allow for improving preconception health (Dennis et al. 2022; Sijpkens et al. 2020; Verbiest 2020). Therefore, we proposed an expanded definition of the preconception period along the following perspectives as evidenced by the reviewed literature: The first attribute in this perspective is biological, which focuses on the days to weeks before pregnancy (Hieronimus and Ensenauer 2021; Shawe et al. 2015; Stephenson et al. 2018). The second important attribute is individual preference that explains the time depends on the intentionality of a couple to conceive regardless of contraception utilisation status and is typically weeks to years before pregnancy (Dennis et al. 2022; Sijpkens et al. 2020; Stephenson et al. 2018; Tieu et al. 2017; Verbiest 2020). The third is the public health perspective aimed at more extended periods or years to address preconception risk factors, such as diet and obesity (Halfon and Forrest 2018; Stephenson et al. 2018; WHO 2013). Lastly, the intergenerational perspective defines the preconception period based on the developmental origin of the disease (DOHaD) framework, which postulates epigenetic mechanisms and a view of life stages as a series of folds rather than linear sequences (Mansfield 2017; Meloni 2018). Understanding all these attributes will provide a valuable framework to identify critical periods and to target various individual and public health initiatives to improve outcomes.

3.2.2. Target Population Attributes

The target population becomes the key operator for the implementation of PCC. Based on different disciplinary views of points, we have summarised these attributes as individual, public and intergenerational. Each person could be seen individually depending on their care preferences and cultural diversity to have a reproductive life plan. The care and messages each woman, man and couple needs differ, and their choices regarding this care vary. So, PCC could be tailored individually (Dean et al. 2013; Hill et al. 2020; Lassi et al. 2019; Stephenson et al. 2018).

Moreover, in the reviewed articles, population health and the public must also be considered when addressing PCC. Findings show the importance of intervention strategies at the public health level to raise awareness of preconception health and to normalise the notion of planning and preparing for pregnancy (Kim et al. 2017; Stephenson et al. 2018; Verbiest 2020). Generally, strategies include improving food environments (fortification with folate), integrating preconception health in school curricula and other policies related to maternal and child health (Marmot 2013; Stephenson et al. 2018; Verbiest 2020). In addition, the population also includes children (Stephenson et al. 2018; St. Fleur, Damus, and Jack 2016). Therefore, the population should be the target of PCC regardless of gender and reproductive capacities. Finally, the literature links intergenerational perspectives with PCC by explaining how preconception health can impact offspring health, including epigenetic alterations to gene expression occurring soon after conception (Warin et al. 2016; Waggoner 2013). The balanced interactions of molecular, physiological, behavioural, cultural and evolutionary processes result in PCC /health, as identified in this perspective (Jacob et al. 2019; McDougall et al. 2021; St. Fleur, Damus, and Jack 2016). This requires care for different generations.

3.2.3. Pathway Attributes

This concept analysis also classified the path attributes into three: before the first pregnancy (universal path), targeted path and both (universal and targeted paths) perspectives. Universal attributes include holistic care during the early years (babies and children) and adolescence, the building block for preconception health. Services for children focus on giving them the best start in life and supporting their chances of entering their reproductive years in optimal preconception health (Halfon and Forrest 2018; Hill et al. 2020; Jacob et al. 2019; Shoaib 2024a, 2024b). Universal services during the reproductive years, provided through primary and sexual health services, are essential for integrating PCC. Key opportunities include consultations for starting or stopping contraception, as well as interactions after miscarriage, fertility advice, abortion, cervical screening or peri‐menopausal care. These services help address future pregnancy planning and preconception health effectively (Halfon and Forrest 2018; Hill et al. 2020; Lewis 2018).

The target path attributes aim at an early intervention to control, manage and mitigate potential preconception risk factors for life carriers in their early reproductive (Dean et al. 2013; Dehlendorf et al. 2021; Segal and Giudice 2019). The last, more comprehensive attribute encompasses universal and targeted PCC path perspectives. This attribute focuses on PCC for subsequent pregnancies. It is aimed at supporting care with the transition from first pregnancy into health visiting and the early years and managing, controlling and mitigating potential preconception risks earlier after the first pregnancy to the entire lifespan (next baby and beyond), including those people with special needs (advanced age, assisted human reproduction and adolescence) (Mattson and Smith 2015; Verbiest 2020).

3.3. Antecedents

As defined by Mackintosh (2006), antecedents of PCC encompass various incidents or phenomena that precede the concept or hold a prior relationship with it. These antecedents include desires for a healthy baby, life events such as reaching adulthood or starting a family, childhood and puberty experiences, the transition to becoming sexually active and aspirations for maintaining healthy reproductive health beyond pregnancy (Schofield and Kapoor 2019; Segal and Giudice 2019). In addition, family planning decisions, intentions to conceive and the influence of partners all play crucial roles in shaping individuals' engagement with PCC. Additionally, specific population needs—such as personal health history and the needs of vulnerable or underrepresented groups, including children, adolescents, older adults, individuals undergoing assisted reproductive technologies and sexual minorities—contribute to the desire for PCC. These antecedents underscore the diverse personal, societal and healthcare system factors influencing an individual's decision to seek PCC.

3.4. Consequences

Based on the reviewed literature, the consequences of PCC span various dimensions, including family‐centred care, lifespan health promotion for a healthy generation, holistic care approaches and decentralised care delivery. These consequences result in several benefits, such as improved pregnancy outcomes, promotion of overall health throughout the lifespan, tailored care to individual preferences and circumstances, accessibility of culturally appropriate care, optimisation of fertility potential, maintenance of reproductive age health, provision of care independent of time and setting, promotion of healthy family dynamics, enhancement of community health and improvements in maternal health (Lassi et al. 2019; Shoaib 2024a, 2024b; Ukoha, Mtshali, and Adepeju 2022; Van Der Zee et al. 2012; Wadhwa et al. 2009; Withanage et al. 2022). In addition, it encompasses improved pregnancy, promotion of healthy behaviours, early identification and management of risks, cost savings and health equity (Figure 2).

3.5. Proposed Operational Definition

PCC is a proactive healthcare strategy that addresses physical, emotional and environmental factors to enhance individual and population health before pregnancy. Through targeted, tailored interventions that consider biological and personal preferences, public health goals and intergenerational impacts, PCC seeks to reduce preconception risks, promote health equity and foster holistic well‐being, ultimately improving outcomes for parents, foetuses and children across generations.

4. Discussion

As outlined by Walker and Avant (2005), the goal of concept analysis extends beyond mere definition elucidation; it serves as a tool to uncover the intricacies, similarities and disparities within a concept while guiding future research endeavours, as articulated by Rodgers (2000). In the realm of PCC, the evolution of this concept has been marked by a shift in focus from individual health interventions towards a broader understanding that encompasses public health and intergenerational dimensions (Dean et al. 2013; Dehlendorf et al. 2021). This analysis delves into the multidisciplinary literature surrounding PCC, shedding light on its various attributes, antecedents and consequences (Khekade et al. 2023; Stephenson et al. 2018).

The attributes of PCC, as unearthed through this analysis, paint a picture of a complex and multifaceted process. The period‐related attributes underscore the importance of recognising preconception as a continuum that spans from days to weeks before conception to extended periods encompassing months to years (Hill et al. 2020; Jacob et al. 2019). This expanded temporal framework allows for a comprehensive approach to addressing preconception risk factors, from immediate concerns to long‐term health considerations extending beyond reproductive years (Jacob et al. 2019; Meloni 2018). Moreover, the intergenerational perspective emphasises the ripple effect of PCC interventions, highlighting the potential to positively impact future generations' health outcomes (Hill et al. 2020; Jacob et al. 2019). The exact duration of PCC is still an area of ongoing research, but the process is complex and requires a multifaceted approach.

Population‐related attributes further underscore the need for tailored and culturally sensitive interventions that address the diverse needs of individuals and communities. (Stephenson et al. 2018; Verbiest 2020). Literature supports this notion, with studies such as those by Dehlendorf et al. (2021) and Hill et al. (2020) advocating for individualised PCC that considers each person's specific needs and circumstances. On the other hand, the public health perspective emphasises the importance of population‐wide interventions that promote preconception health among reproductive‐age individuals and adolescents, as highlighted in the works of Stephenson et al. (2018) and Verbiest (2020). This approach is crucial for individuals who may need to recognise preconception as a critical life phase. Embracing this perspective enables the implementation of research and interventions that can reach a broader audience and address PCC needs more effectively (Hill et al. 2020; Jacob et al. 2019). Finally, the intergenerational dimension advocates for a holistic and lifespan approach to PCC, recognising the interconnectedness of health across generations. This perspective stresses the importance of providing care that spans individuals' entire lifespan, irrespective of age, sex, socio‐demographic status or social justice perspective. Jacob et al. (2019) and Meloni (2018) advocated for this approach, highlighting the necessity of designing interventions that address the current generation's needs while also considering the health and well‐being of future generations.

Path‐related attributes, including universal, targeted and comprehensive perspectives, further enrich our understanding of PCC by highlighting the diverse approaches to intervention and the importance of early and ongoing support (Mattson and Smith 2015; Verbiest 2020). These attributes underscore the need for holistic care that spans life, address specific risk factors and adapt to individual circumstances to maximise effectiveness (Verbiest 2020). The universal path emphasises the importance of early interventions that lay the groundwork for optimal preconception health, starting from childhood and adolescence (Halfon and Forrest 2018; Hill et al. 2020; Jacob et al. 2019). In contrast, the targeted path focuses on identifying and mitigating preconception risk factors among individuals in their reproductive years. Furthermore, it has been argued that PCC should not be restricted to reproductive age and should be open to anyone, as it is related to human existence rather than chronological age (Halfon and Forrest 2018). Notably, an intersectional lens reminds us that PCC should not be limited by age or reproductive status but should be accessible to all individuals, regardless of their life stage or identity (Halfon and Forrest 2018; Hill et al. 2020; Lewis 2018).

Antecedents of PCC shed light on the factors influencing individuals' engagement with this concept, ranging from personal desires for a healthy baby to broader societal influences and healthcare system factors. Understanding these antecedents is essential for tailoring PCC interventions to meet the diverse needs of individuals and populations. As elucidated by this analysis, the consequences of PCC extend far beyond individual health outcomes to encompass broader societal implications. From fostering family‐centred care to promoting community health and equity, PCC can transform health outcomes across generations. Integrating EDI (Equity, Diversity, and Inclusion) principles into PCC initiatives is essential to address systemic disparities and ensure equitable access to care for all individuals and communities. Moreover, the recognition of PCC as a public health imperative underscores the need for collective action to prioritise the health and well‐being of current and future generations.

The current concept analysis has the following strengths. This is the first study on the topic conducted using Rodgers's methods (Rodgers 2000); it will provide direction for future researchers to see and evaluate the concept from an evolutionary point of view. This analysis also includes findings from different disciplines and multiple databases, increasing the result's representativeness. Despite these strengths, there are also some limitations. Even if the search was conducted systematically, relevant articles may have been excluded. Rodgers (2000) also suggested that researchers' systematic database search styles may influence our pre‐understanding of a concept. In the current analysis, we did not include printed media, interviews and other forms of verbalised language, which may affect the concepts cognitively. The qualitative nature of this concept analysis might also bring inherent and unrecognised bias in the data collection and analysis process.

5. Conclusion

The findings of this concept analysis underscore the importance of embedding PCC within broader healthcare policy and practice frameworks to create a more inclusive and impactful approach to reproductive health. PCC's evolving nature calls for policies recognising it as an adaptable, life course intervention that supports individuals of all genders and ages beyond traditional reproductive health boundaries. Policymakers should consider incorporating PCC into preventive health services, focusing on accessible, equitable care that addresses biological but also social and environmental determinants of health. The implications for healthcare practice are substantial. Nurses and healthcare providers should be trained to deliver PCC as a flexible, patient‐centred service tailored to everyone's unique needs. Interprofessional collaboration is essential, allowing for integrated care plans encompassing diverse health aspects. Furthermore, targeted educational campaigns can enhance public awareness of PCC's role in promoting lifelong health and well‐being, potentially fostering broader societal support for its implementation.

Future work should prioritise research that evaluates the effectiveness of PCC interventions across diverse cultural and demographic contexts, refining and adapting these approaches for global application. Studies examining the integration of PCC into primary care and assessing its long‐term impact on health outcomes are essential for building a robust evidence base. Expanding research to include varied populations, including those not traditionally covered by reproductive health programs, is vital to ensure that PCC remains relevant and inclusive in modern healthcare. Advancing these research and policy initiatives will help establish PCC as a universally applicable model with the potential to improve health outcomes across generations significantly.

5.1. Finding Interpretation and Future Directions

This concept analysis determined that PCC should be accessible to everyone, considering various attributes. Proportionate universalism advocates for providing services to all while allocating more resources where they are most required to reduce inequality and enhance outcomes overall (Marmot 2013). Therefore, future research should investigate PCC equity and social justice through the lens of proportionate universalism. In addition, assessing the extent of intergenerational health connections is valuable.

Author Contributions

Y.A.A. conceptualised the study, analysed data and drafted the manuscript. P.P., J.O., Z.S.L. and S.M. critically revised the manuscript, approved the final version for publication and agreed to be accountable for all aspects of the work. All authors meet the ICMJE criteria by contributing to the conception, design, data acquisition, analysis or interpretation or by drafting or revising the manuscript for important intellectual content.

Conflicts of Interest

The authors declare no conflicts of interest.

Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/jan.16711.

Supporting information

Data S1.

Data Availability Statement

Data supporting the study's findings is freely available in the manuscript.