Abstract
Background
Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, the reports, statements and guidelines of national and international health organisations vary in what they recommend individuals should monitor, avoid, reduce or practise in the preconception period.
Objectives
To synthesise and evaluate the evidence across systematic reviews for associations between exposures before conception and adverse pregnancy, birth and postpartum outcomes.
Data sources
MEDLINE, Embase, Epistemonikos (to May 2020) and reference lists of included reviews, without language or date restrictions.
Study selection, data extraction and synthesis
Systematic literature reviews of observational and/or interventional studies reporting associations between preconception exposures in women and/or men of reproductive age and pregnancy, birth or postpartum health outcomes were included. The methodological quality of reviews and the certainty of the evidence underlying each exposure-outcome association were assessed using AMSTAR 2 and the GRADE approach.
Results
We identified 53 eligible reviews reporting 205 unique exposure-outcome associations. Methodological quality was generally low with only two reviews rated as ‘high’ quality and two as ‘moderate’. We found high-certainty, randomised trial evidence that maternal folate supplementation reduces the risk of neural tube defects and anomaly-related terminations. Moderate-certainty, observational evidence was found that maternal physical activity is associated with reduced risk of pre-eclampsia and gestational diabetes, and that paternal age of ≥40 years and maternal body mass index (BMI) and interpregnancy weight gain are associated with increased risk of various adverse pregnancy and birth outcomes. Low- and very low-certainty evidence was found for other associations.
Conclusions
Clinicians and policymakers can be confident that maternal folate supplementation should be encouraged during the preconception period. There is moderate certainty in the evidence base that maternal physical activity, BMI and interpregnancy weight gain and advanced paternal age are important preconception considerations. High-quality research is required to better understand other exposure-outcome associations.
Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, the reports, statements and guidelines of national and international health organisations vary in what they recommend individuals should monitor, avoid, reduce or practise in the preconception period.
Objectives
To synthesise and evaluate the evidence across systematic reviews for associations between exposures before conception and adverse pregnancy, birth and postpartum outcomes.
Data sources
MEDLINE, Embase, Epistemonikos (to May 2020) and reference lists of included reviews, without language or date restrictions.
Study selection, data extraction and synthesis
Systematic literature reviews of observational and/or interventional studies reporting associations between preconception exposures in women and/or men of reproductive age and pregnancy, birth or postpartum health outcomes were included. The methodological quality of reviews and the certainty of the evidence underlying each exposure-outcome association were assessed using AMSTAR 2 and the GRADE approach.
Results
We identified 53 eligible reviews reporting 205 unique exposure-outcome associations. Methodological quality was generally low with only two reviews rated as ‘high’ quality and two as ‘moderate’. We found high-certainty, randomised trial evidence that maternal folate supplementation reduces the risk of neural tube defects and anomaly-related terminations. Moderate-certainty, observational evidence was found that maternal physical activity is associated with reduced risk of pre-eclampsia and gestational diabetes, and that paternal age of ≥40 years and maternal body mass index (BMI) and interpregnancy weight gain are associated with increased risk of various adverse pregnancy and birth outcomes. Low- and very low-certainty evidence was found for other associations.
Conclusions
Clinicians and policymakers can be confident that maternal folate supplementation should be encouraged during the preconception period. There is moderate certainty in the evidence base that maternal physical activity, BMI and interpregnancy weight gain and advanced paternal age are important preconception considerations. High-quality research is required to better understand other exposure-outcome associations.
| Original language | English |
|---|---|
| Number of pages | 13 |
| Journal | Paediatric and Perinatal Epidemiology |
| Early online date | 30 Dec 2021 |
| DOIs | |
| Publication status | E-pub ahead of print - 30 Dec 2021 |
Bibliographical note
Funding Information:This work was supported in part by grant MR/N0137941/1 for the GW4 BIOMED DTP, awarded to the Universities of Bath, Bristol, Cardiff and Exeter from the Medical Research Council (MRC)/UKRI
Publisher Copyright:
© 2021 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.
Keywords
- preconception
- pregnancy
- pregnancy complications
- Birth
- Postpartum
- Umbrella review
- Systematic literature review
- GRADE
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Addressing the key uncertainties of improving preconception health in the UK
Daly, M. (Author), White, J. (Supervisor) & Kipping, R. (Supervisor), 9 May 2023Student thesis: Doctoral Thesis › Doctor of Philosophy (PhD)
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