Characterising and monitoring preconception health in England: a review of national population-level indicators and core data sources

Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infections; mental health, physical health; medication and genetic risk. Sixty-five of the 66 indicators were reported in at least one national routine health data set, survey or cohort study. A measure of preconception health assessment and care was not identified in any current national data source. Perspectives from three (healthcare) professionals described how indicator assessment and monitoring may influence patient care and inform awareness campaign development. This review forms the foundation for developing a national surveillance system for preconception health in England. The identified indicators can be assessed using national data sources to determine the population's preconception needs, improve patient care, inform and evaluate new campaigns and interventions and enhance accountability from responsible agencies to improve preconception health.</p

Women’s preconception health in England: a report card based on cross-sectional analysis of national maternity services data 2018/19

Objective: to present the first national-level report card on the state of women’s preconception health in England.Design: cross-sectional population-based study.Setting: maternity services, England.Population: all pregnant women in England with a first antenatal (booking) appointment recorded in the national Maternity Services Dataset (MSDS) from April 2018 to March 2019 (N=652,880). Methods: we analysed the prevalence of 32 preconception indicator measures in the overall population and across sociodemographic subgroups. Ten of these indicators were prioritised for ongoing surveillance based on modifiability, prevalence, data quality and ranking by multidisciplinary UK experts. Results: the three most prevalent indicators were: proportion of the 22.9% of women who smoked one year before pregnancy who did not quit smoking before pregnancy (85.0%), not taken folic acid supplementation before pregnancy (72.7%), and previous pregnancy loss (38.9%). Inequalities were observed by age, ethnicity and area-based deprivation level. The 10 indicators prioritised were: not taking folic acid supplementation before pregnancy, obesity, complex social factors, living in a most deprived area, smoking around the time of conception, overweight, pre-existing mental health condition, pre-existing physical health condition, previous pregnancy loss and previous obstetric complication.Conclusions: our findings suggest important opportunities to improve the state of preconception health and reduce sociodemographic inequalities for women in England. In addition to MSDS data, other national data sources that record further and possibly better-quality indicators could be explored and linked to build a comprehensive surveillance infrastructure. <br/

Association of a priori dietary patterns with depressive symptoms: a harmonised meta-analysis of observational studies

BACKGROUND: Review findings on the role of dietary patterns in preventing depression are inconsistent, possibly due to variation in assessment of dietary exposure and depression. We studied the association between dietary patterns and depressive symptoms in six population-based cohorts and meta-analysed the findings using a standardised approach that defined dietary exposure, depression assessment and covariates. METHODS: Included were cross-sectional data from 23 026 participants in six cohorts: InCHIANTI (Italy), LASA, NESDA, HELIUS (the Netherlands), ALSWH (Australia) and Whitehall II (UK). Analysis of incidence was based on three cohorts with repeated measures of depressive symptoms at 5-6 years of follow-up in 10 721 participants: Whitehall II, InCHIANTI, ALSWH. Three a priori dietary patterns, Mediterranean diet score (MDS), Alternative Healthy Eating Index (AHEI-2010), and the Dietary Approaches to Stop Hypertension (DASH) diet were investigated in relation to depressive symptoms. Analyses at the cohort-level adjusted for a fixed set of confounders, meta-analysis used a random-effects model. RESULTS: Cross-sectional and prospective analyses showed statistically significant inverse associations of the three dietary patterns with depressive symptoms (continuous and dichotomous). In cross-sectional analysis, the association of diet with depressive symptoms using a cut-off yielded an adjusted OR of 0.87 (95% confidence interval 0.84-0.91) for MDS, 0.93 (0.88-0.98) for AHEI-2010, and 0.94 (0.87-1.01) for DASH. Similar associations were observed prospectively: 0.88 (0.80-0.96) for MDS; 0.95 (0.84-1.06) for AHEI-2010; 0.90 (0.84-0.97) for DASH. CONCLUSION: Population-scale observational evidence indicates that adults following a healthy dietary pattern have fewer depressive symptoms and lower risk of developing depressive symptoms

Dietary patterns during pregnancy and risk of gestational diabetes: a prospective cohort study in Western China

BACKGROUND: Previous research has demonstrated the association between maternal dietary patterns and gestational diabetes (GDM), but evidence in Asian populations remains limited and inconsistent. This study investigated the association between dietary patterns during early pregnancy and the risk of GDM among pregnant women in Western China. METHODS: A prospective cohort study was conducted among 1337 pregnant women in Western China. Dietary intakes were assessed at 15-20 weeks of gestation using a validated food frequency questionnaire. GDM was diagnosed by oral glucose tolerance tests at 24-28 weeks of gestation. Exploratory factor analysis was performed to derive dietary patterns, and logistic regression models were used to examine the association between dietary patterns and GDM. RESULTS: A total of 199 women (14.9%) developed GDM. Three dietary patterns were identified, namely, a plant-based pattern, a meat-based pattern and a high protein-low starch pattern. Notwithstanding a lack of association between dietary patterns and GDM risk in the whole cohort, there was a significant reduction in GDM risk among overweight women (BMI =24 kg/m2); the odds ratio being 0.29 (95% confidence interval 0.09 to 0.94) when comparing the highest versus the lowest score of the high protein-low starch pattern. CONCLUSIONS: There was no significant association between early pregnancy dietary patterns and GDM risk later in pregnancy for women in Western China, but high protein-low starch diet was associated with lower risk for GDM among women who were overweight at pre-pregnancy

Concerns, attitudes, beliefs and information seeking practices with respect to nutrition-related issues: a qualitative study in French pregnant women: A qualitative study in French pregnant women

International audienceBackground: From a life course perspective, pregnancy leads to a rise in nutrition awareness and an increase in information flow in favour of adopting healthier eating behaviours. This qualitative study was designed to better understand the determinants of eating behaviours in French pregnant women by focusing on their concerns, attitudes and beliefs and their nutrition-related information seeking practices. Methods: Seven focus groups were conducted, involving a total of 40 French pregnant women. An inductive thematic approach, adapted from the grounded theory, was adopted to analyse the data. Two major themes were identified: eating behaviour and nutrition-related information behaviour. Results: The eating behaviour theme was divided into four sub-themes using the attribution theory. Three external causes affected the eating behaviour of pregnant women (food restrictions, physiological changes and weight gain), and led to frustration and a perceived loss of control. By contrast the adoption of a healthier diet was perceived as internal by pregnant women, and resulted in self-fulfilment and empowerment regarding the health and the well-being of their baby and themselves, and their weight gain management. Greater attention was paid to nutrition-related information obtained from healthcare providers, the social environment and the mass media. Information was passively absorbed or actively sought by pregnant women, but most was perceived as contradictory, which led to confusion. Conclusion: Pregnancy is accompanied by a rise in nutrition awareness, substantiated by eating behaviour modifications due to external and internal causes. However, conflicts between and within information sources result in confusion that can limit the adoption of healthier eating behaviour