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Missed periods: Scotland’s opportunities for better pregnancies, healthier parents and thriving babies the frst time ... and every time

A primer on preconception health, education and care

During 2015, BBC broadcast a three-part documentary, Countdown to Life: The Extraordinary Making of You. This series begins dramatically:

“100 trillion cells. 280 days. One human life. The person you are was decided before you were even born. The way you smile, the environments you thrive in, the colour of your children’s eyes – from the moment you’re conceived to the moment you’re born, each critical event in the womb can change your life forever. And the clock is ticking.

But that clock was ticking even before “the moment you’re conceived”. Conception also has a ‘back story’, a ‘prequel’, that is as important to the baby – and the expectant mother – as what happens during pregnancy.

The best predictor of birth outcomes – good and bad – is the health and wellbeing of prospective mothers at conception. Healthy, thriving women usually (but not always) give birth to healthy, thriving babies. By contrast, the babies born to unhealthy, stressed and deprived women generally (but not always) have life chances that are compromised even before they draw their first breath. Just as what happens during pregnancy profoundly in#uences our lives from infancy onwards, so too, what is true during the period prior to conception greatly in#uences each and every pregnancy.

This means that:

• The deepest roots of health inequalities and social injustice across the population can be found during the preconception period; and,
• We can dramatically improve women’s wellbeing -- and the odds of babies being healthy at birth and starting life on a level playing !eld -- by the choices we individually and collectively make, and the actions we take, before pregnancy.

Countdown to Life never explicitly mentions preconception health, education and care. But, the tremendous influence of this largely overlooked period in ‘the making of us’ can be found just below the surface throughout this documentary.

For example, there is a section in the first episode showing the results of a long-term study of an African community. It revealed that babies conceived during the wet season were much more likely to lead healthier lives, and have signi!cantly longer life expectancies, than those conceived during the dry season. Why? Because the wet season provided these soon-to-be pregnant women with a far greater supply of more nutritional food. The bene!t did not end with stronger babies. It continued with longer, healthier adulthoods.

While Scotland has light and dark seasons, rather than wet and dry ones, the basic point is just as relevant here. Women in Scotland who are well nourished before becoming pregnant, and who maintain good nutrition throughout pregnancy, are signi!cantly increasing the chances of giving birth to thriving babies who will grow into healthy adults.

At one level, preconception health, education and care is nothing more than simple common sense. Almost everything that improves the antenatal period
– e.g. a healthy, active lifestyle, freedom from poverty or inequality and positive, supportive relationships
– is strengthened by already being !rmly in place before the pregnancy begins. Similarly, almost all the major risks to good pregnancy and birth outcomes
– domestic abuse and other sources of toxic stress, obesity, smoking, drug misuse, drinking alcohol, poor diet, lack of folic acid and vitamin D, certain illnesses (e.g. diabetes, HIV, rubella and now Zika virus), depression and other mental health concerns
– should be dealt with e#ectively during the period prior to pregnancy.

One obvious example is a woman who shows up at her booking appointment (8-12 weeks after conception) five stone overweight. Obesity presents major risks
to the life and health of both mother and baby, but pregnancy is far from the ideal period to remedy this reality. By contrast, the preconception period is exactly the right time to resolve weight problems.

A less understood case involves depression and other mental health challenges. Post-natal depression has received a good deal of professional, media and societal attention in recent decades. This has been of real bene!t to many new parents. And yet, contrary to the conventional wisdom, only a small fraction of such cases are caused by, or originate in, biochemical and hormonal changes during pregnancy or the birth process. Most people diagnosed with post-natal depression had (often undiagnosed and untreated) depression issues antenatally. And, most of them had these mental health concerns prior to becoming pregnant. A wiser society would choose to identify and deal effectively with such mental health matters during the preconception period, rather than begin this assistance during the emotionally intense and often challenging time following the birth of a child.

Everyone understands that the making of a Commonwealth Games athlete depends upon a combination of good genes, good opportunities, good support, good luck ... and very good preparation long before the Opening Ceremony. The same is true of the making of a healthy pregnancy and a thriving baby.

Good genes and good luck are largely beyond our control. But, good opportunities, good support and, most of all, very good preparation are much more in the realm of possibility. These are highly dependent upon the decisions we make and the actions we take – as individuals, as families, as service providers and as a society.

This primer only scratches the surface of this !eld. Each section within it could, and someday should, be the focus of an entire report or book. Still, this introduction offers some key context, data, recommended next steps and additional resources that readers can use to explore any of these matters more fully – and then act upon them positively.