Preconception period critical to baby’s health: study


“You want to stop that [smoking and drinking] before you get pregnant because you often don’t realise initially that you are pregnant,” Black says. “By the time you find out, some of the crucial structures in the spine and the brain have begun to form.”

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And while the majority of women take folic acid once they discover they are pregnant, it needs to be taken for three months before conception to have the most benefit on neural tube defects – defects of the head and the spine – including spina bifida.

Around half of women are overweight or obese entering pregnancy, Black adds. “If you have maternal obesity at the time of conception, you’re more likely to produce a baby that is overweight and more likely that child will be obese.”

Losing weight during pregnancy is not recommended, so any interventions at that point are “too little too late”.

Like many women, Hayley Scutts-Gullery, now 36, had no idea there was anything specific she had to change before trying to conceive.

She and her husband wanted to start trying for a baby in the next six to 12 months and, having witnessed the struggles of friends, the only thing her mind was whether fertility might be an issue.

The Sydney resident had put on 15 kilograms during COVID and wanted to lose some of that weight, but mainly because she knew she would gain more weight during pregnancy.

So when her mum heard an ad on the radio for PreBabe, a world-first research trial exploring how losing weight in the six to 12 months before conception improves outcomes for both the mother and baby, Scutts-Gullery signed up.

The educational component of the program was the first time anyone had explained the implications of being overweight or obese during pregnancy. It came as a shock.

“You think the weight gain will only affect you, but then I was like, if I have a baby, and I’m overweight it can have an effect on my baby,” she says. “I was really deflated, but then I was like, it’s great that I’m doing this. I wasn’t aware of the information about any of this.”

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During the 10-week program, Scutts-Gullery lost five kilograms and started exercising consistently. She and her husband conceived Hugo, a healthy and happy six-month-old, straight away. She says she’s “so happy” she made the changes she did.

For Black, the research highlights the need for better public health messaging around the importance of the preconception period, which can range from three months if it’s taking folic acid to 12 months if you’re looking to lose weight.

“The scientific community have recognised it for years… but it hasn’t permeated down to the community.”

It also highlights the need for structural change – like access to healthy, affordable food and green spaces – to support health behaviours and to start a conversation around having a reproductive life plan.

This is because another finding from the study was that the more pregnancies a woman had, the more likely it was to be unplanned. Women having their fourth or more birth were 10 times less likely to plan their pregnancy than women having their first.

If a woman can’t plan when she has a baby, it can affect her mental and physical health, means she cannot adequately prepare, and it can affect the outcomes for the baby.

According to Black, women’s bodies need at least 12 months to recover from the depletion of growing and giving birth to a baby before trying for another. Breastfeeding is only an effective form of contraception if the baby is less than six months old, the woman is fully breastfeeding (including overnight feeds) and her period hasn’t come back.

“If you’re not planning a pregnancy, we need to educate about reliable contraception and, if you are, it’s thinking about the things that will improve the outcomes of the pregnancy and the long-term health of yourself and the baby.”

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