Preconception health and the life course approach to prevention of non-communicable diseases: Implications for informing policy and practice

Abstract

The life course approach and developmental origins of health and disease (DOHaD) concepts suggest that early intervention in critical periods reduces the risk of developing non-communicable diseases (NCDs) in later life and prevents the intergenerational transmission of this risk. The preconception period is increasingly cited as a platform for preventive interventions, however, while international health organisations have recognised the importance of such early prevention, specific recommendations have not been made. This mixed-methods thesis aimed to explore the use of evidence from life course epidemiology in policy-making and health care practice, with a focus on the preconception period to prevent NCDs in later life and the transmission of risk across generations. The two main streams of implementation that underpinned this thesis were clinical practice and policy.
For the clinical stream, a narrative review of reviews of preconception interventions highlighted that intervening in the preconception period can potentially prevent the intergenerational passage of risk of NCDs. In contrast, a rapid review of published and grey literature showed that most studies and policies adopting the life course approach targeted the pregnancy or early childhood periods. Additionally, there was a need for better measurement strategies as a range of indicators have been proposed to measure health outcomes for different life stages or diseases risks, but with no clear guidelines on how the life course approach can be operationalised through interventions or programmes.
These reviews above informed the development of three subsequent studies. First, a qualitative study of obstetricians and midwives explored their understanding of DOHaD concepts and identified barriers and opportunities for intervening through routine clinical care for NCD prevention. Though understanding of the scientific findings from the field of DOHaD was high, practical factors such as lack of time, practitioners’ views on their role in preconception care and a lack of resources hindered translation in routine care. The second study comprised an online survey to test the acceptability of i.) a nutritional risk assessment tool and ii.) the routine discussion of nutrition and pregnancy intention between reproductive-aged women and healthcare practitioners in the UK. Results showed high acceptability for the tool. The discussion of nutrition and pregnancy intention was considered important, provided that the reasons for doing so were communicated clearly, in a non-stigmatising manner. Finally, a document analysis of meeting minutes and observations of five advocacy groups in the field of DOHaD showed that policy translation has been affected by the lack of a clear message on what needs to be done when communicating to the public and policy-makers. The study also revealed insights into several opportunities with recommendations on framing messages, key stakeholders, and the need to acknowledge the influence of wider determinants of health e.g., economic policies and the environment.
Overall, the findings contribute to the understanding of how opportunities before and during pregnancy can be harnessed to prevent NCDs, improve women’s health and wellbeing and provide a better start to life for the next generation. A framework for implementing the life course approach is discussed and along with an overview of future work needed to address evidence gaps and improve the translation of evidence to policy and practice.

More information

Identifiers

ORCID for Mark Hanson: orcid.org/0000-0002-6907-613X

Catalogue record

Export record