Improving health in the preconception period: building from existing data to create pathways for future intervention

Cassinelli, Emma (2025) Improving health in the preconception period: building from existing data to create pathways for future intervention. Queen's University Belfast, Doctoral Thesis.

Abstract

Preconception health (or health in the period prior to a pregnancy) is known to influence parental, pregnancy, and offspring outcomes. This thesis reports on four studies conducted to inform the development of future interventions to improve preconception health and care in the UK and beyond.
The first study was a systematically-conducted scoping review exploring and synthesising 278 grey literature resources. Resources proposed nine approaches to improve preconception health and care (e.g., the adoption of a life-course approach) and discussed 27 preconception health-influencing factors (e.g., folic acid supplement use). An audit with healthcare professionals (n=17) in Northern Ireland (NI) contextualised findings by exploring the use and awareness of identified relevant resources.
The second study reported the secondary analyses of a questionnaire which aimed to investigate health behaviours, attitudes, and beliefs of adults on the island of Ireland. Survey responses (n=386) differed based on adults’ sex and on whether they had children or not. Findings suggest that specific population groups may have different requirements or preferences with regard to future preconception health and care interventions.
The third study included in this thesis explored the prevalence of key preconception indicators in NI between 2011 and 2021 based on routinely collected maternity data (recorded within the Northern Ireland Maternity System, or NIMATS). Examples of prioritised indicators include planned pregnancy, diet quality, and and body mass index (BMI). The study also investigated the prevalence of the prioritised preconception indicators based on area-level deprivation.
The NIMATS data were further analysed in the fourth study, which focused on exploring the temporal trends of the previously-prioritised preconception indicators (between 2011 and 2021).
A significant component of this thesis was the implementation of Patient and Public Involvement and Engagement (PPIE) throughout all research stages. The Healthy Reproductive Years advisory panel was established at the outset of the PhD, and various methods were used for PPIE integration throughout the research studies included in this thesis. For instance, PPIE was implemented for planning and defining research questions and methods, prioritisation, interpretation of findings, and dissemination of results.
The key findings from the overall thesis provide evidence to support the development of interventions to improve preconception health behaviours and related health outcomes and highlight the benefit of integrating PPIE within initiatives in this field of research.

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Contributors

Author: Emma Cassinelli

Thesis advisor: Danielle Schoenaker

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