Background: There is increasing recognition of the importance of the preconception period for addressing reproductive and intergenerational health inequities and supporting improved maternal and child health outcomes. This study aimed to understand the extent and type of evidence that exists in relation to preconception health for Indigenous peoples living in high-income countries with similar experiences of colonisation, namely, Australia, New Zealand, Canada, and the United States. Methods: This review was conducted as per the JBI methodology and PRISMA Extension for Scoping Reviews. A comprehensive search of PubMed, CINAHL [EBSCO], Ovid Embase, Scopus, and the Wiley Cochrane Library was conducted using keywords and index terms. We included research in English published between January 2010 and June 2023 on quantitative and qualitative primary studies. Data were extracted using a standardised tool, and the analysis included quantitative descriptions and qualitative content analysis. Results: We identified 360 potential studies and included 57 articles in the review. Most studies were from the United States (n = 36, 63.2%) and Australia (n = 13, 22.8%), and they commonly reported associations between preconception health risk factors and maternal or child health outcomes (n = 27, 48.2%) or described the development, implementation, or evaluation of preconception health interventions (n = 26, 46.4%). Common preconception health areas were pre-pregnancy body mass index or weight (n = 34), alcohol (n = 16), diet (n = 14), physical activity (n = 12), and diabetes (n = 11). Most studies focused exclusively on women (n = 46, 80.7%), and very few included men (n = 3, 5.3%). The study populations were mostly urban and rural (n = 25, 43.9%) or rural only (n = 14, 24.6%); however, the geographical remoteness was often unclear (n = 14, 24.6%). Conclusions: While there was some research relating to the preconception health of Indigenous peoples, this review identified considerable research gaps. There is a need for dedicated research into preconception health risk factors and reproductive health outcomes, attitudes and awareness of preconception health, and preconception health interventions for Indigenous peoples.

Background: Healthy Stores 2020 (HS2020), a 12-week randomised controlled trial conducted in partnership with an Aboriginal-owned retail organisation, reduced retailer merchandising and store-level purchases of unhealthy foods. Evidence on the influence of customer-level factors (e.g., sociodemographic and shopping behaviour) on unhealthy food purchases in remote Aboriginal and Torres Strait Islander communities is limited. Aims: This study of secondary outcomes from HS2020 aimed to determine: (1) Customer-level factors associated with no discretionary, and no free sugar purchases within a food shop; and (2) whether these factors modified response to the HS2020 strategy. Methods: A customer intercept survey with collection of transaction data was conducted in the 20 HS2020 participating stores (10 HS2020 strategy; 10 control). Number of items purchased and dollars spent on discretionary and free sugar products was obtained by linking receipt data to a food composition database. Outcomes were discretionary and free sugar purchases per transaction. Robust Poisson regression models estimated associations between outcomes, treatment group, and customer-level factors, with interaction terms to assess effect modification. Statistical significance was set at p < 0.01. Results: The analysis included 783 participants – 87.4% Aboriginal and/or Torres Strait Islander. Participants aged ≥ 35 vs. < 35 years had a significantly higher likelihood of no discretionary purchases (RR = 1.52, 95%CI [1.19, 1.95]) and no free sugar purchases (RR = 1.36, 95%CI [1.36, 2.26]). Participants who had low vs. high impulsive shopping behaviours had a higher likelihood of no discretionary purchasing (did not buy extras: RR = 1.46, 95%CI [1.18,1.80]), and no free sugars purchasing (did not buy extras: RR = 1.70, 95%CI [1.27, 2.29]; made up their minds quickly: RR = 1.51, 95%CI [1.11, 2.05]). Shopping in HS2020 strategy stores was suggestive of a higher likelihood of no free sugar purchases, and shopping without children was suggestive of higher likelihood of no discretionary purchases. Conclusions: In remote community stores, age ≥ 35 years and some low impulsivity behaviours were protective factors of discretionary purchases. Shopping in HS2020 strategy stores and without children may also be protective factors. Results should be considered in a real-world study context where patterns observed align with existing evidence to support health-enabling in-store initiatives. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618001588280.

Indigenous women experience a disproportionate burden of adverse perinatal health outcomes, yet the extent and nature of health promotion interventions addressing modifiable behavioural and social determinants remain poorly synthesised. This scoping review mapped smoking, nutrition, alcohol, physical exercise, and social and emotional wellbeing (SNAPS(o))-related perinatal health promotion programs delivered through Australian Aboriginal Community Controlled Health Organisations (ACCHOs), supplemented by relevant peer-reviewed evidence identified across Australia, Aotearoa New Zealand, Canada, and the United States. A two-phase design looked at peer-reviewed literature from January 2010 to January 2025 across PubMed, CINAHL, and the Cochrane Library, followed by a structured review of Aboriginal Community Controlled Health Organisation (ACCHO) websites in Australia (n = 145). Data were extracted on program characteristics, SNAPS(o) components, implementation models, and evaluation outcomes. Findings were synthesised using content analysis. Thirty-four programs were identified in total, most delivered through ACCHOs (n = 26) and predominantly implemented in Australia (n = 29). Smoking was the most frequently addressed component (n = 18, 55%), while nutrition and social and emotional wellbeing were each included in 27% of programs (n = 9), physical exercise in 18% (n = 6), and alcohol in 15% (n = 5). Grey-literature programs more commonly reflected multi-component, holistic models compared with peer-reviewed studies and formal evaluations. Only 10 programs had identifiable formal evaluation evidence, including published or publicly reported evaluations, almost all of which were identified through academic sources. Evaluations focused primarily on tobacco-related behavioural outcomes, with limited reporting of sustained maternal or infant health endpoints. The perinatal SNAPS(o) intervention landscape for Indigenous women is characterised by strong community-controlled delivery but limited published evaluation, particularly of integrated models implemented within ACCHOs. The concentration of evidence on smoking cessation highlights a need to expand evaluation across broader domains of maternal wellbeing. Strengthening Indigenous-led evaluation frameworks and outcome measures that reflect holistic models of care is essential to advancing equitable and culturally grounded perinatal health systems.

More than one-third of births in Australia are by caesarean section (C-section), projected to reach 45% by 2030. Understanding sociodemographic, clinical, and obstetric practice factors shaping C-section trends is critical for informing policy and maternity care. We conducted a population-based study of 642,857 pregnancies in Queensland (July 2007-December 2017) using the Perinatal Data Collection. Births were classified with the Robson Classification System. Trends in group size, C-section rates, and indications were described. Modified Poisson regression with generalised estimating equations estimated crude and adjusted incidence rate ratios (IRRs) for major Robson groups (RGs). Of 214,569C-sections, key contributors were repeat C-sections (RG5, 38.2%), nulliparous elective (RG2, 20.9%), nulliparous spontaneous labour (RG1, 10.7%), and preterm (RG10, 7.0%) births. Although overall C-section rates remained relatively stable (33.3% in 2007 vs 34.4% in 2017), increasing clinical, demographic, and service-related risk profiles and substantial within-group variation were observed. Between 2007 and 2010 and 2015-2017, C-section declined in RG1 (IRR 0.84) but increased with maternal age ≥ 40 years (IRR 2.27) and pharmacological induction (IRR 1.93). Smaller reductions occurred in RG2 (IRR 0.93), with higher risk for BMI ≥ 30 (IRR 1.24) and private care (IRR 1.18). Minimal change was seen in RG5 and RG10 (IRR 1.00), though hypertension (IRR 1.54) and fetal risk (IRR 1.44) strongly influenced RG10. Midwifery-led care consistently reduced C-section across RGs (IRR 0.83-0.95). Elective C-sections were largely due to non-absolute indications and maternal preference. Stable overall C-section rates mask clinically important heterogeneity driven by maternal and fetal risk profiles and obstetric practices. Expanded analytic use of Robson classification can support group-specific benchmarking, identify modifiable drivers, and inform targeted strategies to optimise C-section use nationally.