A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.

Objective To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia.Design Cross‐sectional study using obstetric records, and postal survey six months after delivery.Setting Department of Obstetrics and Gynaecology, St George's Hospital, London.Population All primiparous women (n= 796) delivered of a live birth in a six month period.Methods Quantitative analysis of obstetric and survey data.Main outcome measures Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems.Results Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre‐pregnancy levels of 38%. Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (P= 0.01) and previous experience of dyspareunia (P= 0.03). At six months the association with type of delivery was not significant (P= 0.4); only experience of dyspareunia before pregnancy (P < 0.0001) and current breastfeeding were significant (P= 0.0006). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional.Conclusions Sexual health problems were very common after childbirth, suggesting potentially high levels of unmet need.

Study objective: To develop a measure of unplanned pregnancy that is valid, reliable, and appropriate in the context of contemporary demographic trends and social mores and can be used in a variety of situations, including the production of population prevalence estimates. Design: A two stage study design: qualitative (inductive) methods to delineate the construct of pregnancy planning, and quantitative/psychometric methods to establish the means of measurement. Setting: Eight health service providers (comprising 14 clinics, including antenatal, abortion, and one general practitioner) across London, Edinburgh, Hertfordshire, Salisbury, and Southampton in the UK. Participants: Samples comprised a mixture of pregnant (continuing pregnancy and opting for abortion) and recently pregnant (post-abortion and postnatal) women. At the qualitative stage, 47 women took part in depth interviews (20 of whom were re-interviewed after the birth of their baby). Items were pre-tested with 26 women, and two psychometric field tests were carried out with, respectively, 390 and 651 women. Main results: A six item measure of unplanned pregnancy was produced. Psychometric testing demonstrated the measure’s high reliability (Cronbach’s α = 0.92; test-retest reliability = 0.97) and high face, content, and construct validity. Women’s positions in relation to pregnancy planning are represented by the range of scores (0–12). Conclusions: A psychometric measure of unplanned pregnancy, the development of which was informed by lay views, is now available. The measure is suitable for use with any pregnancy regardless of outcome (that is, birth, abortion, miscarriage) and is highly acceptable to women.

To determine the extent to which women plan and prepare for pregnancy. Cross-sectional questionnaire survey of pregnant women attending three maternity services in London about knowledge and uptake of preconception care; including a robust measure of pregnancy planning, and phone interviews with a range of health care professionals. We recruited 1173/1288 (90%) women, median age of 32 years. 73% had clearly planned their pregnancy, 24% were ambivalent and only 3% of pregnancies were unplanned. 51% of all women and 63% of those with a planned pregnancy took folic acid before pregnancy. 21% of all women reported smoking and 61% reported drinking alcohol in the 3 months before pregnancy; 48% of smokers and 41% of drinkers reduced or stopped before pregnancy. The 51% of all women who reported advice from a health professional before becoming pregnant were more likely to adopt healthier behaviours before pregnancy [adjusted odds ratios for greatest health professional input compared with none were 2.34 (95% confidence interval 1.54–3.54) for taking folic acid and 2.18 (95% CI 1.42–3.36) for adopting a healthier diet before pregnancy]. Interviews with 20 health professionals indicated low awareness of preconception health issues, missed opportunities and confusion about responsibility for delivery of preconception care. Despite a high level of pregnancy planning, awareness of preconception health among women and health professionals is low, and responsibility for providing preconception care is unclear. However, many women are motivated to adopt healthier behaviours in the preconception period, as indicated by halving of reported smoking rates in this study. The link between health professional input and healthy behaviour change before pregnancy is a new finding that should invigorate strategies to improve awareness and uptake of pre-pregnancy health care, and bring wider benefits for public health.

Objectives To describe the views of the British public on the use of personal medical data by the National Cancer Registry without individual consent, and to assess the relative importance attached by the public to personal privacy in relation to public health uses of identifiable health data. Design Cross sectional, face to face interview survey. Setting England, Wales, and Scotland. Participants 2872 respondents, 97% of those who took part in the Office for National Statistics' omnibus survey, a national multistage probability sample, in March and April 2005 (response rates 62% and 69%, respectively). Results 72% (95% confidence interval 70% to 74%) of all respondents did not consider any of the following to be an invasion of their privacy by the National Cancer Registry: inclusion of postcode, inclusion of name and address, and the receipt of a letter inviting them to a research study on the basis of inclusion in the registry. Only 2% (2% to 3%) of the sample considered all of these to amount to an invasion of privacy. Logistic regression analysis showed that the proportions not concerned about invasion of privacy varied significantly by country, ethnicity, socioeconomic status, and housing tenure, although in all subgroups examined most respondents had no concerns. 81% (79% to 83%) of all respondents said that they would support a law making cancer registration statutory. Conclusions Most of the British public considers the confidential use of personal, identifiable patient information by the National Cancer Registry for the purposes of public health research and surveillance not to be an invasion of privacy.