Thinking of trying for a baby? Stopping the use of contraception might appear to be the first step, but that would be missing out on an invaluable prelude. The evolving field of preconception health is showing intending mothers and fathers the opportunity they have to improve, not only the chances of a child being conceived in the first place, but also the outcome of the pregnancy and long-term health for both baby and mother. About 90 per cent of women of reproductive age have at least one risk factor that they could modify before pregnancy, according to UK research. Studies also suggest up to 70 per cent of pregnancy complications are avoidable. Part of the equation, too, is the impact of men’s health and lifestyle on sperm quality.“If we avoid a growth-restricted baby, or a preterm baby, that has lifelong health implications for that child,” says Fionnuala McAuliffe, UCD professor of obstetrics and gynaecology at the National Maternity Hospital in Dublin. “Their whole life course is changed. That’s how impactful that prepregnancy time can be.“Also for the mother, if she’s a more normal weight, she’s less likely to get blood pressure in pregnancy, less likely to get diabetes, less likely to have blood loss. She will have better health in the long term because her pregnancy has been better.”The Preconception Care and Research Network Ireland, launched at University College Cork (UCC) in February, is modelled on a similar organisation that was set up in the UK in 2018. Still in its early stages here, the partnership is inviting collaboration by researchers, healthcare professionals and policy-makers to look at priorities for advancing preconception health.“We have very little data in Ireland,” says Angela Flynn, senior lecturer in population health at the Royal College of Surgeons in Ireland (RCSI) and a researcher in maternal health. She is involved with the new partnership, as she was with its UK counterpart when working at King’s College London. “From my perspective, it’s how we can generate evidence in Ireland and have some Irish data on women and men before pregnancy, or in between pregnancies as well.”Angela Flynn, senior lecturer in population health at RCSI. For pregnancy planning, health services tend to focus on women with pre-existing conditions, such as diabetes and epilepsy, she says, “whereas the general population of women does not have the same kind of access to services”. Improving health in between pregnancies is a clear target for support, she suggests.“It is hard to identify women before pregnancy in the general population because women don’t tend to present to health services until they’re pregnant,” says Flynn. She sees the HSE’s network of postnatal hubs as an opportunity for advising on optimal health for a subsequent pregnancy, if desired. This would be very much tailored to parents’ previous experience. “It isn’t a one-size-fits-all approach.” Women may have had a complication in pregnancy, and have a chance to try to improve health before trying for another baby. Mothers who experienced hyperemesis (extreme sickness), for example, would have a different perspective to those who had gestational diabetes. Kathy Whyte, who worked as a midwife in London, is a long-time champion of preconception care. She is determined to raise more awareness about research so prospective parents can apply it. “Let’s translate the science and make it accessible and interesting to men and women planning pregnancy,” says Whyte, who has a master’s in nutritional medicine. “It’s too late to implement healthcare when we have the blue line on the pregnancy test. This should be happening before.”She leads a health-tech start-up, Pregnancy Health Check, which is developing an online platform aimed at supporting women and men in preparing for pregnancy, through personalised health insights, education and preventative care. After intending parents register on the app, “we will work with them on their journey to pregnancy, then through pregnancy, and for the first three months of a child’s life”. This arc of data would be very valuable for public health research, says Whyte. Fionnuala McAuliffe, UCD professor of obstetrics and gynaecology at the National Maternity Hospital in Dublin “We can tell so much about future health based on a baby’s gestation and their birth weight. It’s pooling all this data together so that we can use it for predictive and preventative health in the future.”Ahead of the platform’s launch in the coming months, Pregnancy Health Check is inviting women and men to complete a short survey to help build a clearer picture of the reproductive health needs at this stage of life. One of Whyte’s advisors on the project is McAuliffe, who was involved in the development of a preconception toolkit by the International Federation of Obstetrics and Gynecology.Here are some considerations for men and women before conception, to improve their chances of becoming a healthy and happy family:GP check-inAs part of pregnancy planning, intending parents would both do well to seek advice of their GP on any factors relating to their own medical histories and perhaps look for support on any measures listed below.Pre-existing conditionsPreconception care is essential for women with chronic medical conditions, be they cardiovascular, neurological, autoimmune or endocrinal in nature. It is important for them to check if they need to change their medications, or to see if blood pressure or glucose levels are as controlled as they might be. If the prospective father is on medication, there is a possibility, albeit rare enough, says McAuliffe, that this could have a detrimental impact through the sperm. They should ask their GP or pharmacist if there are any considerations to be taken into account.Folic acidA woman taking folic acid, the synthetic version of the vitamin folate (vitamin B9), significantly reduces the risk of having a baby with a neural tube defect, such as spina bifida, or causing hydrocephalus. It can also reduce the risk of miscarriage. The level needs to build up in the body to give the best protection, so should be started at least 14 weeks before trying to conceive. It is such an important precaution, the HSE recommends all women who could get pregnant, even if they are not planning to, should take a daily folic acid supplement. (About half of all pregnancies are said to be unplanned.)[ ‘My daughter gets anxious and overwhelmed, and it can escalate into angry outbursts’Opens in new window ]The usual dose is 400mcg, which is typically the amount in over-the-counter pregnancy vitamins or folic acid supplements. Some women, such as those with coeliac disease, or perhaps taking medication for epilepsy or HIV, or where there is a family history of neural tube defects, might need a higher dose of folic acid (5mg), which would have to be prescribed.Other supplementsSupplementation of other micronutrients, such as vitamin D, calcium and iron where necessary, is associated with a reduction in adverse pregnancy outcomes such as pre-eclampsia and pre-term births.“Up to 80 per cent of women have low iron in their last trimester,” says Whyte. Maintaining optimal iron levels can be a “game changer” for energy throughout pregnancy and for the neurodevelopment of the baby.SmokingCigarette smoking is one of the most significant modifiable risk factors, as it is linked to miscarriage, ectopic pregnancy, restricted foetal growth, stillbirth and neonatal deaths. If either or both of the partners smoke, stopping for good ahead of conception is of singular importance to their unborn child. Needless to say, they should refrain from other recreational drugs too.Alcohol useThis is a leading, preventable cause of birth defects and developmental disorders, with Foetal Alcohol Spectrum Disorder (FASD) being one of the most severe outcomes, causing potentially lifelong adverse effects for the child. Drinking by either parent leading up to conception or during pregnancy increases the risk of FASD, according to a recent Irish-authored article in the Frontiers public health journal. Ireland is estimated to have the third-highest prevalence of FASD worldwide, with up to 7.4 per cent of the population potentially living with the disorder. With no register of the condition here, this estimate was extrapolated from answers pregnant women in Ireland have given on alcohol use in the past.A recent study led by Ciara McCormick of the National Maternity Hospital and published at the end of last year, used urine samples from more than 1,000 pregnant women at three maternity units as an objective measure of the extent of drinking during pregnancy. The research concluded that alcohol intake among pregnant women appears to be much less common than previously estimated.NutritionAs women are born with all their eggs, there was a belief that their status was fixed, says Whyte. “But we now know that, with a nutrient-rich diet, we can actually optimise the health of our eggs.” Men can do the same for sperm during their three-month life span.General healthy eating guidelines apply. Move away from ultra-processed foods, she suggests. “Where possible, we want our bodies to process the food.”Whyte is a fan of Professor Michael Crawford, a veteran UK scientist renowned for research demonstrating how essential omega-3s are for human health. He argues that there is too much focus on land protein – dairy and meat – and not enough on sea protein. ExercisePregnancy is a stress test for the female body so the higher the fitness level going into it, the better. It is going to be difficult to start exercising when pregnant, so developing the habit of at least 150 minutes a week of moderate to vigorous activity beforehand would be wise. Only a third of women reach that recommended level, according to a 2024 Healthy Ireland Survey.“People who are fit seem to manage the pregnancy, delivery and recovery much better than people who aren’t physically fit,” says McAuliffe.Weight managementObesity is the most common medical condition affecting women of reproductive age and is considered an independent risk factor in pregnancy. It brings a greater chance of high blood pressure, insulin-dependent gestational diabetes and of a way-above-average birth weight, which can complicate delivery for mother and baby alike. Nutrition and exercise clearly feed into controlling weight and it is not just an issue for women. Both parents’ weight will influence their newborn’s weight.Mental healthIf somebody has a mental health disorder going into pregnancy, it will probably continue, says McAuliffe, so maximising mental health beforehand would be very important. “There are some studies that look at mental stress in pregnancy; it can interfere with the blood flow of the baby and the growth of the baby.”Be mindful that pregnancy itself is stressful and be prepared for that. She also cites a study in the UCD Perinatal Research Centre looking at diet and stress. “We found that things like B vitamins, fibre, folic acid was associated with better mental health.” As was exercise.Final words for intending fathersFertility issues are no longer regarded as a predominantly female health problem, since male and female factors have been shown to play an almost equal part. So it is hardly surprising men have a significant role in general preconception health too.They too should look at what they eat, what they drink, and what other substances they might use, says Whyte. They could consider dietary supplementation, although the recommendation is always food first for nutrients. Heat exposure is to be avoided. Hot baths, hot tubs and prolonged use of saunas or steam rooms can adversely affect sperm counts and quality.Nor should men rest laptops directly on their thighs, but instead put a cushion or book in between. Once any lifestyle improvement has been made, it can take up to three months for those healthier sperm to appear in the ejaculate. When trying for conception, it is also important to optimise the number of sperm available to reach and fertilise the egg.Therefore, men are encouraged to abstain from ejaculating for two to three days before having sex, or before producing a semen sample for assisted fertility.