Gaps in pre-pregnancy health initiatives need filling

Adolescents and young adults are being missed when it comes to pre-pregnancy health initiatives that could have a long-term impact on maternal, perinatal, and child health outcomes, according to a review by researchers from the University of Adelaide’s Robinson Research Institute and School of Public Health.

The findings, published in Public Health, identify gaps around mental health, domestic and sexual abuse, substance use, sex education, nutrition education, lifestyle modification, and family planning messaging, as well as other areas for young people aged 10 to 25 years old.

The evidence gap map, created using data from 2010 to 2023, found health initiatives were more likely in high and upper-middle income countries and an overwhelming majority focused solely on females (88 per cent).

“It wasn’t surprising to see limited evidence of health initiatives for men, but we were surprised to see limited focus on interventions like prevention of substance and tobacco use, improving lifestyle behaviours and nutrition and the prevention of violence, especially considering its impact on their pregnancy and child health,” senior author Associate Professor Zohra Lassi says.

“More research needs to be done to overcome the challenge by conducting long-term follow-up studies with adolescents to better understand how preconception interventions affect their future pregnancies and the health of their children.

“There’s a pressing need to address the gap in research on young men’s preconception health – these interventions are critical for breaking the cycles of poor health outcomes.”

The review, which examined 18 studies (124 research papers), also found behavioural interventions were limited, with most of the evidence in relation to the monitoring of adverse events of human papillomavirus (HPV) vaccination.

“Adolescence is pivotal for establishing lifelong positive health behaviours and is a time when risky health behaviours may be adopted."Zahra Ali Padhani, lead author and PhD candidate, University of Adelaide

“Early intervention not only contributes to the wellbeing of adolescents but also has long-term implications for their overall health trajectory and the prevention of potential pre-conception-related challenges," says Ms Padhani.

While most preconception-related education is targeted at women of reproductive age, Ms Padhani said messaging should have a broader focus.

“Given that many adverse maternal, perinatal and child health outcomes are preventable, interventions during adolescence can have long-lasting impacts on both individual health and population-level outcomes,” says Ms Padhani.

“Risk assessments and health education during the preconception period are crucial for addressing potential risk factors and improving outcomes long term.”

Associate Professor Lassi said the study highlighted the importance of targeting the right age groups with initiatives, like education and vaccinations, particularly in areas with limited evidence and infrastructure.

“Integrating a HPV vaccination into national immunisation plans, especially in lower-middle income countries, clearly reduces cervical cancer risk and may, as future longitudinal large-scale studies suggest, also lower adverse pregnancy outcomes,” she said.