Researchers have paved the way towards a new system for monitoring the health of people trying for a baby around the world.
For the first time researchers have identified a long list of essential indicators which could be used globally to monitor people's health before pregnancy.
As more women are becoming pregnant with health conditions that can complicate pregnancy and childbirth, people's health before they try to get pregnant has been thrown into the spotlight.
The work is set out in a new paper published in The Lancet and has been led by researchers at the University of Southampton and UCL.
In what is also a first, the metrics consider not just healthcare professionals' views of what should be measured, but also the views of the general public.
Lead author Dr Danielle Schoenaker from the University of Southampton and the National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre (BRC) said: "There is growing evidence that supporting people to optimise health before and between pregnancies can improve pregnancy and birth outcomes and also reduce intergenerational inequalities and chronic disease risk.
"But without the right monitoring systems, governments and health services cannot easily see whether their policies and programmes are working.
"We now need international agreement on which indicators we should measure and monitor, so countries can learn from each other and identify policies and programmes that work."
"If implemented, these metrics could steer future investment in care and support before pregnancy and parenthood, with a view to reducing health inequalities and improving health for future families."
The researchers had previously looked at relevant health indicators already monitored in England, such as smoking rates and the use of folic acid supplements before pregnancy to reduce birth defects, producing a report on the state of the nation's preconception health which was published by the Office for Health Improvement and Disparities in England in 2022.
In their new research, they asked more than 5,000 people from 13 countries, including Australia, Brazil and Ghana, what factors would matter most to them before a pregnancy.*
They found that answers to their surveys were remarkably consistent across country and gender, with mental health, physical health, supportive relationships and finances prioritised. These are therefore important factors that monitoring systems should reflect, they say.
Together with other researchers, clinicians, policy makers and members of the public, they will finalise a list of indicators during an international workshop later this year and will call on the World Health Organisation, the NHS and other agencies responsible for national health surveillance to incorporate the indicators, where possible, into existing infrastructures to enable monitoring of health before pregnancy globally.
Senior author Professor Judith Stephenson from UCL said: "This is an ongoing process to prioritise a set of internationally agreed core indicators for monitoring health before pregnancy.
"Our research found over 120 relevant indicators, far too many to include in a routine monitoring surveillance system, but through a rigorous collaborative process we have whittled that number down to around 40.
"Indicators relating to conception tend to be from a health professionals' perspective - we have, for the first time, produced a set of agreed metrics which reflect the views of the general public.
"A strong international collaboration is now needed to achieve consensus on which core indicators can be compared across low-, middle- and high-income countries."
* The full list of countries which took part in the researchers' survey was Australia, Bangladesh, Belgium, Brazil, Canada, Qatar, Singapore, UK, Ghana, Kenya, Malaysia, South Africa and the USA.
