Dear Professor Ross,
The article by Vogel and colleagues (J Dev Orig Health Dis. 2020 May 18:1–6.) highlights the global importance and far-reaching consequences of optimal nutrition for young women and men – as future parents of the next generation. The authors recommend creation of a worldwide social movement for improved preconception nutrition and provide examples for how it can be promoted to the highest level of national and international awareness. The evidence base is incontrovertible, and the potential societal and economic benefit unquestionable, but how should this be achieved? The authors conveniently propose a solution, a call to action by the International Society for the Developmental Origins of Disease (DOHaD). As President of the Society I am pleased to suggest how the Society and its membership might rise to this challenge.
Over the last year or two, it seems that every meeting of the DOHaD community, every academic society for reproductive health, and many nutritionists’ gatherings have put preconceptional health and nutrition at the top of the agenda. Indeed, a UK Preconception Partnership has been formed, including representatives from our Society, and has described in a series of papers in the Lancet how the nutritional and behavioural lifestyles of young women and men can impact on the lifelong health of the child. They also suggest interventions whereby this might be avoided. The mantra ‘think preconceptional health and nutrition’ has, through these different channels, gradually spread across a wide academic diaspora. Increasingly, we are aware that turning to a healthy lifestyle in pregnancy, from a rather unhealthy one beforehand, is too late to improve the chance of three care-free trimesters, an uneventful birth, and a healthy childhood. Preparation for pregnancy has yet to be widely adopted, however; we know that the majority of young women in the UK do not take folate supplements when contemplating pregnancy. Moreover, the high incidence of obesity in pregnant women and young men in the UK, similar to many other high-income countries and transitioning nations, would imply little acknowledgment of the inherent risks, or perhaps, even disillusionment with the myriad of healthy myths and tips. Points of contact in young men and women with health professionals are few, and despite ‘making every contact count’ (NHS, Health Education England) healthy nutrition behaviours appear to be steadfastly unchanging.
Vogel and colleagues recommend a practical four-step action plan for our Society asking that we (i) continue to build the scientific evidence, (ii) monitor progress made by Governments and commercial companies, (iii) develop advocacy coalitions that unite individuals and organisations around common policy options, and (iv) work with partners to develop an emotive and empowering preconception nutrition awareness campaign.
The first action is the easier, as the Society and many of its >1000 members in 67 countries are working to build setting-specific scientific cases for good preconceptional nutrition. A prime example is the HeLTI project (Healthy Lifestyles Trajectory; https://helti-net.org/about-helti/) a life course study at scale, led by DOHaD members and recruiting women from Canada, South Africa, China, and India to determine whether preconceptional health and nutrition advice will improve the health of mother and child. To review and discuss the evidence, the recent DOHaD Society Congress in Melbourne, Australia, allocated several sessions and a public event to the subject of preconceptional health, and this journal, J DOHaD provides an ideal conduit for worldwide dissemination.
The next three actions are more demanding, requiring globally coordinated advocacy. If we are to monitor progress made by Governments and commercial companies, we need first take a step backwards – as this implies a level of global reach and effectiveness yet to be achieved. National efforts by Government, for example, Public Health England, and an occasional international document, for example, WHO’s ECHO report (ending childhood obesity) highlighting the importance of preconceptional nutrition for the health of the next generation provide potential enlightenment, but are few and far between. Our Society’s journey should begin therefore with developing a global advocacy coalition (iii) and working with our global partners to develop a preconception nutrition awareness campaign (iv).
The International DOHaD Society boasts nine local partner organisations across the globe. In France, the USA, Canada, Latin America, Africa, Japan, China, Australia/New Zealand, and Pakistan, our Chapters and Affiliated Societies are well positioned to catalyse this venture. Each of these geographical regions has nutritional issues which influence the health of young women and men, and as the COVID pandemic sweeps the world, gathering as it does poverty and disruption to food supplies, these can only be exacerbated. I will recommend that each of the DOHaD partner organisations, supported by the International Society, develops a local advocacy coalition to create a social movement with a practical chance of improving preconceptional health and nutrition; members will not only be politicians or health care providers but also people from civil society, community groups, and those with academic and commercial affiliations. Together, effective strategies should emerge which encompass social, environmental, and economic determinants of nutrition in young women and men. The task of each of our local DOHaD groups will be to make their social movement work to convince local Government and commercial providers to support preconceptional health and nutrition (ii) – as a window for the health of the next generation. Our task as the International Society will be to monitor and broadcast progress in each geographical region and as widely as possible, compare and contrast best practice, and thereby engage International policy makers.
