Abstract Introduction The preconception period (i.e., the weeks and months before pregnancy) is a critical window during which parental health behaviours can influence pregnancy outcomes and the child’s long-term health. Modifiable factors such as nutrition, physical activity, substance use, and environmental exposures play a key role, yet women’s ability to adopt and sustain healthy behaviours is shaped by complex psychological, social and environmental influences. This study applies the Theory of Planned Behaviour to identify the beliefs underpinning women’s preconception behaviours, with the aim of informing support for effective and sustained health behaviour change. Methods An Australian national retrospective cross-sectional survey of pregnant women (18-49 years), recruited through social media platforms. The 92-item survey captured respondent socio-demographics, pregnancy status and health conditions, health behaviours, and beliefs regarding preconception health behaviours. Respondents’ level of pregnancy planning was categorised using the London Measure of Unplanned Pregnancy (LMUP). Items regarding preconception beliefs were structured in accordance with the Theory of Planned Behaviour, with a focus on regular exercise, healthy diet, and alcohol avoidance. These beliefs variables were analysed using structured equation modelling to identify paths between latent variables and the items used to estimate each concept. Results The study was completed by 430 pregnant women of whom 72.7% had a planned pregnancy. Most had a partner, were university educated and in good health. Structural equation modelling showed intention strongly predicted exercise (β=0.65), healthy diet (β=0.54) and alcohol avoidance (β=0.64). Perceived control and partner norms influenced intentions, whereas health professional norms had limited effect. Positive beliefs were associated with folate supplement use and smoking cessation. Conclusion These findings highlight intention as a key driver of preconception health behaviours, with perceived control and partner influences playing a more significant role than individual beliefs or health professional input. Effective interventions should therefore address structural barriers and actively involve partners, while respecting women’s autonomy. Overall, couples-focused, multi-level strategies are likely essential to support meaningful and sustained preconception health behaviour change.

Optimizing preconception health offers an opportunity to reverse unfavourable trends in modifiable risk factors and improve reproductive outcomes. This study aims to report the yearly prevalence of key biopsychosocial preconception indicators for over a decade, as reported at antenatal booking appointments in Northern Ireland (UK). The indicators include area-level deprivation, planned pregnancies, and body mass index (BMI) between 2011 and 2021, as well as pre- and early-pregnancy folic acid supplement use between 2015 and 2020. This population-based study was conducted using annual routinely collected maternity data from the Northern Ireland Maternity System (NIMATS). R, accessed via the UK Secure eResearch Platform, was used to calculate yearly proportions. Multinomial regression models explored the relationship between each preconception indicator and year of booking appointment. Patient and Public Involvement and Engagement were integrated throughout the study. Of the 255 117 pregnancies included between 2011 and 2021, 21.4% were from women living in the most deprived quintile and 70.6% from women who reported a planned pregnancy. Obesity rates increased over the study period (e.g. obesity class I: 12.0%-16.1%), and preconception folic acid supplement use remained inadequate, though the use of supplements containing 5 mg of folic acid increased between 2015 and 2020 (400 µg: 34.4%-30.03%; 5 mg: 3.6%-5.0%). Efforts are needed to reverse negative public health consequences of sub-optimal preconception health indicators. Notably, folic acid supplement use was predominantly initiated after conception, suggesting that a renewed focus is needed, particularly supporting women with the greatest need, such as those in the most deprived areas.

AIM:To explore the interconception experiences of women after GDM across Ireland to inform how to optimise health between pregnancies. METHODS:A qualitative descriptive study was implemented. Online semi-structured individual interviews were conducted (April-May 2025) with women living on the island of Ireland who had experienced GDM ≤5 years ago. Data were transcribed and analysed inductively using reflexive thematic analysis. RESULTS:Twenty-seven women participated, and four themes were generated: (1) Shaping health behaviours beyond pregnancy, (2) GDM's emotional legacy, (3) Understanding interconception care and future risk management and (4) Interconception needs and support preferences. CONCLUSIONS:This study provides novel insights into women's interconception experiences following GDM across Ireland and shows behavioural, emotional and healthcare-related impacts between pregnancies. Although education received during pregnancy facilitated behaviour change that persisted postpartum, maintaining GDM-related positive health behaviour changes was often challenging without ongoing support. Postpartum care gaps and a lack of interconception support left women uncertain about their future GDM risk and appropriate pregnancy preparation. These findings highlight the need for interconception care including timely postpartum follow-up, clearer communication about recurrence risk and accessible preconception support for women planning a subsequent pregnancy.

Background Preconception care is a critical component of healthcare for people of reproductive age. A range of primary care professionals can support preconception care delivery. This study explored the beliefs about preconception care and describe the preconception care practice behaviours of general practitioners (GPs), midwives, and naturopaths in Australia. Methods A cross-sectional 32-item online survey was completed between July and September 2022 by GPs, midwives, and naturopaths in Australian clinical practice recruited through professional associations. Data were analysed using descriptive and inferential statistics. Results Participants (n=373) were naturopaths (40.7%), GPs (32.4%) and midwives (26.8%). Most participants believed they could provide preconception care to adults intending pregnancy (73%) and adults intending pregnancy again (63.8%), with some significant differences across professions for adults with no immediate pregnancy intention and adults intending pregnancy (p<0.05). Practice behaviours significantly differed across professions for involving the female and male partners in preconception care (p<0.05). Common reasons women consulted primary care professionals included reproductive and sexual health care, contraceptive advice, assisted reproductive technology, pregnancy support and postnatal care, varying significantly by profession (p<0.05). Frequently addressed preconception topics were nutrition, prenatal supplementation, medical history, substance use, smoking, alcohol, trauma/family violence, partner health, and screening, with significant variation across professions (p<0.05). Conclusions Primary care professions shared consistent views on the importance of preconception care but differed in practice opportunities and focus. Findings support an integrated model involving multiple health professionals in preconception care delivery alongside public health messaging, education funding, and greater attention to gender bias in preconception care. Significance Preconception care is essential healthcare for reproductive-age people, and multiple primary care professionals can support the coordinated delivery of preconception care. This study provides key insights into ‘who’ should provide preconception care. ‘What’ is included in preconception care. And ‘when’ to provide preconception care from the perspective of three primary care professions: GPs, midwives and naturopaths within Australia.

Aims: Research to inform, co-develop and evaluate optimal care for women with early-onset type 2 diabetes (EOT2D) before, during and after pregnancy is lacking. Informed by patient perspectives and the results of the James Lind Alliance priority-setting partnership in diabetes in pregnancy, we aimed to develop a consensus statement to guide future research efforts to meet the needs of women with EOT2D in the preconception, pregnancy and postnatal periods. Methods: Results from three systematic reviews covering interventional, observational and qualitative studies were presented at the Diabetes UK annual professional conference in Glasgow in February 2025. The results were discussed by an expert panel with audience participation. Results: There is very limited research to guide care for women with EOT2D, especially in the preconception and postnatal periods. In pregnancy, there have been limited studies assessing interventions, mainly encompassing medication and glucose sensor use, but most are small and have limited generalisability. Observational data suggests that managing glycaemia, addressing maternal BMI and preventing excessive gestational weight gain improve outcomes for women with EOT2D in pregnancy. Qualitative data highlight the negative impact of EOT2D on pregnancy and the need for optimised support. Targeted, innovative and cross-cultural studies across the reproductive life course are urgently needed to address the short and longer-term maternal and offspring risks for individuals with EOT2D. Conclusions: Given the rising prevalence of EOT2D and the risk of adverse pregnancy outcomes for women with EOT2D and their children, prioritising research in the preconception, pregnancy and postnatal periods is vital to ensure that care needs are met to improve health outcomes for women and their children.

INTRODUCTION:One in five women enters pregnancy with multiple long-term health conditions, which is associated with increased risks of adverse maternal and child outcomes. There is a lack of research exploring individuals' experiences of preconception care for these women, which is also reflected in existing guidelines that predominantly focus on single health conditions. This study aimed to explore experiences of preconception care and support among women with multiple long-term health conditions and health professionals. METHODS:This is a secondary analysis of qualitative data collected by the MuM-PreDiCT consortium. The primary study involved semi-structured interviews between March 2022 and May 2023 with pregnant (> 28 weeks) and postnatal (< 2 years) women with multiple long-term physical and/or mental health conditions in the United Kingdom, and healthcare professionals involved in their care. Data captured within the preconception coding reports were analysed thematically. RESULTS:Fifty-seven women and 51 healthcare professionals were interviewed. Six themes were identified from the thematic analysis. Women and professionals described the importance of tailored preconception care and support, incorporating condition-focused counselling (sub-theme 1) and medication planning (sub-theme 2). Sensitive and realistic care and support were considered essential, but women had mixed experiences of involvement and empathy from different professionals. The significance of optimising antenatal care by making every preconception contact count was emphasised by both women and professionals, who valued early referrals, specialist input and integration of services. Although professionals viewed the preconception period as an opportunity to empower women, many women felt they had to self-advocate and seek information due to gaps in professional awareness, knowledge and education. Professionals reported differing views on who, within the care team, should take responsibility for care delivery. Some believed that women should play an active role in managing their health, including initiating conversations around pregnancy intentions. The delivery of preconception care was complicated by a range of challenges, including a lack of service integration, availability, time and funding. CONCLUSION:Women with long-term health conditions can experience substantial gaps in preconception care, characterised by inconsistent guidance and limited access to tailored, reliable support, which frequently leads to feelings of isolation and the need to seek additional information when preparing for pregnancy. These results will inform the co-development of a care bundle for affected women. PATIENT OR PUBLIC CONTRIBUTION:Our Patient and Public Involvement group was involved in the design of the study and the analysis and interpretation of the data, and two public study investigators are part of the author group.

Abstract Introduction Infertility is a common reproductive health issue, associated with increased risks of pregnancy complications. However, shared underlying risk factors such as age, BMI, PCOS, endometriosis, and lifestyle may partly explain these associations. In a population‐based cohort of women, this study aimed to determine whether a history of fertility problems is independently associated with adverse pregnancy and birth outcomes, including gestational diabetes, hypertensive disorders of pregnancy, low birthweight, and preterm birth. Material and Methods This was a secondary analysis of data from the 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health, that included surveys from 2003 to 2018 (n = 9854). We examined associations between self‐reported fertility problems and four adverse outcomes: gestational diabetes, hypertensive disorders of pregnancy, low birthweight, and preterm birth. Generalized estimating equations with an exchangeable correlation structure were used, with sequential adjustment for socio‐demographic, health, and lifestyle‐related characteristics. Results Among 5653 women who reported a live birth, 897 (15.9%) reported a history of fertility problems, of whom 71.6% had sought help. After adjusting for socio‐demographic factors alone, there was a statistically significant increased risk of adverse pregnancy outcomes for women with a history of fertility problems compared to those without. However, after further adjustment for health characteristics and pregnancy‐related variables, the associations were no longer statistically significant: gestational diabetes [Relative risk (RR): 0.98; 95% confidence interval (CI) (0.78 to 1.22)], hypertensive disorders of pregnancy [RR: 1.08; 95% CI (0.82 to 1.43)], preterm birth [RR: 1.01; 95% CI (0.81 to 1.26)], or low birthweight [RR: 1.04; 95% CI (0.80 to 1.34)]. Conclusions In this large cohort of women in Australian, initial associations between fertility problems and adverse pregnancy outcomes were attenuated after adjustment for key health and lifestyle factors. The absence of associations in fully adjusted models suggests that previously reported risks may reflect shared underlying maternal characteristics rather than infertility itself and highlights the importance of cautious interpretation of statistical significance in large observational studies.

Preconception health improvement is vital for maternal and child health, yet societal perceptions about who holds responsibility for this remain underexplored. We conducted a hybrid workshop at the 2024 UK Preconception Early-Mid Career Researcher (EMCR) Network conference, attended by academics, health professionals and members of the public (N = 60). Small-group discussions on responsibility for preconception health improvement were audio-recorded and transcribed alongside notes from online whiteboards and paper-based flipcharts. Using framework analysis, we applied a deductive coding framework derived from the workshop questions. Attendees felt a disproportionate burden of responsibility for preconception health improvement was placed on women, reflecting deeply entrenched gendered norms within research, healthcare and broader societal structures. Attendees’ recommendations centred around (i) society, community and culture, (ii) education and early awareness, (iii) considerations for future research, and (iv) systems-level and policy solutions. These findings provide valuable insights for developing equitable public health strategies and research agendas relating to preconception health. Being healthy before pregnancy and parenthood is important. It affects pregnancy outcomes and lifelong wellbeing. But there are mixed views on who should be responsible for improving health before pregnancy. We held a workshop with 60 people, including health workers, researchers, and members of the public. We asked who is responsible for health before pregnancy and how this shows up in different contexts. We also asked for suggestions for how to make sure this responsibility is shared evenly. Attendees felt that women carry most of the burden. This happens in health care, research, and everyday life. Men are often left out of conversations about health around pregnancy. Current approaches to improving health before pregnancy focus on women’s choices and actions such as diet and smoking rather than wider issues like poverty, education, and health care access. Attendees felt that health before pregnancy should be a shared responsibility between partners, health workers, government, and society. They suggested including men equally in health care, research, and campaigns around health before pregnancy. They also said that education about this should start early, in schools. They called for changes in communities to support health before pregnancy, so that people don’t need to do this alone. These suggestions can help create fairer approaches to improving health before pregnancy and parenthood that support everyone. They reflect that this requires support from the whole of society.

Introduction:Relational dynamics between partners within a couple planning pregnancy are critical to their preconception health behaviour change and are largely underexamined. Given the need for both reproductive partners to engage in beneficial preconception health behaviours and the influence couples have on each others behaviour, this study examines the concordance between pregnancy planning and preconception health behaviours and health information-seeking within reproductive partner dyads. Methods:A retrospective observational study was undertaken utilizing data from two online cross-sectional 80-item surveys administered simultaneously between December 2020 and September 2021. Eligible study participants were females or birthing people aged 18-49 living in Australia during any stage of pregnancy, and reproductive partners of those that met these criteria. The survey items covered sociodemographic characteristics, level of pregnancy planning, preconception health behaviours, health information seeking, and health history. Cohens kappa (K) (categorical variables) and interclass correlation coefficients (ICC) (continuous variables) were used to identify agreement within the couples. Results:Eighty matched dyads of pregnant females and non-pregnant partners were included. Concordance in pregnancy planning was fair (Κ=0.27) and was primarily seen in couples where both partners reported the pregnancy as planned (42.5%) or ambivalent (18.8%). Couples had very low similarity (ICC:0.22) in weekday alcohol consumption 3 months preconception (pregnant females: 1.2 standard drinks per day (SD1.7); non-pregnant partners: 2.5/day (SD3.5)). Approximately one quarter (26.3%) of couples reported similarities in partners attempting and succeeding in preconception health information-seeking 12 months before pregnancy. There was greater concordance in not discussing preconception health topics with GPs, including topics explicitly covered within clinical guidelines. Conclusion:There is notable discordance in couples preparation for pregnancy in many behaviours relevant to positive pregnancy outcomes, and in their health service engagement and experience. There is a clear need to provide care to both reproductive partners to ensure the best possible outcome for the future generations. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: University of Technology Sydney Medical Research Ethics Committee (ETH23-8329) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Ethical clearance did not include public sharing of data. A de-identified dataset is available from the authors upon reasonable request and subject to approval from the overseeing ethics committee. National Institute for Health and Care Research, NIHR302955, NIHR203319 Australian Research Council, FT220100610

Abstract Objective to describe the provision of preconception care across publicly funded or contracted health and social care settings in the UK. Design and setting online cross-sectional survey conducted October-December 2025. Population healthcare professionals delivering preconception care, recruited via professional organisations and networks. Methods quantitative data were analysed using descriptive statistics and qualitative free-text responses using inductive content analysis. Outcome measures preconception care content, target population, frequency of provision, funding and commissioning models, and approaches for reporting and monitoring. Results Eighty-seven healthcare professionals completed the survey. Most were women (89.3%), aged 41-60 (63.1%) and based in England (84.5%). Participants represented diverse roles, mainly obstetric/maternal-fetal specialists (23.0%), specialist nurses (16.0%), GPs and midwives (13.8% each). Preconception care primarily targeted women ≥20 years (98.9%), with fewer targeting men and adolescents. Care was usually embedded within relevant consultations (69.4%), particularly contraception, medication and health condition reviews, and often a one-off interaction (75.3%). Content focused on condition-related management/medication (68.6%), folic acid (66.3%), risky behaviours (smoking, alcohol, illicit drugs) (40.7%), diet (37.2%) and weight (36.0%). Services were mostly not formally commissioned (62.4%), lacked financial incentives (84.7%) and had no audit/service evaluation requirements (81.2%). Conclusions Preconception care in the UK is delivered by a wide range of healthcare professionals. Their engagement has improved considerably when compared with studies conducted over a decade ago, but preconception care remains fragmented, opportunistic and poorly supported by commissioning and system infrastructure. Strengthening integrated care pathways, funding mechanisms and use of standardised resources is essential to achieve consistent and equitable preconception care.

The preconception period is an opportunity to address health-related behaviours to optimise pregnancy and child health outcomes. However, preconception health research and practice are primarily focused on females while similar attention on males remains underdeveloped. To address evidence gaps and inform effective paternal preconception health support, the aim of this systematic review was to identify the health beliefs, attitudes, and intentions of males toward pregnancy planning and preconception health and care. A literature search was conducted in seven databases: Medline, Embase, PubMed, CINAHL, PsycINFO, Scopus, and Web of Science to identify original research regarding pregnancy planning or preconception health beliefs, attitudes, and/or intentions among generally healthy adult males. Methodological rigour of included studies was assessed using the Newcastle Ottawa Scale (NOS) and the Critical Appraisal Skills Programme (CASP) Qualitative Studies checklist. Nine studies were included; cross sectional studies (n=6); a qualitative exploratory case study (n=1); a mixed method study (n=1) and a study incorporating qualitative and quantitative surveys (n=1). Analysis identified three broad themes: 1) Importance of Preconception Health and Care; 2) Paternal Preconception Behaviours; and 3) Inequalities in Preconception Health and Preconception Care. Findings reveal 1) Many males did not attend a preconception care consultation and believed it was not needed, or they already knew enough about a healthy pregnancy. 2) Males often agreed that smoking and alcohol consumption can affect the quality of their sperm and sometimes agreed it is important to consume a healthy preconception diet and to be physically active to achieve a healthy weight before conception. 3) For many males, there was a tendency to direct a greater level of responsibility to the female than to themselves regarding preconception health. African American males can feel marginalised. Males do not always opt for a preconception consultation and many believe they are adequately prepared for a healthy pregnancy. Further, many males place a greater level of responsibility for planning and preparing for pregnancy on their partners rather than themselves. Further research focused upon male experiences and perspectives around preconception health is needed to inform targeted preconception health education, policy and care.

Abstract Background Parental health before pregnancy influences maternal and child outcomes. Primary care professionals, including general practitioners [GPs], midwives, and naturopaths, can provide preconception care, yet many report limited knowledge and difficulty accessing relevant information. This study described Australian GPs’, midwives’, and naturopaths’ preconception health literacy, including knowledge and ability to access information. Methods Between July and September 2022, Australian GPs, midwives, and naturopaths completed a 32-item online cross-sectional survey. Participants were recruited through professional associations, and data were analysed using descriptive and inferential statistics Results Participants (N=373) included naturopaths (40.7%), GPs (32.4%), and midwives (26.8%). Reported barriers to clinician health literacy including lack of preconception care resources (25.5%), and limited clinician knowledge (23.6%). The proportion identifying limited clinician knowledge differed significantly between professions (GP: 31.4%; midwives: 23.0%; naturopaths: 17.8%; p=0.030). The highest level of accurate knowledge regarding preconception exposures was for pre-pregnancy obesity (82.7%), while low birth weight was the most accurately identified preconception outcomes (83.7%). Incorrect responses were most common for maternal multivitamin use as an exposure (28.3%) and childhood leukaemia as an outcome (26.3%). Differences between professions were strongest for infant outcomes, with moderate associations observed for shoulder dystocia (V=.2355), precipitous labour (V=.2173), macrosomia (V=.2060), labour dystocia (V=.2018) and cryptorchidism (V=.2018). Discussion Preconception health literacy varies across primary care professions. Clinicians require greater access to targeted resources and education tailored to their differing scopes of practice and experience. Improving clinician preconception health literacy may strengthen consistent evidence-based care and support better maternal, child, and long-term family health outcomes.

BACKGROUND:Public health crises like environmental disasters and COVID-19 place psychological burden on affected communities, with pregnant and new mothers disproportionately impacted. With the escalating incidence of such crises, understanding the mechanisms that support maternal resilience is crucial for effective intervention. METHOD:We investigated partner support as a potential protective factor for mothers' mental health following the Australian 2019-2020 bushfires and COVID-19 pandemic. Data were from 278 mothers living in the ACT and NSW who were pregnant during the bushfires and participants in the Mother and Child 2020 (MC2020) longitudinal cohort study, and 99 of their partners. Moderation analyses tested whether total partner support (dyadic coping) predicted the impact of crises during pregnancy on maternal mental health at 21-38 months postpartum. Secondary analyses examined how mothers' and partners' perceptions of the support provided to mothers contributed to maternal mental health. RESULTS:Mothers with greater crisis impact reported higher depression, anxiety and stress symptoms, and lower wellbeing at 21-38 months postpartum. The effect of crisis impact on mothers' mental health was not moderated by partner support; however, partner support showed the strongest association with maternal mental health, including improvements from the perinatal period to 21-38 months postpartum. Critically, the relationship between partner support and mothers' mental health was primarily driven by mothers' perceptions of the support they received. CONCLUSION:Strengthening partner support may significantly enhance maternal mental health and resilience surrounding public health crises. Intervention efforts should focus on guiding partners to provide support that aligns with mothers' needs.

Preconception health can be optimized through preconception care, which is considered an effective catalyst for behavior change prior to parenthood and is of paramount importance due to the influence that health behaviors can have on pregnancy and offspring outcomes. The preconception health and preconception health behaviors of males before they become fathers for the first time remain underexplored and are an emerging area of interest for public health and reproductive health research. This article is the first report and quantitative cross-sectional analysis of the national dataset pertaining to male health, Ten to Men, reporting data relevant to male health across the life course, during preconception. This report offers research foresight into the health behaviors (e.g., smoking or alcohol), health conditions, health consultations, medications, health information, and health literacy of Australian males prior to becoming a father (n = 572). The findings of this research support an undervalued albeit indispensable research area by providing up-to-date evidence-based information regarding paternal preconception health and health behaviors. This public health research with a focus on paternal preconception health behaviors and health behavior change can only strengthen the call for preventive health and offer preconception health and preventive knowledge about males for the research community and practitioners.

AIMS:Research to inform, co-develop and evaluate optimal care for women with early-onset type 2 diabetes (EOT2D) before, during and after pregnancy is lacking. Informed by patient perspectives and the results of the James Lind Alliance priority-setting partnership in diabetes in pregnancy, we aimed to develop a consensus statement to guide future research efforts to meet the needs of women with EOT2D in the preconception, pregnancy and postnatal periods. METHODS:Results from three systematic reviews covering interventional, observational and qualitative studies were presented at the Diabetes UK annual professional conference in Glasgow in February 2025. The results were discussed by an expert panel with audience participation. RESULTS:There is very limited research to guide care for women with EOT2D, especially in the preconception and postnatal periods. In pregnancy, there have been limited studies assessing interventions, mainly encompassing medication and glucose sensor use, but most are small and have limited generalisability. Observational data suggests that managing glycaemia, addressing maternal BMI and preventing excessive gestational weight gain improve outcomes for women with EOT2D in pregnancy. Qualitative data highlight the negative impact of EOT2D on pregnancy and the need for optimised support. Targeted, innovative and cross-cultural studies across the reproductive life course are urgently needed to address the short and longer-term maternal and offspring risks for individuals with EOT2D. CONCLUSIONS:Given the rising prevalence of EOT2D and the risk of adverse pregnancy outcomes for women with EOT2D and their children, prioritising research in the preconception, pregnancy and postnatal periods is vital to ensure that care needs are met to improve health outcomes for women and their children.

As efforts to support pregnancy planning and improve preconception health are increasing at scale, appropriate systems to monitor progress are required. Despite developments in a few countries, no surveillance systems currently in operation are using a comprehensive set of indicators for monitoring preconception health. This Review describes relevant indicators, reflecting both system-level and individual-level factors, that can be drawn from routine data sources to form the basis for developing new surveillance systems. We present a new framework for national and international surveillance that incorporates, for the first time, community perspectives on the factors that matter most before pregnancy and parenthood. Finally, we describe an international collaboration working towards a core set of indicators that can be compared across low-income, middle-income, and high-income countries, and discuss future directions to enhance and expand international monitoring of pregnancy planning and preconception health.