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March 17, 2020

Pre-conception care for men? The 3 months leading up to pregnancy

Many new mothers anticipate returning to their pre-expectant bodies and temporarily idling careers by taking good care of their overall health before becoming pregnant – a concept known as pre-conception health.

But what about men? Shouldn’t they, like their partners, take proactive measures so that the potentially harmful effects of certain habits, like taking prescription drugs or keeping on excess weight, don’t negatively impact their offspring?

A trio of papers published in April 2018 in the journal The Lancet explain how the pre-conception health choices of both men and women can influence factors such as a baby’s brain development and birth weight. Together, the papers underscore the notion that pre-conception regimens play a significant role in bettering birth outcomes as well as the overall health of babies – not just when they’re born, but as they continue to grow, develop, and mature.

Indeed, Milton Kotelchuck, a senior scientist at Massachusetts General Hospital and professor of pediatrics at Harvard Medical School, who, like the other experts quoted here, did not play a role in the Lancet papers, recently told CNN, “Really, almost all of the important epigenetics, all the important embryologic development, takes place in the first few weeks of the pregnancy. That's when lots of the really key things are happening before people even know they're pregnant. Your brain development, your entire spine, all the nerves are developed in the first couple of weeks."

All the more reason, then, for both men and women to invest in pre-conception care. Here’s how each of the three papers breaks that down, scientifically and personally:

The first paper takes a look at how to determine when people are entering a pre-conception phase, noting that from a purely biological perspective, this would include several days before an embryo begins growing. But from the personal perspective of the couple – how they think and behave – that period should start as soon as a couple has thoughts of conceiving a child.

This could be months or even years prior, depending on what issues are in play – diabetes, for instance, as well as diet.

Far as diet is concerned, obesity isn’t the only factor, though it is associated with lowered sperm counts in men. Dr. Haywood Brown, professor of obstetrics and gynecology at the Duke University School of Medicine and president of the American College of Obstetricians and Gynecologists, told CNN, "We also know that people who are extremely underweight also have a higher risk of babies being small, and so there's an extreme on both ends."

The second paper delves further into how the health of both the mother and father – including factors such as body composition, diet, stress, and metabolism -- can affect a baby’s long-term chances of running into immune, metabolic, cardiovascular, and neurological complications.

Researchers for the second paper concluded that a “key window” exists during which the above factors “can induce increased risk of chronic disease in offspring”.

And the implications of this phase of pre-conception health go even further, according to Kotelchuck. For instance, does the man prove a help or a hindrance when it comes to supporting his partner’s pre-natal care needs? Has he taken the appropriate steps to determine whether he’s carrying any sexually transmitted diseases?

Plus, Kotelchuck adds, “The father's genes also are very important in the development of the placenta and whether the placenta's nurtured well enough."

Which brings us to proactive measures available to couples, the focus area of the third paper. Researchers homed in on strategic approaches, such as giving nutrient-rich snacks to women prior to conception; mitigating health-harming habits such as drinking and smoking; and, in some cases, even providing cash payments to incentivize people to improve their pre-conception health.

Dr. Aimee Eyvazzadeh, a reproductive endocrinologist in San Francisco, refers to this pro-active period as “trimester zero”, a reference to the three traditional trimesters of pregnancy.

"Rather than try to get pregnant with zero guidance,” she told CNN, “all people should get a pre-conception checkup and be taught about what they can do to promote lifelong health in their future offspring, and it certainly starts with the parents”.

Kotelchuck agrees, stressing that all intervention measures should also include fathers.

"If you do pre-conception care for women because you're interested in the health of not only the baby but also the woman over her life course ... you have to talk to dads in the same way," he said.

Another proactive measure that should be central to anyone’s concept of pre-conception care: Protecting and storing your assets before “trimester zero” appears on even the most distant horizon.

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