Carter, T., Schoenaker, D., Adams, J. et al. Paternal preconception modifiable risk factors for adverse pregnancy and offspring outcomes: a review of contemporary evidence from observational studies. BMC Public Health 23, 509 (2023). https://doi.org/10.1186/s12889-023-15335-1
Abstract
Background
The preconception period represents transgenerational opportunities to optimize modifiable risk factors associated with both short and long-term adverse health outcomes for women, men, and children. As such, preconception care is recommended to couples during this time to enable them to optimise their health in preparation for pregnancy. Historically, preconception research predominately focuses on maternal modifiable risks and health behaviours associated with pregnancy and offspring outcomes; limited attention has been given to inform paternal preconception health risks and outcomes. This systematic review aims to advance paternal preconception research by synthesising the current evidence on modifiable paternal preconception health behaviours and risk factors to identify associations with pregnancy and/or offspring outcomes.
Methods
Medline, Embase, Maternity and Infant care, CINAHL, PsycINFO, Scopus, and ISI Proceedings were searched on the 5th of January 2023, a date limit was set [2012–2023] in each database. A Google Scholar search was also conducted identifying all other relevant papers. Studies were included if they were observational, reporting associations of modifiable risk factors in the preconception period among males (e.g., identified as reproductive partners of pregnant women and/or fathers of offspring for which outcomes were reported) with adverse pregnancy and offspring outcomes. Study quality was assessed using the Newcastle–Ottawa Scale. Exposure and outcome heterogeneity precluded meta-analysis, and results were summarised in tables.
Results
This review identified 56 cohort and nine case control studies. Studies reported on a range of risk factors and/or health behaviours including paternal body composition (n = 25), alcohol intake (n = 6), cannabis use (n = 5), physical activity (n = 2), smoking (n = 20), stress (n = 3) and nutrition (n = 13). Outcomes included fecundability, IVF/ISCI live birth, offspring weight, body composition/BMI, asthma, lung function, leukemia, preterm birth, and behavioural issues. Despite the limited number of studies and substantial heterogeneity in reporting, results of studies assessed as good quality showed that paternal smoking may increase the risk of birth defects and higher paternal BMI was associated with higher offspring birthweight.
Conclusion
The current evidence demonstrates a role of paternal preconception health in influencing outcomes related to pregnancy success and offspring health. The evidence is however limited and heterogenous, and further high-quality research is needed to inform clinical preconception care guidelines to support men and couples to prepare for a health pregnancy and child.
Plain English Summary
The time prior to conception, preconception, is widely acknowledged as an integral period whereby a woman’s health, lifestyle, and diet influence the outcomes of future pregnancy and the health of future offspring. Similarly, the influence of a man’s health, lifestyle, and diet during preconception on pregnancy and offspring outcomes must be considered. However, the male reproductive partner’s role during preconception has attracted much less researcher attention when compared to maternal exposures and outcomes and may be undervalued.
Therefore, this review explores the modifiable risk factors of males in the preconception period and how these risks influence adverse pregnancy and/or offspring outcomes. A total of 65 papers are included for review which examined risks associated with factors such as alcohol use, physical activity, stress, and nutrition. Overall, the papers identified some consistent results: paternal smoking increased risk of adverse offspring outcomes, while increased paternal body mass index was associated with higher offspring birthweight. Nevertheless, this review concludes that paternal preconception modifiable risk factors remain largely underexplored. Evidently, more high-quality research must be conducted to better understand the health, lifestyle, and diets of males in the preconception period and how various paternal modifiable risks can influence their partner’s pregnancy and the health and developmental outcomes of their offspring.