Guideline

Received: 2 March 2022 | Revised: 12 May 2022 | Accepted: 7 June 2022
DOI: 10.1002/rfc2.8
REVIEW
A scoping review of nutritional interventions and policy

guidelines in the interconception period for prevention of
noncommunicable diseases
Daniella Watson1 | Chandni M. Jacob2,3 | Gareth Giles4 |

Fionnuala M. McAuliffe5 | Keith Godfrey2,3,6 | Mark Hanson2,3
1
Global Health Research Institute, Human
Development and Health, Faculty of Medicine, Abstract
University of Southampton, Southampton, UK Introduction: The interconception period is considered a time when parents are
2
Institute of Developmental Sciences, Human likely to engage with health messages and are in frequent contact with healthcare
Development and Health, Faculty of Medicine, professionals. Through this scoping review and policy analysis, we synthesized
University of Southampton, Southampton, UK
articles and guidelines on interconception care to provide recommendations to
3
Southampton NIHR Biomedical Research
improve health outcomes for parents, infants and future generations.
Centre, University Hospital Southampton NHS
Foundation Trust, University of Southampton, Methods: Four databases were searched systematically, using Medical Subject
Southampton, UK Headings and free‐text terms based on ‘interconception’ and ‘postpartum.’
4
Public Policy|Southampton, University of Selected articles included systematic reviews, pilot studies and guidelines on
Southampton, Southampton, UK interconception and postpartum interventions published globally and in English
5
UCD Perinatal Research Centre, School of by UK public health organizations and government agencies between 1 January
Medicine, University College Dublin, National 2010 and 12 January 2021. Thirty percent of titles, abstracts and full‐text papers
Maternity Hospital, Dublin, Ireland
were double‐screened. The description table of identified guidelines was used as a
6
MRC Lifecourse Epidemiology Centre,
template to qualitatively generate key categories, which later developed into a
University of Southampton, Southampton, UK
framework of six domains. Findings are described using a narrative synthesis
Correspondence approach.
Daniella Watson, D08 Institute of Developmental Results: We found 47 documents with guidelines, 29 systematic reviews and 6
Science, University Hospitals Southampton NHS pilot studies on interconception and postpartum care. Six domains were generated
Foundation Trust, Southampton, UK.
as follows: interconception care, nutrition‐specific, nutrition‐sensitive, personal‐
Email: D.Watson@soton.ac.uk
centred care, health professional, and multistakeholder approach. Interconception
Funding information care opportunities include the postpartum period, family planning, routine
The RANK Foundation practice and risk assessments. Health and nonhealthcare professionals with roles
to play in the interconception period include general pratitioners, health visitors,
dieticians, nutritionists, health psychologists, community groups, local authorities
and charities such as Tommy's and First Step Nutrition.
Conclusions: The interconception and postpartum periods offer crucial
opportunities to intervene, to reduce possible long‐term effects of suboptimal
nutrition. Although the policy analysis for this scoping review focused on the
United Kingdom, the literature review had a global focus and the recommenda-
tions can have wider implications for other countries.
KEYWORDS
interconception care, maternal health, noncommunicable disease prevention, nutrition, postpartum
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the
original work is properly cited.
© 2022 The Authors. Reproductive, Female and Child Health published by John Wiley & Sons Ltd.
18 | wileyonlinelibrary.com/journal/rfc2 Reproductive, Female and Child Health. 2022;1:18–41.

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INTERCONCEPTION CARE OPPORTUNITIES FOR NCD PREVENTION | 19
INTRODUCTION routine health visitor appointment postpartum, by health

professionals including midwives, health visitors, nutri-
Preconception health is the period before conception and is tionists and primary care practitioners in clinical and
a critical period for improving health outcomes of future community settings.18
generations, including reducing the prevalence of noncom- Through this scoping review and policy analysis, we
municable diseases (NCDs) in the mother and offspring.1 aimed to synthesize articles and guidelines on interconcep-
Increasing evidence suggests that maternal risk factors for tion care to develop recommendations for use in healthcare
later NCDs can worsen through pregnancy and postdeliv- and practice, with particular reference to improving
ery, for example, associated with postpartum weight nutrition‐related health outcomes and NCD risk for parents
retention.2 In addition, parents' preconception body mass and the next generation. Two research questions were
index (BMI) is more strongly associated with the risk of addressed:
childhood obesity in the offspring than weight gain during
pregnancy.3,4 Similarly, in women with a high BMI, losing 1. What models of interconception and postpartum care
weight before the next pregnancy reduces the risk of adverse are in use or have been described in literature globally?
outcomes such as large for gestational age (LGA) babies,5–8 2. What guidelines of interconception and postpartum care
while interpregnancy weight gain increases the risk of LGA are in use or have been described in the United
births. Although pregnancy can be a “teachable moment” Kingdom?
for behaviour change, findings from recent high‐quality
pregnancy interventions to address obesity suggest that risk
factors should be addressed before conception for greatest MATERIALS A ND METHODS
benefit.9
Promoting preconception health is challenging given the The scoping review was conducted to explore the published
wide time window (potentially the entire reproductive life), and grey literature on interconception care,19 using three
and that prospective parents who require additional support different simultaneous methods as follows: (1) review of
for pregnancy preparation and planning generally do not studies in the interconception period; (2) review of
seek this. Moreover almost 50% of pregnancies are systematic reviews in the interconception and postpartum
unplanned.10 The interconception period provides an period; and (3) grey literature review of policy guidelines in
opportunity for engagement when parents are in more the interconception and postpartum period. A protocol was
frequent contact with healthcare professionals. Moreover, developed internally but not registered publicly.
beneficial outcomes might be shown over a shorter
timescale than with interventions designed for the pre-
conception period overall. In the United Kingdom, ~58% of Review of studies in interconception period
births are second or third parity,11 suggesting that (Research question 1)
postpartum preconception care could be made available to
a large group of women and their partners who may decide We specifically searched for and included pilot studies due
to conceive. Outcomes of this include breastfeeding to the paucity of trials in the interconception period. A
duration, addressing postpartum weight retention, mental scoping search on Google Scholar was conducted to identify
health, infant growth and neurocognitive and emotional all studies exclusively in the interconception period and
development, as well as health aspects of a subsequent field experts were consulted (see Table 1). All relevant
pregnancy.9,12,13 published papers identified were pilot studies, although
According to the 2013 World Health Organization these lack the power and rigour of randomized controlled
policy brief14 on preconception care, interconception care trials (RCTs) or systematic reviews, they were included as
is delivered between the end of pregnancy and the start of they provide preliminary evidence.
the next pregnancy, notably in the first 24 months
postpartum, to improve outcomes for potential future
pregnancies,15,16 promote parental and infant health, and Review of reviews for interventions and
to reduce risk factors for NCDs before the next postpartum period (Research question 1)
pregnancy.16 It helps to bridge the postpartum period to
either a subsequent pregnancy or the decision not to Systematic review articles published in English 1 January
conceive again.17 A proposed framework for interconcep- 2010–12 January 2021 were searched for on four major
tion care includes risk assessment, health promotion, medical and social science databases: Cochrane library,
clinical and psychosocial interventions, and visits at EMBASE, MEDLINE, and CINAHL. Using a combination
2 weeks, 6 weeks, 6 months and 1 year postpartum.16 In of Medical Subject Headings and free text, the search
the United Kingdom, Public Health England (PHE) and strategy was based on terms relating to the interconception
National Institute for Health and Care Excellence (NICE) or postpartum period and nutrition, which also included
guidance recommend that interconception care should be wider outcomes including physical activity and prevention
discussed from the first antenatal appointment to the last of NCDs.
20 | WATSON ET AL.
TABLE 1 Inclusion criteria and search terms
PICO Inclusion criteria description Search terms

Publication type Published research articles, national and local guidelines. See databases
English, 2010–current 12 February 2021, review, human
Study design All study designs evaluating maternal and child nutrition Pilot OR Pilot evaluation OR Implement* OR Evaluation
interventions.
Population Women and men who have experienced at least one Interconception OR Inter*conception
pregnancy in the United Kingdom (and Europe if OR
needed) Interpregnancy OR inter*pregnancy OR Consecutive pregnancy OR
Perinatal OR post*partum OR post*natal OR following childbirth
OR post*pregnancy OR after birth OR following pregnancy OR
birth interval
AND
UK OR United Kingdom OR Britain OR England OR Scotland OR
Wales OR Ireland
Interventions Interconception care models from primary care and Primary Care OR GP OR general practitioner* OR Health visitor OR
community care. Nurse OR Secondary OR Health professional OR Midwife* OR
Community OR Healthcare provider* OR Dietician* OR
Obstetrician*
AND
Nutrition* OR Diet* OR food OR eat* OR nutrient
Outcomes At least one of the following nutrition, diet, PA, Outcome‐based search terms were not added, as nutrition
noncommunicable disease outcomes for: interventions included many different outcomes related to lifestyle
‐ NCDs changes, such as those described in the box on the left.
‐ Body composition
‐ Nutrient status
‐ Diet
‐ PA
‐ Behavioural outcomes such as changes in self‐efficacy,
attitude, knowledge
‐ Both maternal and infant outcomes will be extracted if
available
Note: Organizations and agencies included the following: NICE, PHE, Royal College of General Practice, Royal College of Obstetricians and Gynaecologists, Royal College Of
Midwives, UK Department of Health Social Care, UK House of Commons and Lords Hansard archives, parallel parliament, SUREstart, Tommy's, and First Steps Nutrition Key
words on interconception and postpartum were entered into the organization or agencies' search tab to identify relevant documents.
Abbreviations: NCD, noncommunicable disease; NICE, National Institute for Health and Care Excellence; PA, physical activity; PHE, Public Health England; PICO, Population,
Intervention, Comparison and Outcome.
Publications were stored in Endnote X9.2, duplicates ensure a level of consistency, and any queries were resolved
removed and papers screened on Rayyan qcri online through discussion. Table 4 shows a descriptive table of the
website.20 Thirty percent of paper titles, abstracts and full systematic reviews, meta‐analyses and pilot studies.
text were double‐screened by a second author. Table 1
shows the inclusion criteria. Discrepancies were resolved by
team review, which was deemed the final consensus. Studies Grey literature review of policy guidelines in
were excluded if none of the outcome criteria were part of the interconception and postpartum period
the reviews but included reviews with additional outcomes (Research question 2)
besides nutrition. There were no exclusion criteria based on
study design. Figure 1 shows paper removal in the screening Additionally, a review of published guidelines from 11 UK
process. public health organizations and government agencies was
Assessment of risk of bias for review articles was also conducted. The United Kingdom was selected as a case
conducted using the McMaster University Health Evidence study to identify the current state of recommendations and
Quality assessment tool,21 which uses a 10‐point framework guidelines for multiple stakeholders in the interconception
to assess the strength of evidence and categorizes studies as period. As the policy review identified documents with a
strong (Score 8–10), moderate (5–7) or weak (0–4) quality. range of issues within the interconception and postpartum
A separate assessment of risk of bias was conducted for the period, thematic analysis was conducted by two experienced
pilot studies using an adapted version of the Centre for (7 years+) qualitative researchers to synthesis the guidelines
Reviews and Dissemination (Tables 2 and 3).22 All identified into key domains.23 Guideline documents were entered into
studies were assessed by two independent reviewers (DW a reporting table, which included the relevant recommen-
and CMJ). Ten percent of studies were double assessed, to dations (Table 5).
were generated from thematic analysis of the policy

documents.
Findings from pilot studies on interconception

care during the postpartum period
Six studies were identified, scoring high (1) to moderate (5)

quality. Pilot studies focused on outcomes, including
nutritional supplementation, mental health outcomes,
interconception care provision, and contraception and
process evaluation of the studies.25–31 Interconception care
interventions can include risk assessments leading to
tailored care, complex interventions and educational
components, including counselling, multivitamin supple-
mentation, peer support groups, walking programmes,
contraception, mental health and substance support, and
dental care.25,26 Although none of these interventions were
followed up to assess infant outcomes, they have improved
women's uptake of multivitamins supplements, mental
health support, use of contraception, physical exercise and
dental care.25,26,30 Additionally, women in one pilot
interconception intervention prioritized their socio-
economic needs over medical priorities, suggesting that
interconception care needs to address the wider determi-
nants of health.27 Health professionals (physicians/nurses)
and women involved in interventions, who focused on
F I G U R E 1 Preferred Reporting Items for Systematic Reviews and interconception care, considered the intervention acceptable
Meta‐Analyses (PRISMA) flow diagram of review of reviews
(uploaded in Supplementary Information). and appropriate. However, only 13% of health professionals
felt they could implement interconception care into routine
practice, as it did not fit into their current priorities and
they expected little interest from women.28
Descriptive tables of the reviews, pilot studies and
guidelines were used to underpin the synthesis of the
findings and key messages. The guidelines description table Evidence for interventions for nutritional
was qualitatively analysed using NVivo software version 12 outcomes postpartum (Review of reviews)
to generate categories, later developed into a framework of
six domains, which structure the results. Findings are Twenty‐nine systematic review articles were identified (24
described using a narrative synthesis approach based on the systematic reviews and 5 Cochrane reviews); 20 were of high
six key domains of focus of the guidelines.24 Narrative quality, 7 moderate quality and 2 low quality (Tables 3 and
synthesis was conducted to provide a high‐level overview of 4). Despite recent attention to the interconception period, a
the findings from the three methods described above. systematic review on interconception care for women with a
Figure 1 shows the systematic inclusion of studies for the history of gestational diabetes found no eligible published
review of review; a figure to illustrate the additional two trials.32 Postpartum weight loss programmes, which
methods was not possible as these methods were searched included a combination of diet support and physical
manually. activity, showed the most significant weight reduction in
mothers.33–41 Evidence for solely diet or physical activity
interventions was inconclusive.33,37,42–45 Women's knowl-
RESULTS edge of self‐care,46 behaviour change strategies such as goal
setting38,39 and digital interventions,47,48 were also associ-
We found 47 documents with guidelines, alongside 29 ated with weight loss. Lifestyle interventions including diet
systematic reviews and 6 pilot studies on interconception and physical activity for women with previous gestational
and postpartum care in which the interventions and diabetes mellitus (GDM) showed significant reduction in
outcomes may also inform care. These findings are postnatal diabetes49–52 and weight loss,52–54 which was more
synthesized into a framework for interconception care. A effective when the intervention was delivered soon after
narrative synthesis of the scoping review is presented below delivery.49 There was limited evidence for lifestyle interven-
and organized by the methods used and the domains that tions for women with previous diagnosis of a hypertensive
| 22
TABLE 2 Risk of bias for pilot studies
Assign-
ment to
treatment
groups Similar Loss at Primary
Study truly Assessors Participants at Selection follow‐ Interconception Intervention outcome Intention Analytical Cofounding Sample
Author, year design random randomized randomized Blinding baseline criteria up assessment delivery variability to treat methods analysis size Score
Coonrod, −1 −1 −1 −1 0 +1 0 0 −1 −0 −1 −1 0 +1 −1 −6
2014
Handler, −1 −1 −1 −1 +1 0 −1 −1 −1 0 +1 −1 0 +1 −1 −6
2013
Sijpkens, 0 −1 −1 −1 0 +1 −1 +1 −1 0 +1 −1 +1 0 0 −2
2019
Srinivasan, +1 0 −1 −1 +1 0 0 0 +1 0 +1 −1 +1 +1 0 3
2018;
DeMarco,
2020
Ravindran, +1 +1 −1 0 +1 +1 +1 0 −1 0 +1 +1 0 +1 −1 5
2020
Upadhya, +1 +1 +1 +1 +1 +1 +1 0 −1 0 +1 +1 +1 +1 0 10
2020
Note: ROB score: +1 is low ROB, 0 is medium, −1 is high ROB.

Abbreviation: ROB, risk of bias.
WATSON
ET AL.
TABLE 3 Risk of bias of systematic reviews
Level of
evidence in Methodological Combine Appropriate Data support
Inclusion Search Years primary quality of the Transparent findings methods used to author
Author, year PICO criteria strategy covered studies primary studies results across studies combine studies interpretation Score Risk of bias
Adegboye, 2013 ✓ ✓ X ✓ ✓ X ✓ ✓ ✓ ✓ 8 Strong
Berger, 2014 ✓ ✓ ✓ ✓ ✓ ✓ X ✓ X ✓ 7 Moderate
Choi, 2013 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong
Dalrymple, 2019 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong
Dodd, 2019 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong
Ferguson, 2019 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ X X 7 Moderate
Garad, 2020 ✓ ✓ X ✓ ✓ X ✓ ✓ ✓ ✓ 8 Strong
Goveia, 2018 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong
Guo, 2016 ✓ ✓ X ✓ ✓ ✓ ✓ X X ✓ 7 Moderate

INTERCONCEPTION CARE OPPORTUNITIES FOR NCD PREVENTION
Hutchesson, 2020 ✓ ✓ ✓ ✓ ✓ X NA ✓ X ✓ 7 Moderate
Hewage, 2019 ✓ ✓ ✓ ✓ ✓ X ✓ ✓ ✓ ✓ 9 Strong
Jones 2016 ✓ ✓ X ✓ ✓ ✓ X X X X 5 Moderate
Lau, 2017 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 10 Strong
Li, 2020 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ X ✓ 9 Strong
Lim, 2015 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong
Lim, 2019 ✓ ✓ X ✓ ✓ X ✓ ✓ ✓ ✓ 8 Strong
Lim, 2020 ✓ ✓ X ✓ ✓ ✓ X ✓ ✓ ✓ 8 Strong
Lui, 2019 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ X ✓ 9 Strong
Markova, 2015 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ X ✓ 9 Strong
Neville, 2014 ✓ ✓ X ✓ ✓ X X ✓ X ✓ 6 Moderate
Oliveira, 2016 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 10 Strong
Panagopoulou, X X X ✓ X X X X X ✓ 2 Weak
2017
Schoenaker, 2021 ✓ X X X ✓ X X X X NA 2 Weak
Sherifali, 2017 ✓ ✓ X ✓ ✓ X ✓ ✓ ✓ ✓ 8 Strong
Taylor, 2020 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ X ✓ 9 Strong

|
(Continues)
23
24 | WATSON ET AL.
disorder of pregnancy55 or with postpartum iron deficiency
Risk of bias
anaemia.56 There was no evidence that different doses of
postpartum Vitamin A supplementation benefited maternal
Strong
Strong
Strong
Strong
or infant mortality and morbidity.57 One review on dietary,
behavioural and medical interventions for postpartum
constipation found no eligible trials.58
Score
9
9
10
Postpartum interventions were delivered in various
settings including hospitals, clinics, home, communities,
interpretation
outdoors and school halls.38,41,46 Interventions were also

Data support
delivered by a range of clinical and nonclinical profes-

author
sionals, including midwives, general practitioners, dietitians,

heath psychologists, lifestyle counsellors, health coaches,
✓
nutrition professionals and interventionists.35,38,41,59,60

However, clinical health professionals delivering interven-
methods used to
combine studies
tions resulted in greater weight loss for mothers compared

Appropriate
with nonhealth professionals.59 Early postnatal discharge

combined with home and individualized midwifery support
reduced costs and improved the satisfaction, health and
NA
✓
X
well‐being of both mother and infant.61

across studies
Combine
findings
Review of Interconception and postpartum

guidelines for policy and healthcare practice
✓
✓
Transparent
Forty‐seven documents with guidelines on interconception

and postpartum nutrition and health interventions were
results
identified from health bodies including NICE, PHE and the

Royal Colleges, and from parliamentary discussions
✓
(Table 5). The guidance highlighted six key domains as

primary studies
Methodological
follows:
quality of the
Interconception care
✓
Guidance on nutrition during the interconception period

evidence in
was more aimed at women postpartum without considera-

primary
Level of
studies
tion of impacts on potential future pregnancies. Guidelines

✓
on the interconception period recommended weight

management postpartum and after successive pregnancies,62
covered
and consideration on contraception postdelivery.18,63 PHE64

Abbreviation: PICO, Population, Intervention, Comparison and Outcome
Years
guidance advised that interconception plans should be

✓
discussed with health visitors in the antenatal period and be

flexibly followed up between pregnancies.
strategy
Search
Nutrition‐specific interventions
Inclusion
criteria
Nutrition‐specific interventions directly address immediate

✓
determinants of fetal and child nutrition and development

PICO
through adequate food and nutrient intake, feeding and

(Continued)
caregiving.65 Guidance by the Parliamentary Office of

✓
Science and Technology66 and other bodies62,67–71 recom-

mends that health professionals advise and support women
Pligt, 2013
Turawa, 2020
Author, year
Vincze, 2019
to exclusively breastfeed for up to 6 months, including

Tieu, 2017
TABLE 3
exploration of the potential barriers. Balanced healthy diets,

van der
including example recipes, were recommended to be

advised by health professionals; notably, dieticians and
TABLE 4 Description table of included interconception and postpartum reviews
# Author, year, country Aims Participants Method Intervention Key findings RoB
Interconception (n = 7)
1 Sijpkens et al., 2019, The To integrate PCHC services and Physicians and nurses Pilot study PCHC‐trained physicians and nurses 60% of the PCHC professionals −02
Netherlands perform an implementation (n = 112) to new parents. (n = 112) in seven Dutch promoted interconception care,
evaluation. municipalities discussed the possibility of interconception
interconception care with new care was discussed in 29%
parents during their routine 6‐ (n = 1849) of all visits, almost half
month infant visit. PCHC professionals found
discussions on interconception
care during visits acceptable and
appropriate, yet only 13% of
professionals felt that the topic of
interconception care could be
incorporated into routine practice.
2 Ravindran et al., 2020, To examine the feasibility and Public health nurses in rural Pilot study A pilot randomized control trial was Most participants were satisfied with 5
Canada acceptability of an and urban Canada to conducted in three urban and rural the intervention, including the
interconception intervention women between 2 and sites in Ontario, Canada, delivered number and length of sessions and
delivered by public health nurses. 12 months postpartum by public health nurses. Women content of recommendations.
after a first birth. (n = 16) in the intervention arm

received preconception risk
assessment, tailored education, and
clinical follow‐up referrals, whereas
the control received standard care.
Participants completed a survey
with open‐ended questions to assess
acceptability.
3 Srinivasan et al., 2018; To address specific maternal risk Mothers with children aged Intervention Mothers (n = 11 521) attending ‘well Direct provision of multivitamin 3
DeMarco et al., factors for poor subsequent birth 0–24 months in the United study child visits’ in 19 health centres in supplementation was found to be
2020, USA outcomes. States. the United States were risk assessed more effective than solely
and 60% of the high‐risk mothers counselling about the use of
receive counselling and multivitamin supplementation.
multivitamin supplementation. Women who were most likely to
become pregnant were more likely
to initiate multivitamin
supplementation by the next
routine visit.
4 Coonrod et al., To describe and present results of 102 women who have Retrospective Women (n = 102) in Phoenix, USA, All women with mental health issues −6
2014, USA preconception care services experienced a prior descriptive who had experienced prior preterm were supported, 93% who were not
aimed at underserved women preterm birth or stillbirth. study birth or stillbirth, were enroled onto planning for a pregnancy were on
who have experienced an adverse an intervention providing education contraception, 75% were taking
birth outcome. delivered by clinicians, peer support folate supplement, 53% were
groups, a walking programme, exercising, and 37% received
contraception, folic acid, dental dental care.
|
(Continues)
25
26
TABLE 4 (Continued)
|
care, mental health and substance
support before a future pregnancy.
5 Handler et al., To evaluate the implementation of a 220 low‐income African Pilot study Low‐income African American women Women perceived themselves as −6
2013, USA pilot interconceptional care American women with a (n = 220), who had experienced healthy and did not see medical
programme. prior adverse pregnancy prior preterm birth or a stillbirth care as a priority compared with
outcome. were invited to an intervention that their socioeconomic needs.
integrated social services, family Women's perception of
planning, and medical care. contraception effectiveness did not
align with clinical knowledge.
6 Upadhya et al., To assess the effectiveness of a pre/ Paediatric clinicians (physician RCT Paediatric clinicians (physician or nurse Contraceptive use, pregnancy 10
2020, USA interconception women's health or nurse practitioner) practitioner) were trained to screen incidence, and the use of
intervention delivered during delivered to mothers with and deliver a brief educational preventive care were not
paediatric primary care using a infants under 12 intervention to mothers in the significant for mothers in the
cluster randomized trial. months old. intervention arm, and mothers intervention; however, the
(n = 415) in both arms received intervention increased the daily
preconception health information folic acid use and reduced
and a 90‐day supply of prevalence of smoking at 6 months
multivitamin. follow‐up but not at 12 months.
7 Tieu et al., 2017 To assess the effects of Women who have been Cochrane No eligible published trials were No eligible published trials were 9
interconception care for women diagnosed with GDM in a Systematic identified. identified.
with a history of GDM on previous pregnancy. Review
maternal and infant health Diagnosis of GDM made of RCTs Three ongoing trials
outcomes. according to individual 1. The effects of a diet and exercise
study criteria. intervention.
2. Effects of an intensive lifestyle

intervention, supported with
liraglutide treatment.
3. The effects of a weight loss and

exercise intervention compared
with lifestyle education.
Postpartum (n = 28)
Postpartum weight loss (n = 17)
1 Adegboye et al., 2013, To evaluate the effect of diet, exercise Women recruited to the Cochrane All studies involved aerobic exercise – 14 RCTs included 8
USA (n = 10), or both for weight reduction in intervention programme Systematic programmes and majority studies
Australia (n = 2), UK women after childbirth, and to up to 24 months after Review gave prescription of a calorie‐ – Women who exercised did not
(n = 1), assess the impact of these childbirth and were of RCTs restricted diet. Programme ranging lose significantly more weight
Taiwan (n = 1) interventions on maternal body overweight or obese, or from 6 months to a 1‐year long. than women in the usual care
composition, cardiorespiratory had gained excessive group.
fitness, breastfeeding
WATSON
ET AL.
TABLE 4 (Continued)
performance and other child and weight during pregnancy, – Women who took part in a diet
maternal outcomes or both. or diet plus exercise programme
lost significantly more weight
than women in the usual care
group.
2 Berger et al., 2014, USA To assess the benefits and harms of Women who were Systematic Combined nutrition and exercise – 13 RCTs included. 7
(n = 9), Iran (n = 1), postpartum behavioural weight postpartum, enroled in the review interventions solely exercise – Greater weight loss in the
UK (n = 1), Taiwan management interventions that study in the early of RCTs interventions, and nutrition‐only combined intervention group
(n = 1), Greece included nutrition, exercise, or postpartum period (up to intervention. versus standard care, ranging
(n = 1), combined nutrition and exercise 12 weeks following from 0.17 to 4.9 kg.
Sweden (n = 1) components. delivery); women from any Trials ranged from 1 day to 6 months – Results from exercise and
geographical and racial/ after delivery. The duration of the nutrition only interventions were
ethnic background. interventions was 3–9 months. inconclusive.
3 Choi et al., 2013, USA To review the effectiveness of PA and Women in the postpartum Systematic All studies included PA (exercise classes – 4 postpartum women RCTs 9
(n = 3), UK (n = 1) PA plus diet interventions in period. review or pedometers) and diet counselling included.
managing weight among of RCTs including one to one and weight‐
overweight or obese pregnant or loss session groups. – Postpartum women in the

postpartum women. combined intervention groups
Interventions ranged between 10 weeks significantly lost more body
and 9 months. weight (−1.22 kg; 95% CI: −1.89,
−0.56) than those in the control
groups.
– Supervised physical activity plus

diet interventions were the most
effective.
4 Dalrymple et al., 2018 To evaluate the effectiveness of Pregnant and postpartum Systematic Intervention content included a – 15 RCTs included (postpartum 7
lifestyle interventions in women with a BMI > 25 review combined approach of diet and n = 12; pregnancy and
overweight or obese pregnant kg/m2 of RCTs physical activity or diet only. postpartum n = 3)
and/or postpartum women for – Postpartum interventions
managing postpartum weight up The intervention duration between reported significant
to 2 years after giving birth. 10 weeks to 10 months. improvements in postpartum
Delivered by dietitian, lifestyle weight when compared with the
counsellor, health coach, nutrition control group.
professional or an interventionist. – Interventions associated with
GWG and PPWR
5 Dodd et al., 2018 To evaluate postpartum dietary and/ Women who had given birth Systematic Diet interventions alone, PA – 27 RCTs included. 9
or physical activity interventions to a healthy singleton review and intervention alone, and combined – A combined intervention
to promote weight loss and infant and (1) were meta‐ diet and PA. provided greater postpartum
improve health in a subsequent overweight or obese; (2) analysis weight loss, which was
pregnancy. had a normal BMI upon of RCTs maintained at 12 months
commencing pregnancy postpartum.
|
(Continues)
27
28
TABLE 4 (Continued)
|
but whose gestational – Dietary intervention in the
weight gain. postpartum period were more
likely to have significant weight
loss at the completion of the
intervention compared with
women who received no
intervention.
6 Ferguson et al., 2019 To investigate the effectiveness of Postnatal women no Systematic Both diet and PA interventions, PA – Nine systematic reviews 7
lifestyle weight management restriction on BMI, review of alone, and dietary interventions included.
interventions for postnatal without a history of GDM. systematic alone. – Meta‐analysis showed that
women. reviews lifestyle interventions involving
Trials >12 weeks duration were PA and/or dietary changes
included. resulted in a reduction in
postnatal weight.
– Participants who received
interventions of between 3 and
12 weeks duration was −2.6 kg
lower than the comparator
group.
7 Garad et al., 2020, USA To identify the health literacy Postpartum women within 2 Systematic Interventions included self‐care, social – 33 RCTs included. 8
(n = 16), UK (n = 3), domains utilized in postpartum years postdelivery review and support or participation in – Health literacy domain self‐care
Australia (n = 5), weight management meta‐ decision‐making or codesign. Three was associated with a significant
Greece (n = 1), Israel interventions and to determine analysis studies has interactions with health reduction in body weight and
(n = 1), Sweden their impact on weight, diet and of RCTs providers. increase in physical activity.
(n = 2), Japan PA in postpartum women. – No other health literacy domain
(n = 1), Canada Delivered by dietitians, health was associated with significant
(n = 2), Thailand interventionist, behavioural outcomes in weight, energy
(n = 1), Taiwan counsellor. intake or physical activity.
(n = 1), Iran (n = 3). Delivered at/by text/phone, centre,
clinic, home, community, outdoor
and school hall.
8 Hutchesson et al., 2020, To examine the extent and range of Women of childbearing age. Systematic Most interventions had a combination – 87 RCTs and 3 systematic 7
USA (n = 40), research undertaken to evaluate review of of diet and physical activity alone or reviews included.
Australia (n = 14) behavioural interventions that RCTs and in combination. – Interventions focused on
support women of childbearing systematic promoting both changes to
age to prevent or treat overweight reviews The interventions were delivered by dietary behaviour and physical
and obesity. dietitians or nutritionists and activity to achieve changes to
clinicians. weight‐related outcomes.
Iinterventions delivered at hospitals,
clinic and the participant's homes.
WATSON
ET AL.
TABLE 4 (Continued)
9 Lau et al., 2017, To assess effective are e‐based Women with overweight or Systematic E‐based lifestyle interventions setting – 5 postpartum RCTs and 2 10
Postnatal: USA lifestyle interventions for obesityduring the perinatal review and behavioural goals and receiving pregnancy and postpartum RCTs
(n = 3), Australia improving maternal and neonatal period (starting from meta‐ lifestyle counselling including included.
(n = 1), Sweden outcomes among overweight or pregnancy to 1 year analysis dietary control. – Meta‐analyses demonstrated
(n = 1) and antenatal obese perinatal women. postpartum). of RCTs significant result for limiting
are the rest. Theoretical/conceptual frameworks gestational weight gain, losing
used design interventions. postnatal weight in 1–2 months,
Duration of the intervention from 4 increasing self‐reported
weeks to 12 months. moderate and vigorous PA and
reducing caloric intake using
diet‐related software.
– E‐based lifestyle intervention is
an acceptable approach.
10 Lim et al., 2020, USA To describe the associations between Postpartum women within Systematic Lifestyle modification (diet, PA or – 46 RCTs included. 8
(n = 14), Australia behavioural strategies and weight 2 years of delivery. review and behavioural therapy). – Meta‐analysis showed
(n = 4), UK (n = 3), loss in postpartum women. The meta‐ postpartum lifestyle
Iran (n = 3), Canada secondary aim was to describe analysis The behavioural change strategies of interventions significantly
problem‐solving, goal setting of
(n = 2), Greece the associations between of RCTs improved weight and PA but not
(n = 1), Sweden behavioural strategies and key outcome, reviewing outcome goal, in energy intake. No individual
(n = 1), Japan lifestyle factors associated with feedback on behaviour, self‐ strategy was significantly
(n = 1), Israel (n = 1), weight loss (i.e., diet (energy monitoring of behaviour, associated with weight or PA
Taiwan (n = 1), intake) and physical activity) in behavioural substitution. outcomes. Behavioural strategies
Thailand (n = 1) postpartum women. relating to self‐regulation are
associated with greater reduction
in energy intake.
11 Lim et al., 2019, USA To evaluate the intervention Postpartum women within Systematic Most studies provided individualized – 33 RCTs included. 8
(n = 15), Australia characteristics associated with 2 years of childbirth. review and lifestyle, dietary or PA goals or – Diet and physical activity
(n = 4), UK (n = 3), weight loss in postpartum women meta‐ plans. combined had significantly
Iran (n = 3), Canada using the TIDieR framework. analysis greater weight loss compared
(n = 2), Sweden of RCTs. Delivered by health professionals, with physical activity‐only
(n = 2), Greece dietitians or nutritionists, exercise interventions.
(n = 1), Thailand physiologists, and nonhealth – Health professional‐delivered
(n = 1), Japan professionals. interventions had significantly
(n = 1), Named theory for the intervention, greater weight loss than those
Taiwan (n = 1) mostly social cognitive theory delivered by nonhealth
(n = 8) and transtheoretical professionals.
model (n = 2).
12 Lim et al., 2015, USA To identify lifestyle intervention Postpartum women within Systematic Combined diet and exercise – 46 studies included, 32 RCTs 9
(n = 24), Australia strategies associated with weight 12 months of delivery. review and interventions, exercise‐only and included in meta‐analysis.
(n = 6), Taiwan loss in postpartum women. meta‐ diet‐only interventions. – Diet and physical activity when
(n = 4), Canada analysis combined were significantly
(n = 3), Austria
|
(Continues)
29
30
TABLE 4 (Continued)
|
(n = 1), Finland Interventions required in‐person more effective on weight loss
(n = 1), Greece participation or telephone delivery. compared with PA alone.
(n = 1), The – Studies with self‐monitoring had
Netherlands (n = 1), A range of health professionals— significantly greater weight loss
Sweden (n = 1), nurses, dietitians, exercise than those without.
Japan (n = 1), UK physiologists, diabetes educators,
(n = 1), China research assistants, trained
(n = 1), counsellors, health educators and
Thailand (n = 1) fitness instructors.
13 Neville et al., 2014, USA To systematically review the Breastfeeding mothers, ≤2 Systematic All studies included an exercise – 6 studies included. 6
(n = 5), literature about the effectiveness years postpartum and with review component either on its own or – Dietary‐based intervention
Sweden (n = 1) of weight management a BMI > 18.5 kg/m2 combined with dietary modification studies appeared to be the most
interventions in breastfeeding or a dietary intervention. efficacious in promoting weight
women. loss; however, few studies were
All interventions were home‐based with tailored toward the needs of
pre‐ and postintervention breastfeeding women.
measurements carried out in a
clinic or research centre.
14 Panagopoulou To present the contemporary Midwifery care to women in Systematic Diet, exercise and postnatal weight – 355 studies included. 2
et al., 2017 parameters of midwifery care in the postnatal period. review and management. – Early postnatal discharge
the postnatal period. qualitative combined with home midwifery
meta‐ Postnatal care at home compared with support reduces costs and
synthesis the hospital, doctor‐led or improves the satisfaction, health
midwifery‐led care. and well‐being of both mother
and infant.
15 Sherifali et al., 2017, To assess the effectiveness of eHealth Adult women of childbearing Systematic Health behaviour component (nutrition – 4 postpartum studies included 8
USA (n = 7), Spain technologies for weight age in the postpartum review and or PA) in the eHealth (6 pregnancy included studies).
(n = 2), UK (n = 1) management during pregnancy period (and during meta‐ technology.Diabetes prevention – The effect for postpartum
and the postpartum period, and pregnancy). analysis programme with 12 online women resulted in a significant
to review the efficacy of eHealth modules. reduction in weight after 3 to 12
technologies on health Duration of the interventions ranged months.
behaviours, specifically nutrition from 23 to 52 weeks. – Significant reduction in total
and PA. daily energy intake of 442.0 kcal
and in percentage of total daily
intake of fat and added sugars
16 Van der Pligt et al., Diet, PA combined and alone Women postpartum Systematic Diet, PA combined and alone 11 studies included. Both dietary and 8
2013, USA (n = 6), interventions. Studies included review interventions. Studies included physical activity components had
Canada (n = 1), theoretical frameworks. theoretical frameworks. the most success at decreasing
Taiwan (n = 1), postpartum weight retention.
Finland (n = 1),
Greece (n = 1),
Sweden (n = 1)
WATSON
ET AL.
TABLE 4 (Continued)
17 Vincze et al., 2019 To evaluate the effectiveness of Women (≥18 years) up to 12 Systematic Combination of individualized PA and – 14 RCTs included in postpartum 9
interventions that include a months postpartum (and review of diet interventions. period, 5 started during
nutrition component aimed at during pregnancy). studies pregnancy and continued to
improving GWG and/or Dieticians were the main deliverers of postpartum.
postpartum weight retention. the intervention. – Meta‐analysis found that
Interventions started from 24 h postpartum women in the
postdelivery to 24 months intervention group lost 3.25 kg
postpartum. Intervention duration more on average than those in
ranged from 10 weeks to 10 the comparator group.
months. – Successful postpartum
interventions after childbirth
included at least one interaction
with a dietitian or nutritionist
and included a structured PA
intervention in addition to
dietary content and specifically
monitoring weight.
Lifestyle interventions for women with previous GDM (n = 6)
18 Goveia et al., 2018, USA To systematically review postpartum Women with previous GDM. Systematic Most interventions focused on changes – 15 RCTs included, 8 RCTs were 9
(n = 3), Australia randomized trials to summarize Women with current or review and in diet and PA. included in the meta‐analysis.
(n = 4), China the benefits of lifestyle previous diagnosis of Type meta‐ – Meta‐analysis found 25%
(n = 4), Spain interventions for women with 1 or Type 2 diabetes were analysis Studies included remote contact, reduction on incidence of
(n = 1), Malaysia previous GDM excluded. of RCTs facilitated group sessions, face to diabetes. Only trials offering
(n = 1), Israel (n = 1), face individual sessions either at intervention soon after delivery
Ireland (n = 1) home or the hospital/clinic. (<6 months postpartum) were
Duration of follow‐up ranged between effective.
6 months and 5 years. – No benefit was found regarding
measures of glycemia. Although
moderate reductions in weight
and waist circumference were
observed, effects were larger with
longer follow‐up.
19 Guo et al., 2016, To evaluate the outcomes of clinical Women previously diagnosed Systematic Postpartum lifestyle interventions – 12 RCTs included. 7
Australia & USA trials that focus on diabetes with having GDM. review included combined and sole – The mean annual T2DM
(n = 7), China and prevention among women with of RCTs nutrition and PA intervention. incidence of the intervention
Hong Kong (n = 5) pervious GDM. group was lower but not
Women were recruited from 6 weeks to significant than the comparison
4 years postpartum and the study group.
duration ranged from 12 weeks to – About 50% of studies and two‐
60 months. thirds of studies, respectively,
Specialists such as dieticians, exercise reported a significant decrease in
physiologists, or diabetes educators insulin resistance‐related
|
(Continues)
31
32
TABLE 4 (Continued)
|
were employed to deliver the measures and weight‐related
intervention. measures in the intervention
group compared with the
comparison group.
20 Hewage et al., 2020, To review the effectiveness and cost‐ Women with a history of Systematic Lifestyle education focused mainly on – 21 included RCTs and 16 studies 9
USA (n = 3), China effectiveness of lifestyle GDM of any parity or review and education and provided counselling included in the meta‐analysis.
(n = 3), Ireland interventions on anthropometric, ethnic origin. meta‐ on improving PA and dietary – Meta‐analysis found significant
(n = 2), Hong Kong glycemic and cardiovascular analysis of behaviour. postpartum weight mean
(n = 1), Malaysia outcomes in women with RCTs and reduction in the
(n = 1), Israel (n = 1), previous GDM. cost‐ Most studies included one‐to‐one intervention arm.
Egypt (n = 1), effective- sessions, some had group meetings – The effect of lifestyle
Spain (n = 1). ness or supplemented with phone intervention on weight change
analysis consultations. was significantly greater in
Trial duration/follow‐up was 13 weeks studies of longer duration.
to 12 months.
21 Jones et al., 2017 To synthesize current knowledge and Women with prior GDM. Systematic Diet and PA interventions with – 10 RCTs included. 5
practices around tailoring review behaviour change. – RCTs found both significant
multimodal interventions for of RCTs reduction of total fat intake, total
situational and cultural relevance Modes: Telephone and mailings (n = 7) carbohydrate intake, and
to reduce DM risk in women and websites (n = 3) at home. glycemic load.
with prior GDM. Interventions started both during – RCTs found nonsignificant small
pregnancy and in the postpartum changes in weight loss, decreased
period dietary fat, and increased
breastfeeding
– No RCTs found improvement
in PA.
22 Li et al., 2020 To address: (1) the effects of lifestyle Women with GDM in the Systematic Nutrition, PA and lifestyle – 10 RCTs included for 9
Postpartum: China intervention (diet and/or physical index pregnancy without review interventions. postpartum
(n = 6), Spain activity and the use of insulin if having Type 1 diabetes of RCTs – Lifestyle intervention within 3
(n = 1), USA (n = 1), needed) during pregnancy on the mellitus or T2DM before Intervention duration between 4 weeks years after delivery was highly
Malaysia (n = 1) risk of diabetes postpartum and the intervention. and 3 years. Most lifestyle effective in reducing the risk of
(2) the effects of lifestyle interventions were delivered within postpartum diabetes.
intervention (diet and/or physical 3 years postpartum. – Lifestyle intervention during
activity) within 3 years after pregnancy was not effective at
delivery, that is, before the peak reducing the risk of postpartum
risk period of diabetes after diabetes.
delivery, on the long‐term risk of
diabetes among women with
prior GDM.
23 Schoenaker et al., 2021 To provide an overview of findings Women at risk of GDM Review of Preconception risk assessment ‐ 12 RCTs included. 2
from observational and systematic ‐ Healthcare providers could
intervention studies on the role review with play a role in supporting
WATSON
ET AL.
TABLE 4 (Continued)
of diet, physical activity, and meta‐ Diet, physical activity alone and healthy behaviours and
weight (change) during these analysis combined. prevention of weight retention,
periods in the primary and contribute to providing
prevention of GDM Digitally delivered and linked health continuum of care before,
technology (smartphones, Websites, during, and between
text messaging, wearables, and pregnancies.
sensors)
Postpartum additional outcomes (n = 5)
24 Lui et al., 2019 To identify trialled interventions to Women <10 years postpartum Systematic One calcium trial starting from the first – 2 RCTs included. 9
reduce cardiovascular risk after HDP. review follow‐up visit outside of pregnancy – Calcium trial found a
after HDP. of RCTs and continued until 20 weeks' nonsignificant trend toward
gestation if another pregnancy decreased blood pressure.
occurred. – Education RCT found significant
increase in knowledge of CVD
One online education programme RCT risk factors, reported healthy
to increase awareness of risk factors eating and decreased physical
and personalized phone‐based inactivity.
lifestyle coaching in women who

had a pre‐eclampsia affected
pregnancy in the 5 years preceding
enrolment.
25 Markova et al., 2015 To assess the efficacy and harms of Women with a postpartum Hb Systematic Interventions included: Oral iron – 22 RCTs included. 9
the available treatment modalities value of 120 g/L review therapy, folate (folic acid and – Evidence was not clear regarding
for women with postpartum iron (7.4 mmol/L) or less. of RCTs vitamin B9), parenteral the efficacy of the interventions
deficiency anaemia. These administration of iron, on postpartum iron deficiency
include oral and parenteral iron, erythropoietin, blood transfusion anaemia.
erythropoietin, and blood allogeneic blood. – Intravenous iron was superior
transfusion. regarding gastrointestinal harms;
however, anaphylaxis and
cardiac events occurred and
more data are needed to establish
whether this was caused by
intravenous iron.
26 Oliveira et al., 2016 To evaluate the effects of Vitamin A Postpartum women, Systematic Maternal Vitamin A supplementation – 14 RCTs included. 10
supplementation for postpartum breastfeeding or not, from review (β‐carotene or retinyl palmitate in – There was no evidence of benefit
women on maternal and infant countries where Vitamin A of RCTs oil or water‐miscible formulation) from different doses of Vitamin
health. deficiency is a concern alone or in combination with other A supplementation for
were eligible. micronutrients (examples: iron, postpartum women on maternal
folic acid, vitamin E). and infant mortality and
morbidity, compared with other
doses or placebo.
(Continues)
| 33
34 | WATSON ET AL.
Abbreviations: BMI, body mass index; CI, confidence intervals; GDM, gestational diabetes mellitus; GWG, gestational weight gain; HDP, hypertensive disorders after pregnancy; PA, physical activity; PCHC, preventive child health care; PPWR,
nutritionists were advised to include dietary advice for
RoB
10
9
families on low budgets.62,68,71–74 Community schemes
were recommended, such as cooking and eating clubs.68
The frequency of the study intervention – Significantly higher mean infant‐
food hygiene for complementary

Practical cooking lesson, meal planning, – 12 included postpartum studies.
intervention group at follow‐up

Health professionals were recommended to promote
cooking skills of postpartum
– Significant improvements in
mothers in the intervention
– Significant improvement in
supplementation, for example, with folic acid, Vitamins C
women and parents in the
feeding practice scores by

and D,62,67,75,76 for mothers postpartum through the
Healthy Start scheme.68 Women with previous GDM are
feeding practices.
offered a diabetes test and lifestyle support when planning
0 RCTs included.
for subsequent pregnancies, and advised on managing
Key findings
group.
blood glucose levels.77 Women with overweight or obesity
are recommended to be offered a tailored weight‐loss
programme with their health professional or a club such as
Slimming World.62,67,70,71,78–80 Slimming World pro-
ranged from weekly to monthly and
grammes reduce energy intake whilst meeting the UK

surgery, as well as educational and
some interventions were provided
Interventions could include laxatives,

culinary medicine and nutrition,
dietary guidelines.81
in intense, short bursts ranging
from 2 to 12 consecutive days.
and cooking or culinary skills
education of any duration.
postpartum weight retention; RCTs, randomized control trials; T2DM, Type 2 diabetes mellitus incidence; TIDieR, Template for Intervention Description and Replication.
behavioural interventions.
Nutrition‐sensitive interventions
Nutrition‐sensitive interventions indirectly address the

underlying determinants of fetal and child nutrition and
Intervention
development, such as through nutrition security, caregiving

resources, access to health services and safe and hygienic
environments.65 Guidelines for indirectly supporting nutri-
tion recommend that postpartum women engage in regular,
moderate‐intensity physical activity.67,69,70,82 Health profes-
review of
of RCTs
studies
Systematic
Systematic
review
sionals were recommended to screen and monitor women's

Method
and infants' well‐being,71,83–87 especially during crises such

as coronavirus disease 2019 (COVID‐19) lockdowns.88
(including or not including
Overall, many guidelines targeted recommendations to-

up to 5 years postpartum
including their partners)
their child or children).
Women in the postpartum
wards healthcare professionals. This included supporting

To determine the impact of culinary Women (including or not
women with other health issues, which indirectly impact on

nutrition, such as mental health, recovery from labour,
dyspareunia, urinary issues, domestic violence, substance
abuse and loss of a pregnancy.70,85,89–92 Many of these
Participants
period.
interventions included an element of social support which

can enhance nutritional behaviour and well‐being.79,85,93
Two guidelines recommended and enacted financial
nutrition‐education interventions
for women with or without their
parental cooking skills, nutrition
schemes for parents with newborns and maternity and

partners during preconception,
paternity payment during the COVID‐19 pandemic.94,95

pregnancy or postpartum on
knowledge, parent/child diet
To evaluate the effectiveness of

quality or health outcomes.
Guidance also advised that fathers need to be offered

interventions for treating
postpartum constipation.
information and support in adjusting to their new role and

responsibilities within the family unit.72,85,88,96,97 For
parents who have experienced a previous pregnancy loss,
extra appointments with health professionals have been
proposed as important for reassurance; however there is
little guidance on this.91,97
Aims
Person‐centred care
Author, year, country
countries (n = 20),
(Continued)
countries (n = 8),
countries (n = 3).
28 Turawa et al., 2014

27 Taylor et al., 2020,
middle‐income
High‐income
low‐income
Health professionals were advised to use evidence‐based

behaviour change techniques to motivate and support
families with their nutrition and health.62,67,69,70,78,98 This
TABLE 4
includes being able to help people to identify how their

behaviour is affecting their health, draw up an action plan,
#
make the changes and maintain them. Advice and support

TABLE 5 Health guidelines mapped to the six domains identified in the paper
Six domains (cross indicates that the guidance included the domain)
Organization Nutrition‐ Nutrition‐ Role of the Need for a multi‐
(number of Interconception specific sensitive Person‐ health stakeholder
documents) Target group care interventions interventions centred care professional approach
NICE (16) Health professionals X X X X X
Parliamentary Member of X X X X X
guidance (13) parliament
Royal colleges (5) Health professionals X X X
PHE guidance (4) Health professionals X X X X X
Tommy's Researchers, women X X X X

charity (4) considering a
pregnancy
Sure Start (3) Families X X X X X
First steps Health professionals X X

nutrition (2)
Note: Charitable organizations and NGOs with a website provide information for the general public.
Abbreviations: NGO, non‐governmental organization; NICE, National Institute for Health and Care Excellence; PHE, Public Health England.
were recommended to be tailored and personalized to each through the use of tools such as the FIGO nutrition
family, to discuss realistic postpartum nutrition plans and checklist103 and provide appropriate support. Women
expectations that fit into their life.67,69,70,79,83–85,89 This type identified as high risk were recommended to be referred
of care was proposed to continue across the reproductive to dieticians for specific nutritional issues, or to health
life course from preconception before the first pregnancy to visitors, GPs, and nurses to discuss weight management
interconception care in subsequent pregnancies.66,86,87,98–100 throughout the reproductive period, especially postpar-
The interconception period is unique in that health tum.67,69,78 Health professionals were advised to have
professionals can support women based on their previous appropriate knowledge and skills to give advice on balanced
pregnancy experience to minimize risk and support healthy diets, supplements, nutritional needs of infants and weight
behaviour changes. management.67,68,70,71
Role of the health professional Need for a multi‐stakeholder approach

Supportive communication from health professionals was a A consistent domain was that third sectors and local
key thread throughout the guidelines. These recommended authorities have roles to play in supporting women with
that health professionals should provide advice, support and breastfeeding, mental health and parenting support, and in
an opportunity to explore family concerns.67,72,83–85,101 This providing community services and recreational pro-
included support for setting goals on breastfeeding, diet and grammes such as walking groups and affordable
physical activity.62,67,69 Continuous, monitored and updated creches.67,71,75,78,79,89,93 Pharmacists were encouraged to sell
training for health professionals on communication skills healthy start supplementation.75 Community‐focused ap-
and technical knowledge of nutrition and wider health proaches were widely recognized to have a greater reach,
advice was a consistent domain.62,70 ensure that families are not left behind, and provided
The guidelines emphasized that continuity of care is accessible opportunities for women to discuss and make
needed across the reproductive period, with recommenda- changes in the interconception period. A multi‐stakeholder
tions to have the same health professionals for each woman approach would guarantee a more holistic collaborative
and consistent online and in‐person support.71,85 During strategy to interconception health, with organizations
the COVID‐19 pandemic, health visitors and mothers working together to avoid duplicating efforts and save
became more adept and confident with online communica- funds. Food manufacturers, retailers and supermarkets were
tion tools to ensure continuity of care,88,89,102 offering an recommended to be engaged in creating healthier food
opportunity to use these for blended support in the future.67 environments.68,75,104 The UK Department of Health and
Health professionals were also encouraged to be connected Social Care announced a change in legislation to restrict the
to and refer at‐risk women to other health professionals or promotions of unhealthy foods in retailers in April 2022,105
to organizations external to the health system.85,89 For which might hold manufacturers, retailers and super-
example, they could identify nutritionally at‐risk women markets more accountable. Devolved UK administrations
36 | WATSON ET AL.
are advised to also engage in co‐producing policies that and Public Involvement (PPI) project found that language
consider the full reproductive life course, including the around gender in the interconception period is not
interconception period. National parliaments in the United currently inclusive of all genders.109,110 Language within
Kingdom were advised to hold governments to account in this period focuses on ‘pregnant women,’ ‘mothers’; and
delivering the above policies through select committee ‘fathers,’ yet, as one PPI contributor explained “To become
scrutiny and advocacy functions. pregnant, you need a uterus (womb) but you don't need to be
a woman”.109 More work needs to be conducted on how
best to engage parents from all backgrounds in the
DISCUSSION interconception period.
The policy guidance and scoping review evidence
This scoping review and policy analysis revealed an suggested conducting risk assessments to screen parents in
important gap in interconception care interventions and clinical and community settings. This would support
guidelines to improve maternal and child health; only one consideration of the parent's biological, physical and
systematic review on interconception care was identified, psychosocial factors that can lead to a better understanding
which itself found no studies. The identified pilot studies on of their wider underlying circumstances, pick up asympto-
interconconception health provided insight into the poten- matic and missed cases, reduce inequalities such as some
tial benefits of intervening in the interconception period, high‐risk groups and structure a personalized intervention.
including by improving women's uptake of multivitamins It is therefore important to understand the attitudes of
supplements, mental health support, use of contraception, families receiving interconception care, concerning their
physical exercise and dental care.25,26 These pilot studies previous pregnancy and its outcomes. This should include
should be seen as preliminary evidence and more large‐scale conversations about parents' knowledge of the importance
research is needed to draw robust conclusions. The of healthy behaviours such as physical activity and diet for
identified systematic reviews on intervening in the postpar- both their own and their child's health and preparation for a
tum period, particularly diet and physical activity interven- subsequent pregnancy. This would enable parents and
tions, revealed significant reductions in women's postnatal health professionals to cocreate acceptable and effective
weight and prevalence of diabetes. The UK guidance interventions in this period.
advised similar nutrition‐based advice to that utilized in
the pilot studies and review of reviews, but also had a focus
on the wider determinants of health, such as financial INTERPRETATION
aspects. This scoping review provides an overview of the
potential components of effective interconception care Based on the findings of our scoping review and policy
intervention and guidelines, but further work is needed to analysis, we propose that postnatal care, for example, with
gain secure evidence on the short‐ and long‐term maternal health visitors or home‐visiting programmes, should be
and child health outcomes of intervening in the inter- redesigned to ensure continuity from antenatal to postnatal
conception period. care and to promote parents' and baby's lifelong
Overall, results from both the scoping review and policy health.88,89,102 This should focus on planning, preparation,
analysis suggest that the interconception and postpartum optimizing health, nutrition and lifestyle for any future
periods offer important opportunities to reduce possible pregnancies. Health professionals should be trained in
negative long‐term effects on the offspring, or problems for supportive and nonstigmatizing communication skills
the mother such as GDM, hypertension, nutritional informed by behaviour change techniques,62,67,69,70,78,98 to
deficiencies or reduction of postpartum weight retention, facilitate empowering person‐centred consultations and
and to prevent problems in any future pregnancies. considering the whole reproductive life course,66,86,87,98–100
Postpartum health also affects outcomes of the next including the interconception period. Although the success
pregnancy106 and experiencing an adverse outcome in a of these types of training is reported in the literature, more
previous pregnancy is a strong predictor of future needs to be done to train health professionals. One such
reproductive risk.107 Postpartum visits are a useful gateway training based on these principles is Making Every Contact
to interconception care.107 Current clinical guidelines for Count (MECC) ‘Healthy Conversation Skills’ training.111
postpartum care recommend support on breastfeeding, Health Education England extends this training as part of
healthy diet and physical activity, weight loss and contra- the MECC initiative that enables health and social care
ception.108 Figure 2 illustrates the opportunities to intervene practitioners to have brief but meaningful conversations
in the interconception period based on this review. with every patient they meet. Health professionals trained in
Pregnancy planning and contraception offer a window MECC have the unique opportunity to discuss interconcep-
of opportunity to have conversations about interconception tion care with women and their partners.
nutrition and health with parents. This includes the We suggest that health professionals conduct risk
appropriate language to be used when talking to parents. assessments in routine appointments on topics including
The studies and guidelines included in our study focused diet and nutrition, physical activity, mental health, domestic
only on people who identified as female. A recent Patient abuse, alcohol or drug use, smoking, finances and housing,
FIGURE 2 Care opportunities for nutrition in the interconception period (Uploaded in Supplementary Information documents)
and dental health.25,26 This could include asking parents if scheme to receive vitamin supplements (folic acid, Vitamins
they had a high‐risk pregnancy. In routine appointments, C/D).68 Nonhealth organizations such as local authorities
health professionals could also consider delivery of a diet and the third sector could also contribute to this agenda by
and physical activity intervention during the postpartum providing community programmes to support family‐wide
period to support weight management and prevent future nutrition, especially between pregnancies.67,71,75,78,79,89,93
diabetes33–41 and, by proxy, interconception health and Those in the food production and consumption industries
health in the next pregnancy. This should be provided in a and policy‐makers should engage in ways to create healthier
supportive nonstigmatizing manner, as we know that food and an overall healthy environment.68,75,104
parents are prone to weight stigma during preconception,
pregnancy and postpartum.112 Future research is needed in
in this area exploring pilot interconception interventions in STRENGTHS A ND LIMITATIONS
routine care, with long‐term follow‐up to assess the impact
on parental and infant outcomes including interpregnancy This is a substantial scoping review of international
weight, GDM, conversion to Type 2 diabetes, breastfeeding published and grey literature with the UK as a case study
and incidence of postnatal depression. within the interconception and postpartum period. Quality
Although the guidance on postpartum follow‐up of assessment was conducted using a validated tool.19
parents who had GDM or high‐risk pregnancies being Although only 30% of the published systematic reviews
offered annual HbA1c tests and self‐monitoring of HbA1c were double‐screened and extracted by two independent
levels is available, it is unclear how often this is reviewers, overall there was agreement between the two
implemented in routine care.77 This also needs to be reviewers and discrepancies were resolved through discus-
connected with an offer of an Oral Glucose Tolerance Test sion. The scoping review provides an updated overview of
in future pregnancies. We call on public health commis- opportunities to deliver interconception care. Although the
sioners and managers to improve enrolment of eligible primary focus was to develop recommendations specific to
parents with children aged 0–4 years onto the Healthy Start the UK setting, the findings can support interconception
38 | WATSON ET AL.
care in other settings too, such as other high‐income Research Centre, and Chandni M. Jacob is supported by the
countries that this review draws evidence from. A limitation European Union's Horizon 2020 LifeCycle Project under
of our analysis is that specific recommendations for grant agreement number 733206. For the purpose of Open
countries in the global south would require a separate Access, the author has applied a Creative Commons
review considering the differences in dietary patterns, the Attribution (CC BY) licence to any Author Accepted
triple burden of malnutrition and other risk factors for Manuscript version arising from this submission.
NCDs. Being a scoping review, and due to heterogeneity in
outcomes considered, a meta‐synthesis could not be CO N F LI C T O F I N T E R E S T
performed. None to declare. Keith Godfrey has received reimbursement
for speaking at conferences sponsored by companies selling
nutritional products, and is part of an academic consortium
CO NC LU SION that has received research funding from Abbott Nutrition,
Nestec, BenevolentAI Bio Ltd. and Danone.
Although there is limited evidence of the effectiveness of
intervening in the interconception period, evidence from DA TA AVAILABILITY STATEME NT
pilot interconception studies and systematic reviews on Data sharing is not applicable to this article, as no new data
intervening in the postpartum period provide a starting were created or analysed in this study.
point for developing future effective interventions and
guidelines to improve maternal and child health. Interven- ETHICS STATEMEN T
ing in the interconception period potentially offers a crucial Not applicable.
opportunity to intervene, to reduce possible long‐term
effects of suboptimal nutrition on the parent, their child and ORCID
in a future pregnancy. Clinical stakeholders can contribute Daniella Watson http://orcid.org/0000-0001-6353-7495
to this agenda through routine appointments, conducting Chandni M. Jacob http://orcid.org/0000-0002-2024-0074
risk assessments and by being trained to use empowering Fionnuala M. McAuliffe http://orcid.org/0000-0002-
behaviour change communication skills. Investment by UK 3477-6494
public health organizations and government agencies in Keith Godfrey http://orcid.org/0000-0002-4643-0618
determining the value of intervening in the interconception Mark Hanson http://orcid.org/0000-0002-6907-613X
period is needed; if found to be effective, further investment
will be needed in guideline development and translation of REF ER ENC ES
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Family Nurse Partnership, making a real difference for young doi:10.1002/rfc2.8

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Received: 2 March 2022 | Revised: 12 May 2022 | Accepted: 7 June 2022

A scoping review of nutritional interventions and policy

Daniella Watson1 | Chandni M. Jacob2,3 | Gareth Giles4 |

18 | wileyonlinelibrary.com/journal/rfc2 Reproductive, Female and Child Health. 2022;1:18–41.

INTRODUCTION routine health visitor appointment postpartum, by health

TABLE 1 Inclusion criteria and search terms

PICO Inclusion criteria description Search terms

were generated from thematic analysis of the policy

Findings from pilot studies on interconception

Six studies were identiﬁed, scoring high (1) to moderate (5)

TABLE 2 Risk of bias for pilot studies

Note: ROB score: +1 is low ROB, 0 is medium, −1 is high ROB.

Berger, 2014 ✓ ✓ ✓ ✓ ✓ ✓ X ✓ X ✓ 7 Moderate

Choi, 2013 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong

Dalrymple, 2019 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong

Dodd, 2019 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong

Ferguson, 2019 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ X X 7 Moderate

Garad, 2020 ✓ ✓ X ✓ ✓ X ✓ ✓ ✓ ✓ 8 Strong

Goveia, 2018 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong

Guo, 2016 ✓ ✓ X ✓ ✓ ✓ ✓ X X ✓ 7 Moderate

Hutchesson, 2020 ✓ ✓ ✓ ✓ ✓ X NA ✓ X ✓ 7 Moderate

Hewage, 2019 ✓ ✓ ✓ ✓ ✓ X ✓ ✓ ✓ ✓ 9 Strong

Jones 2016 ✓ ✓ X ✓ ✓ ✓ X X X X 5 Moderate

Lau, 2017 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 10 Strong

Li, 2020 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ X ✓ 9 Strong

Lim, 2015 ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓ 9 Strong

Lim, 2019 ✓ ✓ X ✓ ✓ X ✓ ✓ ✓ ✓ 8 Strong

Lim, 2020 ✓ ✓ X ✓ ✓ ✓ X ✓ ✓ ✓ 8 Strong

Lui, 2019 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ X ✓ 9 Strong

Markova, 2015 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ X ✓ 9 Strong

Neville, 2014 ✓ ✓ X ✓ ✓ X X ✓ X ✓ 6 Moderate

Oliveira, 2016 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 10 Strong

Schoenaker, 2021 ✓ X X X ✓ X X X X NA 2 Weak

Sherifali, 2017 ✓ ✓ X ✓ ✓ X ✓ ✓ ✓ ✓ 8 Strong

Taylor, 2020 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ X ✓ 9 Strong

disorder of pregnancy55 or with postpartum iron deﬁciency

outdoors and school halls.38,41,46 Interventions were also

delivered by a range of clinical and nonclinical profes-

sionals, including midwives, general practitioners, dietitians,

nutrition professionals and interventionists.35,38,41,59,60

tions resulted in greater weight loss for mothers compared

with nonhealth professionals.59 Early postnatal discharge

well‐being of both mother and infant.61

Review of Interconception and postpartum

Forty‐seven documents with guidelines on interconception

identiﬁed from health bodies including NICE, PHE and the

(Table 5). The guidance highlighted six key domains as

Guidance on nutrition during the interconception period

was more aimed at women postpartum without considera-

tion of impacts on potential future pregnancies. Guidelines

on the interconception period recommended weight

and consideration on contraception postdelivery.18,63 PHE64

guidance advised that interconception plans should be

discussed with health visitors in the antenatal period and be

Nutrition‐speciﬁc interventions directly address immediate

determinants of fetal and child nutrition and development

through adequate food and nutrient intake, feeding and

caregiving.65 Guidance by the Parliamentary Oﬃce of

Science and Technology66 and other bodies62,67–71 recom-