What should the world measure before pregnancy? 5,000 people across 13 countries weigh in

The gap between pregnancy care and pre-pregnancy care

Healthcare systems worldwide have invested heavily in prenatal care - monitoring mothers and fetuses from the first trimester onward. But by the time a pregnancy is confirmed, some of the most consequential biological and social factors are already locked in. Obesity, diabetes, mental illness, substance use, nutritional deficiencies, medication exposure - all shape pregnancy outcomes, and all are established well before conception.

The problem is not that clinicians are unaware of this. The problem is that no standardized system exists to track preconception health at a population level. Individual countries monitor fragments - England tracks folic acid supplementation rates, for example - but there is no agreed-upon global framework for measuring whether populations are entering pregnancy in good health.

A new study published in The Lancet, led by researchers at University College London and the University of Southampton, takes a significant step toward building one.

From 120 indicators to a workable list

The research team began by identifying every health indicator that could plausibly be relevant to preconception health. They found more than 120. That is far too many for any routine surveillance system. The challenge was narrowing the list to a core set that could be compared across countries with vastly different healthcare infrastructures.

Through what Professor Judith Stephenson at UCL described as "a rigorous collaborative process," the team whittled 120-plus indicators down to roughly 40, covering 12 domains: wider determinants of health (education, employment, housing), healthcare access, emotional and social wellbeing, reproductive health, health behaviors and weight, environmental exposures, preventive screening, immunization and infections, mental health conditions, physical health conditions, medication safety, and genetic risk.

The indicators cover both women and men, reflecting growing evidence that paternal health factors - including weight, substance use, and age - independently influence pregnancy and child outcomes.

What the public actually cares about

Most health monitoring systems are designed by health professionals. This study did something different. The researchers surveyed more than 5,000 people from 13 countries - including Australia, Bangladesh, Brazil, Ghana, Kenya, and the UK - asking what factors would matter most to them before a pregnancy.

The answers were remarkably consistent across geography and gender. Mental health topped the list nearly everywhere. Physical health, supportive relationships, and financial stability followed closely. These priorities did not shift dramatically between high-income and low-income countries, or between men and women.

That consistency matters. It suggests that a core monitoring framework could genuinely work across diverse national contexts. "We have, for the first time, produced a set of agreed metrics which reflect the views of the general public," Stephenson said. "Together, these indicators will give us a more holistic view of health before people try to get pregnant."

Why governments cannot see what is not measured

Dr. Danielle Schoenaker from the University of Southampton and the NIHR Southampton Biomedical Research Centre framed the practical stakes clearly: "Without the right monitoring systems, governments and health services cannot easily see whether their policies and programmes are working."

Consider folic acid. Supplementation before conception reduces neural tube defects. Some countries fortify staple foods. Others run awareness campaigns. Others do neither. Without standardized measurement, there is no way to compare what works, where the gaps are, or whether investment in preconception programs is paying off.

Multiply that across 12 health domains and 178-plus countries, and the scale of the monitoring gap becomes apparent. A woman entering pregnancy with uncontrolled diabetes in Accra, a man with untreated depression in Sao Paulo, a couple exposed to workplace chemicals in Dhaka - each represents a preconception health failure that current systems largely do not capture.

The road to a global standard

The indicator list is not final. A workshop scheduled for Geneva in November 2026 will bring together researchers, clinicians, policymakers, and members of the public to finalize the core set. The researchers then plan to call on the World Health Organization, the UK's National Health Service, and other national agencies to incorporate these indicators into existing health surveillance infrastructures.

That last step is crucial - and uncertain. Building new surveillance systems from scratch is expensive and slow. The researchers' strategy is to piggyback on systems that already exist, adding preconception indicators to routine data collection rather than creating parallel infrastructure. Whether individual countries will adopt the framework remains an open question, particularly in low-income settings where basic health data collection is already stretched thin.

"A strong international collaboration is now needed to achieve consensus on which core indicators can be compared across low-, middle- and high-income countries," Stephenson said.

The study represents the work of the international Core Indicators for Preconception Health and Equity (iCIPHE) Alliance. If the group succeeds, the result will be something that currently does not exist: a global picture of whether humanity is entering parenthood healthy - or whether we are building the next generation's health problems before the first cell divides.