Effectiveness of Preconception Nutritional Supplements and Behavioral Interventions: A Systematic Review and Meta-analysis
1
Faculty of Nursing, University of Alberta, Edmonton, Canada
2
Robinson Research Institute,, University of Adelaide, Adelaide, Australia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Preconception health influences pregnancy outcomes, with poor nutrition and health-related behaviors linked to anemia, preeclampsia, and fetal growth restriction. Despite increasing attention, evidence on preconception nutritional and behavioral interventions remains limited, fragmented, and inconsistently synthesized.
OBJECTIVES:
To synthesize evidence on the effectiveness of preconception nutritional supplementation and behavioral interventions across maternal and neonatal health outcomes.
METHODS:
We conducted a systematic review and meta-analysis following PRISMA guidelines and PROSPERO registration (CRD42024592645). Studies published from the inception to October 1, 2024, were identified through major databases. Eligible designs included randomized, non-randomized, and controlled before–after studies involving women aged 18–45 planning pregnancy. Interventions included nutritional supplementation (e.g., folic acid, calcium, multiple micronutrients) and behavioral/lifestyle strategies (e.g., counseling, diet, physical activity) and were analyzed separately by intervention type and outcome. Meta-analyses were conducted using RevMan software. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was rated using GRADE.
RESULTS:
Twenty-four studies were included. Lifestyle interventions reduced the risk of gestational diabetes mellitus (GDM) (RR: 0.76; 95% CI: 0.60–0.95), lowered gestational weight gain (GWG) (MD: –3.88 kg; 95% CI: –10.53 to –4.75), and improved GWG adequacy (RR: 1.62; 95% CI: 1.17–2.25). Nutritional supplementation reduced GDM risk (RR: 0.55; 95% CI: 0.43–0.71), increased birth weight by 72.26 g (95% CI: 47.40–97.12; I² = 96%), reduced preeclampsia risk with calcium (RR: 0.71; 95% CI: 0.54–0.92), and lowered neurodevelopmental disorder risk with folic acid/multivitamin use (RR: 0.14; 95% CI: 0.11–0.18). No pooled or synergistic effects across intervention categories were estimated.
CONCLUSIONS:
Outcome-specific evidence suggests that preconception nutritional and behavioral interventions are associated with improvements in selected maternal and neonatal outcomes. However, heterogeneity and limitations of underlying studies constrain causal inference, underscoring the need for rigorous longitudinal and integrated intervention research.
Preconception health influences pregnancy outcomes, with poor nutrition and health-related behaviors linked to anemia, preeclampsia, and fetal growth restriction. Despite increasing attention, evidence on preconception nutritional and behavioral interventions remains limited, fragmented, and inconsistently synthesized.
OBJECTIVES:
To synthesize evidence on the effectiveness of preconception nutritional supplementation and behavioral interventions across maternal and neonatal health outcomes.
METHODS:
We conducted a systematic review and meta-analysis following PRISMA guidelines and PROSPERO registration (CRD42024592645). Studies published from the inception to October 1, 2024, were identified through major databases. Eligible designs included randomized, non-randomized, and controlled before–after studies involving women aged 18–45 planning pregnancy. Interventions included nutritional supplementation (e.g., folic acid, calcium, multiple micronutrients) and behavioral/lifestyle strategies (e.g., counseling, diet, physical activity) and were analyzed separately by intervention type and outcome. Meta-analyses were conducted using RevMan software. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was rated using GRADE.
RESULTS:
Twenty-four studies were included. Lifestyle interventions reduced the risk of gestational diabetes mellitus (GDM) (RR: 0.76; 95% CI: 0.60–0.95), lowered gestational weight gain (GWG) (MD: –3.88 kg; 95% CI: –10.53 to –4.75), and improved GWG adequacy (RR: 1.62; 95% CI: 1.17–2.25). Nutritional supplementation reduced GDM risk (RR: 0.55; 95% CI: 0.43–0.71), increased birth weight by 72.26 g (95% CI: 47.40–97.12; I² = 96%), reduced preeclampsia risk with calcium (RR: 0.71; 95% CI: 0.54–0.92), and lowered neurodevelopmental disorder risk with folic acid/multivitamin use (RR: 0.14; 95% CI: 0.11–0.18). No pooled or synergistic effects across intervention categories were estimated.
CONCLUSIONS:
Outcome-specific evidence suggests that preconception nutritional and behavioral interventions are associated with improvements in selected maternal and neonatal outcomes. However, heterogeneity and limitations of underlying studies constrain causal inference, underscoring the need for rigorous longitudinal and integrated intervention research.
| eISSN: | 2654-1459 |
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