Influence of paternal preconception health on pregnancy, intrapartum, postpartum and early childhood outcomes: protocol for a parallel scoping review

Strengths and limitations of this study

  • The protocol follows the well-established methodology from Joanna Briggs Institute to ensure the production of a high-quality review.

  • Included studies will report on paternal preconception health across the perinatal period and into early childhood (0–5 years).

  • The search is only conducted in English, which might miss eligible, non-English studies.

Introduction

Preconception care is defined as the provision of behavioural, social or biomedical interventions to women and partners before conception.1 Preconception care can enable and optimise health while limiting risk factors associated with short-term and long-term adverse outcomes for women, men and their children. In this study, ‘women’ are defined as all perinatal persons who are able to do the physical act of birthing regardless of their gender identity or expression. ‘Men’ are defined as the non-birthing partners of women who participate in the procreation of children.

While there is international consensus on the importance and key components of preconception care,2 the attributes of men receiving preconception care remain unclear.3 Paternal preconception care is important due to ever-growing evidence suggesting the male partner’s health and well-being before birth can significantly influence diverse child outcomes, including obesity and psychopathology.4 5 Evidence supporting paternal preconception care considers men’s contribution to child health and development before conception via direct (genetic and epigenetic contributions—health and lifestyle behaviours, exposure to environmental toxins, life stressors and neuroendocrinology) and indirect pathways (the couple’s relationship and the influence of men on their partner’s health and health behaviours).4 To promote the importance of paternal preconception health,6 the Paternal Origins of Health and Disease model7 was developed and suggests the preconception population includes all reproductively aged women and men.

The care provided during the preconception period must respond to a clear set of exposure factors that are relevant to everyone. A systematic review of preconception care guidelines8 found that of the 11 articles identified only half provided preconception care guidance for men. There is a need for health professionals and couples to readily access evidence-based information regarding paternal preconception health exposures and outcomes to inform clinical practice and direct health decisions. To date, the evidence in the field of paternal preconception is disjointed and focused on particularly modifiable or non-modifiable health conditions on specific perinatal and child health outcomes. For example, there are systematic reviews that have found that paternal smoking during the preconception period is associated with an increased risk of pregnancy loss9 and childhood acute lymphoblastic leukaemia.10 Similarly, non-modifiable factors such as advanced paternal age have also been associated with low birth weight11 and pregnancy loss.12 However, what is missing from the current evidence in this field is an overarching review of the influence of paternal preconception health on perinatal and early childhood outcomes, which can be used as a framework to inform this field moving forward.

A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis and PROSPERO was conducted and no current or underway systematic reviews or scoping reviews on the topic were identified. A previous systematic review of paternal preconception care was completed by Carter et al
13 but focused narrowly on correlations or associations between modifiable risk factors and the influence on adverse pregnancy and/or offspring outcomes. As there is no clear synthesis of the available evidence on the influence of paternal preconception health on perinatal and child outcomes, a scoping review was undertaken, rather than a systematic review. As part of the current scoping review, consolidating outcomes is important to guide future systematic reviews. The current scoping review builds on the existing evidence through the examination of the influence of modifiable (eg, body mass index (BMI), environmental exposures) and non-modifiable (eg, age, medical diagnosis) paternal preconception health broadly. Additionally, the current review is not limited to adverse perinatal and child outcomes but is inclusive of both adverse (eg, miscarriage, childhood cancer) and non-adverse (eg, time to pregnancy, birth weight) outcomes.

This protocol outlines two scoping reviews. A decision to conduct two parallel scoping reviews was undertaken for a variety of reasons. First, the search strategy would yield a potentially large overlap of the same studies, thus, one single search will be conducted with the studies allocated to the appropriate review based on outcomes, potentially included in both reviews. Second, by separating the outcomes into pregnancy/intrapartum and postpartum/childhood outcomes, the evidence targets differing health policies, clinicians and research foci.

The objectives of the reviews are twofold:

  1. To identify, consolidate and analyse the literature on the influence of paternal preconception health on pregnancy and intrapartum outcomes.

  2. To identify, consolidate and analyse the literature on the influence of paternal preconception health on postpartum and early childhood outcomes.

Eligibility criteria

Participants

The review will consider studies that include all reproductively aged men in the preconception period who are identified as the contributing procreation partner of a child for which direct or indirect outcomes were reported. Studies that report on the indirect effects of preconception health of non-contributing procreation partners (eg, same-sex parents) will also be included. No geographical or parity limitations will be applied. Studies that solely reported on maternal outcomes or did not separate out paternal outcomes (eg, reports on parents broadly) will be excluded.

Concept

This review will seek to map the data on the influence of paternal preconception health in relation to pregnancy, intrapartum, postpartum and early childhood outcomes. Both direct (genetic and epigenetic contributions) and indirect pathways (psychosocial and relational)4 will be included. Only studies that report on the influence of paternal preconception health as a primary outcome will be included, excluding studies that report on it as a secondary or moderating variable.

Scoping review #1—pregnancy and intrapartum
  1. Pregnancy outcomes of interest include but are not limited to time to pregnancy, miscarriage and stillbirth;

  2. Intrapartum outcomes of interest include but are not limited to preterm birth, live birth/neonatal mortality, vaginal versus caesarean section rates, assisted birth and placental weight;

Scoping review #2—postpartum and child outcomes
  1. Postpartum outcomes of interest include but are not limited to offspring birth weight, head circumstance, birth defects, breast feeding and parental mental health; and

  2. Early childhood outcomes (0–5 years) of interest include but are not limited to BMI (child)/body weight, growth, asthma or reactive airways, developmental delay, internalising and externalising behaviours, cancer and chronic conditions.

Type of sources

This scoping review will consider both experimental and quasi-experimental study designs including randomised controlled trials, non-randomised controlled trials, before and after studies and interrupted time-series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case–control studies and analytical cross-sectional studies will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports and descriptive cross-sectional studies for inclusion. Further, qualitative studies will be considered that include, but are not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research. Mixed method studies will also be included. Reviews (systematic, non-systematic, scoping, etc) will be excluded but will be evaluated for original studies to be included, if applicable. Letters to the editor, editorials, commentaries, conference abstracts, dissertations, books, book chapters and grey literature will not be included. Only studies published after 2013 will be included to provide a contemporary perspective.

Methods

This review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews14 and will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews.15

Search strategy

The search strategy was developed in consultation with a health science librarian (see online supplemental appendix 1). The final search strategy, including all identified keywords and index terms, was adapted for each included database and/or information source with the search conducted on 16 January 2024. Databases to be searched include MEDLINE All (Ovid), Embase (Elsevier), CINAHL Full Text (EBSCO), Scopus (Elsevier) and PsycINFO (EBSCO). The reference list of all included sources of evidence will be screened for additional studies using Citation Chaser or Scopus. No time limitations will be applied in the search.

Supplemental material

Study selection

All identified citations through the search will be uploaded to Covidence16 and duplicates will be removed through their automation process. After a pilot of inclusion/exclusion criteria, title and abstracts and full text will be screened by two reviewers with disagreements solved with a third reviewer or discussion. Reasons for exclusion at the full-text stage will be reported. The results of the search will be reported in full in the final scoping review and presented in a PRISMA flow diagram.14

Data extraction and synthesis

The data extracted will include specific details about the population, study, methods and outcomes. Data extraction will be piloted before full data are extracted by one reviewer and verified by another. For qualitative studies, themes and relevant quotes will be extracted and organised thematically. For quantitative studies, data will be organised by outcomes and summarised. The findings will be presented in narrative form including tables and figures, where appropriate. Additionally, the evidence on the influence of paternal preconception health will be categorised into four primary health outcome themes: knowledge, behaviour and attitudes, health status and access to healthcare services.17 No quality appraisal will be undertaken, consistent with the scoping review methodology.15

Patient and public involvement

Patients or the public will be involved as stakeholders in the design, conduct, reporting or dissemination plans of our research as appropriate.

Ethics and dissemination

Ethics approval is not required for this scoping review. Results will be published in peer-reviewed journals as well as presented at relevant national and international conferences and meetings.

Summary

Paternal preconception care is a growing concept that developed from women’s preconception health movement and the maternal and child health life course perspective, as well as pioneering research from the child development, public health data and family planning fields. A comprehensive examination of the current science of how men’s preconception health impacts outcomes in pregnancy, the intrapartum period, postnatally and early childhood is needed. Findings will guide a framework for the understanding of men’s own subsequent health and development across time.

Ethics statements

Patient consent for publication

Acknowledgments

Special thanks to Kristy Hancock from the Maritime SPOR Support Unit for helping us develop the search strategy.

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