JustificationThe preconception period is the earliest window of opportunity to ensure optimal human development. Pregnancy and childbirth outcomes can be improved by interventions offered to support the health and well-being of women and couples prior to conception. Thus, preconception care is essential in preparing for the first thousand days of life. Adolescence, the stage of life that typically comes before the preconception stage, is characterized by various high-risk behaviors like substance abuse, sexual experimentation, injuries, obesity, and mental health issues which can adversely affect their health in adult life. Thus, a Consensus Guideline for pediatricians on providing preconception care to adolescents and young adults can go a long way in making the generations to come, healthier and more productive.ObjectiveThe purpose of these recommendations is to formulate an evidence-based Consensus Statement that can serve as a guidance for medical professionals to provide preconception care for young adults and adolescents.Intended UsersAll obstetric, pediatric, and adolescent health care providers.Target PopulationAdolescents and young adults.ProcessA large proportion of adolescents seek care from pediatricians and there is a lack of Consensus Guidelines on preconception care. Therefore, the Indian Academy of Pediatrics called an online National Consultative Meeting on April 03, 2023, under the chairmanship of Dr MKC Nair and the National Convenor Dr Himabindu Singh. A group of pediatricians with wide experience and expertise in adolescent health care were assigned the task of formulating evidence-based guidelines on preconception care. The group conducted a comprehensive review of existing evidence by searching resources including PubMed and Cochrane databases. Subsequently, a physical meeting was held at Amritsar on October 07, 2023 during which the consensus was reached through discussions and voting. The level of evidence (LoE) of each recommendation was graded as per the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011.RecommendationsEvery woman planning a pregnancy needs to attain and maintain a eumetabolic state. Prospective couples need to be counselled on the importance of a healthy lifestyle including a nutritious diet, avoidance of substance abuse, and timely screening for genetic disorders. Screening for and management of sexually transmitted diseases in males and females, appropriate vaccination and addressing mental health concerns are also recommended.

ObjectiveExisting studies, in mostly male samples such as veterans and athletes, show a strong association between traumatic brain injury (TBI) and mental illness. Yet, while an understanding of mental health before pregnancy is critical for informing preconception and perinatal supports, there are no data on the prevalence of active mental illness before pregnancy in females with TBI. We examined the prevalence of active mental illness ≤2 years before pregnancy (1) in a population with TBI, and (2) in subgroups defined by sociodemographic, health, and injury-related characteristics, all compared to those without TBI.MethodThis population-based cross-sectional study was completed in Ontario, Canada, from 2012 to 2020. Modified Poisson regression generated adjusted prevalence ratios (aPRs) of active mental illness ≤2 years before pregnancy in 15,585 females with TBI versus 846,686 without TBI. We then used latent class analysis to identify subgroups with TBI according to sociodemographic, health, and injury-related characteristics and subsequently compared them to females without TBI on their outcome prevalence.ResultsFemales with TBI had a higher prevalence of active mental illness ≤2 years before pregnancy than those without TBI (44.1% vs. 25.9%; aPR 1.46, 95% confidence interval, 1.43 to 1.49). There were 3 TBI subgroups, with Class 1 (low-income, past assault, recent TBI described as intentional and due to being struck by/against) having the highest outcome prevalence.ConclusionsFemales with TBI, and especially those with a recent intentional TBI, have a high prevalence of mental illness before pregnancy. They may benefit from mental health screening and support in the post-injury, preconception, and perinatal periods.Plain Language TitleMental illness in the 2 years before pregnancy in a population with traumatic brain injury

INTRODUCTION:Renal transplant recipients are frequently transitioned to new immunosuppression regimens (ISR) in anticipation of pregnancy to reduce teratogenic risks. The consequent effects on perinatal outcomes and renal allograft condition are not known. We evaluated the risks of transitioning to a new ISR in the preconception period on perinatal outcomes and allograft condition in renal transplant recipients.METHODS:Institutional review board approval was obtained for the study. A retrospective cohort study at a single tertiary-care center included all pregnancies with a history of renal transplant between January 1995 and 2021. Patients who did not have a pregnancy following their transplant or who were still pregnant at the time of data analysis were excluded. Study groups included patients who transitioned to a new ISR prior to pregnancy versus patients who continued on their established ISR.RESULTS:Of 93 pregnancies identified, 27 patients, with a total of 30 pregnancies, met inclusion criteria. Preconception ISR transition occurred in 13 pregnancies (48.1%). There were no significant differences in maternal characteristics between groups. Preconception ISR transition was associated with a significantly later gestational age at delivery (36.0 versus 30.9, P=.02) and a non-statistically-significant higher live birth rate (84.6% versus 52.9%, P=.07). Overall, maternal and fetal composite adverse outcomes and acute renal injury in pregnancy did not differ between groups.CONCLUSION:Transitioning patients to a new ISR in the preconception period did not significantly affect perinatal outcomes or allograft condition in pregnancy; however, women may deliver at a later gestational age. Additional studies are needed to further investigate this association.

According to the psychological account of personal identity, our identity is based on the continuity of psychological connections, and so we do not begin to exist until these are possible, some months after conception. This entails the psychological account faces a challenge from the non-identity problem—our intuition that someone cannot be harmed by actions that are responsible for their existence, even if these actions seem clearly to cause them harm. It is usually discussed with regard to preconception harms, but in the context of the psychological account, it is also applicable to prenatal harms. Inflicting prenatal injury is widely thought to be morally impermissible, but if the injury is identity-determining on the psychological account, then no-one seems to be harmed—rather, the injury is responsible for bringing them into existence. Here, I argue that identity-determining injuries can routinely occur on the psychological account, and that this undermines the account. I assess Nicola Williams’ proposal to salvage the account based on a trans-world account of personal identity, and show that it is unsuccessful. I then show that Jeff McMahan’s embodied mind account of personal identity is also susceptible. I conclude that identity-determining prenatal injuries pose a significant challenge for the psychological account and its variants, and provide a reason for supporting alternative accounts that fix personal identity at conception.