MEN'S PRECONCEPTION HEALTH

"The piece of the puzzle that is missing is the role of the paternal germline in the aetiology of genetic( and possibly epigenetic) mutations in the offspring. Most spontaneous genetic mutations arise in our species via the fathers' germline (not the mothers) and are powerfully influenced by age and environmental/lifestyle factors such as smoking and obesity." Aitken, 2017

I recently nursed a neonate with bradycardia as low as 50bpm. What was of great interest to us was him being in no form of distress or experiencing any other abnormal finding. He was under our care for some time as clinicians worked round the clock to establish the cause and monitor for any cardiopulmonary arrest. This was our greatest concern because for this age group this is absurd. Fortunately, the stay was uneventful and he was stepped down to continue with prescribed antiarrhythmics pending placement of a defibrillator at a later date.

Within the short stay, extensive testing was done to determine the root cause for the bradycardia. Among the ordered tests it was established via an Echo study that he had a congenital heart block. A review of maternal records led to a tentative conclusion that it is closely linked as an outcome of a pre-existing maternal autoimmune condition. No paternal preconception record existed and this drew my attention. Had we missed something more? Or was this conclusion enough?

So what is preconception care?

The World Health Organization (2013), defines preconception care as the provision of “biomedical, behavioural and social health interventions to women and couples before conception occurs. 

It aims to;

1. Improve maternally and child health status by encouraging behaviour modification in both the short and long term (Frey et al., 2012).

2. Allows early detection and diagnosis of certain conditions in the preconception stage allowing for better decision making and planning among the partners. Conditions that may be detected include HIV, genetic disorders, infertility/subfertility, STIs, mental health concerns etc, (World Health Organization, 2013).

This is helpful for it allows for increased preparedness among the couples. For instance, planning may involve considering setting finances aside for frequent future hospital visits, a need for modification of home environment setups if a child is likely to develop congenital abnormalities, adjusting one's career trajectory, discussions on consideration of other alternatives to having children etc.

A review of existing literature reveals inadequate attention to men's preconception health (O'Brien et al., 2018). According to Frey et al. (2012), despite many men being aware of the need for optimal health as prospective fathers, this does not translate to knowledge on the specificities involved in the same which meant that health providers were missing out on this critical information. Within the African continent, it is unfortunate that there exists so much data on preconceptions efforts directed towards the female gender and paucity of data on the same for men. With that being said, it is, important to be cognizant of the fact that healthcare utilization is complex and somewhat inconsistent (Rosu et al., 2017).

Preconception health among men

Garfield (2018), summarizes preconception health for men as a reproductive health plan, health assessment, health promotion, and clinical and psychological interventions to improve adolescent and young men's health.

This is essential as other researchers such as Misra et al. (2010); van der Zee et al. (2013) have identified that, paternal involvement results in better health outcomes  of a nation by;

·       Increasing rates of prenatal care.

·       Decreasing maternal rates of alcohol consumption.

·       Encouraging fathers to actively participate in their children’s lives.

·       Promote good relationships with their partners.

·       Prevents direct and indirect harm to his future child.

How can we enhance preconception health among men?

   Prompt men to develop a procreative consciousness through 

•  Encouraging visualization of their future kids' health by appealing to the concept of the greater good.
• Have lengthy discussions on different health practitioner visits on the impact of age and the ability to promote the conception of a healthy foetus. ( To be aimed for during health screening visits). 
• Address gendered perceptions of men in society and this will most likely encourage a positive outlook towards increasing their screening risks.
• Have more female practitioners provide men sexual health service
• Use creative tools to assess their sexual health issues at different age groups for example use of the HEADSS tool among adolescents and use of SNAP tool among men greater than 40years (Addison et al., 2021, Noble et al., 2015).
• Encourage men to openly discuss their problems with no judgement.
• Providing the services among already existing screening models(O'Brien et al., 2018).

In conclusion, we have learnt that it is important for preconception services to also be provided to men and that we need to be creative while at it. Remember, "Parenting begins the moment you make any conscious effort to care for your own health in preparation for enhancing your child's conception." Carista Luminare-Rosen

References

1. Addison, J., Herrera, N., Tuchman, L., & Bokor, B. (2021). HEADSS Up! Missed Opportunity for Psychosocial Screening in Hospitalized Adolescents. Hospital Pediatrics, 11(4), 417-421. https://doi.org/10.1542/hpeds.2020-000216
2. Frey, K., Richard, E., & Brie, N. (2012). Preconception healthcare: what do men know and believe? Journal of Men's Health, 9(1), 25-35. https://doi.org/10.1016/j.jomh.2011.11.001
3. Garfield, C. F. (2018, Jan). Toward Better Understanding of How Fathers Contribute to Their Offspring's Health. Paediatrics, 141(1). https://doi.org/10.1542/peds.2017-3461
4. Misra, D. P., Caldwell, C., Young, A. A., Jr., & Abelson, S. (2010, Feb). Do fathers matter? Paternal contributions to birth outcomes and racial disparities. Am J Obstet Gynecol, 202(2), 99-100. https://doi.org/10.1016/j.ajog.2009.11.031
5. Noble, N., Paul, C., Turon, H., & Oldmeadow, C. (2015). Which modifiable health risk behaviours are related? A systematic review of the clustering of Smoking, Nutrition, Alcohol and Physical activity (‘SNAP’) health risk factors. Preventive medicine, 81, 16-41.
6. O'Brien, A. P., Hurley, J., Linsley, P., McNeil, K. A., Fletcher, R., & Aitken, J. R. (2018). Men's Preconception Health: A Primary Health-Care Viewpoint. American journal of men's health, 12(5), 1575-1581. https://doi.org/10.1177/1557988318776513
7. Rosu, M. B., Oliffe, J. L., & Kelly, M. T. (2017). Nurse Practitioners and Men’s Primary Health Care. American journal of men's health, 11(5), 1501-1511. https://doi.org/10.1177/1557988315617721  
8. van der Zee, B., de Wert, G., Steegers, E. A., & de Beaufort, I. D. (2013). Ethical aspects of paternal preconception lifestyle modification. American Journal of Obstetrics & Gynecology, 209(1), 11-16. https://doi.org/10.1016/j.ajog.2013.01.009
9. World Health Organization. (2013). Preconception care to reduce maternal and childhood mortality and morbidity: policy brief.