Over the last several decades, evidence indicates that many strategies to prevent the two leading causes of infant mortality in the developed world – birth defects and prematurity/low birthweight – have their greatest influence when commenced before a pregnancy is conceived. The traditional prenatal care pathway to preventing poor pregnancy outcomes is often inadequate because it starts too late. A good example is that adequate folate levels at the time of organogenesis (days 17-56 after conception) is associated with a 50%-70% reduction in neural tube defects. By waiting to start vitamins with folic acid at the first prenatal visit it will be too late to prevent most neural tube defects.

Unfortunately, as illustrated by the articles featured in this issue, most women, even those hoping to become pregnant, are not adopting proven protective behaviors before conception. Many explanations exist: health promoting messages are not reaching women; they are being framed in a way that lacks personal relevance; they are not reiterated regularly; they involve personal or financial costs that are judged negatively; or they lack credibility. The bottom line is that impacting health choice, such as eating more green leafy vegetables, taking a multivitamin with folic acid daily or achieving a healthy BMI, is far more complex than we know how to address. Until translational research receives the funding and respect it deserves, we will continue to have a disconnect between the science we know and its ability to shape the futures of today’s women and tomorrow’s children.

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