More equitable preconception health: paternal life course opportunities for better pregnancy, child, and family outcomes.

# More equitable preconception health: paternal life course opportunities for better pregnancy, child, and family outcomes *The Lancet 2026* Review More equitable preconception health: paternal life course opportunities for better pregnancy, child, and family outcomes Jonathan Y Huang*, Felicia M Low*, Michelle Z L Kee, Lorenzo N Hopper, Ka Kei Sum, Gerard Siew Keong Chung, Joseph Keawe‘aimoku Kaholokula, Judith Stephenson, Danielle Schoenaker*, Keith M Godfrey* Men and partners are important contributors to the health of future generations, yet their own preconception health Lancet 2026; 407: 1459–69 and wellbeing remain secondary considerations in research, practice, and policy. Siloed research has exacerbated this Published Online deficit. Clinical research typically has a narrow focus on proximal behavioural factors related to periconceptional March 16, 2026 events (eg, paternal dietary influences on the sperm epigenome), with social research focusing largely on postnatal https://doi.org/10.1016/ S0140-6736(26)00148-0 parenting. Here, we update and reappraise the evidence for men’s role in preconception health through a *Contributed equally transdisciplinary review. Across biological and behavioural research, young men’s early life course experiences have Department of Public Health been shown to shape their own and their partner’s preconception physical, emotional, and behavioural health. Sciences, Thompson School of Moreover, focusing on men’s preconception health oers a corrective for legacies of sexism, which place responsibility Social Work & Public Health, for intergenerational health solely on the birthing parent, and of racism and colonialism, which have disproportionately University of Hawai‘i at disrupted the familial and societal roles of Black and Brown men. We provide three case studies illustrating these Mānoa, Honolulu, HI, USA (J Y Huang PhD); Centre for ethical concerns and conclude that greater attention to young men would lead to more equitable and holistic Quantitative Medicine, Duke- preconception health interventions and policy. NUS Medical School, Singapore (J Y Huang PhD); Koi Tū Centre Introduction and ethnic inequities in preconception, antenatal, and for Informed Futures, Auckland, New Zealand Nurturing preconception health is now widely child health.6,7 Moreover, siloed research neglects (F M Low PhD); Institute for recognised as being key to securing the health and insights from Indigenous, Asian, African, and other Human Development and wellbeing of future generations. Men and partners have global perspectives7,8 that naturally de-centre adult Potential, Agency for Science, an important role, yet their own preconception health individuals in favour of community-driven, inter- Technology and Research (A*STAR), Singapore and influences on maternal periconception health generational, and life course influences on preconception (M Z L Kee PhD); Department of remain secondary considerations in research, practice, health. Epidemiology and Community and policy. One driver for this disparity has been a This Review presents a holistic view of the contributions Health, College of Health and historically narrow focus on the proximal clinical factors of men to preconception health, focusing on three aspects. Human Services, University of North Carolina at Charlotte, related to periconceptional events,1,2 such as paternal First, we provide a transdisciplinary review of paternal Charlotte, NC, USA dietary influences on the germ line.2 However, promotion life course eects on male and female preconception (L N Hopper PhD); Population of preconception health has evolved into a broader health, pregnancy, and ospring outcomes, highlighting Health Sciences, Bristol Medical mandate encompassing upstream social, behavioural, underexplored targets for intervention. Second, we School, University of Bristol, and structural determinants of preconception health in people of reproductive age.3 Notably, Schoenaker et al’s multi-national survey identified that both women and Key messages men consistently rank mental health, social, and • Boys and young men are an important but persistently underappreciated population financial support as high priorities before conception. for preconception interventions to improve intergenerational health Life course influences and healthy, engaged partners • Social and biological factors over the male life course influence male health and and fathers have been proposed as being key to maternal wellbeing at reproductive ages, and have important influences on maternal mental health, antenatal care attendance, and human preconception health potential.4,5 Nonetheless, the prevailing literature • Supporting male preconception health is integral to health equity and reproductive remains generally siloed, leaving large underexplored justice, expanding the scope of interventions towards shared responsibility for intervention spaces in the life course of boys and young parenthood men. Social science approaches largely focus on the • Greater attention to the life course health and wellbeing of boys and young men is an transmission of culture or behaviours from parents to important part in addressing intergenerational disparities arising from legacies of children, and clinical and biomedical approaches favour colonialism and racism narrow mechanisms of intergenerational transmission • Recognition of the broader implications of male health and behaviours across the life (eg, via sperm epigen omics). These divisions leave wide course on male and female preconception health is informing new targets for gaps in understanding intergenerational biological intervention and monitoring of preconception health indicators phenomena and how they are expressed within and • Greater appreciation for preconception social and biological roles of males calls for policy across populations and cultures, hindering translation makers, public health agencies, clinicians, and men themselves to prioritise the roles and to eective preconception interventions. Failing to responsibilities of men in a more equitable vision to improve pregnancy, child, and consider the health and wellbeing of young men and family outcomes fathers specifically exacerbates and perpetuates racial Review Bristol, UK (K K Sum MSc); discuss equity implications of the exclusion of men in Life course and intergenerational determinants Department of Social Work, preconception and intergenerational health. Finally, we of male preconception health Faculty of Arts & Social focus on the implications of this exclusion on future Search strategy and selection criteria Sciences, National University interventions and policy in paternal preconception We conducted a semi-structured meta-review of recent of Singapore, Singapore (G S K Chung PhD); health. literature (primarily from 2000 to 2025; appendix) and John A. Burns School of We define paternal preconception health as medical, used three case studies as examples highlighting the Medicine, University of Hawai‘i behavioural, and psychosocial factors and their wider broad-ranging ethical consequences of research and at Mānoa, Honolulu, HI, USA determinants in the life course of males that can policy agendas that neglect the role of men and fathers. A (Prof J K Kaholokula PhD); EGA Institute for Women’s Health, influence pregnancy and birth outcomes and the health holistic approach to preconception health that integrates University College London, and development of children, not limited to the biological sociobehavioural causes with biomedical mechanisms London, UK relationship to the pregnant person or developing fetus requires engagement with the specific contexts in which (Prof J Stephenson FFPH); (panel 1). This integrated framework spans: (1) the early men and families live. Therefore, these case studies are School of Human Development and Health, University of life and intergenerational social, political, and cultural not intended to represent the breadth of experiences Southampton, Southampton, determinants of health and behaviours of boys; (2) the of—or potential eects on—men from communities UK (D Schoenaker PhD, biological role of fathers in healthy conception; and globally; rather, they illustrate the eects of two broader Prof K M Godfrey FMedSci); MRC Life course Epidemiology (3) the social role of biological fathers and potentially phenomena, colonialism and family-disrupting policies, Centre, University of non-biological partners in protecting or harming the on men’s preconception health within specific contexts. Southampton, Southampton, health of the pregnant person and child (figure 1). Other communities and contexts will experience UK (D Schoenaker PhD, substantially dierent implications that can be elucidated Prof K M Godfrey FMedSci); NIHR Southampton Biomedical through deeper anthropological inquiry.9,10 We conclude Research Centre, University of Panel 1: Men and intersecting, sexual, gender, and family- with a discussion of implications, including how these Southampton and University role identities concepts contribute to overcoming barriers in acceptance Hospital Southampton NHS Foundation Trust, A broad spectrum of sexual, gender, and partnership and uptake of preconception intervention and policy. Southampton, UK identities are described within this Review. We intentionally (D Schoenaker PhD, use common, but socially and contextually constructed, Periconceptional determinants of sperm health: animal Prof K M Godfrey FMedSci) experimental models and human trials terms for males across the life course (ie, boys, men, and Correspondence to: fathers). We recognise and allow for the conflation of gender, We begin our review with advances in sperm health Dr Jonathan Y Huang, research that featured in the 2018 Lancet Series on Department of Public Health sexual, and social roles or their common intersections as they Sciences, Thompson School of might present in various cultures. In this way, we are preconception health.1,2 By 2018, there was already Social Work & Public Health, concerned not only with individuals who can produce viable substantial evidence from animal experimental models University of Hawai‘i at Mānoa, male gametes post-puberty, but also anyone who would for the eects of paternal nutrition on sperm epigenomic Honolulu, HI 96822, USA jon.huang@hawaii.edu identify with these roles. This construction leads us to a programming and ospring outcomes.2 Increasing See Online for appendix broader definition of preconception health that encompasses experimental evidence has since documented the acts proximal to oocyte fertilisation, and the totality of importance of varied paternal preconception exposures primordial social and behavioural factors commonly and related epigenomic pathways, including weight status attributed to males that contribute to healthy conception, and exercise,11 environmental toxicants,12–16 and psychological trauma.17,18 However, this experimental pregnancy, and offspring health and wellbeing. evidence remains mixed as to whether interventions, such Social, biological, Biological factors political, and Sperm cultural factors epigenome alterations Lifestyle, mental Transmission of health, nutrition, epigenetic and and age other information Early life health and Offspring health behaviours before and behaviours reproductive age Nature of relationship Maternal Fetal Paternal with (future) pregnant preconception programming parenting person and perinatal health practices Sociocultural factors Potential biological and sociocultural intergenerational effects Figure 1: An integrated social and biological framework for male preconception health 1460 Review Panel 2: Addressing challenges in interpreting findings in observational studies of paternal factors Threats to inference clearly defined, could help to pinpoint and estimate realistic • Infrequent intent to recruit, or challenges in securing effects of paternal preconception factors42 participation of, males in population-based studies39 Approaches to account for maternal contributions • Studies of infertility beset with confounding and limited • Stratification: in mothers without overweight, paternal generalisability39 preconception BMI was associated with the child’s • Partitioning genomic or shared environment effects bodyweight trajectory from infancy through to adolescence, (or both), such as postnatal parenting40 as well as adverse glucose tolerance (ie, reduced Matsuda • Confounding by, or mediation through, correlated Index and an increased Homeostatic Model Assessment of maternal exposures41 Insulin Resistance score; both p<0·0001)25 • Poorly specified exposure assessment and exposure timing39 • Adjustment: when adjusted for maternal folate intake, Potential solutions higher paternal preconception folate intake was associated • Application of target trial emulation methods, in which with longer gestational periods (ie, 2·6-day longer gestation inclusion criteria and exposure conditions and timing are per 400 µg/day increase in folate, 95% CI 0·8–4·3)44 as micronutrient supplementation,19 exercise,11 or dietary grandmothers.28 These results highlight the importance changes,20 can reverse sperm epigenomic damage. of preconception sperm health in paternal early life and Although weight loss interventions (eg, bariatric surgery) intergenerational health. More recent observational show improvements in adult male cardiometabolic cohorts and consortia29 are studying paternal eects on outcomes,21 the immediate benefits to fertility, pregnancy, reproductive and pregnancy outcomes against a concern and ospring outcomes are less clear.22 for global trends in declining sperm quantity and quality.30 Mechanistic clinical studies also emphasise the Life course and intergenerational determinants of transgenerational eects of paternal life course sperm health: longitudinal, non-experimental human influences,27 including paternal smoking and weight studies status;31 metabolic syndrome;32 mental health and From a physiological perspective, preconception psychological distress;18 alcohol, tobacco, and illicit experiences of males were not believed to be able to aect substance use;33 and advanced paternal age.34,35 ospring due to rapid sperm turnover. However, long- lasting epigenomic modifications occur throughout the Male life course and intergenerational determinants male life course, including genome-wide repro gram ming under a holistic concept of preconception health during primordial germ cell migration in early embryos. Although sperm health is one mechanism by which Furthermore, early life exposures, including nutrition, paternal preconception factors can influence ospring environmental toxicants, and other stressors, can aect health, male health and social behaviours have broader pre-pubertal primordial germ cell dierentia tion to influences, including through maternal biology and spermatogonia and thereafter to spermatozoa, and can behaviours and paternal parenting (figure 1). Identifying influence post-fertilisation modifications via sperm both direct (ie, the sperm epigenome and paternal histones, seminal fluid components,23,24 and signalling parenting) and indirect (eg, maternal health and molecules (eg, small non-coding RNA, microRNA, tRNA- behaviours) paternal influences can widen targets for derived small RNA, and spermatozoa mitochondrial preconception intervention. Paternal factors more RNA).25,26 Consequently, these exposures over the entire commonly studied in mothers can have similar (or male reproductive life course can produce long-lasting potentially larger) eects compared with their eects on ospring. Numerous reviews now support corresponding maternal factors; for example, in paternal pre-pubertal health influences on ospring 529 090 Chinese couples, the odds of birth defects were development, including across generations due to 35% higher in infants born to fathers reporting any intrauterine exposures.24,27 In a Swedish cohort study of preconception alcohol consumption (adjusted odds ratio 11 561 men, paternal overnutrition (proxied by abundant [OR] 1·35, 1·14–1·59).36 Oldereid et al37 found advanced harvests) during an important pre-pubertal period (ie, age paternal age at conception to be related to stillbirth, birth 9–12 years) was associated with an increased diabetes defects, autism spectrum disorders, and schizophrenia. mortality risk in sons (hazard ratio [HR] 1·84, 95% CI Furthermore, a meta-analysis has associated paternal age 1·21–2·79). Paternal grandfather exposure to abundant greater than 45 years with autism spectrum disorder harvests pre-puberty was associated with a >3-fold risk of (adjusted OR 1·43, 1·33–1·53).37 In more than any cancer death and >4-fold risk of death from non- 7 million father–child dyads, children of fathers with smoking-related cancers (HR 4·39, 2·02–9·53), with no depressive disorders or subclinical symptoms were more corresponding associations for women, mothers, or likely to themselves have depression compared with Review children of fathers without such symptoms (OR 1·42, advice.55 Women who perceived their partners as being 1·17–1·71).38 more supportive had substantially lower levels of perinatal However, numerous analytical challenges have depression and anxiety,56–58 whereas avoidant partner hindered understanding of paternal preconception health coping styles are associated with higher rates of maternal eects (panel 2). Particular concerns include the depression.59 Other meta-analyses support strong disproportionate focus on maternal characteristics correlations between paternal and maternal depression without addressing confounding by paternal factors and across the perinatal period.60,61 Poor maternal mental the use of highly selective, non-generalisable samples health in the periconception period adversely influences with paternal data.39 For example, evidence for ospring cognitive and socioemotional outcomes in ospring,62 epigenomic mediation of maternal periconception health whereas positive maternal mental health beneficially eects is strongly attenuated when accounting for impacts the child’s language and social communication paternal confounding factors.41–43 Most studies do not skills.63 distinguish between associations arising from The life course development of executive functions preconception (eg, genomic or epigenomic) or postnatal (ie, essential cognitive processes that allow individuals to (eg, shared environment or parenting behaviours) maintain cognitive control and adapt behaviour to paternal influences, which could have opposing eects. challenging settings64) is central to a partner’s ability to be For example, a systematic review found evidence for supportive and caring.65 Adverse childhood experiences advanced paternal age being advantageous in certain (ACEs), such as poverty, maltreatment, and neglect, are ospring outcomes, such as educational attainment, robustly related to executive function deficits throughout externalising behaviours, and responsiveness to mental life.66 Men with executive dysfunctions, such as reduced health treatments.45 However, one twin study on the social self-control, tend to show avoidant coping mechanisms, development of ospring found that adverse such as alcohol consumption in response to negative consequences were associated with extremes in paternal emotions.65 These coping mechanisms can influence age, with older fathers (ie, those aged >40–45 years) maternal alcohol consumption and other risk-taking conveying preconception risk through genomic eects, behaviours,67 and can lead to intimate partner violence.68 and younger fathers (aged <20–25 years) conveying Executive function deficits can raise tension between postnatal risk through non-genomic social factors.46 In partners, increasing depressive and anxiety symptoms in turn, determinants such as age at childbearing are pregnant women,69,70 and subsequent adverse pregnancy influenced by prevailing policies, social norms, and and developmental outcomes.67,71,72 Conversely, male cultural contexts that shape men’s health directly and partners who use eective coping strategies against define the role of men in relationships.47 The identification adverse experiences are better equipped to provide a of relevant paternal preconception targets therefore supportive family environment.73 requires more rigorous analytical methods and a more comprehensive view of drivers of paternal preconception The male early life course and determinants of postnatal health and behaviours. Social science research on paternal parenting and child development parenting and the role of fathers7,48,49 provides a guide for Early life factors in men that influence ospring important social mechanisms, potential preconception outcomes via paternal parenting are a key component of health indicators,3 and targets for intervention. preconception health. Clinical factors that aect sperm and the ospring epigenome—such as paternal Partner support of maternal preconception and mental health, age, and physical health status pregnancy health preconception—can also influence relationship quality, Partners are particularly important in shaping maternal coparenting dynamics, family conflicts, infant bonding, health during periconception. Physical (ie, instru mental, and infant neurodevelopment through behavioural practical, and material) and socioemotional (ie, supportive, pathways established before reaching reproduction and neglectful, or abusive) relationships with partners are key parenthood.29,74 Determinants of paternal parenting are drivers of women’s preconception health. Partners have particularly salient, as paternal parenting can be more direct roles in decisions involving family planning, use of important than maternal parenting for outcomes such reproductive-related and general health care, and health- as child weight status.75 One core determinant is related behaviours at reproductive stages.4 Paternal paternal mental health. Men’s ACEs are widely support (eg, co-habitation or financial support) is recognised as important contributors to anxiety and associated with increased maternal participation in depression in adolescence and young adulthood,76 antenatal care,50 reduced maternal alcohol and tobacco persist into reproductive age,77 and are exacerbated use,51,52 low birthweight reduction, and increased during the transition to parenthood.78,79 Male ACEs are breastfeeding rates.50–54 Pregnant women reported robustly related to their own80 and their partners’76 healthier dietary choices when their partners were actively preconception anxiety and depression, which in turn involved in cooking and grocery shopping, rather than adversely aect their ability to parent.76 Boys’ exposures when oering more passive support, such as giving to ACEs are common and have lasting consequences, 1462 Review contributing to the 8–10% of fathers experiencing Equity implications of neglecting the role of depression from preconception to postpartum.60,77–79,81 A men in preconception health 20-year follow-up of adult men found those who Case 1: pre-empting maternal blame and responsibility reported subclinical depression or anxiety in adolescence A major consequence of medicalisation and pathologising and age 20–29 years were almost five times more likely pregnancy is the potential for women and childbearing to report psychological distress (ie, a General Health people to become targets of blame and the sole bearers of Questionnaire-12 score ≥3) during their partner’s responsibility for ospring outcomes.95–97 Acknowledging pregnancy, compared with men without reported social and cultural biases is important as they influence adolescent depression or anxiety.77 The early origins of not only the types of research conducted, but potentially paternal distress, including through executive function impede opportunities for developing, evaluating, and development, could help explain why perinatal-focused translating male preconception interventions and policies. interventions are largely ineective in reducing paternal The consequence of such biases is particularly acute when depression or its ospring sequelae.82 By contrast, there is evidence that paternal preconception eects can eorts to mitigate the eects of parental childhood be stronger than maternal factors. In ASD, for example, ACEs on preconception mental and physical health paternal age can have an even stronger eect than highlighted positive relationships and experiences, maternal age; in meta-analyses, each 10-year decrease in including “perceiving support, protection, trust, and maternal age was associated with a small and statistically belonging from family, friends, and the community”.83 non-significant 7% reduction in the odds of autism Development and maintenance of such positive lasting (OR 0·93, 0·69–1·24), compared with a 26% reduction for relationships in boys and young men could be key to lower paternal age (0·74, 0·64–0·86; one-sided interaction improving immediate preconception health and p value 0·09).98 Although understudied, romantic partners preventing ACEs in the next generation,84 further and spouses have important roles in fertility decisions, emphasising the need to better understand the role of health behaviours, and socioemotional and instrumental fathers within context, community, and family support. Solely focusing on optimising maternal structures.85 preconception health therefore leaves a gap in men’s understanding of, and preparedness for, preconception Neurobiological and behavioural changes in expectant health.81 A growing expectation of more equal participation fathers in family planning, pregnancy, and childcare76 has not Support for intergenerational transmission of paternal been met with a commensurate increase in ecacious caring is evident in recent hormonal and neuroimaging interventions. The absence of male-focused or partner- research. Like women, men also experience hormonal focused materials is often cited as the major barrier to changes over the course of pregnancy, including men participating in antenatal care,99 as reflected in clear reductions in testosterone, vasopressin, and oestradiol gaps100 in recommendations for, and provision of, men’s over the postpartum transition.86,87 These changes are preconception health services. A US study suggested two- associated with increased parenting sensitivity and thirds of men had unmet preconception health-care engagement in subsequent years. A meta-analysis of needs,101 and most preconception care guidelines 50 studies (N=7080 men)88 found moderate eects of internationally omit guidance for men.102 Paternal lower testosterone on parenting quality. In Filipino men,89 fathers showed greater decreases in salivary testosterone than childless men, and those who grew up with engaged, Panel 3: Paternal–maternal relationship dynamics as supportive fathers had even lower salivary testosterone.90 distinct preconception health indicators Preliminary research suggests microstructure and • Most studies on socioeconomic predictors of macrostructure brain changes in expectant and new preconception and antenatal health focus solely on fathers,91 mirroring well characterised changes in maternal or aggregate, household-level factors104 maternal brain structure.92,93 In small, cross-national • However, social mechanisms tend to drive convergent studies,91 transition to fatherhood was associated with health-related and risk-taking behaviours within context-specific reductions in cortical volumes of the partnerships; socioeconomic (eg, educational) gradients default mode network, which is associated with the in poor health are therefore underestimated when resting state, internal narrative, planning, and visual women are considered in isolation from partners105 networks. In turn, greater reductions in these cortical • Directionality matters: when examined in sequence, volumes, which could be related to identifying and paternal perinatal depression predicted worsening responding to infant needs, have been associated with symptoms in postpartum mothers, but not the reverse106 self-reported increased engagement and bonding with • These findings suggest the importance of considering infants.94 Although understudied, these mechanisms interactions between partner characteristics as distinct support a physiological basis for life course eects on indicators of periconception health beyond those paternal preconception and ospring-related postnatal characteristics in isolation behaviours centred on engagement and caring. Review preconception care has almost exclusively focused on impacts of changes in gender-attributed societal roles.116 proximal, individualised, and clinical determinants of Traditionally, Native Hawaiian men had roles as warriors, healthy conception (eg, smoking cessation),103 neglecting navigators, farmers, fishermen, builders, carvers, and the role of early life described in this Review. Finally, healers. These men were responsible for the health and treating partners as individuals leaves large gaps in wellbeing of their ‘ohana (family) and kaiāulu developing important preconception health indicators and (community), and had important roles in child rearing, potential interventions that are related to couples’ especially in supporting younger males to become healthy dynamics above and beyond their individual actions and productive adults.117 Around age 8 years, a boy would (panel 3). A holistic view of men’s roles in preconception leave his mother’s side to join the Halemua men’s house health would help shift the focus away from mothers as to learn his occupation, familial and societal obligations, the sole bearers of responsibility for ospring health. and the associated socioreligious practices from other men. However, colonisation, including the introduction of Case 2: disproportionate impacts of colonialism on the Christianity, replaced or banned such practices in favour health of young native and Indigenous men of labour, parenting, and child-rearing practices that Viewing men as individual actors, separate from family, predominated in the Anglo-Eurocentric continental USA. ancestry, and responsibility for raising the next The loss of these roles within communities came with generation, is at odds with many traditional Indigenous, racist judgments of inferiority and the loss of social and Asian, African, and other cultures and communities. communal ties that buer against adversities. This loss of Research across diverse nations and settings often shows cultural practices harms preconception physical and fathers to be nurturing, highly engaged in childcare, and mental health, impairing men’s ability to fully participate situated within expanded family structures supporting as supportive partners and fathers. Moreover, over- child development, without the typical role delineations policing and loss of generational wealth, livelihoods, and found in the dominant cultures of modern, post-colonial supportive communities all contribute to disproportionate societies.8,107–110 For example, these nurturing, pro-social incarceration, precluding the physical presence needed to roles were seen as aspirational goals in middle-age and support partners before, during, and after pregnancy. older-age African American men’s concepts of manhood.111 Conversely, the reclamation of Native Hawaiian male Among Indigenous people whose connections to land, cultural practices and fellowship could serve to undo these traditions, and cultural practices have been disrupted and harms and foster improved preconception health erased by colonialism, life course health consequences (panel 4).109 are disproportionately borne by young men who This case study is entirely consonant with our experience high burdens of ACEs.112 These men are also conceptualisation of the role of men in holistic disconnected from the traditional roles and practices that preconception health. A renewed focus on men (beyond facilitate community, support, kinship, and the sense of mere providers of sperm) as members of partnerships, belonging that buers against adversity.83 families, and communities, and on the importance of Among Native Hawaiian boys and young men, the community caring to buer against early life adversities, 1893 overthrow of the Sovereign of the Kingdom of is at the core of male preconception health. Hawai‘i Queen Lili‘uokalani, and subsequent annexation of Hawai‘i by the USA, has led to widespread actions that Case 3: harmful social policies that exacerbate racial and aect preconception health inequities.113 The seizure of socioeconomic perinatal and life course disparities lands and political control resulted in cultural loss, The eects of social policies on paternal engagement are discriminatory policies and practices (eg, banning of profound. Numerous policies either discourage or native language), environmental hazards, and persistent outright restrict fathers’ involvement in the preconception economic and social disadvantages. In turn, this loss of and early life stages of their children. For instance, self-determination led to historical trauma (ie, inter- although paternity leave is lauded to increase fathers’ generationally transmitted, cumulative, and collective involvement in child engagement and caregiving, meagre emotional harm) that have manifested as ACEs with provisions and protections continue to signal their lesser attendant sequelae, including obesity, substance use, importance. Moreover, social policies in some countries stress, and depression. Native Hawaiian ‘ōpio (youth) (eg, the USA) are restrictive in ways that sideline paternal have associated historical loss of land and traditional participation in childcare.6,119 Policies restricting govern- practices with feelings of pain and sadness, but also with ment benefits (eg, child subsidies, nutritional benefits, anger, loss of control, self-harm and physical violence, and housing) to single parents—or to mothers hopelessness, and avoidant behaviour.114 The link between specifically—disincentivise paternal engagement in historical trauma and executive function, therefore, could antenatal care and child rearing, especially in formal underlie poorer educational outcomes and higher rates of capacities, and can even disincentivise marriage.120 In suicide, arrest, and incarceration in young Native Hawaiian the USA, these disincentives are particularly acute for men.8,115 These men might also be more aected by Black fathers on low income, who can be driven away cultural loss than young women due to dierential from their children and paternal responsibilities as a 1464 Review Panel 4: Addressing adverse childhood experiences—the revitalisation of cultural practice • Adverse childhood experiences (ACEs) are a key upstream (ie, kāne), notably by revitalising interest in Lua as a cause of male preconception health disparities. Policies for traditional, male-oriented practice. addressing ACEs include: adopting national strategies, • Drawing from the Halemua concept of establishing a enhanced data and research, strengthening prevention and supportive community of males, from ‘ōpio (youth) to early intervention, integrating ACEs into educational policy, kūpuna (elders), grassroots Halemua-like groups emerged support for families, cross-sector collaborations, and public to engage their male members in revitalising socioreligious awareness campaigns.118 ceremonies that had been banned or abandoned due to • More specific and practical models of these policies are needed Christianisation. These groups sought to reconnect men to for boys and young men. For example, the practice of Lua, the their Hawaiian culture, identity, and support systems. traditional fighting art of Hawai‘i, could be used to address • In 2006, ‘Aha Kāne—the Foundation for the Advancement high rates of ACEs, interpersonal violence, substance use, and of Native Hawaiian Males—was established to improve the academic underachievement in Hawaiian males through early wellbeing of Native Hawaiian kāne, their families, and prevention and targeted efforts to engage them in building a communities. ‘Aha Kāne engaged men of all ages in sense of community, centred on cultural revitalisation. cultural activities designed to reconnect them to their • The Hawaiian Renaissance movement began in the 1970s native language, ceremonies, and other practices, while to uplift native culture, including language, traditional instilling strong ‘ohana and kaiāulu values and dance (ie, hula), navigation, the protection of cultural and encouraging them to act as positive role models for the natural resources, and self-determination. next generation of young men. • Since the 1990s, attempts have been made to specifically uplift the health and wellbeing of Native Hawaiian males result of punitive child support policies.121,122 Barriers to health,102 and health services often fail to provide paternal participation are exacerbated by decades of information for men.127 Although most men do not receive disproportionate imprisonment of minoritised young preconception education and care,101,128,129 the case to do so men, with adverse consequences of both their grows more urgent: male obesity, smoking, mental illness, development and their ability to support mothers of their and medications that impair male reproductive health are children.123 Despite these substantial barriers, minoritised, common from a young age,128,130–132 and are becoming non-resident fathers—especially Black Americans—often increasingly prevalent.130,131 Moreover, these factors are remain more engaged with children than non-resident stratified by race and ethnicity,130 underscoring the need White fathers, indicating a broader understanding of for culturally sensitive paternal preconception health care. parenting beyond rigid, nuclear family-oriented marital arrangements.7 Family-disrupting policies are not Individual-level barriers exclusive to Black American men, and the global Raising awareness about paternal preconception health is dynamics of migration due to economic policies, war and essential. Research suggests that men generally wish to conflict, and other hazards aect men and fathers be involved in planning and preparing for pregnancy and dierently. However, little research exists on the parenthood once they understand how their health aects implications for preconception and perinatal health.124,125 pregnancy and child outcomes.133 Based on consistent Continuing to investigate and address policies that findings from surveys and focus groups in the USA, impede or otherwise artificially shape men’s Europe, and Africa, most men agree with statements participation126 in families is crucial for supporting such as “as a man I can contribute to a healthy pregnancy reproductive justice and creating a more equitable and child”.134–137 When asked how they can contribute, framework that supports the important role of fathers in men often describe roles as “ensuring a healthy preconception and early childhood development. relationship with [their] partner” and “making sure [they] have a house and are financially stable”.3 However, men Implications for current and future are often unaware of the full extent of their potential preconception interventions and policy in boys, contribution, based on common misconceptions that men, and partners “pregnancy and child outcomes are almost solely So far, we have reviewed how narrow views on the role of influenced by the woman’s health” and “[they are] already men on pregnancy and ospring health restricted the healthy enough”.135,137 Research in sub-Saharan Africa scope and opportunities for initiatives and interventions indicated that men desired greater engagement in to improve paternal preconception health, such that these improving maternal and child health, but felt that their lag well behind those supporting women. Half of ability to do so was limited by culture-specified gender international clinical preconception care guidelines do not roles focused on providing for and advising their include recommendations for male preconception families.138 Additional barriers, such as lower rates of Review accessing health care compared with women and sparse immediate behavioural change,135 but many articulate knowledge about male fertility and preconception health their desire to support healthy pregnancies and among health-care professionals,138–140 further hinder ospring, persevere in family engagement, and even improvements to male preconception health. More recognise more direct contributions (eg, sperm health). research is needed to establish the best ways to educate Moreover, traditional cultures, when reinvigorated and and support men, but existing studies consistently not impeded by policies, are strong drivers of pro-social highlight an important role for health-care professionals, male engagement in families, partnerships, and child followed by trusted online resources.133,135,136,141 rearing. The immediate opportunity is for providers and systems to allow these strengths to flourish, alongside Social and political barriers health-care provision for boys’ and young men’s holistic In addition to social policies and personal factors (eg, wellbeing. health status, substance use, and mental health), multiple societal factors aect a father’s ability and opportunity to Vision of male preconception health interventions engage with their child.142 For example, traditional gender We present a vision for potential policies that embrace a norms and cultural expectations often maintain the broader understanding of the importance of the male life notion that child rearing is predominantly a maternal course and the eects of men on maternal preconception responsibility. Engaged fathers, particularly from health (figure 2). Such an approach recognises that minoritised communities, can be viewed with distrust143 promoting the health and wellbeing of women and men or otherwise excluded.144 Economic factors, such as job before and during the first 1000 days after conception will insecurity and inadequate wages, can hinder fathers’ have lasting biological eects on the male ospring that ability to participate fully in their children’s lives.145 support their later preconception health as future fathers. Overcoming these barriers is essential for aligning with ACEs underlie life course determinants of male broader reproductive justice goals. Culturally competent preconception health and behaviours influencing maternal initiatives that promote mental health management, health and wellbeing. A transgenerational life course flexible work arrangements, and overall wellness can approach, starting with a focus on the first 1000 days of life, empower men and shift societal perceptions to encourage should be combined with societal interventions that paternal engagement. Eorts that provide structural prevent ACEs, alongside individual-level, culturally relevant support tailored to the unique needs of fathers, especially remediation for those who experienced ACEs (panel 4). A those from minoritised communities, are crucial. roadmap has been proposed for a coordinated, preventative, Initiatives that address social determinants of health, and remediative response at all levels of policy making in such as access to health care, housing, and education, can the UK.118 Biomedical determinants of paternal precon- enhance men’s preconception health and engagement as ception health, such as genetic and congenital conditions, fathers. disability, subfertility, and serious health conditions, often act from early childhood; consequently, their management Facilitators in childhood should be protective of future reproductive Although men themselves are important facilitators for health (eg, avoiding testicular irradiation for childhood improving preconception health, shifting social norms cancer).146 By promoting health literacy as a route to healthy and ensuring that health-care systems support men’s behaviours, policy measures centred on the education involvement in parenthood preparation is also essential. system (ie, from the early years to higher education) can Some men express skepticism over their need for support paternal preconception health. A cluster First 1000 days Nurturing care Biomedical Education Community and Economic Neighbourhood Health and care determinants social context system Lasting effects of Responsive care Genetic and Early years, school, Social integration, Financial stability, Physical environment, Access to high- disparities before and prevention of congenital conditions, college, vocation migration, support, income or debt community, quality care that is and during adverse childhood toxicants, advanced and higher education, employment, support, paternity deprivation, housing, linguistically and pregnancy and experiences age, subfertility, and literacy exposure to racism, leave, food security, green spaces and culturally appropriate infancy, transmitted (eg, deprivation, and serious health violence, trauma, and access to parks, and and respectful across generations threat, and neglect) conditions stress, safety, and healthy nutrition transportation justice Life course support for boys and future fathers, through family, peers, community, partners, the health and care system, and societal policies Promotion of better paternal (and maternal) preparation for parenthood Improved maternal, paternal, pregnancy, offspring, and family outcomes Figure 2: Holistic life course determinants of male preconception health 1466 Review randomised trial showed that incorporating Southampton Equity implications of neglecting the role of men in preconception LifeLab’s Me, My Health and My Children’s Health health section. DS and KMG contributed to drafting portions of the Implications for current and future preconception interventions and engagement programme into the school science policy in boys, men, and partners section. JYH, FML, DS, and KMG curriculum had lasting benefits on how critically contributed to the figures. JYH and KMG contributed to managing and adolescents considered their health-related behaviours, administering the project. DS and KMG contributed to supervising the with similar eects in both boys and girls.147 project. All authors contributed to substantive revisions and edits to the manuscript. Public health policy makers now recognise the importance of wider determinants of health. Successful Declaration of interests We declare no competing interests. models have applied these determinants to women’s preconception health,148 but such an approach has yet to Acknowledgments JYH, MZLK, and GSKC were supported by the Singapore Biomedical be embraced in policies aecting men. These policies Research Council (Health and Human Potential Seed Grant should address the community and social context, and H22P0M0009). JYH is supported by the US National Institutes for Health economic and fiscal measures, including reducing food (grant numbers 2U54MD007601 and L60HD119875) and Health insecurity and supporting positive neighbourhood and Resources and Services Administration (5-UE7-MC26282-10). FML is supported by the Wright Family Foundation. KKS is supported by the physical environments. Many opportunities exist for Wellcome Trust (218495/Z/19/Z). KMG is supported by the UK Medical health-care systems to provide future fathers with access Research Council (MC_UU_12011/4), the National Institute for Health to high-quality, culturally appropriate preconception and Care Research (NIHR; NIHR Senior Investigator [NF-SI-0515–10042] care (eg, medication reviews for men with long-term and NIHR Southampton Biomedical Research Centre [NIHR203319]), and Alzheimer’s Research UK (ARUK-PG2022A-008). DS is supported by conditions such as epilepsy and mental ill health). the NIHR through an NIHR Advanced Fellowship (NIHR302955) and the The training of health-care providers to discuss NIHR Southampton Biomedical Research Centre (NIHR203319). preconception health with both men and women is an No funding was set aside for the writing of this manuscript and funding unmet need. Such provision should be combined with agencies had no oversight over the content or decision to submit the manuscript. All other authors declare no competing interests. public information initiatives on how biosocial factors, References such as lifestyle choices, advanced paternal age, and 1 Stephenson J, Heslehurst N, Hall J, et al. Before the beginning: health conditions, can aect fertility and ospring nutrition and lifestyle in the preconception period and its health. importance for future health. Lancet 2018; 391: 1830–41. 2 Fleming TP, Watkins AJ, Velazquez MA, et al. Origins of lifetime health around the time of conception: causes and consequences. Conclusion Lancet 2018; 391: 1842–52. This Review, in elucidating the far-reaching role of men 3 Schoenaker D, Hall J, Verbiest S, et al. Measuring progress in in preconception health, reinforces the need for holistic pregnancy planning and preconception health. Lancet 2026; published online March 16. https://doi.org/10.1016/S0140- strategies beyond participation in preventative health 6736(26)00192-3. care in early adulthood,103 into care for the early 4 Kotelchuck M, Lu M. Father’s role in preconception health. development of boys and young men. Paternal precon- Matern Child Health J 2017; 21: 2025–39. 5 Black RE, Liu L, Hartwig FP, et al. Health and development from ception health necessitates engagement and preconception to 20 years of age and human capital. Lancet 2022; participation from clinicians and education, social, and 399: 1730–40. mental health-care professionals, along with traditional 6 Lu MC, Jones L, Bond MJ, et al. Where is the F in MCH? Father reproductive specialties. The disproportionate, inter- involvement in African American families. Ethn Dis 2010; 20 (suppl): S2-49-61. generational harms borne by Indigenous, non-White, 7 Edin K, Tach L, Mincy R. Claiming fatherhood: race and the and socio economically disadvantaged men and their dynamics of paternal involvement among unmarried men. families as a result of poor attention to young men’s Ann Am Acad Pol Soc Sci 2009; 621: 149–77. 8 Sinclair KA, Kaholokula JK. Achieving health equity for Native health must also be acknowledged. Such a holistic Hawaiian men: Aia I hea ka wai a kāne. In: Grith DM, Bruce MA, framework will also aid identification of how social Thorpe RJ Jr, eds. Men’s health equity: a handbook. Taylor & Francis forces that shape ideals of masculinity are linked to 2019: 486–96. 9 Powis R, Bunkley EN. Handbooks and health interpreters: how men young men’s mental health and their roles as caretakers, are assets for their pregnant partners in Senegal. Soc Sci Med 2023; and thus serve as additional drivers of preconception 331: 116074. health.149 A transdisciplinary approach to preconception 10 Powis R. (Mis)measuring men’s involvement in global health: the case of expectant fathers in Dakar, Senegal. health research across the life course, integrating social BMC Pregnancy Childbirth 2022; 22: 754. and biological pathways, and explicitly including a more 11 Kusuyama J, Alves-Wagner AB, Makarewicz NS, Goodyear LJ. equitable consideration of men and partners, provides a Eects of maternal and paternal exercise on ospring metabolism. strong opportunity to deliver a comprehensive Nat Metab 2020; 2: 858–72. 12 Greeson KW, Crow KMS, Edenfield RC, Easley CA 4th. Inheritance preconception health strategy. of paternal lifestyles and exposures through sperm DNA Contributors methylation. Nat Rev Urol 2023; 20: 356–70. JYH, FML, DS, and KMG contributed to conceptualisation and overall 13 Capobianco E, Pirrone I. Paternal programming of fetoplacental methodology. JYH and FML contributed to review of the literature and and ospring metabolic disorders. Placenta 2023; 141: 71–77. drafting original material for the entire manuscript. MZLK, KKS, and 14 Bonde JP, Flachs EM, Rimborg S, et al. The epidemiologic evidence GSKC contributed to review of the literature and drafting portions of the linking prenatal and postnatal exposure to endocrine disrupting chemicals with male reproductive disorders: a systematic review Life course and intergenerational determinants of male preconception and meta-analysis. Hum Reprod Update 2016; 23: 104–25. health section. LNH and JKK contributed to drafting portions of the Review 15 Kumar N, Singh AK. Impact of environmental factors on human 37 Oldereid NB, Wennerholm U-B, Pinborg A, et al. The eect of semen quality and male fertility: a narrative review. Environ Sci Eur paternal factors on perinatal and paediatric outcomes: a systematic 2022; 34: 6. review and meta-analysis. Hum Reprod Update 2018; 24: 320–89. 16 Krzastek SC, Farhi J, Gray M, Smith RP. Impact of environmental 38 Dachew B, Ayano G, Duko B, Lawrence B, Betts K, Alati R. Paternal toxin exposure on male fertility potential. Transl Androl Urol 2020; depression and risk of depression among ospring: a systematic 9: 2797–813. review and meta-analysis. JAMA Netw Open 2023; 6: e2329159. 17 Gapp K, Bohacek J, Grossmann J, et al. Potential of environmental 39 Easey KE, Gkatzionis A, Millard LAC, Tilling K, Lawlor DA, enrichment to prevent transgenerational eects of paternal trauma. Sharp GC. Challenges in using data on fathers/partners to study Neuropsychopharmacology 2016; 41: 2749–58. prenatal exposures and ospring health. J Dev Orig Health Dis 2024; 18 Tan X, Luo J, Ding X, Li H. Preconception paternal mental 15: e25. disorders and child health: mechanisms and interventions. 40 Sharp GC, Lawlor DA. Paternal impact on the life course Neurosci Biobehav Rev 2023; 144: 104976. development of obesity and type 2 diabetes in the ospring. 19 McPherson NO, Fullston T, Kang WX, et al. Paternal under- Diabetologia 2019; 62: 1802–10. nutrition programs metabolic syndrome in ospring which can be 41 Sharp GC, Salas LA, Monnereau C, et al. Maternal BMI at the start reversed by antioxidant/vitamin food fortification in fathers. of pregnancy and ospring epigenome-wide DNA methylation: Sci Rep 2016; 6: 27010. findings from the pregnancy and childhood epigenetics (PACE) 20 Roach AN, Bhadsavle SS, Higgins SL, et al. Alterations in sperm consortium. Hum Mol Genet 2017; 26: 4067–85. RNAs persist after alcohol cessation and correlate with epididymal 42 Sum KK, Burton MA, Alcazar CG, Teh AL, Godfrey KM, Huang JY. mitochondrial dysfunction. Andrology 2024; 12: 1012–23. Strength of evidence for paternal influence on ospring epigenome 21 Kim MS, Kim JY, Song YS, et al. Association of bariatric surgery in observational human studies: a systematic review and risk-of-bias with indicated and unintended outcomes: an umbrella review and appraisal for non-randomized exposures. Epigenetics 2025; meta-analysis for risk-benefit assessment. Obes Rev 2024; 20: 2594322. 25: e13670. 43 Si J, Meir AY, Hong X, et al. Maternal pre-pregnancy BMI, 22 Hieronimus B, Ensenauer R. Influence of maternal and paternal ospring epigenome-wide DNA methylation, and childhood pre-conception overweight/obesity on ospring outcomes and obesity: findings from the Boston Birth Cohort. BMC Med 2023; strategies for prevention. Eur J Clin Nutr 2021; 75: 1735–44. 21: 317. 23 Soubry A, Hoyo C, Jirtle RL, Murphy SK. A paternal environmental 44 Martín-Calvo N, Mínguez-Alarcón L, Gaskins AJ, et al, and the legacy: evidence for epigenetic inheritance through the male germ EARTH Study team. Paternal preconception folate intake in relation line. BioEssays 2014; 36: 359–71. to gestational age at delivery and birthweight of newborns conceived 24 Shi Q, Qi K. Developmental origins of health and disease: impact of through assisted reproduction. Reprod Biomed Online 2019; paternal nutrition and lifestyle. Pediatr Investig 2023; 7: 111–31. 39: 835–43. 25 Tomar A, Gomez-Velazquez M, Gerlini R, et al. Epigenetic 45 Neeser NB, Martani A, De Clercq E, et al. Building a family at advanced parental age: a systematic review on the risks and inheritance of diet-induced and sperm-borne mitochondrial RNAs. Nature 2024; 630: 720–27. opportunities for parents and their ospring. Hum Reprod Open 2023; 4: hoad042. 26 Vaz C, Burton M, Kermack AJ, et al. Short-term diet intervention comprising of olive oil, vitamin D, and omega-3 fatty acids alters 46 Janecka M, Haworth CMA, Ronald A, et al. Paternal age alters social the small non-coding RNA (sncRNA) landscape of human sperm. development in ospring. J Am Acad Child Adolesc Psychiatry 2017; Sci Rep 2025; 15: 7790. 56: 383–90. 27 Wilkinson C, Low F, Gluckman P. Beyond genes: how fathers play a 47 Gilmore D. Manhood in the making: cultural concepts of biological role in the health of future generations. https://doi. masculinity. Yale University Press, 1990. org/10.17608/k6.auckland.20335161 (accessed Oct 10, 2024). 48 Lamb ME. The history of research on father involvement: an 28 Vågerö D, Pinger PR, Aronsson V, van den Berg GJ. Paternal overview. Marriage Fam Rev 2000; 29: 23–42. grandfather’s access to food predicts all-cause and cancer mortality 49 Cabrera NJ, Volling BL, Barr R. Fathers are parents, too! Widening in grandsons. Nat Commun 2018; 9: 5124. the lens on parenting for children’s development. 29 Jansen E, Marceau K, Sellers R, et al, and the Program Collaborators Child Dev Perspectives 2018; 12: 152–57. for Environmental Influences on Child Health Outcomes. The role 50 Alio AP, Salihu HM, Kornosky JL, Richman AM, Marty PJ. of fathers in child development from preconception to postnatal Feto-infant health and survival: does paternal involvement matter? influences: opportunities for the National Institutes of Health Matern Child Health J 2010; 14: 931–37. Environmental influences on Child Health Outcomes (ECHO) 51 Martin LT, McNamara MJ, Milot AS, Halle T, Hair EC. The eects of program. Dev Psychobiol 2024; 66: e22451. father involvement during pregnancy on receipt of prenatal care 30 Levine H, Jørgensen N, Martino-Andrade A, et al. Temporal trends and maternal smoking. Matern Child Health J 2007; 11: 595–602. in sperm count: a systematic review and meta-regression analysis of 52 Rocklie L, Peters S, Heazell AEP, Smith DM. Factors influencing samples collected globally in the 20th and 21st centuries. health behaviour change during pregnancy: a systematic review and Hum Reprod Update 2023; 29: 157–76. meta-synthesis. Health Psychol Rev 2021; 15: 613–32. 31 Carter T, Schoenaker D, Adams J, Steel A. Paternal preconception 53 Kortsmit K, Garfield C, Smith RA, et al. Paternal involvement and modifiable risk factors for adverse pregnancy and ospring maternal perinatal behaviors: pregnancy risk assessment outcomes: a review of contemporary evidence from observational monitoring system, 2012–2015. Public Health Rep 2020; 135: 253–61. studies. BMC Public Health 2023; 23: 509. 54 Parker JJ, Simon C, Bendelow A, et al. Fathers, breastfeeding, and 32 Billah MM, Khatiwada S, Morris MJ, Maloney CA. Eects of infant sleep practices: findings from a state-representative survey. paternal overnutrition and interventions on future generations. Pediatrics 2023; 152: e2022061008. Int J Obes (Lond) 2022; 46: 901–17. 55 van Lonkhuijzen RM, Rustenhoven H, de Vries JHM, 33 Lo JO, Hedges JC, Chou WH, et al. Influence of substance use on Wagemakers A. The role of the partner in the support of a pregnant male reproductive health and ospring outcomes. Nat Rev Urol woman’s healthy diet: an explorative qualitative study. 2024; 21: 534–64. BMC Pregnancy Childbirth 2023; 23: 760. 34 Zweifel JE, Woodward JT. The risky business of advanced paternal 56 Rini C, Schetter CD, Hobel CJ, Glynn LM, Sandman CA. Eective age: neurodevelopmental and psychosocial implications for social support: antecedents and consequences of partner support children of older fathers. Fertil Steril 2022; 118: 1013–21. during pregnancy. Pers Relatsh 2006; 13: 207–29. 35 Kaltsas A, Moustakli E, Zikopoulos A, et al. Impact of advanced 57 Yargawa J, Leonardi-Bee J. Male involvement and maternal health paternal age on fertility and risks of genetic disorders in ospring. outcomes: systematic review and meta-analysis. Genes (Basel) 2023; 14: 486. J Epidemiol Community Health 2015; 69: 604–12. 36 Zhou Q, Song L, Chen J, et al. Association of preconception 58 Plantin L, Olykoya A, Ny P. Positive health outcomes of fathers’ paternal alcohol consumption with increased fetal birth defect risk. involvement in pregnancy and childbirth paternal support: a scope JAMA Pediatr 2021; 175: 742–43. study literature review. Fathering 2011; 9: 87–102. 1468 Review 59 Livingston JD, Youssef GJ, StGeorge J, et al. Paternal coping and 84 Perales F, Kusko E, Flood M, King T. Like father, like son: psychopathology during the perinatal period: a mixed studies empirical insights into the intergenerational continuity of systematic review and meta-analysis. Clin Psychol Rev 2021; masculinity ideology. Sex Roles 2023; 88: 399–412. 86: 102028. 85 Cabrera NJ, Tamis-LeMonda CS, Bradley RH, Hoerth S, 60 Paulson JF, Bazemore SD. Prenatal and postpartum depression in Lamb ME. Fatherhood in the twenty-first century. Child Dev 2000; fathers and its association with maternal depression: a meta- 71: 127–36. analysis. JAMA 2010; 303: 1961–69. 86 Edelstein RS, Chopik WJ, Saxbe DE, Wardecker BM, Moors AC, 61 Thiel F, Pittelkow MM, Wittchen HU, Garthus-Niegel S. LaBelle OP. Prospective and dyadic associations between expectant The relationship between paternal and maternal depression during parents’ prenatal hormone changes and postpartum parenting the perinatal period: a systematic review and meta-analysis. outcomes. Dev Psychobiol 2017; 59: 77–90. Front Psychiatry 2020; 11: 563287. 87 Bakermans-Kranenburg MJ, Verhees MWFT, Lotz AM, 62 Meaney MJ. Perinatal maternal depressive symptoms as an issue Alyousefi-van Dijk K, Van IJzendoorn MH. Is paternal oxytocin an for population health. Am J Psychiatry 2018; 175: 1084–93. oxymoron? Oxytocin, vasopressin, testosterone, oestradiol and 63 Phua DY, Kee MZL, Meaney MJ. Positive maternal mental health, cortisol in emerging fatherhood. Philos Trans R Soc Lond B Biol Sci parenting, and child development. Biol Psychiatry 2020; 87: 328–37. 2022; 377: 20210060. 64 Diamond A. Executive functions. Annu Rev Psychol 2013; 64: 135–68. 88 Meijer WM, van IJzendoorn MH, Bakermans-Kranenburg MJ. 65 Nolen-Hoeksema S. Emotion regulation and psychopathology: the Challenging the challenge hypothesis on testosterone in fathers: role of gender. Annu Rev Clin Psychol 2012; 8: 161–87. limited meta-analytic support. Psychoneuroendocrinology 2019; 110: 104435. 66 Lund JI, Toombs E, Radford A, Boles K, Mushquash C. Adverse childhood experiences and executive function diculties in 89 Gettler LT, McDade TW, Feranil AB, Kuzawa CW. Longitudinal children: a systematic review. Child Abuse Negl 2020; 106: 104485. evidence that fatherhood decreases testosterone in human males. Proc Natl Acad Sci USA 2011; 108: 16194–99. 67 McBride N, Johnson S. Fathers’ role in alcohol-exposed pregnancies: systematic review of human studies. Am J Prev Med 2016; 51: 240–48. 90 Gettler LT, Rosenbaum S, Kuo PX, et al. Evidence for an adolescent sensitive period to family experiences influencing adult male 68 Romero-Martínez Á, Sarrate-Costa C, Moya-Albiol L. A meta- testosterone production. Proc Natl Acad Sci USA 2022; analysis of cognitive functioning in intimate partner violence 119: e2202874119. perpetrators. Neuropsychol Rev 2024; 34: 1191–212. 91 Martínez-García M, Paternina-Die M, Cardenas SI, et al. First-time 69 Bacchus LJ, Ranganathan M, Watts C, Devries K. Recent intimate fathers show longitudinal gray matter cortical volume reductions: partner violence against women and health: a systematic review and evidence from two international samples. Cereb Cortex 2023; meta-analysis of cohort studies. BMJ Open 2018; 8: e019995. 33: 4156–63. 70 Bayrampour H, McDonald S, Tough S. Risk factors of transient and 92 Hoekzema E, Barba-Müller E, Pozzobon C, et al. Pregnancy leads to persistent anxiety during pregnancy. Midwifery 2015; 31: 582–89. long-lasting changes in human brain structure. Nat Neurosci 2017; 71 Evans J, Melotti R, Heron J, et al. The timing of maternal depressive 20: 287–96. symptoms and child cognitive development: a longitudinal study. 93 Paternina-Die M, Martínez-García M, Martín de Blas D, et al. J Child Psychol Psychiatry 2012; 53: 632–40. Women’s neuroplasticity during gestation, childbirth and 72 Rifkin-Graboi A, Meaney MJ, Chen H, et al. Antenatal maternal postpartum. Nat Neurosci 2024; 27: 319–27. anxiety predicts variations in neural structures implicated in anxiety 94 Saxbe D, Martínez-García M. Cortical volume reductions in men disorders in newborns. J Am Acad Child Adolesc Psychiatry 2015; transitioning to first-time fatherhood reflect both parenting 54: 313–21. engagement and mental health risk. Cereb Cortex 2024; 73 Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women 34: bhae126. at risk of antenatal anxiety and depression: a systematic review. 95 Sharp GC, Lawlor DA, Richardson SS. It’s the mother! How J Aect Disord 2016; 191: 62–77. assumptions about the causal primacy of maternal eects influence 74 Cardenas SI, Morris AR, Marshall N, et al. Fathers matter from the research on the developmental origins of health and disease. start: the role of expectant fathers in child development. Soc Sci Med 2018; 213: 20–27. Child Dev Perspect 2022; 16: 54–59. 96 Warin M, Zivkovic T, Moore V, Davies M. Mothers as smoking 75 Wake M, Nicholson JM, Hardy P, Smith K. Preschooler obesity and guns: fetal overnutrition and the reproduction of obesity. parenting styles of mothers and fathers: Australian national Fem Psychol 2012; 22: 360–75. population study. Pediatrics 2007; 120: e1520–27. 97 Richardson SS, Daniels CR, Gillman MW, et al. Society: don’t blame 76 Grat N, Lo B, Easton SD, Pineros-Leano M, Davison KK. Maternal the mothers. Nature 2014; 512: 131–32. and paternal adverse childhood experiences (ACEs) and ospring 98 Wu S, Wu F, Ding Y, Hou J, Bi J, Zhang Z. Advanced parental age health and wellbeing: a scoping review. Matern Child Health J 2024; and autism risk in children: a systematic review and meta-analysis. 28: 52–66. Acta Psychiatr Scand 2017; 135: 29–41. 77 Spry E, Giallo R, Moreno-Betancur M, et al. Preconception 99 Albuja AF, Sanchez DT, Lee SJ, Lee JY, Yadava S. The eect of prediction of expectant fathers’ mental health: 20-year cohort study paternal cues in prenatal care settings on men’s involvement from adolescence. BJPsych Open 2018; 4: 58–60. intentions. PLoS One 2019; 14: e0216454. 78 Giallo R, Wynter K, McMahon G, et al. Preconception factors 100 Abed Alah M. Unlocking the path to healthier families: associated with postnatal mental health and suicidality among first- the untapped potential of men’s preconception health. J Prev 2024; time fathers: results from an Australian longitudinal study of men’s 45: 1–8. health. Soc Psychiatry Psychiatr Epidemiol 2023; 58: 1153–60. 101 Harris NL, Richardson Cayama M, Arias C, et al. Assessing the 79 Cameron EE, Sedov ID, Tomfohr-Madsen LM. Prevalence of unmet preconception care needs of men in the United States by paternal depression in pregnancy and the postpartum: an updated race/ethnicity and nativity. Sex Reprod Healthc 2023; 36: 100840. meta-analysis. J Aect Disord 2016; 206: 189–203. 102 Dorney E, Boyle JA, Walker R, et al. A systematic review of clinical 80 Skjothaug T, Smith L, Wentzel-Larsen T, Moe V. Prospective fathers’ guidelines for preconception care. Semin Reprod Med 2022; adverse childhood experiences, pregnancy-related anxiety, and 40: 157–69. depression during pregnancy. Infant Ment Health J 2015; 36: 104–13. 103 Czeizel AE, Czeizel B, Vereczkey A. The participation of prospective 81 Goldstein Z, Rosen B, Howlett A, Anderson M, Herman D. fathers in preconception care. Clin Med Insights Reprod Health 2013; Interventions for paternal perinatal depression: a systematic review. 7: 1–9. J Aect Disord 2020; 265: 505–10. 104 Sum KK, Tint MT, Aguilera R, et al. The socioeconomic landscape 82 Rominov H, Pilkington PD, Giallo R, Whelan TA. A systematic of the exposome during pregnancy. Environ Int 2022; 163: 107205. review of interventions targeting paternal mental health in the perinatal period. Infant Ment Health J 2016; 37: 289–301. 105 Monden CWS, van Lenthe F, de Graaf ND, Kraaykamp G. Partner’s and own education: does who you live with matter for self-assessed 83 Narayan AJ, Lieberman AF, Masten AS. Intergenerational health, smoking and excessive alcohol consumption? Soc Sci Med transmission and prevention of adverse childhood experiences 2003; 57: 1901–12. (ACEs). Clin Psychol Rev 2021; 85: 101997. Review 106 Paulson JF, Bazemore SD, Goodman JH, Leiferman JA. The course 130 Righton O, Flynn A, Alwan NA, Schoenaker D. Preconception health and interrelationship of maternal and paternal perinatal depression. in adolescence and adulthood across generations in the UK: findings Arch Womens Ment Health 2016; 19: 655–63. from three British birth cohort studies. PLoS One 2024; 19: e0299061. 107 Li X, Hu Y, Huang C-YS, Chuang SS. Beyond W.E.I.R.D. (Western, 131 Anakwe A, Ortiz K, Kotelchuck M, BeLue R. Preconception health educated, industrial, rich, democratic)-centric theories and indicators among adult US men: race/ethnicity variations and perspectives: masculinity and fathering in Chinese societies. temporal trends. Andrology 2025; 13: 7–21. J Fam Theory Rev 2021; 13: 317–33. 132 Dennis CL, Brennenstuhl S, Brown HK, Bell RC, Marini F, Birken CS. 108 Juhari R, Yaacob SN, Talib MA. Father involvement among Malay High-risk health behaviours of pregnancy-planning women and men: muslims in Malaysia. J Fam Issues 2012; 34: 208–27. is there a need for preconception care? Midwifery 2022; 106: 103244. 109 Else IRN, Andrade NN, Hishinuma ES. The role of Native Hawaiian 133 Schoenaker D, Gafari O, Taylor E, et al, and the UK Preconception mothers and fathers in conveying traditional Hawaiian beliefs and Partnership. What does ‘preconception health’ mean to people? A practices to children. Hülili. 2007; 3: 93–106. public consultation on awareness and use of language. Health Expect 110 Morrell R, Dunkle K, Ibragimov U, Jewkes R. Fathers who care and 2024; 27: e14181. those that don’t: men and childcare in South Africa. S Afr Rev Sociol 134 Kransdorf LN, Raghu TS, Kling JM, et al. Reproductive life planning: 2016; 47: 80–105. a cross-sectional study of what college students know and believe. 111 Grith DM, Cornish EK. “What defines a man?”: perspectives of Matern Child Health J 2016; 20: 1161–69. African American men on the components and consequences of 135 Maas VYF, Poels M, Stam AL, Lieftink N, Franx A, Koster MPH. manhood. Psychol Men Masc 2018; 19: 78–88. Exploring male perceptions regarding the need to engage in 112 Ye D, Reyes-Salvail F. Adverse childhood experiences among preconception care—a mixed-method study amongst Dutch Hawai’i adults: findings from the 2010 Behavioral Risk Factor (prospective) fathers. Eur J Contracept Reprod Health Care 2022; Survey. Hawaii J Med Public Health 2014; 73: 181–90. 27: 322–29. 113 Goodyear-Ka’opua N, Hussey I, eds. A nation rising: Hawaiian 136 Cassinelli EH, McClure A, Cairns B, et al. Exploring health movements for life, land, and sovereignty. Narrating Native behaviours, attitudes and beliefs of women and men during the Histories, 2014. preconception and interconception periods: a cross-sectional study 114 Riley L, Su‘esu‘e A, Hulama K, Neumann SK, Chung-Do J. Ke ala i of adults on the island of Ireland. Nutrients 2023; 15: 3832. ka Mauliola: Native Hawaiian youth experiences with historical 137 Ojifinni OO, Ibisomi L. Perception of men’s need for trauma. Int J Environ Res Public Health 2022; 19: 12564. preconception care—a qualitative exploration among health care 115 Oce of Hawaiian Aairs. Kānehō’ālani—transforming the health providers and community members. Front Public Health 2022; of Native Hawaiian men. https://www.oha.org/wp-content/uploads/ 10: 958618. Kane_Health_Report_Final_web-REV.pdf (accessed Nov 28, 2023). 138 Watson D, Chatio S, Barker M, et al, and the INPreP study group. 116 Kaholokula JK, Aitaoto N, Werner K. Pacific Islanders and gender. Men’s motivations, barriers to and aspirations for their families’ In: Nadal KL, Mazzula SL, Rivera DP, eds. The SAGE encyclopedia health in the first 1000 days in sub-Saharan Africa: a secondary qualitative analysis. BMJ Nutr Prev Health 2023; 6: 39–45. of psychology and gender. SAGE Publications, 2017: 1253–58. 117 Tengan TPK. Native men remade. Duke University Press, 2008. 139 Sternberg P, Hubley J. Evaluating men’s involvement as a strategy in sexual and reproductive health promotion. Health Promot Int 118 Clark H, Royal P, Webb LR, et al. Adverse childhood experiences: 2004; 19: 389–96. roads to recovery. https://fhcappg.org.uk/wp-content/ uploads/2024/03/ADVERSE-CHILDHOOD-EXPERIENCES-FINAL- 140 Wang Y, Hunt K, Nazareth I, Freemantle N, Petersen I. Do men REPORT.pdf (accessed Oct 10, 2024). consult less than women? An analysis of routinely collected UK general practice data. BMJ Open 2013; 3: e003320. 119 Yang YT, Wallington SF, Morain S. Paid leave for fathers: policy, practice, and reform. Milbank Q 2022; 100: 973–90. 141 Quayyum F, Dombrowski SU. Barriers to nutritional pregnancy preparation and support needs in women and men: qualitative 120 Wilcox B, Gersten C, Regier J. Marriage penalties in means-tested study based on the Theoretical Domains Framework. tax and transfer programs. issues and opinions. https://acf.gov/ Womens Health (Lond Engl) 2021; 17: 17455065211042182. sites/default/files/documents/ofa/hmrf_marriagepenalties_paper_ final50812_6_19.pdf (accessed Oct 10, 2024). 142 Coakley TM, Shears JK, Randoilph SD. Understanding key barriers to fathers’ involvement in their children’s lives. Child Youth Serv 121 Nepomnyaschy L. Child support and father–child contact: testing 2014; 35: 343–64. reciprocal pathways. Demography 2007; 44: 93–112. 143 Garfield CF, Isacco A. Fathers and the well-child visit. Pediatrics 122 Turner KJ, Waller MR. Indebted relationships: child support arrears 2006; 117: e637–45. and nonresident fathers’ involvement with children. J Marriage Fam 2017; 79: 24–43. 144 Grace B, Shawe J, Johnson S, Stephenson J. You did not turn up… I did not realise I was invited…: understanding male attitudes 123 Geller A, Cooper CE, Garfinkel I, Schwartz-Soicher O, Mincy RB. towards engagement in fertility and reproductive health Beyond absenteeism: father incarceration and child development. discussions. Hum Reprod Open 2019; 2019: hoz014. Demography 2012; 49: 49–76. 145 Diniz E, Monteiro L, Veríssimo M. Work gains and strains on father 124 Vo HN, McKenzie-McHarg K, Bennett PC, Mai DL. Lived involvement: the mediating role of parenting styles. Children (Basel) experiences of migrant fathers in the perinatal period: a systematic 2023; 10: 1357. review and analysis. J Immigr Minor Health 2024; 26: 1070–84. 146 Baliga S, Patel S, Naqa IE, et al. Testicular dysfunction in male 125 Mprah A, Haith-Cooper M, Duda-Mikulin E, Meddings F. childhood cancer survivors treated with radiation therapy: A systematic review and narrative synthesis of fathers’ (including a PENTEC comprehensive review. Int J Radiat Oncol Biol Phys 2024; migrant fathers’) experiences of pregnancy and childbirth. 119: 610–24. BMC Pregnancy Childbirth 2023; 23: 238. 147 Woods-Townsend K, Hardy-Johnson P, Bagust L, et al. A cluster- 126 Powis R. Making Sure She Eats Right: Absent-presence, articulation, randomised controlled trial of the LifeLab education intervention to and surveillance-care in Senegalese men’s maternal support. improve health literacy in adolescents. PLoS One 2021; 16: e0250545. Med Anthropol 2025; 44: 273–85. 148 Clark H, Royal P, Wright P, et al. A preconception care strategy. 127 Steel A, Gibson H, Adams J, Schoenaker D. What preconception Children’s Alliance, 2023. health services would the public find when searching the internet in Australia? Results from a simulated internet-search study. 149 Over H, Bunce C, Konu D, Zendle D. What do we need to know BMC Health Serv Res 2024; 24: 93. about the manosphere and young people’s mental health? Child Adolesc Ment Health 2025; 30: 272–74. 128 Shawe J, Patel D, Joy M, Howden B, Barrett G, Stephenson J. Preparation for fatherhood: a survey of men’s preconception health Copyright © 2026 Elsevier Ltd. All rights reserved, including those for knowledge and behaviour in England. PLoS One 2019; 14: e0213897. text and data mining, AI training, and similar technologies. 129 Hogg K, Rizio T, Manocha R, McLachlan RI, Hammarberg K. Men’s preconception health care in Australian general practice: GPs’ knowledge, attitudes and behaviours. Aust J Prim Health 2019; 25: 353–58. 1470 --- [PDF原文](https://sci-net.xyz/storage/7932541/9d84df5ae829c3e23e2131039792c3fce1333fb8e3e3428d755dddf51225b7ce/More-equitable-preconception-health-paternal-life-course-opportunities-for-better-pregnancy.pdf) DOI: 10.1016/S0140-6736(26)00148-0