KKH-MCHRI joins landmark study to establish first global system to track health before pregnancy

• Researchers from KKH-MCHRI are part of a pioneering effort to identify global indicators for monitoring pre-pregnancy health
• Singapore's findings prioritise physical and mental well-being for prospective parents

18 March 2026, Singapore – KK Women's and Children's Hospital Maternal and Child Health Research Institute (KKH-MCHRI) is part of a pioneering study that is paving the way towards the first global system for monitoring the health of people planning to start a family.

Globally, preconception health is in the spotlight with rising incidence of obesity and mental health challenges. More women are becoming pregnant with health conditions that can complicate pregnancy and childbirth - such as obesity, diabetes and mental illness.

The new study, published in The Lancet¹,  presented for the first time a set of indicators covering 12 areas (Annex A) that can be used globally to monitor the health of both men and women of reproductive age, before pregnancy. Also, for the first time, views of the general public are included in such a study, alongside views of healthcare professionals.

Across all 13 participating countries², over 5,000 participants were asked what factors would matter most to them before a pregnancy, and the responses were remarkably consistent. Mental health, physical health, supportive relationships, and finances were collectively prioritised, before pregnancy.

The key health and social indicators for this global framework were identified through a collaboration led by researchers at University College London (UCL) and the University of Southampton,  with KKH-MCHRI as the Singapore partner.

The Singapore perspective

In Singapore, the two top priorities raised by participants were physical health and mental health, findings that are significant given the country’s declining fertility rates at an all-time low of 0.87 in 2025, and the national emphasis on supporting couples who wish to start families.

"Singapore’s findings are in line with global trends. These complement our ongoing population health research and clinical work with the S-PRESTO and HELMS cohorts³, and reinforce the life-course approach — that early intervention addressing the broader determinants of preconception health can create an environment to better support couples wanting to start families, and encourage parenthood," said Dr Ku Chee Wai, Theme Lead for Preconception Health,  KKH Maternal and Child Health Research Institute (KKH-MCHRI), a co-lead for the Singapore study.

Next steps

Senior author Professor Judith Stephenson from the UCL EGA Institute for Women's Health highlighted that researchers have distilled over 120 indicators to 40 core ones for a practical global surveillance system. She emphasised, “A strong international collaboration is now needed to achieve consensus on which core indicators can be compared across low-, middle- and high-income countries.”

Lead author Dr Danielle Schoenaker from the University of Southampton and the National Institute for Health and Care Research Southampton Biomedical Research Centre noted that optimising preconception health improves birth outcomes and reduces chronic disease risks and intergenerational inequalities. She added, “Without the right monitoring systems, governments and health services cannot easily see whether their policies and programmes are working.”

The team will work with other researchers, clinicians, policy makers and members of the public at an international workshop in November 2026 to finalise the indicators. They will then call on the World Health Organisation, NHS England and other global agencies responsible for national health surveillance to incorporate the indicators, where possible, into existing infrastructures to enable health monitoring before pregnancy.

¹ 'Measuring progress in pregnancy planning and preconception health' by Danielle Schoenaker, Jennifer Hall, Sarah Verbiest, Engelbert A. Nonterah, Wendy V. Norman, Ghadir Fakhri Al-Jayyousi, Hanan F. Abdul Rahim, Nadira Sultana Kakoly, Ana Luiza Vilela Borges, Danielle Mazza, Chee Wai Ku, Jerry Kok Yen Chan, Ilse Delbaere, Shane A. Norris, Eric Steegers, Geraldine Barrett, Gabriella Conti, Judith Stephenson, for the international Core Indicators for Preconception Health and Equity (iCIPHE) Alliance. The study has been published in The Lancet on 16 March 2026.

² Australia, Bangladesh, Belgium, Brazil, Canada, Qatar, Singapore, the UK, Ghana, Kenya, Malaysia, South Africa and the USA.

³ S-PRESTO: Singapore Preconception Study of Long-Term Maternal and Child Outcomes; and HELMS: Healthy Early Life Moments in Singapore

Annex A: The 12 areas covered by the indicators

1. Wider determinants of health: Education, employment, ethnicity, migrant status, deprivation; plus system-level factors such as housing, transport and working conditions.
2. Health care: Preconception checks, routine health reviews, dental care; access to services, trained providers, insurance coverage.
3. Emotional and social health: Social support, domestic abuse, family pressures; availability of support services.
4. Reproductive health and family planning: Pregnancy intention, contraception, fertility issues, obstetric history; access to contraception, fertility services and safe abortion.
5. Health behaviours and weight: Folic acid supplements, vitamin deficiency, diet, activity, sleep, smoking, alcohol, substances, BMI; food fortification policies, food insecurity, green space access.
6. Environmental exposures: Exposure to hazardous substances; air pollution, water safety and sanitation.
7. Preventive health screening: Cervical screening and access to screening programmes.
8. Immunisation and infections: Vaccination status, STIs, malaria, HIV, hepatitis; vaccination coverage and malaria prevention tools.
9. Mental health conditions: Diagnosed mental illness, stress levels, past perinatal mental illness; access to mental health services.
10. Physical health conditions: Diabetes, hypertension, epilepsy, asthma, Polycystic ovary syndrome (PCOS), endometriosis, cardiovascular disease and others; access to disease-specific check-ups.
11. Medication: Use of medicines unsafe in pregnancy (e.g., valproate, warfarin); access to safer alternatives.
12. Genetic risk: Family history of inherited conditions, consanguinity; access to genetic screening.