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However, the reports, statements and guidelines of national and international health organisations vary in what they recommend individuals should monitor, avoid, reduce or practise in the preconception period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To synthesise and evaluate the evidence across systematic reviews for associations between exposures before conception and adverse pregnancy, birth and postpartum outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>MEDLINE, Embase, Epistemonikos (to May 2020) and reference lists of included reviews, without language or date restrictions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study selection, data extraction and synthesis<\/jats:title><jats:p>Systematic literature reviews of observational and\/or interventional studies reporting associations between preconception exposures in women and\/or men of reproductive age and pregnancy, birth or postpartum health outcomes were included. The methodological quality of reviews and the certainty of the evidence underlying each exposure\u2010outcome association were assessed using AMSTAR 2 and the GRADE approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 53 eligible reviews reporting 205 unique exposure\u2010outcome associations. Methodological quality was generally low with only two reviews rated as \u2018high\u2019 quality and two as \u2018moderate\u2019. We found high\u2010certainty, randomised trial evidence that maternal folate supplementation reduces the risk of neural tube defects and anomaly\u2010related terminations. Moderate\u2010certainty, observational evidence was found that maternal physical activity is associated with reduced risk of pre\u2010eclampsia and gestational diabetes, and that paternal age of \u226540\u00a0years and maternal body mass index (BMI) and interpregnancy weight gain are associated with increased risk of various adverse pregnancy and birth outcomes. Low\u2010 and very low\u2010certainty evidence was found for other associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Clinicians and policymakers can be confident that maternal folate supplementation should be encouraged during the preconception period. There is moderate certainty in the evidence base that maternal physical activity, BMI and interpregnancy weight gain and advanced paternal age are important preconception considerations. High\u2010quality research is required to better understand other exposure\u2010outcome associations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12855","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T06:29:35Z","timestamp":1640932175000},"page":"288-299","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Preconception exposures and adverse pregnancy, birth and postpartum outcomes: Umbrella review of systematic reviews"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6694-3835","authenticated-orcid":false,"given":"Michael","family":"Daly","sequence":"first","affiliation":[{"name":"University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth R.","family":"Kipping","sequence":"additional","affiliation":[{"name":"University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Tinner","sequence":"additional","affiliation":[{"name":"University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Sanders","sequence":"additional","affiliation":[{"name":"Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James\u00a0W.","family":"White","sequence":"additional","affiliation":[{"name":"Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00682-6"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30451-0"},{"key":"e_1_2_7_4_1","unstructured":"World Health Organisation.Congenital anomalies.https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/congenital\u2010anomaliesAccessed July 9 2021."},{"key":"e_1_2_7_5_1","volume-title":"Trends in Maternal Mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA","author":"World Health Organization","year":"2019"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30311-8"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.07.067"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30312-X"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/S2040174421000258"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2702.2003.00662.x"},{"key":"e_1_2_7_11_1","volume-title":"Clinical Practice Guidelines We Can Trust","author":"Steinberg E","year":"2011"},{"key":"e_1_2_7_12_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6","author":"Pollock M","year":"2020"},{"key":"e_1_2_7_13_1","first-page":"CD004073","article-title":"Vitamin supplementation for preventing miscarriage","author":"Rumbold A","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_14_1","first-page":"CD004073","article-title":"Vitamin supplementation for preventing miscarriage","author":"Balogun OO","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_15_1","first-page":"372","article-title":"PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews","volume":"2021","author":"Page MJ","year":"2020","journal-title":"The BMJ"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-12-51"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.12.002"},{"key":"e_1_2_7_18_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Chandler J","year":"2019"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmt041"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-012-1210-9"},{"key":"e_1_2_7_21_1","unstructured":"National Institute for Health and Care Excellence (NICE).Fertility problems: assessment and treatment. 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