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Improved maternal nutritional status is hypothesized to promote good pregnancy and infant health outcomes but trial evidence supporting the commencement of nutritional supplementation before conception is sparse. The NiPPeR (Nutritional Intervention Preconception and During Pregnancy to Maintain Healthy Glucose Metabolism and Offspring Health) multinational double-blind randomized controlled trial conducted in the United Kingdom, Singapore, and New Zealand tested a nutritional formulation containing myo-inositol, probiotics, and multiple micronutrients (intervention), compared with a standard micronutrient supplement (control), taken at preconception and throughout pregnancy. The primary outcome of gestational glycemia at 28 weeks' gestation showed no difference. However, differences in several prespecified secondary outcomes were notable. The intervention reduced the incidence of preterm delivery particularly those associated with preterm prelabor rupture of membranes, operative delivery for delayed second stage, and major postpartum hemorrhage. It may also shorten time to conception in overweight women, to that similar to nonoverweight/obese women. Importantly, the intervention associated with a reduction in the incidence of rapid infant weight gain and high body mass index at 2 years among offspring. Such evidence indicates the potential for preconception maternal nutritional interventions to have appreciable impact in shaping the long-term health of an individual and building resilience against noncommunicable chronic diseases in the future., (© 2024 S. Karger AG, Basel.)