Traditionally, research on the developmental origins of health and disease has predominantly focused on maternal pregnancy exposures, leaving paternal health largely underexplored. The role of paternal factors in offspring health is an emerging field that addresses direct genetic and epigenetic influences and indirect environmental impacts. Paternal health may influence epigenetic changes in sperm production and/or quality, mainly induced by environmental exposures such as diet and smoking, which can determine an intergenerational transmission. Moreover, paternal mental health issues such as anxiety or depression can negatively impact emotional and/or behavioral outcomes in offspring. More specifically, another cutting-edge topic regards how the pre-conception use of some psychotropic drugs by the future father could negatively impact gestational, fetal, and/or neonatal outcomes. Despite the critical role of paternal factors, there is still a significant gap in research focusing on paternal variables in the perinatal period, being commonly conceived as a maternal-centric medical practice that often neglects paternal role in the occurrence and/or maintenance of maternal mental health condition and/or their role in fetal and/or neonatal outcomes. This chapter will explore these dynamics in depth, examining the impact of paternal health behaviors on offspring across different domains from genetic and epigenetic factors to mental health and behavioral outcomes. The final goal includes addressing knowledge gaps among clinicians as well as providing a more comprehensive understanding of paternal influences during the perineal period. Finally, the authors will propose a set of recommendations regarding the management of preconceptional care that equally engage both parents in the reproductive health process.