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This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.

Good health in the years before having a child protects women themselves, and also their future children. But research found that most (92%) pregnant women had at least one health-related behaviour or condition that increased the chance of harm. This was usually not taking folic acid before they became pregnant, but could also be smoking, living with obesity or having a pre-existing mental or physical health condition.

Information about the state of women’s health before pregnancy is lacking. In this study, researchers assessed data that is routinely collected at the first antenatal appointment.

They found that women and babies from deprived areas may be at higher risk of pregnancy and birth complications than those from less deprived areas because of behaviours or conditions. In addition, younger women and black women were less likely than others to take folic acid before becoming pregnant.

The results were used by the UK Government Office for Health Improvement and Disparities (OHID) in its first annual ‘report card’ on the health of women before pregnancy (2018-2019).

For more information about health in the lead-up to pregnancy, visit the NHS website.

The issue: how healthy are women before pregnancy?

Living well before and during pregnancy affects both the health of women and the future health of their child. Initiatives in the UK (for instance by the NHS and the charity, Children’s Alliance) seek to improve health before pregnancy. National Institute for Health and Care Excellence (NICE) guidelines state that women need advice about health before pregnancy. Initiatives include advice on diet, weight management, smoking, drug use and immunisation.

The UK Preconception Partnership (made up of professional bodies including the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, charities and OHID) suggested that women’s health before pregnancy should be monitored regularly via an annual ‘report card’. The report card provides a picture of the health of women in the population before pregnancy. It allows the Government to monitor its delivery of strategies to improve health before pregnancy.

The Partnership proposed indicators that could impact future pregnancies: medical, behavioural and social risk factors (such as domestic abuse or immigration), and other influences on health (belonging to an ethnic minority group or being unemployed, for instance).

The current study is the first report card of women’s health in the lead up to pregnancy.

What’s new?

The study included all pregnant women in England who had a first antenatal (booking) appointment from April 2018 to March 2019 (almost 653,000 women, with an average age of 30 years). It was based on data from a national registry of information routinely collected at antenatal appointments.

In this study, the research team focused on 10 predictors of poor outcomes. Each is common (affects 5% or more of the population), could potentially be changed (smoking status and diet, for instance), and is reliably recorded.

The study found that:

  • most (92%) women had at least one risk for mother or baby, usually (73%) not taking folic acid before pregnancy
  • many (85%) women who smoked did not quit in the year before pregnancy
  • half (50%) were living with overweight or obesity
  • many (39%) had a previous pregnancy loss
  • some (19%) had at least 1 physical health condition
  • some (9%) had at least 1 mental health condition.

Women in the most deprived areas generally had more predictors of poor health than those living in the least deprived areas. They were more likely to report complex social factors (domestic abuse or immigration, for instance), to be unemployed and seeking work. They were also more likely to become pregnant before the age of 20.

Age was itself a risk factor. Younger women were less likely to take folic acid and more likely to smoke before becoming pregnant than women over 20. Women under 20 were also more likely to have pre-existing mental health conditions.

Black women were more likely to have diabetes before pregnancy, and to have obesity, than white women. They were also less likely to take folic acid before pregnancy.

Why is this important?

Improving health before becoming pregnant can prevent poor pregnancy outcomes, and influence the child’s future health. The findings show that most women have at least 1 risk factor for poor mother or baby health. Risks were highest for black women and those from more deprived areas. The researchers suggest that annual monitoring of health before pregnancy will inform national policies to improve health and reduce inequalities.

The study will raise awareness of the importance of good health before pregnancy among policymakers, healthcare professionals and the general public. It highlights opportunities to reduce health inequalities.

The researchers caution that 15% of data were missing for most indicators and this may have biased some of the findings.

What’s next?

The researchers are working with OHID to produce a yearly picture of women’s health before pregnancy. This is part of the Government’s national public health surveillance system which monitors whether strategies for improving health are effective. The 10 indicators in this study are being used in future surveillance.

The findings have been highlighted in a Children’s Alliance report calling for preconception care to be included in the Government’s health strategy. The researchers hope their findings will inform national strategies (such as the Women’s Health Strategy) and improve people’s access to tailored support to improve their health.

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This summary is based on: Schoenaker DAJM, and others. Women's preconception health in England: a report card based on cross-sectional analysis of national maternity services data from 2018/2019. BJOG: An International Journal of Obstetrics and Gynaecology 2023; 130: 1187 – 1195.

The UK Preconception Partnership, which champions improving preconception care in England.

Funding: This study was funded by the NIHR Southampton Biomedical Research Centre and NIHR Senior Investigator [NF-SI-0515-10042].

Conflicts of Interest: One of the study authors has received funding from several pharmaceutical companies. See paper for full details.

Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

NIHR Evidence is covered by the creative commons, CC-BY licence. Written content and infographics may be freely reproduced provided that suitable acknowledgement is made. Note, this license excludes comments and images made by third parties, audiovisual content, and linked content on other websites.

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