Pre-pregnancy care rarely recorded in General Practice services, highlighting a missed opportunity for improving women’s health

Published on Wednesday, 26 March 2025 Post

New research by Yangmei Li, Jennifer J Kurinczuk, Fiona Alderdice, Maria A Quigley, Oliver Rivero-Arias, Julia Sanders, Sara Kenyon, Dimitrios Siassakos, Nikesh Parekh, Suresha De Almeida and Claire Carson at the NIHR Policy Research Unit in Maternal and Neonatal Health and Care highlights that pre-pregnancy care is rarely documented in General Practice (GP) services, representing a missed opportunity to optimise women's health.

The study describes women's engagement with GP services in the year preceding pregnancy, focusing on pre-pregnancy care, and explores whether women with recognised risk factors for poor pregnancy outcomes receive targeted care.

Using routine electronic health records from 193,578 women of reproductive age held by the UK Clinical Practice Research Datalink (CPRD), researchers identified 14,326 women with a confirmed pregnancy starting between 2017 and 2018. Among these women, in the year preceding pregnancy:

• 7.6% had records indicating specific pre-pregnancy care (including folic acid advice, fertility discussions, and general pre-pregnancy care and advice).
• 41.0% had records of health promotion (including advice on nutrition, smoking cessation, weight management, alcohol, and contraception).

Women with pre-existing medical conditions, placing them at higher risk of adverse pregnancy, maternal and perinatal health outcomes, were more likely to receive health promotion (ranging from 46.0% to 83.9% for various risk groups). However, the levels of pre-pregnancy care remained low (between 4.7% and 14.9%).

Despite the low prevalence of documented pre-pregnancy care, almost all pregnant women had some engagement with GP services in the year prior to the start of pregnancy (96.9%). Nearly 80% had one or more face-to-face appointments with a general practitioner, and 44.2% with a nurse. Additionally, around one fifth had records of cervical screening appointments during this period. Women with pre-existing conditions were even more likely to have engaged with GP services in the year prior to the pregnancy (between 97.7% and 100.0%).

These findings suggest that while GP contact is common before pregnancy, pre-pregnancy care is rarely documented, potentially reflecting low levels of consultation for, or discussion of, pregnancy planning. This gap highlights a missed opportunity to improve women's health more effectively, particularly for those with known risk factors for poor pregnancy, perinatal, and longer-term outcomes.

Read the research in full in the BMC Public Health journal.