Building the case for preconception care in primary care to support women to prepare for pregnancy

Aim: To find new ways to better support women to prepare for a healthy pregnancy and baby. Background: My research has shown that 9 in 10 women in England who become pregnant have lifestyle risk factors such as smoking or a poor diet, or health conditions such as epilepsy or obesity. If these are minimised or well-controlled before pregnancy this can help prevent health problems such as stillbirth or having a baby born too early or with birth defects. After women find out they are pregnant there is little time to make changes to improve their health. The best way to improve the health of mothers and babies is to help women improve their health as much as possible before they become pregnant. Healthcare professionals in general practice, like GPs and nurses, can help women to improve their chances of a healthy pregnancy and child. Yet most GPs and nurses do not routinely talk about pregnancy intentions with women and give them advice on how to prepare for pregnancy. My research will produce the knowledge to inform this change in care. Design and methods: During my research I will work with healthcare professionals in general practice and with women from diverse backgrounds. First, we will identify the risk factors and pregnancy outcomes that can be addressed by general practice teams. I will obtain information on these factors and outcomes from up to 3.5 million women and children. This information is collected by health services in England such as in general practices, hospitals and community services. I will combine information collected by these health services to create one database. I will then use this to find out how many pregnancy complications (such as the number of babies born too early) could be prevented if risk factors were minimised (such as reducing or quitting smoking) before pregnancy. I will develop guidance that will help healthcare professionals to have conversations about pregnancy intentions with women who have risk factors. The guidance will describe how to support these women to prepare for pregnancy or avoid unintended pregnancy. To find out if using this guidance works in practice and is acceptable to healthcare professionals and women I will test it in general practices in England. Finally, I will work out the costs of using the guidance in practice. I will also calculate the cost savings through reducing pregnancy complications and other health problems for mothers and children. Patient and public involvement (PPI): A diverse group of 25 people aged 18-45 have helped inform this research. They believe there is a need for healthcare professionals in general practice to be more proactive in raising awareness and in offering support to help women to prepare for pregnancy. During my research this PPI group will help me to find diverse and inclusive methods to recruit study participants. They will also influence decisions about which risk factors and pregnancy outcomes are important to address in general practice. Public contributors will help to develop the guidance that will describe how healthcare professionals can support women in appropriate and relevant ways. They will also help to interpret the meaning of the research findings. Dissemination: Public contributors will help to create blogs, infographics and videos that will summarise the findings. These will be shared with patients and the public through general practices (for example on posters and video screens) and through charities (for example in newsletters and on websites). Findings will also be shared with healthcare professionals and researchers. This will be done through scientific publications, conference presentations, websites and social media.