An article in The Lancet concluded that:
‘There are strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread.’
During pregnancy, women are exposed to a wealth of information and guidance about what they can do to reduce their risks of adverse outcomes. However, in the pre-conception period, this is not the case.
Let's take one woman, Mary. Mary did not find out about how important folic acid was until she told her doctor she was pregnant, which was week 6, and did not see a midwife until week 12. The doctor did not want to worry Mary and so did not tell her that it would have been more effective to start taking folic acid 2 months before stopping contraception, in order to build it up for maximum protection.
Mary's BMI was over 30. After her pregnancy was confirmed, she received information about her weight, as well as extra appointments and tests. Everyone explained to Mary that her weight increased the risk of pre-eclampsia and gestational diabetes. Mary wished that she had known about this before pregnancy so that she could have tried to lose weight.
Mary had never been active and was surprised to learn that this was recommended during pregnancy. She did not know where to start and found it extremely hard to begin new activities as she was so tired in the first trimester. The urge to follow her friends' advice to put her feet up instead was much more tempting.
Mary was told that she was more likely to need intervention during the birth due to her BMI. She found this frightening and it made her worry about labour and birth.
Mary's baby, Ben, was born in February 2018. Mary had suffered from a range of social and physical problems because of her weight and did not want the same for her baby. Unfortunately, she was told by a doctor that because of her weight before and during pregnancy, Ben is also genetically coded to be at increased risk of health problems and obesity himself.
The information gap
Mary is fictitious, but this scenario is not unlikely. Without proactively approaching their GP or practice nurse, it is possible for a woman to start a family with no idea of how her lifestyle could affect not just her pregnancy, but her child's future, too. Focus groups held by Tommy's and Public Health Engand revealed gaps more clearly:
‘I knew almost nothing. You read up on all the stuff about being healthy during a pregnancy, but nothing really before that. It never even occurred to me, we just started trying and a few months later, it happened.’
One difficulty is that the responsibility for providing this information falls between a number of health professional roles: a doctor may not raise pre-conception health spontaneously; a midwife may not see it as their role; a health visitor may discuss contraception between babies but might not discuss pregnancy planning further. A sexual health nurse or fertility doctor will discuss these topics, but each sees only a fraction of the population.
‘I don't have time to bring up new topics, I have enough on my plate dealing with whatever they've come in with.’
‘We only see them when they are pregnant so it's too late for us to be involved.’
Planning for Pregnancy tool
The profile of pre-conception care is rising; however. Public Health England (2018) produced a document to make the case for pre-conception care, supporting Local Maternity Systems to embed it into wider services for women of a reproductive age.
As a part of this wider work, the ‘Planning for Pregnancy’ tool was developed. It is a public-facing tool, created to address the information gap and promote the importance of planning for pregnancy. The tool asks women 15 questions and gives tailored results based on their answers.
The tool was launched with a social media campaign, ‘#AreYouReady?’, the success of which is testament to a public thirst for information. Of those who click on the tool, almost 80% complete it and get their results. A second phase of the campaign ran in February 2019. To date, 150 000 women have completed the tool. BJM