Women's preconception health in England: A report card based on national maternity services data 2018/19

Background: The impact of the burgeoning policies and programmes aimed at optimising the population’s preconception health requires evaluation through national surveillance. As initial steps towards a national surveillance infrastructure, we present the first national-level report card on the state of preconception health of women in England based on indicators routinely recorded through maternity services and identify 10 initial priority indicators for ongoing surveillance.Methods: This cross-sectional population-based study used data from all pregnant women in England with a first antenatal (booking) appointment recorded in the national Maternity Services Dataset (MSDS) from April 2018 to March 2019 (N=652,880). Data on 32 indicators were routinely collected at booking appointments. We analysed the prevalence of each indicator across the overall population and sociodemographic subgroups. Ten of these indicators were prioritised for ongoing surveillance based on modifiability, prevalence, data quality and ranking by multidisciplinary UK experts.Findings: The three most prevalent indicators were: proportion of smokers who did not quit smoking during the year before pregnancy (85.0%), not taken folic acid supplementation before pregnancy (72.7%), and previous pregnancy loss (38.9%). Inequalities were observed by age, ethnicity and area-based deprivation level, most strongly and consistently for smoking around the time of conception and pre-existing mental health conditions. The 10 indicators prioritised were: not taking folic acid supplementation before pregnancy, obesity, complex social factors, living in a most deprived area, smoking around the time of conception, overweight, pre-existing mental health condition, pre-existing physical health condition, previous pregnancy loss and previous obstetric complication.Interpretation: Our findings suggest important opportunities to improve the state of preconception health and reduce sociodemographic inequalities for women in England. In addition to MSDS data, other national data sources that record further and possibly better-quality indicators could be explored and linked to build a comprehensive surveillance infrastructure.Funding Information: DS is supported by the National Institute for Health and Social Care Research (NIHR) Southampton Biomedical Research Centre [IS-BRC-1215-20004]). KG is supported by the UK Medical Research Council (MC_UU_12011/4), the NIHR (NIHR Senior Investigator [NF-SI-0515- 10042] and NIHR Southampton Biomedical Research Centre [IS-BRC-1215-20004]), the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP) and the British Heart Foundation (RG/15/17/3174).Declaration of Interests: KG has received reimbursement for speaking at conferences sponsored by companies selling nutritional products, and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec, BenevolentAI Bio Ltd. and Danone. The other authors have no conflicts of interest to disclose.Ethics Approval Statement: Participant consent was not required for this study under the Health and Social Care Act 2012. Anonymised MSDS data were accessed through OHID, who have a data sharing agreement with NHS Digital. Ethics approval for the current study was granted by the University of Southampton Faculty of Medicine Ethics Committee (ID 57993) and the NHS Health Research Authority and Research Ethics Committee (IRAS ID 285601; REC reference 20/WM/0231)