Background Optimising a woman’s health prior to pregnancy benefits her at the time, throughout the pregnancy and the life course of mother and baby. In the UK pre-pregnancy care tends to be provided through primary care and sexual health clinics, with the onus on women to seek out services. As ~45% of pregnancies in the UK are unplanned, general health promotion in women of reproductive age is also important. We aimed to describe women’s engagement with General Practice (GP) services, to establish whether it is possible to identify women receiving pre-pregnancy care in the 12 months before their pregnancy, and whether women who have pre-existing risk factors are targeted for pre-pregnancy care.

Methods Primary care data were drawn from the Clinical Practice Research Datalink (CPRD) GOLD to identify women aged 18–48 yrs on 01/01/2017, who were registered for 12 months with an English GP practice, and had linked hospital data. Women’s demographic characteristics, lifestyle factors, and pre-existing conditions were described. Diagnoses, symptoms, prescriptions and administrative codes for health conditions and pre-pregnancy care were used to describe engagement with GP services, and to explore the feasibility of identifying pre-pregnancy care in routine GP data. CPRD Pregnancy Register and hospital maternity data were used to identify those who subsequently became pregnant, to describe pre-pregnancy care in the year prior to conception. Women with known risk factors for poor perinatal outcomes were assessed for evidence of targeted provision.

Results Over 200,000 women were included, of whom 20,884 became pregnant during follow-up. Among women who became pregnant, only 6.6% had pre-pregnancy care, including folic acid advice, in the year prior to pregnancy; 35.6% had general health promotion records including advice on nutrition, smoking cessation, weight management, alcohol consumption and family planning/contraception. While women with pre-existing conditions generally received higher levels of general health promotion (between 43.3% and 77.4% for various risk groups) than the overall population, the levels of pre-pregnancy care were similar (between 6.8% and 11.8%).

Conclusion Pre-pregnancy care is rarely recorded in primary care in England, reflecting low levels of consultations for pregnancy planning, even among those with recognised health conditions. Low rates of preconception care indicates most women do not seek support from GP services until after they conceive. This represents a missed opportunity for promoting pre-pregnancy and subsequent health, particularly in those with recognised risk factors for poor pregnancy and perinatal outcomes and long term health problems.