Preconception indicators and associations with health outcomes reported in UK routine primary care data: a systematic review

Background
Routine primary care data may be a valuable resource for preconception health research and to inform the provision of preconception care.

Aim
To review how primary care data could provide information on the prevalence of preconception indicators and examine associations with maternal and offspring health outcomes.

Design and setting
Systematic review of observational studies using UK routine primary care data.

Method
Literature searches were conducted in March 2023 using five databases to identify observational studies that used national primary care data from individuals aged 15–49 years. Preconception indicators were defined as medical, behavioural, and social factors that may impact future pregnancies; health outcomes included those that may occur during and after pregnancy.

Results
From 5259 screened records, 42 articles were included. The prevalence of 37 preconception indicator measures was described for female patients, ranging from 0.01% for sickle cell disease to >20% for each of advanced maternal age, previous caesarean section (among those with a recorded pregnancy), overweight, obesity, smoking, depression, and anxiety (irrespective of pregnancy). Few studies reported indicators for male patients (n = 3) or associations with outcomes (n = 5). Most studies had a low risk of bias, but missing data may limit generalisability of the findings.

Conclusion
The findings demonstrated that routinely collected UK primary care data could be used to identify patients’ preconception care needs. Linking primary care data with health outcomes collected in other datasets is underutilised, but could help to quantify how optimising preconception health and care could reduce adverse outcomes for mothers and children.