Major step towards a global system to track health before pregnancy

Researchers have paved the way for a new system to monitor the health of people trying for a baby around the world.

For the first time, researchers have identified a list of essential indicators. These could be used globally to monitor people’s health before pregnancy.

The work is set out in a new paper published in The Lancet. It has been led by researchers at the NIHR Southampton Biomedical Research Centre (BRC) and UCL.

Optimising health before pregnancy

More women are becoming pregnant with health conditions that can complicate pregnancy and birth. It is therefore important to ensure people are as healthy as possible before trying for a baby.

Dr Danielle Schoenaker at the University of Southampton and BRC is lead author on the paper.

“There is growing evidence that supporting people to optimise health before and between pregnancies can improve pregnancy and birth outcomes, and also reduce intergenerational inequalities and chronic disease risk,” she said.

“But without the right monitoring systems, governments and health services cannot easily see whether their policies and programmes are working.”

Working out what works globally

The researchers had previously looked at relevant health indicators already monitored in England. These include smoking rates, and the use of folic acid supplements before pregnancy to reduce birth defects.

They used their findings from this to produce a report on the state of the nation’s preconception health. This was published by the Office for Health Improvement and Disparities in England in 2022.

“We now need international agreement on which indicators we should measure and monitor,” said Dr Schoenaker. “Then countries can learn from each other and identify policies and programmes that work.”

“If implemented, these metrics could steer future investment in care and support before pregnancy and parenthood, with a view to reducing health inequalities and improving health for future families.”

Asking people what matters to them

The researchers asked over 5,000 people what factors would matter most to them before a pregnancy.

These people lived in 13 different countries. These were Australia, Bangladesh, Belgium, Brazil, Canada, Qatar, Singapore, UK, Ghana, Kenya, Malaysia, South Africa and the USA.

They found answers to their surveys were remarkably consistent across countries and genders.

Mental health, physical health, supportive relationships and finances were consistently prioritised. The researchers therefore suggest these are important factors that monitoring systems should reflect.

Professor Judith Stephenson from UCL is senior author on the paper.

“Indicators relating to conception tend to be from a health professionals’ perspective,” she said. “We have, for the first time, produced a set of agreed metrics which reflect the views of the general public.”

Using the indicators

The researchers will finalise a list of indicators during an international workshop later this year. They will do this with other researchers, clinicians, policy makers and members of the public.

They will call on agencies responsible for national health surveillance to incorporate the indicators, where possible, into existing infrastructures. These will include the World Health Organisation and the NHS.

This will enable monitoring of health worldwide before pregnancy.