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 informing 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 five databases (March 2023) 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. Screening, data extraction and quality assessment were conducted by two reviewers. Results From 5,259 records screened, 42 articles were included. The prevalence of 30 preconception indicators 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 low risk of bias, but missing data may limit generalisability. Conclusion Findings: demonstrate that routinely collected UK primary care data can be used to identify patients’ preconception care needs. Linking primary care data with health outcomes collected in other datasets is underutilised but could help quantify how optimising preconception health and care can reduce adverse outcomes for mothers and children. How this fits in Provision of preconception care is not currently embedded into routine clinical practice but may be informed by routinely collected primary care data. This systematic review demonstrates that UK primary care data can provide information on the prevalence of a range of medical, behavioural and social factors among female patients of reproductive age, while limited research has examined male preconception health or associations with maternal and offspring health outcomes. Routinely recorded electronic patient record data can be used by primary healthcare professionals to search for preconception risk factors and thereby support individualised preconception care, while aggregate data can be used by public health agencies to promote population-level preconception health. Further data quality improvements and linkage of routine health datasets are needed to support the provision of preconception care and future research on its benefits for maternal and offspring health outcomes.