Document resource
Background Nearly one in three UK pregnancies are to women born abroad. Maternal health inequalities exist between migrant and non-migrant women and a woman’s preconception health has a strong influence on pregnancy outcomes. Our previous research showed that migrant women in vulnerable situations are less likely to take folic acid pre-pregnancy, more likely to have hepatitis B and diabetes preconception and to access antenatal care late. Women with language-barriers face additional barriers to care.Primary care-based preconception interventions can reduce preconception risk factors. However, it is unknown how women interact with primary care before pregnancy. We aimed to describe whether women interact with primary care in the year preconception, differences between interpreter-users and non-interpreter-users, and changes with COVID-19.Methods This retrospective cohort study used data from a UK population-based national linked dataset of primary care, secondary care and maternity records (NHS England Secure Data Environment). Participants included women with estimated conception dates between 1/3/2019–29/2/2024, aged 18–49 years.Outcome measures were interactions with general practice (GP) (excluding prescriptions) in the year preconception (yes/no), according to interpreter use, and according to preconception year (before, overlapping with, or after March 2020).Results Among 2,182,280 participants, 61,140 used interpreters. Median age was 31.0 among interpreter-users (interquartile range (IQR) 23–39), and 30.9 (IQR 23–38) among non-interpreter-users. Among interpreter-users, 49.7% (95%CI 49.3%-50.1%) were in the most deprived quintile versus 22.7% (95%CI 22.6–22.7%) of non-interpreter users. 62.5% (95%CI 62.0–62.8%) of interpreter-users were of ethnic minorities (excluding white minorities), versus 22.1% (95%CI 22.0–22.1%) of non-interpreter users.Among interpreter-users, 79.5% (95%CI 79.2–79.8%) interacted with GP in the year preconception, versus 85.0% (95%CI 84.9–85.0%) of non-interpreter-users.Among individuals with their preconception year pre-COVID-19 (March 2020), 81.7% (95%CI 21.6–81.8%) interacted with GP in the year preconception. Among those with their preconception year post-COVID-19, 88.6% (95%CI 88.5–88.6%) interacted with the GP. Among individuals whose preconception year overlapped with March 2020, 80.1% (95%CI 80.0–80.2%) interacted with GP.Conclusions Primary care remains a promising avenue for interventions aimed at improving preconception health. Targeted interventions in a range of languages are needed outside of primary care for some women.Results are preliminary and have not been peer reviewed by the CVD-COVID-UK/COVID-IMPACT Consortium. This work was carried out with the support of the BHF Data Science Centre led by HDR UK (BHF Grant no. SP/19/3/34678), and MRC Reference no. MR/W01498X/1.*We’ve used the terms women/woman, but recognise not all pregnant or birthing people identify as women.