Nine in ten women in England enter pregnancy with at least one indicator that may increase health risks to them and their baby, according to new research.
Common indicators were women not quitting smoking, failing to take folic acid before pregnancy or having a previous pregnancy loss.
Researchers from the NIHR Southampton Biomedical Research Centre, hosted by University Hospital Southampton and University of Southampton, analysed data from over 650,000 mothers.
They created a first national picture of women's health before pregnancy.
The team say the findings show an urgent need for nationwide policies to help women improve health before pregnancy.
Large-scale analysis
Women who are healthy and well when they enter pregnancy are less likely to develop complications. Their children also tend to have better long-term developmental and health outcomes.
This study used data on 652,880 pregnant women in England. It was routinely collected by midwives at appointments between April 2018 and March 2019.
Information ranged from women's employment status and social support to pregnancy complication history, health behaviours and medical conditions.
The researchers considered a range of behaviours and conditions that put mother and baby at risk. These include smoking, not taking recommended folic acid supplements, obesity and previous pregnancy loss.
The results, published in BJOG, an international journal of obstetrics & gynaecology, found some common behaviours and conditions.
Among the 23% of women that smoked, 85% did not quit smoking before pregnancy.
Almost three quarters did not take a recommended folic acid supplement.
Dr Danielle Schoenaker, lead author and Research Fellow at University of Southampton, said:
"Our analysis shows that there is an urgent need for the government, NHS and public health agencies to develop and put in place population-level policies and programmes that support all women to be as healthy as possible before and between pregnancies.
"Such policies may start from educating children about the importance of being healthy before starting a family, to improving food environment and affordability and implementing effective mandatory flour fortification with folic acid.
"Routine conversations and support for pregnancy preparation could also be offered by primary healthcare services."
Health inequalities
How common indicators were varied widely based on women's age, ethnicity and the level of deprivation in the area where they lived.
For example, younger women were less likely to have a physical health condition when entering pregnancy, but more likely to have a mental health condition compared with older women.
Women from a black ethnic background were more likely to be living with obesity, but less likely to smoke around the time of getting pregnant compared with white women.
Generally, more health risk indicators were observed in women living in the most deprived areas.
Prof Nisreen Alwan, Professor of Public Health at University of Southampton, said:
"Health inequalities before pregnancy must be narrowed with population-level policies across multiple sectors to address the wider determinants of health. This is to benefit all parents-to-be in society and allow them to prioritise their health and wellbeing, particularly those affected by social and economic hardship."
National picture of women's health
The study was advanced in collaboration with the Office for Health Improvement and Disparities (OHID) in England.
Southampton researchers will continue their work with OHID to publish a yearly picture of women's health before pregnancy.
This will help evaluate if current policies are effective, and advocate for new policies, to optimise health before pregnancy and reducing inequalities.
Minister for Women's Health, Maria Caulfield said: "All babies deserve the best start in life, which is why we're working to improve preconception care and information for women.
"The NHS website is an excellent place to access up-to-date free help and advice, including support to stop smoking.
"We're consulting on the amount of folic acid added to white flour – a step that could help women carry healthy foetuses and avoid neural tube defects.
"And we'll also be reconvening the Maternal Disparities Taskforce in April to continue to drive progress in improving access to preconception and maternity care for all mothers and babies."
