New research  from UK pregnancy charity Tommy’s shows most women still consume harmful substances like alcohol and caffeine while trying for a baby, suggesting low awareness of the risks and fuelling calls for a national strategy to improve preconception health.
A 2018 Series in renowned medical journal the Lancet detailed how parents’ health can affect pregnancy outcomes and the lifelong wellbeing of mother and child , and Tommy’s research at the time found women typically spent more time planning a holiday than a pregnancy . Despite proposals for public health policies to improve awareness and behaviours, the NHS has no specific services to help people physically prepare for pregnancy, and by the time someone comes to antenatal care it may be too late for them to make important changes.
Research published on 28 July 2021 in BMC Pregnancy & Childbirth studied 131,182 women who used Tommy’s Planning for Pregnancy tool, which asks questions about maternal health to give tailored advice on lifestyle changes that can reduce pregnancy risks. The research team at King’s College London found troubling trends in women’s lifestyles while trying for a baby, particularly among the under-25s and those with a BMI below 18.5.
20% of women planning a pregnancy admitted to smoking cigarettes – above the 14% UK national average  – and 3.7% said they used recreational drugs[1.1]. Younger or underweight women were more likely to take these risks, with 31% smoking and 5% taking drugs even while actively trying for a baby[1.2]. These women were also the least likely to be taking proactive steps like vitamin supplements[1.3] to improve their health, so the study authors are calling for targeted national efforts to engage and support these groups.
Only half (53%) the women in the study ate their five-a-day, and even fewer (43%) exercised for the recommended 150 minutes a week[1.4]. More than half of those who reported their weight had a high BMI, but researchers noticed similar behaviour patterns across the recommended BMI and overweight groups[1.5]; it appears people often don’t realise when they’re carrying extra weight and may need advice from healthcare professionals. Another concerning finding was that most (60%) women with a long-term health condition or history of pregnancy complications hadn’t spoken to a doctor about their plans for a baby[1.6], which could open the door to crucial preconception care.
The team observed some short-term shifts toward healthier behaviours but warned these may not be enough to have significant benefits – and for some behaviours, the opposite was true. For example, 20% of those who’d stopped using contraception were smoking, yet 24% smoked if they’d been trying to conceive for a year or more[1.7]. Researchers also highlighted that women who drank alcohol were more likely to consume caffeine, suggesting low awareness of how cutting down on these things can aid pregnancy.
Research author Dr Angela Flynn, nutritional sciences lecturer at King’s College London, commented: “Every parent wants to give their children the best start in life, but our study suggests it’s not well known in the UK that people can take steps before they even start trying to increase their chances of having a safe pregnancy and a healthy baby. Despite lots of evidence that folic acid supplements improve pregnancy health, few people we studied were taking them when trying for a baby – and research from the turn of the century found similar trends, so it’s worrying that awareness and behaviours haven’t really improved. The road to parenthood isn’t always straightforward so it’s vital to let people know how they can prepare themselves, as well as having support services available for anyone who needs help to give up risky but addictive behaviours like smoking or drug use.”
Study findings will contribute to an ‘annual report card’ recommended by the UK Preconception Partnership to measure progress on targets for improving the nation’s health, once specific interventions to help people to prepare for pregnancy are added into existing public health strategies tackling related issues like smoking and obesity.
Co-author Dr Sara White, who also runs one of the specialist Tommy’s pregnancy research clinics at St Thomas’ Hospital in London, explained: “Our study highlights the importance of targeted support for women planning a pregnancy. This data can be a benchmark to inform the national public health strategy, as proposed by the UK Preconception Partnership; they currently have access to NHS patient data from early pregnancy appointments, but here we have real world insight from people still in the planning stages. We’ve also got a unique window onto these women’s behaviour, as they may well be more open when anonymously using the Tommy’s tool than if we asked face-to-face in a clinic setting.”
Drs White and Flynn are now leading another study to see if people identified by the Tommy’s tool as facing lifestyle-related pregnancy risks can be supported to change their behaviour and improve their health through specialist coaching.
Tommy’s midwife Amina Hatia advised: “Most people make changes to look after their health and wellbeing once they know they’re expecting, but many don’t realise that acting even earlier can really help get the body ready for pregnancy. It’s not just about cutting out risky things like caffeine, alcohol and cigarettes; taking positive steps like keeping active and eating a balanced diet can also make a big difference. Pregnancy-related health issues often have nothing to do with parents’ lifestyles, but research shows there are things that can reduce the risks, so sharing this information is a vital part of our mission to make the UK the safest place in the world to have a baby. Starting a family can be stressful and knowledge is power when it comes to making that journey as smooth as possible.”
Thurrock mum-of-two Amanda Eaton, 28, knew that pregnancy might be a challenge because of her polycystic ovaries, so she and her husband Judd adopted a healthy eating regime when they decided they wanted children. After slowly and safely losing weight, they found they were expecting now two-year-old daughter Shelbie within a few months of trying, so followed the same routine before welcoming baby brother Archie in April 2021.
Amanda said: “I went to see my GP who prescribed a drug called metformin and recommended I take pregnancy vitamins, and my husband started taking supplements for his health too. I don’t really drink tea or coffee so staying away from caffeine wasn’t a problem, but the big change was losing weight. I ditched sugary drinks for low-calorie versions and had a much healthier diet. It was a lengthy process but really worth it – I felt healthier physically but also psychologically. For me, preparing my body was the most important part of planning for pregnancy; I think if I hadn’t taken that preparation so seriously, we’d probably still be trying.”
Tommy’s developed its free online Planning for Pregnancy tool with Public Health England and the Royal College of Obstetricians & Gynaecologists, after a survey by the charity found 1 in 4 pregnant women had stopped using contraception the same week they decided to try for a baby , leaving little time for any changes to support their future family’s health. As well as offering tailored support to physically prepare for pregnancy, it provides helpful information about conception more generally, from fertility and sexual health to mental wellbeing. The tool is also endorsed by NHS England, the Institute of Health Visiting and the Royal College of General Practitioners.
Professor Viv Bennett, Chief Nurse and director of maternity and early years at Public Health England, commented: “Good preconception health – how women are in the weeks, months and years leading up to pregnancy – plays a crucial role in the health of women and their babies and on into childhood. We need to provide clear information and support women who want to have a family in the future to start making positive changes to improve their health now – in advance of becoming pregnant, to help give every child the best start in life.”
Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, added: “Nutrition and lifestyle in the preconception period is crucial to having a good pregnancy and birth. Diet, weight and the body’s metabolism prior to conception impacts on the chances of conceiving naturally, having a good pregnancy and delivery, as well as affecting the health of children in their later life. Focussing on the importance of maintaining a healthy diet and weight prior to conception will not only improve the health of individuals, but also the health and quality of life of future generations.”
For more information and personally tailored advice on improving preconception health, visit www.tommys.org/
Main image: Tommy’s midwife Amina Hatia. Source: Tommy’s
1. 1 Table 1 (page 5)
1.2 Table 3 (page 7)
1.3 29% of under-25s took folic acid compared with 49-55% across older age groups (Table 3, page 7)
1.4 Table 1 (page 5)
1.5 Table 4 (page 8)
1.6 Table 1 (page 5)
1.7 Table 5 (page 9)
3. Of 750 pregnant women surveyed by Tommy’s in June 2018, 67% said they spent three or more months planning for a holiday compared with 20% who spent this long planning for a pregnancy.
5. Of 750 pregnant women surveyed by Tommy’s in June 2018, 39% said they had stopped using contraception during the same week when they made the decision to have a baby.