A 2018 Series in renowned medical journal the Lancet detailed how parents’ health can affect pregnancy outcomes and the lifelong well-being of mother and child, and our survey 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.
Our new research (published today in BMC Pregnancy & Childbirth) studied 131,182 women who used our Planning for Pregnancy tool, which asks questions about maternal health to give tailored advice on lifestyle changes that can reduce pregnancy risks. The team at our London research centre 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.
What did we find?
20% of women planning a pregnancy said they smoked cigarettes (above the 14% UK national average) and 3.7% used recreational drugs. 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. These women were also the least likely to be taking proactive steps like folic acid and other vitamin supplements to improve their health, so the study authors are calling for targeted national efforts to engage and support these groups.
Only half the women in the study ate their five-a-day, and even fewer (43%) exercised for the recommended 150 minutes a week. 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, so 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, 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, 1 in 5 who’d stopped using contraception were smoking, yet 1 in 4 smoked if they’d been trying to conceive for a year or more. 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.
“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.” - Tommy’s midwife Amina Hatia
Where do we go from here?
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.
“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.” - Research author Dr Sara White, who runs one of our specialist pregnancy research clinics at St Thomas’ Hospital in London
Drs White and Flynn are now leading another study to see if people identified by the tool as facing lifestyle-related pregnancy risks can be supported to change their behaviour and improve their health through specialist coaching.
“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.” - Tommy's researcher Dr Angela Flynn
Why is this important?
Thurrock mum-of-two Amanda Eaton 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.
“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.” - Mum-of-two Amanda
We developed the Tommy's Planning for Pregnancy tool with Public Health England and the Royal College of Obstetricians & Gynaecologists, after our survey found 1 in 4 pregnant women stopped using contraception the same week they decided to try for a baby, leaving little time for changes to support their future family’s health.
“We welcome the call for a research strategy looking into women’s lifestyles while trying for a baby. There is a lack of information about the actions that women can take when planning a pregnancy to increase fertility, increase the chance of having an uncomplicated pregnancy, and help achieve the best outcome for mother and baby. We have called for improved access to information and support on preconception health in our Women’s Health Strategy, as the promotion of healthy behaviours will not only improve the health of the individual but will positively impact future generations.” - Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists
As well as offering tailored support to physically prepare for pregnancy, our tool provides helpful information about conception more generally, from fertility and sexual health to mental well-being. It's been endorsed by NHS England, the Institute of Health Visiting and the Royal College of General Practitioners.
“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.” - Prof Viv Bennett, Chief Nurse at Public Health England
Check out our Planning for Pregnancy Tool for more information and personally tailored advice on improving preconception health