Women much less likely to seek preconception advice for mental health compared to physical conditions, study shows

Fewer than 1 in 10 women and birthing people with mental health conditions seek medical advice before they get pregnant, new research shows, suggesting that more investment in preconception care is needed.

A new study led by researchers at King’s College London, with the University of Strathclyde and Tommy’s, has found that women with mental health conditions are much more likely to have physical health problems than those without. 

However, they’re also much less likely to seek advice from a medical professional in the period before they get pregnant compared to women who have a physical condition alone.   

Ensuring mothers get the mental health support they need throughout their pregnancy journey is vital when we know that the majority of new mothers’ deaths are due to mental ill health. 

Our researchers found that just 8.9% of people with a mental health condition sought medical advice while planning their pregnancy compared to 41% of respondents solely managing a physical health condition, despite mental health problems being more common.  

They were also less likely to exercise and more likely to smoke tobacco or use illegal drugs. 

Published in BJOG: An International Journal of Obstetrics and Gynaecology, this new study suggests that healthcare professionals should be supported to have conversations with all women and birthing people of reproductive age about planning for pregnancy, including how to improve their physical and mental health. 

Data was collected from more than 130,000 people using our Planning for Pregnancy tool, an online tool which helps people understand their preconception behaviours and how they can improve the health of their future pregnancy and child or children. 

Dr Claire Wilson is an NIHR Academic Clinical Lecturer and Psychiatry Specialist Registrar based at King’s College London’s Institute of Psychiatry, Psychology & Neuroscience. As one of the study’s lead authors, she says: 

“The preconception period represents a golden opportunity for both future mothers and their physicians to intervene and optimise the health of mother and child. Our research has, however, established clear differences in approach between women managing physical and mental health conditions which could have strong implications for the future health of both mother and child.” 

In their study Dr Wilson and the team explain that preconception care currently focuses largely on contraception rather than considering the needs of women with combined physical and mental health issues who are looking to conceive.  

This is despite previous research showing that women who received education and counselling before they get pregnant are more likely to have better knowledge and reduce risky behaviour such as drinking alcohol. 

Tommy’s Midwifery Manager Kate Marsh says: 

“Women with pre-existing mental health conditions are more likely to have both physical and mental health problems during their pregnancy and afterwards. This is why it’s vital they get the right care during their pregnancy journey. Many don’t get the information and support they need during the preconception period to make an informed decision about their care. Up to 90% of women will stop taking mental health medication, often without support from a healthcare professional.   

“This can have severe consequences, like relapse which puts themselves and their baby at higher risk. Upskilling and resourcing primary care providers so they include healthy preconception conversations into routine appointments, including discussing medication, can support women and birthing people to make changes that can improve their chances of a healthy pregnancy and birth.”  

Dr Raquel Catalao, the study’s joint senior author and an Academic Clinical Fellow at King’s IoPPN says: 

“Mental health problems are on the rise for women, particularly young women, with important consequences for their long-term health. Supporting those who wish to conceive to improve their health is key to improve long term outcomes for women and their babies. This requires investment in access to preconception care and better integration between primary care, mental and maternal health services.” 

Our guide for health professionals on delivering preconception care to women with serious mental illness