Global indicators identified to monitor health before pregnancy worldwide

The key health and social indicators needed for a new global system to monitor people's health before pregnancy have been identified for the first time by researchers at University College London and the University of Southampton.

As more women are becoming pregnant with health conditions that can complicate pregnancy and childbirth, such as obesity, diabetes and mental illness, pre-pregnancy health has been thrown into the spotlight.

In a new paper published in The Lancet, the researchers present, for the first time, a long list of indicators which could be used globally to monitor the health of people of reproductive age - including both men and women - before pregnancy.

Importantly, these identified metrics reflect not only healthcare professionals' views but for the first time, also those of the general public.

The researchers had previously looked at relevant health indicators already monitored in England, such as smoking rates and the use of folic acid supplements before pregnancy to reduce birth defects, producing a report on the state of the nation's preconception health which was published by the Office for Health Improvement and Disparities in England in 2022.

In their new research, they asked more than 5,000 people from 13 countries, including Australia, Brazil and Ghana, what factors would matter most to them before a pregnancy.

They found that answers to their surveys were remarkably consistent across country and gender, with mental health, physical health, supportive relationships and finances prioritised. These are therefore important factors that monitoring systems should reflect, they say.

At an international workshop in Geneva in November they will work with other researchers, clinicians, policy makers and members of the public, to finalise a list of indicators. They will then call on the World Health Organisation, the NHS and other agencies responsible for national health surveillance to incorporate the indicators, where possible, into existing infrastructures to enable monitoring of health before pregnancy globally.

Senior author Professor Judith Stephenson (UCL EGA Institute for Women's Health) said: "This is an ongoing process to prioritise a set of internationally agreed core indicators for monitoring health before pregnancy.

"Our research found over 120 relevant indicators, far too many to include in a routine surveillance system, but through a rigorous collaborative process we have whittled that number down to around 40.

"Indicators relating to conception tend to be from a health professionals' perspective – we have, for the first time, produced a set of agreed metrics which reflect the views of the general public. Together, these indicators will give us a more holistic view of health before people try to get pregnant.

"A strong international collaboration is now needed to achieve consensus on which core indicators can be compared across low-, middle- and high-income countries."

Lead author Dr Danielle Schoenaker, from the University of Southampton and the National Institute for Health and Care Research Southampton Biomedical Research Centre, said: "There is growing evidence that supporting people to optimise health before and between pregnancies can improve pregnancy and birth outcomes and also reduce intergenerational inequalities and chronic disease risk.

"But without the right monitoring systems, governments and health services cannot easily see whether their policies and programmes are working.

"The right set of metrics could also steer future investment in care and support before pregnancy and parenthood, with a view to reducing health inequalities and improving health for future families."