Priority topics for preconception care in general practice: a consensus study

This consensus study involving UK primary care practitioners and people of reproductive age identified four priority topic areas—patient knowledge, ideas and concerns, health conditions, and health behaviors—to guide structured, opportunistic preconception care discussions in general practice.

The Gist

The "Pre-Pregnancy Pit Stop": A Simple Guide to the Study

Imagine your body is a car, and a future pregnancy is a long, important road trip. Before you hit the highway, you wouldn't just jump in and drive; you'd want to check the oil, make sure the tires are inflated, and ensure the GPS is set correctly. This is what preconception care is: getting your health ready before you try to have a baby.

However, in the UK, doctors (GPs) are like busy mechanics in a very crowded garage. They have hundreds of cars to fix every day, and they often don't have enough time to do a full safety check on every single vehicle. While there are huge manuals (guidelines) with 30+ things to check, it's impossible to cover them all in a 10-minute appointment.

The Big Question: If a doctor only has a few minutes, what are the most important things they should ask about to make sure the "road trip" starts safely?

The Mission: Finding the "Top 4" Checkpoints

This study gathered two groups of experts to solve this puzzle:

1. The Drivers: People of reproductive age (potential parents).
2. The Mechanics: Doctors and nurses who work in general practice.

They used a special voting process (like a game of "survival of the fittest" for ideas) to narrow down a massive list of 37 possible topics to just the four most critical areas that fit into a short conversation.

The Four "Pit Stop" Checkpoints

Instead of a long checklist, the study agreed that doctors should focus on these four "buckets" of conversation. Think of them as the four main stations at a gas station where you stop before a long drive:

1. The "Knowledge Check" (What do you know?)

• The Metaphor: Before driving, do you know how to use the car's features?
• The Reality: Do you know what "preconception health" means? Do you know that taking folic acid is like putting a shield on the baby's brain? The goal here is to see if the patient has the basic map or if they need a quick lesson on how pregnancy works.

2. The "Dream & Worry" Chat (What's on your mind?)

• The Metaphor: Are you excited for the trip, or are you nervous about the route?
• The Reality: This isn't just about "Are you trying to get pregnant?" It's about listening to the patient's story. Have they had a baby before? Did they lose a pregnancy? Are they worried about something? This station is about understanding their hopes, fears, and past experiences so the doctor knows how to talk to them.

3. The "Engine Health" Scan (Are there any mechanical issues?)

• The Metaphor: Is the engine running smoothly, or are there warning lights on the dashboard?
• The Reality: This covers physical and mental health.
  • Medications: Are you taking any pills that might be bad for a baby (like some acne meds or mood stabilizers)?
  • Mental Health: Are you feeling anxious or depressed?
  • Vaccines: Is your immune system up to date (like having a spare tire ready)?
  • Safety: This is a crucial new addition: Is the patient safe at home? The study emphasized asking about abuse (physical, sexual, or emotional) because it's a major risk factor that often goes unnoticed.

4. The "Fuel & Habits" Check (What are you putting in the tank?)

• The Metaphor: Are you putting premium fuel in, or are you running on empty?
• The Reality: This is about lifestyle.
  • Smoking & Alcohol: These are like pouring sand into the gas tank.
  • Weight & Diet: Is the body getting the right nutrients?
  • Supplements: Are you taking the "vitamin boost" (folic acid) needed for the baby's development?

Why This Matters

Before this study, doctors were stuck between "saying nothing" (because they were too busy) and "saying everything" (which was overwhelming).

This study is like giving the mechanic a smart, simplified checklist. It says: "You don't need to check the spark plugs, the transmission, and the radio all at once. Just check these four main things. If something looks wrong, you can dig deeper later."

The Takeaway

The researchers found that by focusing on these four simple areas, doctors can have a meaningful, patient-centered conversation in just a few minutes. It turns a chaotic, overwhelming task into a manageable, friendly chat that could save lives and ensure healthier starts for future families.

In short: Don't try to read the whole manual. Just check the Knowledge, the Dreams, the Engine, and the Fuel. That's the secret to a safe road trip.

Technical Summary

Technical Summary: Priority Topics for Preconception Care in General Practice

1. Problem Statement

Preconception care is critical for optimizing fertility, pregnancy outcomes, and the long-term health of parents and offspring. However, in UK general practice, this care is inconsistently delivered. Primary care practitioners face significant barriers, including:

• Limited consultation time: Opportunities for "opportunistic" care (discussions during routine visits) are constrained.
• Lack of prioritization: Existing guidance, such as the National Institute for Health and Care Excellence (NICE) recommendations, covers over 30 risk factors but offers little direction on how to prioritize these topics for brief encounters.
• Misalignment of priorities: There is limited evidence on how the priorities of people of reproductive age align with those of clinical practitioners, leading to potential gaps in patient-centered care.

The study aimed to establish a consensus on a feasible, prioritized list of topics for opportunistic preconception care discussions in UK general practice.

2. Methodology

The researchers employed a rigorous, three-step consensus study design involving two distinct stakeholder groups: people of reproductive age (16–49 years) and primary care practitioners (GPs, nurses, practice managers). The study adhered to the ACCORD guideline and included strong Patient and Public Involvement (PPI).

• Step 1: Topic Identification (Qualitative Phase)

  • Sources: A review of NICE guidelines, international guidelines, and systematic reviews (2018–2023) identified 33 initial topics.
  • Stakeholder Input: Online workshops with people of reproductive age ($n=15$) and interviews with practitioners ($n=14$) were conducted to refine the list, add missing topics (e.g., neurodiversity, gender identity), and remove obsolete ones (e.g., Zika travel).
  • Outcome: A final list of 37 potential topics was generated for the Delphi survey.

• Step 2: Delphi Survey (Quantitative Phase)

  • Process: A three-round online Delphi survey was conducted (September 2024–February 2025).
  • Participants: 85 participants completed Round 1; 63 completed all three rounds (74% retention).
  • Mechanism: Participants rated topics on a 9-point scale regarding their importance for a hypothetical clinical scenario.
  • Consensus Criteria:
    • Consensus In: $\ge$70% of both groups rated "Critically important" (7–9) AND $\le$15% rated "No/limited importance" (1–3).
    • Consensus Out: $\ge$70% of both groups rated "No/limited importance" AND $\le$15% rated "Critically important".
  • Result: 11 topics reached "Consensus In" after Round 2; no new topics reached consensus in Round 3.

• Step 3: Consensus Workshop (Synthesis Phase)

  • Participants: 21 participants (mix of public and practitioners) attended a final 3-hour online workshop in April 2025.
  • Process: Breakout sessions discussed topics that had not reached consensus in the Delphi survey. Voting was conducted via Mentimeter.
  • Final Consolidation: Participants agreed that 16 individual priority topics were too numerous for routine practice. They collaboratively grouped these into four overarching topic areas to facilitate flexible, patient-centered discussions.

3. Key Contributions

• Development of a Prioritized Framework: The study moved beyond a "checklist" approach to create a structured, flexible framework consisting of four overarching domains.
• Integration of Dual Perspectives: It successfully bridged the gap between clinical priorities and patient values, identifying where priorities diverged (e.g., practitioners prioritized folic acid/immunization more highly initially, while patients prioritized mental health/infertility).
• Identification of Novel Priorities: The study highlighted topics often underrepresented in current guidelines but deemed critical by the consensus group, such as "Patient knowledge of preconception health," "Ideas, concerns and expectations," and "Physical, sexual, and emotional abuse."
• Public Involvement: The study utilized a robust PPI model, with a Public Advisory Group involved from protocol development through to the final paper, ensuring the output was relevant to the target population.

4. Results

The consensus process reduced the initial 37 topics to 16 specific priority topics, which were then synthesized into four overarching topic areas for clinical discussion:

1. Patient Knowledge of Preconception Health and Pregnancy: Assessing understanding of fertility, pregnancy risks, and necessary preparations.
2. Ideas, Concerns, and Expectations (ICE): Exploring pregnancy intentions, timing, prior pregnancy experiences (including loss), and patient anxieties.
3. Health Conditions: Reviewing chronic conditions, medication use (teratogenic risks), mental/physical health, immunization status, and history of abuse.
4. Health Behaviors: Addressing folic acid supplementation, smoking, alcohol consumption, and weight status.

Notable Findings on Divergence:

• Differences in Scoring: In the Delphi rounds, reproductive-age participants rated "Infertility," "Mental Health," and "Genetic conditions" as critically important more often than practitioners. Conversely, practitioners rated "Weight status," "Nutritional deficiencies," and "Folic acid" as more critical.
• Resolution: The final consensus workshop harmonized these views, ensuring both clinical safety (e.g., folic acid) and patient experience (e.g., mental health, abuse screening) were included.
• Excluded Topics: Topics such as "Exposure to air pollution" and "Contraception use" were voted out or deprioritized as less suitable for initial brief opportunistic consultations.

5. Significance and Implications

• Clinical Practice: The four-topic framework offers a pragmatic tool for GPs to initiate preconception care without being overwhelmed by lengthy checklists. It supports a "Ask-Advice-Assist" model, allowing clinicians to screen for risks and signpost resources efficiently during routine visits (e.g., medication reviews, contraception consultations).
• Policy and Guidelines: The findings suggest that future NICE guidance should explicitly include patient knowledge assessment and sensitive topics like abuse and mental health, which are currently under-prioritized in standard checklists.
• Implementation: The authors recommend embedding these priority areas into Electronic Medical Records (EMR) templates and developing co-designed digital tools to support opportunistic delivery.
• Future Research: The study calls for the co-development of care pathways and evaluation of how implementing this prioritized framework affects maternal and perinatal health outcomes and health disparities.

In conclusion, this study provides the first consensus-based, evidence-informed framework for opportunistic preconception care in UK general practice, balancing clinical necessity with patient-centered feasibility.