Preconception care in general practice: optimizing clinical guidance by incorporating patient and practitioner views

Schoenaker, Danielle, Lovegrove, Elizabeth, Santer, Miriam, Matvienko-Sikar, Karen, Carr, Helen, Alwan, Nisreen A. and Godfrey, Keith (2025) Preconception care in general practice: optimizing clinical guidance by incorporating patient and practitioner views. Australian Journal of Primary Health, 31 (4), [89]. (doi:10.1071/PYv31n4abs).

Abstract

Background: preconception care guidelines recommend primary care practitioners consider a range of topics to support patients who are thinking about having a baby. These topics are based on scientific evidence and expert opinion, but the content does not consider patient and practitioner views.

Aim: as part of a consensus study to define priority topics for preconception care in general practice, we aimed to identify topics currently missing from clinical guidance based on patient and primary care practitioner perspectives; and explore differences in their views on which topics should be prioritised for preconception care.

Methods: the study involved: (1) identifying initial topics through literature and guideline reviews, and potential additional topics through patient workshops and practitioner interviews; (2) prioritising topics through a three-round Delphi survey; and (3) reaching consensus in an online workshop. UK-based patients and practitioners were recruited via a Public Advisory Group, charities and professional organisations. Data from patients and practitioners were analysed separately.

Findings: literature and guideline reviews identified 32 topics for preconception care. Patients (n = 15) additionally highlighted ‘neurodiversity’ and ‘gender identity and transition’, while practitioners (n = 14) identified ‘pregnancy anxiety’, ‘living circumstances’ and ‘ethnicity’ as relevant. In the first Delphi round, ‘infertility issues/treatment’ and ‘mental health’ were scored important by the majority (>70%) of patients (n = 48), but not practitioners (n = 37). Most practitioners, but not patients, scored ‘weight status’ and ‘folic acid supplement use’ as important. While consensus was reached in the final workshop on four priority topics (n = 21 patients/practitioners), diverse views on for example the importance of infertility and ethnicity remained.

Implications: our study highlights the need to consider both patient and practitioner perspectives when developing evidence-based content of clinical guidance for preconception care. While individualised patient care will be needed, incorporating agreed priority topics into clinical guidance may maximise opportunities to promote healthy pregnancies in primary care.

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Contributors

Author: Danielle Schoenaker

Author: Elizabeth Lovegrove

Author: Miriam Santer

Author: Nisreen A. Alwan

Author: Keith Godfrey

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