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

Abstract

Background: primary care practitioners are well-positioned to support patients of reproductive age in preparing for pregnancy. Preconception care is ideally integrated when opportunities arise during routine consultations. However, practical and realistic guidance is needed to overcome implementation barriers, such as limited consultation time. Aim: to achieve consensus among primary care practitioners and patients on topics that might be prioritised as part of opportunistic preconception care in general practice. Methods: a three-step consensus process was undertaken: (1) identifying initial candidate topics through literature and guideline reviews, workshops with patients, and interviews with primary care practitioners; (2) prioritising topics using a three-round Delphi survey; and (3) reaching agreement on final priority topics through an online workshop. Participants were UK-based patients and primary care practitioners recruited via a Public Advisory Group, charities, and professional organisations. Findings: the reviews and workshops/interviews with patients (n = 15) and practitioners (n = 14) identified 37 preconception care topics which were included in the Delphi survey. Eighty-five participants completed the first Delphi round, with 63 completing all three rounds. Based on the Delphi rounds, 11 topics were included and no topic met predefined criteria for exclusion. All topics were discussed at the final workshop (n = 21 participants) and six additional topics achieved consensus to be included. Workshop participants agreed that the 17 priority topics should be combined into four topic areas: (1) knowledge of preconception health and pregnancy, (2) ideas, concerns and expectations (e.g. pregnancy intention, timing, prior pregnancy experiences), (3) health conditions (e.g. medication use, mental and physical health, immunisation), and (4) health behaviours (e.g. folic acid supplement use, smoking, alcohol consumption). Implications: the agreed priority topic areas offer a structured foundation for opportunistic patient-centred preconception care in primary care. The findings support the need for further co-development of practical tools and support to enable implementation in routine practice