Researchers in Northern Ireland looked at over 255,000 pregnancies between 2011 and 2021 to understand how women’s health habits were changing. They found that more women were becoming overweight, fewer women were planning their pregnancies, and most women weren’t taking folic acid supplements before getting pregnant—even though this vitamin is crucial for baby’s development. The study suggests that helping women get healthier before pregnancy could prevent serious health problems for both mothers and babies.

The Quick Take

  • What they studied: How healthy women in Northern Ireland were before and during early pregnancy, looking at weight, poverty levels, whether pregnancies were planned, and whether women took folic acid vitamins
  • Who participated: Over 255,000 pregnant women who had their first prenatal appointment in Northern Ireland between 2011 and 2021, representing all income levels and backgrounds
  • Key finding: Obesity rates climbed from 12% to 16% over the decade, and most women (about 65-66%) weren’t taking folic acid supplements before pregnancy, even though it’s critical for preventing birth defects
  • What it means for you: If you’re planning to get pregnant, starting folic acid supplements and maintaining a healthy weight before conception may reduce risks of complications. However, this study shows many women don’t do this, suggesting healthcare systems need better education and support

The Research Details

This was a population-based study using real medical records from every maternity hospital in Northern Ireland over 10 years. Researchers looked at information women reported at their first prenatal appointment, including their weight, whether their pregnancy was planned, where they lived, and whether they were taking folic acid supplements. They tracked how these numbers changed year by year and used statistical methods to identify trends. The study included nearly all pregnancies in the region during this time period, making it very representative of the actual population.

Using real medical records instead of surveys makes this study very reliable because the information comes directly from healthcare visits rather than people’s memories. Looking at 10 years of data shows whether trends are getting better or worse, which helps public health officials decide where to focus efforts. The large number of pregnancies studied means the findings are likely to apply to other similar populations.

This study is strong because it includes almost all pregnancies in a region rather than just a sample, uses official medical records rather than surveys, and tracks changes over a long time period. The main limitation is that it only looks at women in Northern Ireland, so results might be different in other countries with different healthcare systems or populations. The study also depends on women accurately reporting information at their appointments.

What the Results Show

Over the 10-year period, obesity rates increased noticeably. Women with obesity class I (the first level of obesity) went from 12% to 16.1% of all pregnant women. About 70.6% of pregnancies were planned, meaning about 29% were unplanned. Women living in the poorest areas made up 21.4% of all pregnancies, showing that poverty and pregnancy are connected. Most concerning was folic acid supplement use: only about 34% of women were taking the standard 400 microgram dose before pregnancy, and only 5% were taking the higher 5 milligram dose that’s recommended for women at higher risk. The good news is that use of the higher-dose folic acid increased slightly from 3.6% to 5% between 2015 and 2020, suggesting some improvement in awareness.

The study found that folic acid supplements were mostly started after women became pregnant, not before. This is important because the first few weeks of pregnancy—when many women don’t know they’re pregnant yet—are when folic acid is most critical for preventing birth defects. The connection between poverty and pregnancy was clear: women in the most deprived areas had less access to preconception health information and support. The data also showed that unplanned pregnancies (about 29% of all pregnancies) meant these women had even less time to prepare their bodies for pregnancy.

This study adds to existing research showing that many women don’t get adequate preconception care. Previous studies have shown that folic acid prevents serious birth defects, but many women don’t start taking it early enough. The increasing obesity rates match trends seen in other developed countries. This research confirms that preconception health is a public health problem that needs attention, similar to findings from other regions.

The study only included women in Northern Ireland, so results might not apply to other countries with different populations or healthcare systems. The information came from what women reported at their first prenatal visit, which might not be completely accurate—some women might forget or not want to share certain details. The study couldn’t explain why trends were changing, only that they were. It also couldn’t look at women who didn’t get prenatal care at all. Finally, the study couldn’t prove that improving these factors would definitely prevent problems, only that they’re connected to pregnancy outcomes.

The Bottom Line

Women planning pregnancy should: (1) Start taking folic acid supplements at least one month before trying to conceive—use 400 micrograms daily, or 5 milligrams if you have risk factors like diabetes or previous birth defects; (2) Reach a healthy weight before pregnancy if possible; (3) Talk to a doctor about preconception health at least 3 months before trying to get pregnant. These recommendations are supported by strong evidence. Healthcare providers should improve education about preconception health, especially for women in lower-income areas who may have less access to information.

Anyone planning to become pregnant should pay attention to this research. Women in lower-income areas should especially seek out preconception health information and support. Healthcare providers, public health officials, and policymakers should care because this research shows where improvements are needed. Women who have already become pregnant should still start folic acid supplements immediately, as some benefit is still possible. This research is less relevant for women who aren’t planning pregnancy, though unplanned pregnancies are common, so all women of childbearing age could benefit from knowing about folic acid.

Folic acid works best when started before pregnancy and continued through the first trimester (first 3 months). Weight loss typically takes 3-6 months to show meaningful results. The benefits of preconception health planning appear during pregnancy and in the first year of a baby’s life, with reduced risks of birth defects, premature birth, and low birth weight. Long-term benefits for the child’s health may continue throughout life.

Want to Apply This Research?

  • If planning pregnancy, track daily folic acid supplement intake (yes/no each day) and weight weekly. Set a goal to reach recommended weight range 3 months before trying to conceive. Log any preconception health appointments with your doctor.
  • Set a daily phone reminder to take folic acid supplement at the same time each day (like with breakfast). Use the app to schedule a preconception health appointment with your doctor. Track which foods you’re eating to support healthy weight management. Log conversations with healthcare providers about pregnancy planning.
  • For women planning pregnancy: Monitor folic acid supplement adherence daily for at least 3 months before conception and throughout pregnancy. Track weight monthly and aim for gradual, healthy loss if needed (1-2 pounds per week). After conception, continue tracking supplement use and prenatal appointment attendance. For healthcare providers: Monitor population-level trends in preconception health indicators annually to identify areas needing more support.

This research describes trends in preconception health but does not provide medical advice. If you are planning pregnancy or are pregnant, consult with your healthcare provider about your individual health needs, including appropriate folic acid supplementation, weight management, and preconception care. This study was conducted in Northern Ireland and may not apply to all populations or healthcare systems. The findings suggest associations between preconception health factors and pregnancy outcomes but do not prove cause-and-effect relationships. Always follow your doctor’s personalized recommendations for your specific situation.