Pregnant women contacted their GPs an average of 3.6 times during pregnancy and postpartum, in addition to the care provided by midwives or obstetricians. They had on average 1.4 more contacts with their GPs than non-pregnant women. The diagnoses made by GPs for pregnant women and non-pregnant women were quite similar. Most of the diagnoses recorded for pregnant women were related to pregnancy problems. However, differences appeared regarding urological problems and musculoskeletal problems. Urological problems were more often recorded with pregnant women, whereas non-pregnant women had musculoskeletal problems more often. The number of prescribed medications was much lower in pregnant women than non-pregnant women. Medication prescribed during pregnancy and postpartum mainly concerned pregnancy-related medication. Finally, pregnant women were most frequently referred to obstetrical healthcare professionals, whereas non-pregnant women were most frequently referred to physiotherapists.
This is the first study to examine the consultation rates, diagnoses and management of pregnant women in general practice. We found that, in addition to the maternal care provided by midwives and obstetricians, pregnant women have more contacts with their GP during pregnancy and the postpartum period compared to non-pregnant women. The excessive number of contacts related to pregnancy, birth and family planning can explain this difference. Pregnant women might be more worried about their health, resulting in a lower threshold for consulting their GP. Furthermore, pregnancy is a special period in which more health problems occur and extra care is required
. However, we do not know why pregnant women choose to consult a GP instead of their obstetric care providers. This is remarkable because GPs in the Netherlands are not the key professionals providing obstetric care. Maybe, pregnant women are more familiar with their GP as compared to their midwife or obstetrician, or women do not have the knowledge to decide whether a symptom is related to pregnancy. Regarding obstetricians, difficulties in getting an appointment may also play a role. Finally, regarding midwives, some pregnant women may primarily contact their GP if they expect that they will need medication, which cannot be prescribed by their midwife.
Our finding that pregnant women consult their GPs frequently for problems unrelated to pregnancy is in agreement with Coco’s study
 that showed that GPs who provide prenatal care also address non-obstetrical problems frequently. Detailed comparisons of our results with those of Coco are not possible due to different classification systems (ICD-9 vs. ICPC-1), a different study setting (family physicians providing prenatal care vs. GPs not providing prenatal care), and different study variables (exclusion of pregnancy related diagnoses vs. inclusion of all diagnoses).
‘Pregnancy’ was recorded for 41% of all pregnant women. This could be interpreted as not every GP recording pregnancy in the electronic medical record, even though they may know about it. For instance, in the UK the percentage of women visiting a GP as the first professional seen during pregnancy is 82.5%
. Obviously, every GP needs to know about a pregnancy and to have this recorded in the medical record: this information is indispensable when problems arise or medication has to be prescribed. On the other hand, midwives and obstetricians should inform GPs about their client’s pregnancy.
We found more diagnoses of cystitis in pregnant women, which confirms that cystitis occurs more frequently during pregnancy. The lower number of musculoskeletal problems of pregnant women presented to their GP could be explained by the commonly held belief among women that musculoskeletal symptoms are to a certain extent ‘normal’ during pregnancy and postpartum and that they need no special attention. In addition, GPs might have coded musculoskeletal problems in pregnant women under the pregnancy-related problems chapter of the ICPC (W); for instance code W29 ‘Pregnancy symptom/complaint other’ instead of musculoskeletal problems (ICPC chapter L).
Medication was less often prescribed to pregnant than to non-pregnant women, which reflects the justified reluctance to prescribe medication during pregnancy because of the potential teratogenic effects of medication use during pregnancy.
Finally, pregnant women were more often referred to other healthcare professionals compared to non-pregnant women. Although musculoskeletal problems were less frequently recorded in pregnant women, they were relatively frequently referred to a physiotherapist. Referring pregnant women to physiotherapists could replace a drug prescription.
Strengths and limitations of the study
A major strength of our study is the use of a very large and nationally representative dataset of contacts, prescriptions and referrals for both pregnant and non-pregnant women.
This study also has some limitations. First, the recording of data is not always complete, despite completeness being quite high. However, the amount of missing data did not differ between pregnant and non-pregnant women, making an impact on our findings unlikely. Evidently, regarding the diagnosis ‘pregnancy’, many more cases were missed (59%). We do not think that such an under-registration also holds for other diagnoses, which the GP considers to be less self-evident. Moreover, we had no data on other potentially relevant background characteristics such as ethnicity, making it impossible to assess ethnic subgroups. Third, a limitation could be that the pregnant women group had a higher proportion of women belonging to the low and high SES group than non-pregnant women. However, it is unlikely that we missed any women, as all Dutch inhabitants are listed at a general practice. This finding probably reflects that women are less likely to become pregnant in middle SES areas.
Our findings have implications for education, research and daily care. The apparently important role of GPs for pregnant women during their pregnancy should result in the training of GPs to recognise and manage health problems during pregnancy and obstetric emergencies.
Second, future research is needed to get more insight into the reasons pregnant women to seek GP care. A better understanding of the pregnant women’s perspective will enable all healthcare professionals involved to respond more appropriately to the needs of pregnant women.
Third, GPs have to participate in the obstetrical healthcare provider team, and may provide shared care as already occurs in some countries like Ireland
Collaboration and sharing of relevant information should be organised. An integrated digital environment can facilitate this communication. Software tools could be helpful for appropriately recording pregnancy in the electronic medical record, e.g. by prompting this on the occasion of a pregnancy test or a referral to a midwife or obstetrician.