Hypertension in pregnancy: diagnosis and management

  • NICE guideline
  • NG133
  • Published: 
  • Last updated: 
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Implementation support toolkit

Attendance at, and content of, routine antenatal appointments

The challenge

Supporting women and pregnant people to attend their first antenatal ("booking") appointment by 10 weeks of pregnancy will enable early identification of potential risks and ensure that care is planned according to their needs.

Nationally, the proportion of booking appointments held by 10 weeks of pregnancy has remained relatively steady at around 65% for the last few years. However, there is notable integrated care board (ICB) and provider variation. In 2024/25 the percentage of booking appointments held by 10 weeks ranged from 42% to 78% between ICBs, and 20% to 85% between providers.

Statistics also show there is substantial variation in attendance when broken down by ethnicity of the mother. White women have consistently been the most likely to attend booking by 10 weeks (71% in 2024/25), and Black or Black British women have been the least likely (52% in 2024/25).

Insight provided to NICE from the healthcare system indicates that some of the reasons for the variation in practice identified may be:

  • health inequalities (for example, demographics, diverse ethnic minority populations, vulnerable groups)

  • differing processes for arranging bookings

  • lack of awareness in both service users and providers around the importance of booking early, and of the process to follow

  • women and pregnant people cancelling or not attending appointments

  • women and pregnant people not monitoring period dates

  • variation in workforce capacity and necessary skills to be able to deliver appointments

  • the quality of data available, and consistency of data being recorded (including ethnicity data).

The booking appointment and subsequent routine antenatal appointments are also important opportunities for ongoing risk assessments on the health and wellbeing of the woman or pregnant person and their baby. Early identification of potential medical, genetic, social and emotional risk factors enables organisation of additional, specialist management and support. Ongoing risk assessment and monitoring helps reduce the risk of adverse outcomes for both parent and child.

Data showed that, in 2024/25, 92% of booking appointments included a risk assessment for previous obstetric history (previous live births, caesareans, stillbirths and miscarriages) recorded. However, only 61% and 56% included a risk assessment for mental health or social and personal circumstances (complex social factors, disability, employment status of woman and partner, and feeling supported in pregnancy), respectively.

Insight provided to NICE from the healthcare system indicates that some of the reasons for the variation in practice may be:

  • lack of time in the appointment

  • the risk assessment was carried out, but not recorded

  • staff felt uncomfortable in their ability to carry out non-obstetrics-related risk assessments correctly, or were unsure of exactly what questions to ask based on the person's circumstances

  • staff did not feel comfortable in asking non-obstetrics-related questions as they were unsure about, or felt unable to provide, the follow-up support that would be needed if a risk was identified and were concerned this could in turn damage trust and reduce engagement.

What support is available

Support from NICE

  • NICE has produced an interactive schedule of antenatal appointments resource, which details best practice regarding the scheduling and content of the routine antenatal appointments that should be offered during pregnancy, including what questions to ask about mental health and social and personal circumstances. Providers and practitioners can use this resource to review what routine antenatal appointments should be scheduled for both nulliparous and parous women and pregnant people, and what the content of each of these appointments should consist of. The resource also directs users to additional guidance and support where relevant.

  • NICE has published 2 clinical knowledge summaries on antenatal care:

    • The clinical knowledge summary on the care of an uncomplicated pregnancy covers recommendations on baseline clinical care for all women and pregnant people, and management of healthy women and pregnant people with an uncomplicated singleton pregnancy, as well as the management of common minor ailments that may be experienced during pregnancy. It also discusses the antenatal appointments and the screening tests which are offered during pregnancy.

    • The clinical knowledge summary on antenatal and postnatal depression covers the management of pre-existing or newly diagnosed depression in pregnancy and the management of depression in the postnatal period, including in people who are breastfeeding.

  • NICE has developed an interactive mental health checklist that provides specific information regarding the mental health assessment, and any follow-up actions that may need to be taken, which should be used at both the first and subsequent antenatal appointments.

  • The quality statements on access to antenatal care and risk assessment in NICE's quality standard on antenatal care include information on the level of quality to aim for, and how to measure performance regarding access to antenatal care and risk assessments, respectively.

Support from our partners

Please see the section on addressing ethnic health inequalities for further advice in relation to this topic.

Note that external websites and resources have not been produced by NICE. NICE has not made any judgement about the methodology, quality or usability of the websites or resources.

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