BACKGROUND: Optimising women's pre-pregnancy health is a policy priority for benefits spanning pregnancy and throughout the mother and baby's life. In the UK pre-pregnancy care (PPC) tends to be delivered in primary care, with the onus on women to seek services. We aimed to describe women's engagement with General Practice (GP) in the year preceding pregnancy, including specific PPC; to explore whether women with recognised risk factors for poor pregnancy outcomes receive targeted care. METHODS: Data for women aged 18-48yrs and registered for ≥ 12 months with a GP on 01/01/2017, were drawn from English Clinical Practice Research Datalink (CPRD) GOLD, a source of electronic health record data. Demographic characteristics, lifestyle factors and health conditions were described. CPRD Pregnancy Register and linked hospital data were used to identify pregnancies in 2017/18 and to describe PPC in the year preceding pregnancy. RESULTS: Of 193,578 women included, 14,326 had a confirmed pregnancy. 7.6% of the pregnant women had records indicating specific PPC in the preceding year, whilst 41.0% had records of health promotion (advice on nutrition, smoking, weight, alcohol and contraception). More women with pre-existing medical conditions received health promotion (46.0%-83.9% for various risk groups), although the levels of PPC remained low (4.7%-14.9%). CONCLUSIONS: PPC was rarely recorded, likely reflecting low levels of consultation for, or discussion of, pregnancy planning. This represents a missed opportunity for maximising women's health, particularly in those with recognised risk factors for poor pregnancy, perinatal and longer-term outcomes.