Women’s knowledge, attitudes and views of preconception health and intervention delivery methods: a cross-sectional survey

Michael P. Daly*, James White, Julia Sanders, Ruth R. Kipping

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)
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Background: Several preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, few studies have investigated women’s knowledge of and attitudes towards preconception health, and the acceptability of potential intervention methods. Methods: Seven primary care centres in the West of England posted questionnaires to 4330 female patients aged 18 to 48 years. Without providing examples, we asked women to list maternal preconception exposures that might affect infant and maternal outcomes, and assessed their knowledge of nine literature-derived risk factors. Attitudes towards preconception health (interest, intentions, self-efficacy and perceived awareness and importance) and the acceptability of intervention delivery methods were also assessed. Multivariable multilevel regression examined participant characteristics associated with these outcomes. Results: Of those who received questionnaires, 835 (19.3%) responded. Women were most aware of the preconception risk factors of diet (86.0%) and physical activity (79.2%). Few were aware of weight (40.1%), folic acid (32.9%), abuse (6.3%), advanced age (5.9%) and interpregnancy intervals (0.2%), and none mentioned interpregnancy weight change or excess iron intake. After adjusting for demographic and reproductive covariates, women aged 18–24-years (compared to 40–48-year-olds) and nulligravid women were less aware of the benefit of preconception folic acid supplementation (adjusted odds ratios (aOR) for age: 4.30 [2.10–8.80], gravidity: aOR 2.48 [1.70–3.62]). Younger women were more interested in learning more about preconception health (aOR 0.37 [0.21–0.63]) but nulligravid women were less interested in this (aOR 1.79 [1.30–2.46]). Women with the lowest household incomes (versus the highest) were less aware of preconception weight as a risk factor (aOR: 3.11 [1.65–5.84]) and rated the importance of preconception health lower (aOR 3.38 [1.90–6.00]). The most acceptable information delivery methods were websites/apps (99.5%), printed healthcare materials (98.6%), family/partners (96.3%), schools (94.4%), television (91.9%), pregnancy tests (91.0%) and doctors, midwives and nurses (86.8–97.0%). Dentists (23.9%) and hairdressers/beauticians (18.1%) were the least acceptable. Conclusions: Our findings demonstrate a need to promote awareness of preconception risk factors and motivation for preconception health changes, particularly amongst younger and nulligravid women and women with lower incomes. Interventions to improve preconception health should focus on communication from healthcare professionals, schools, family members, and digital media.

Original languageEnglish
Article number729
Number of pages14
JournalBMC Pregnancy and Childbirth
Issue number1
Publication statusPublished - 24 Sept 2022

Bibliographical note

Funding Information:
This work was supported in part by grant MR/N0137941/1 for the GW4 BIOMED DTP, awarded to the Universities of Bath, Bristol, Cardiff and Exeter from the Medical Research Council (MRC)/UKRI. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Funding Information:
The authors thank the women who took part in this study, the staff of the general practices who acted as the study’s participant identification centres, and NIHR CRN West of England who helped us to recruit these practices and funded the study’s service support costs. We also wish to thank: Rona Campbell, Deborah Lawlor, Gemma Morgan and Rhiannon Macefield, who provided guidance on the study’s design; Mike Bell at NIHR ARC West, who facilitated the study’s public involvement; and Judith Stephenson, Chandni Maria Jacob, Deirdre de Barra and Jo Williams, who reviewed the study’s protocol and materials prior to its conduct.

Publisher Copyright:
© 2022, The Author(s).


  • Cross-sectional studies
  • Health knowledge, attitudes, practice
  • Intervention development
  • Preconception care
  • Surveys and questionnaires


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