title: How do women prepare for pregnancy? Preconception experiences of women attending antenatal services and views of health professionals.
abstract: OBJECTIVE
  To determine the extent to which women plan and prepare for pregnancy.
  
  
  METHODS
  Cross-sectional questionnaire survey of pregnant women attending three maternity services in London about knowledge and uptake of preconception care; including a robust measure of pregnancy planning, and phone interviews with a range of health care professionals.
  
  
  RESULTS
  We recruited 1173/1288 (90%) women, median age of 32 years. 73% had clearly planned their pregnancy, 24% were ambivalent and only 3% of pregnancies were unplanned. 51% of all women and 63% of those with a planned pregnancy took folic acid before pregnancy. 21% of all women reported smoking and 61% reported drinking alcohol in the 3 months before pregnancy; 48% of smokers and 41% of drinkers reduced or stopped before pregnancy. The 51% of all women who reported advice from a health professional before becoming pregnant were more likely to adopt healthier behaviours before pregnancy [adjusted odds ratios for greatest health professional input compared with none were 2.34 (95% confidence interval 1.54-3.54) for taking folic acid and 2.18 (95% CI 1.42-3.36) for adopting a healthier diet before pregnancy]. Interviews with 20 health professionals indicated low awareness of preconception health issues, missed opportunities and confusion about responsibility for delivery of preconception care.
  Despite a high level of pregnancy planning, awareness of preconception health among women and health professionals is low, and responsibility for providing preconception care is unclear. However, many women are motivated to adopt healthier behaviours in the preconception period, as indicated by halving of reported smoking rates in this study. The link between health professional input and healthy behaviour change before pregnancy is a new finding that should invigorate strategies to improve awareness and uptake of pre-pregnancy health care, and bring wider benefits for public health.
authors: Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom.
authors: Judith
authors: J
authors: Stephenson
authors: Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom.
authors: Dilisha
authors: D
authors: Patel
authors: Health Sciences and Social Care, Brunel University, Uxbridge, United Kingdom.
authors: Geraldine
authors: G
authors: Barrett
authors: Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom.
authors: Beth
authors: B
authors: Howden
authors: Infection & Population Health, Institute of Epidemiology, UCL, London, United Kingdom.
authors: Andrew
authors: A
authors: Copas
authors: Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom.
authors: Obiamaka
authors: O
authors: Ojukwu
authors: University College London Hospitals, London, United Kingdom.
authors: Pranav
authors: P
authors: Pandya
authors: Reproductive Medicine, Institute of Women's Health, UCL, London, United Kingdom.
authors: Jill
authors: J
authors: Shawe
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006281:Health Occupations / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data; D010465:Perception; D016742:Preconception Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult