title: Why do women invest in pre-pregnancy health and care? A qualitative investigation with women attending maternity services.
abstract: BACKGROUND
  Despite the importance attributed to good pre-pregnancy care and its potential to improve pregnancy and child health outcomes, relatively little is known about why women invest in pre-pregnancy health and care. We sought to gain insight into why women invested in pre-pregnancy health and care.
  
  
  METHODS
  We carried out 20 qualitative in-depth interviews with pregnant or recently pregnant women who were drawn from a survey of antenatal clinic attendees in London, UK. Interviewees were purposively sampled to include high and low investors in pre-pregnancy health and care, with variation in age, partnership status, ethnicity and pre-existing medical conditions. Data analysis was conducted using the Framework method.
  
  
  RESULTS
  We identified three groups in relation to pre-pregnancy health and care: 1) The "prepared" group, who had high levels of pregnancy planning and mostly positive attitudes to micronutrient supplementation outside of pregnancy, carried out pre-pregnancy activities such as taking folic acid and making changes to diet and lifestyle. 2) The "poor knowledge" group, who also had high levels of pregnancy planning, did not carry out pre-pregnancy activities and described themselves as having poor knowledge. Elsewhere in their interviews they expressed a strong dislike of micronutrient supplementation. 3) The "absent pre-pregnancy period" group, had the lowest levels of pregnancy planning and also expressed anti-supplement views. Even discussing the pre-pregnancy period with this group was difficult as responses to questions quickly shifted to focus on pregnancy itself. Knowledge of folic acid was poor in all groups.
  
  
  CONCLUSIONS
  Different pre-pregnancy care approaches are likely to be needed for each of the groups. Among the "prepared" group, who were proactive and receptive to health messages, greater availability of information and better response from health professionals could improve the range of pre-pregnancy activities carried out. Among the "poor knowledge" group, better response from health professionals might yield greater uptake of pre-pregnancy information. A different, general health strategy might be more appropriate for the "absent pre-pregnancy period" group. The fact that general attitudes to micronutrient supplementation were closely related to whether or not women invested in pre-pregnancy health and care was an unanticipated finding and warrants further investigation.
authors.affiliation: Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK. geraldine.barrett@brunel.ac.uk.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Barrett
authors.affiliation: School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK. j.shawe@surrey.ac.uk.
authors.forename: Jill
authors.initials: J
authors.lastname: Shawe
authors.affiliation: Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK. beth.howden@bristol.ac.uk.
authors.forename: Beth
authors.initials: B
authors.lastname: Howden
authors.affiliation: Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK. dilisha.patel@ucl.ac.uk.
authors.forename: Dilisha
authors.initials: D
authors.lastname: Patel
authors.affiliation: Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK. rmjbooj@ucl.ac.uk.
authors.forename: Obiamaka
authors.initials: O
authors.lastname: Ojukwu
authors.affiliation: University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK. pranav.pandya@uclh.nhs.uk.
authors.forename: Pranav
authors.initials: P
authors.lastname: Pandya
authors.affiliation: Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK. judith.stephenson@ucl.ac.uk.
authors.forename: Judith
authors.initials: J
authors.lastname: Stephenson
mesh_terms: D000328:Adult; D019587:Dietary Supplements; D005193:Family Planning Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008131:London; D016742:Preconception Care / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D036301:Qualitative Research; D043762:Reproductive Behavior / Q000523:psychology*; D014803:Vitamin B Complex / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014803:Vitamin B Complex; D005492:Folic Acid