Background: Several preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, few studies have investigated womens knowledge of and attitudes towards preconception health, and the acceptability of potential intervention methods. Methods: Seven GP practices in the West of England posted questionnaires to 4,330 female patients aged 18 to 48. Without providing examples, we asked women to name maternal preconception risk factors. Womens knowledge of nine literature-derived risk factors was then assessed. 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 the 4,330 women 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 18-25-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 channels were printed healthcare materials (99.5%), websites/apps (98.6%), family/partners (96.3%), schools (94.4%), television (91.9%), pregnancy tests (91.0%) and doctors, midwives and nurses (86.8-93.5%). 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.

The authors have declared no competing interest.

This work was supported 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

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The South West Frenchay Research Ethics Committee gave ethical approval for this work

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