# Preconception Health Attitudes and Behaviours of Women: A Qualitative Investigation
## 4 Discussion  
In our sample of 15 women of reproductive age, women predominantly prioritised the importance of engaging in healthy lifestyle behaviours such as pre-pregnancy vitamin supplementation, nutrition and exercise as important during the preconception period. Most women signalled pregnancy intention to their GP; however, very few recalled having undertaken a comprehensive health check. Anxiety, stress and difficulties accessing reliable information online were particular challenges experienced during the preconception period. Women indicated a preference in receiving preconception health information at least three months prior to conceiving, particularly regarding supplementation, nutrition and exercise, through a range of platforms, predominantly including online and via healthcare providers. Priorities healthy lifestyle behaviours is consistent with previous findings of a qualitative study exploring fertility-related knowledge in which awareness of the impact of adverse lifestyle behaviours such as smoking, drinking alcohol and poor diet on fertility was high amongst respondents [25]. Additionally, a cross-sectional study exploring women's and men's beliefs about lifestyle, fertility and pregnancy across 104 countries found that eating a variety of fruits and vegetables and not smoking or drinking alcohol were perceived as the most important lifestyle behaviours to optimise for a healthy pregnancy [26]. Given the rising prevalence of overweight and obesity [15], and the impact of excess weight on maternal and infant outcomes [17; 18; 27], it is encouraging to see the prioritisation of a healthy lifestyle prior to conception. The prioritisation of a healthy lifestyle may suggest that women view self-regulating behaviours as more achievable and favourable. Additionally, most women in our study perceived having a healthy lifestyle prior to actively trying to conceive and this may explain why most women carried this behaviour into preconception. Although supplementation use has been considered less important for a healthy pregnancy by a sample of women and men across 104 countries [26], most women in our study took pre-pregnancy supplements and felt that it was an important action to take. This is consistent with findings from the Australian Longitudinal Study on Women's Health, which reported \(\sim\)63% of women were taking at least one dietary supplement during preconception [28]. Given the established evidence recommending pre-pregnancy vitamin supplementation, continued effort to raise awareness of the importance of preconception folic acid and iodine is still warranted. Most women in our study signalled pregnancy intention to their GP, sought information and adopted positive lifestyle behaviours preconception. Previous research has indicated that active pregnancy planning, by means of consulting a healthcare provider or searching for information, is associated with greater likelihood of engaging with healthy lifestyle behaviours, such as reducing alcohol consumption and improving diet or folic acid consumption [29; 30]. Encouragingly, women in our study had also taken steps to join or upgrade their private health insurance to include obstetrics cover in preparation for pregnancy. This may explain the increased likelihood of pregnancy planning and healthcare engagement in this sample. Private healthcare has previously been reported as an enabling factor for engaging preconception care services [31; 32]. Further, increased motivation towards healthy lifestyle to optimise individual health and that of their unborn child is likely when pregnancy intention is high with women more receptive to health related information, as shown here, highlighting a critical opportunity for primary health care providers. On the other hand, a small group of women in our study actively chose not to signal pregnancy intent to their health care provider and viewed preconception care as necessary to engage with only when experiencing difficulty conceiving.