# Preconception Health Attitudes and Behaviours of Women: A Qualitative Investigation
## 1 Introduction  
Health prior to conception is recognised as a critical window with profound and lasting effects across the reproductive life course, impacting on fertility, outcomes during pregnancy as well as short and long term health implications for both women and future generations [1]. The significance of this period has been recognised globally by the World Health Organisation Commission on Ending Childhood Obesity, who have identified preconception as one of six key recommended time-points to prioritise for future childhood and adolescent obesity prevention [2].  
In the absence of clinical practice guidelines for preconception healthcare in Australia [3], recommendations for primary care by The Royal Australian College of General Practitioners (RACGP) include implementing preconception care for all women of reproductive age (15 to 49 years). This encompasses evaluation of medical history (i.e., reproductive life plan; medical, reproductive and family history; medication use; general physical assessment and vaccination history) and health related behaviours (i.e., folic acid and iodine supplementation; healthy weight; nutrition and exercise; psychosocial health; smoking, alcohol and illegal drug cessation and healthy environments) [4]. These recommendations align internationally, with similar practice recommendations published in the US [5]and UK [6]. Whilst high quality evidence of the effectiveness of preconception interventions on pregnancy outcomes is limited [7], previous research demonstrates intervening during preconception optimises behaviour change including dietary change, folic acid supplementation, smoking reduction, weight loss and control of diabetes, and these may improve pregnancy outcomes including reduced risk of miscarriage, neural tube defects, stillbirth, abnormal birth weight and preterm birth [8; 9; 10; 11].  
Despite the importance of this period, women planning a pregnancy are a diverse and difficult to reach population, with little regular healthcare engagement prior to pregnancy and limited awareness of preconception health messages [11; 12]. Previous research also demonstrates that even when receptiveness to preconception health information is increased, many women do not perceive themselves to be a high-risk population in need of preconception care [12]. Yet, young women of reproductive age present the population group at highest risk of obesity development with rapid weight gain, suboptimal lifestyle behaviours and related major reproductive, metabolic and psychological complications [13]. Within high and middle income countries, over 50% of women enter pregnancy overweight or obese [14; 15; 16], with a higher body mass index (BMI) prior to conception increasing the risk of complications during pregnancy including gestational diabetes mellitus (GDM), preeclampsia, caesarean section and the birth of a large-for-gestational-age infant [17; 18]. Further, children born to obese mothers are twice as likely to develop childhood obesity, independent of maternal age, race, parity, education, gestational weight gain, child gender and birthweight [19].  
To better facilitate effective engagement strategies and targeted interventions during preconception, improved understanding of women's attitudes, behaviours and information needs is warranted. To date, there are few in-depth exploratory studies of preconception health engagement and associated perceived barriers and enablers. To address this, we conducted a qualitative study exploring women's attitudes, behaviours and information needs during the preconception period in relation to preventive strategies recommended by the RACGP to identify gaps and inform future preconception health initiatives in this setting.