# What Influences Women’s Knowledge, Attitudes, and Practices Toward Preconception Care? A Systematic Review and Meta-Analysis

## TL;DR

This study identifies factors like education and age that influence women's knowledge, attitudes, and behaviors toward preconception care, which can help improve maternal and neonatal health.

## Contribution

The study provides a systematic review and meta-analysis of determinants of preconception care knowledge, attitudes, and practices among women.

## Key findings

- Higher education and prior PCC training significantly improve PCC knowledge.
- Older age and positive attitudes are strong predictors of favorable PCC attitudes.
- Prior counseling and higher education are key determinants of PCC behaviors.

## Abstract

Maternal and neonatal mortality remain significant global challenges, with 287,000 pregnancy-related deaths in 2020 and a neonatal mortality rate of 17 per 1,000 live births in 2019. Preconception care (PCC) can mitigate these outcomes, yet low uptake persists. Unintended pregnancies and risky preconception behaviors (e.g., smoking, poor folic acid intake) exacerbate health disparities, underscoring the need to understand determinants of PCC knowledge, attitudes, and practices (KAP).

This systematic review and meta-analysis examined the determinants of KAP regarding PCC among women of reproductive age. Following PRISMA guidelines, we analyzed studies from PubMed and ScienceDirect, retrieved between January and March 2025. The study protocol was registered in PROSPERO (CRD42025637031).

This systematic review and meta-analysis included 13 observational studies assessing preconception care (PCC) knowledge, attitudes, and practices. The analysis revealed that higher education levels (AOR=28.55, p<0.00001), multiparity (AOR=2.91, p=0.02), prior PCC training (AOR=13.47, p<0.00001), contraceptive history (AOR=5.05, p<0.00001), and workplace library access (AOR=4.26, p<0.00001) significantly enhanced PCC knowledge. For PCC attitudes, older age (>35 years, AOR=8.73, p<0.00001) and higher education (AOR=5.51, p=0.007) were strong predictors. Regarding PCC behaviors, key determinants included older age (AOR=3.16, p<0.0001), positive attitudes (AOR=2.96, p<0.0001), higher education (AOR=2.49, p<0.00001), and prior counseling (AOR=11.29, p<0.00001). Substantial heterogeneity was observed for some associations, but overall effects remained significant.

These findings highlight that education, age, healthcare access, and prior PCC engagement are critical factors influencing PCC outcomes. Interventions targeting these determinants could improve preconception care uptake and maternal health outcomes.