Iranian women Behaviors Associated with Preconception health

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Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy. Preconception care can identify and modify biomedical, behavioral, and social risks to the woman's health or pregnancy outcome through prevention and management. Materials and Methods The present descriptive study was performed on 330 pre-pregnancy women who were eligible to participate in the study and met the inclusion criteria in 2021. demographic characteristics, pre-conception care, and general health questionnaires were used. Data analysis was performed with SPSS 21 software Results The mean age of participants was 33.02 ± 10.19 years, and the majority had high-school diplomas (67.2%) and were homemakers (59.4%). Factors influencing on occurring high-risk pregnancy were examined in six dimensions. 10.29% of participants due to Family history, 4.9% for Medical History,6.5% due to Infection history,11.57% because of Gynecologic/obstetric history, 85.08% to Environmental history, and 19.92% due to Nutrition history were at risk of high-risk pregnancy. 24.99% were also in poor general health. Conclusion Approximately half of the participants claimed to have at least one risk factor for high-risk pregnancies. Since most people have at least one risk factor for high-risk pregnancies, it seems that screening, education, and timely care before pregnancy can reduce maternal and neonatal mortality and complications. Preconception Mortality Morbidity High risk pregnancy Introduction Pregnancy may be accompanied by certain diseases that existed before pregnancy; most diseases that significantly affect the person often worsen if they occur in pregnant women. Pregnancy is considered high-risk when the mother or fetus is at higher risk of disability (morbidity) or death (mortality). Many conditions can be corrected by intervention before conception. Nevertheless, prevention measures that help mothers avoid the risks of complications during pregnancy will be successful only if they begin before pregnancy. The prevalence of high-risk pregnancies has been reported to be 20% worldwide. In addition, 50% of perinatal deaths are seen in high-risk pregnancies ( 1 ). In studies conducted in Iran, among 3157 pregnant women, 39.8% had urinary tract infection, 5.8% had a history of abortion, 3.8% were aged over 35, 2.7% were aged under 18, and 2.4% had abnormal weight gain, 2.4% anemia, and 1.7% hypertension ( 2 ). Many women who have not received pre-conception care or sufficient prenatal care are at risk for complications threatening themselves and their fetuses during pregnancy ( 3 ). Jack et al. conducted a comprehensive pre-conception risk assessment on 136 women with negative pregnancy tests; about 95% of these women report at least one problem that could impact future pregnancies. These included medical or reproductive problems (52%), family history of genetic diseases (50%), increased risk of human immunodeficiency virus infection (30%), increased risk of hepatitis B or illicit substance abuse (25%), alcohol consumption (17%), and nutritional risks (54%) ( 4 ). Approximately 585000 women die every year due to complications in pregnancy and childbirth, with 99% of the deaths occurring in developing countries ( 5 ). A study conducted in Kurdistan showed that high-risk pregnancies more than double the odds of infants’ death ( 6 ). Care before, during, and after childbirth can save the lives of women and newborn babies. The global maternal death ratio fell by 44% between 1990 and 2015. The goal of the Sustainable Development Goals (SDGs) is to reduce the global maternal mortality rate to less than 70 deaths per 100,000 live births between 2016 and 2030 ( 7 ). The physical, mental, and social health of young couples is associated with family health and creating a healthy generation. The root of many health problems such as abnormalities and adverse pregnancy outcomes should be sought in the pre-marital and pre-conception period ( 8 ). Raising women's awareness in the pre-conception stage is among the factors affecting the mother and infant's health as it makes mothers more motivated to participate in prenatal care; the results of studies show that women who received prenatal care began prenatal care earlier ( 9 ). Due to the importance of pre-conception care, the present study investigating health factors associated with high-risk pregnancy Materials and Methods This descriptive study was conducted on women who referred to Kerman health centers from 2021 to 2022. Participants included women before the birth of the first live baby who were eligible to participate in the study and met the inclusion criteria. Inclusion criteria age 18–45 and no pregnancy during the study Exclusion criteria unwillingness to answer and complete the questionnaire after seeing it. The minimum sample was calculated as 330 people. After receiving the ethics code and referring to the health centers of Kerman, a list of women who had never given birth to a live baby was prepared. Sample size and sampling The sample size of each health center was determined according to the number of women eligible to participate in the study, among whom we randomly selected the desired number to participate in the study. In the next step, we contacted those participants and explained the research purpose. If they wished to participate, written informed consent was obtained from them. Due to the COVID-19 outbreak, the questionnaires were completed online. Measuring tools The questionnaires included demographic characteristics, pre-conception care, and general health questionnaires. The demographic part included age, occupation, education, race, religion, place of residence, economic status, kinship relation with the spouse, forced or involuntary marriage, and selected contraception method. The pre-conception care questionnaire was derived from pre-conception care items in health care system, which included eight areas of family history, medical history, infections, gynecology and obstetrics history, environmental factors, nutrition, clinical examinations, and laboratory tests. The General Health Questionnaire (GHQ), a 28-item questionnaire developed by Goldberg and Hiller (1979), consists of four scales (physical symptoms, anxiety and insomnia, social dysfunction, and severe depression), and each scale has seven questions. It measures the psychological state of a person, with a score above 6 on any scale or a total scale above 22 indicating psychological illness. This questionnaire has been validated in various studies, including the study conducted in Iran, and its reliability has been confirmed by a Cronbach's alpha of 0.90 ( 10 ). Data analysis After completing the questionnaires and collecting the data, the collected information was analyzed using SPSS V21. In this study, descriptive statistical tests were used Results The mean age of participants was 33.02 ± 10.19 years, and the majority had high-school diplomas (67.2%) and were homemakers (59.4%). Most women (54%) preferred cesarean delivery, and 83.6% of women were unaware of pre-conception care (Table. 1). Regarding family history, 73.8% of participants reported a history of diseases such as cardiovascular problems, diabetes, hypertension, liver problems, thyroid, etc., in at least one of their parents or first-degree relatives. Regarding the participants own medical history, 53.2% reported a current illness they were being treated for, and 33.3% had contracted COVID-19. Regarding infections, 7.8% had a history of blood transfusions, and 6.3% had a sexually transmitted infection. Regarding gynecology and obstetrics history, 38.2% were infertile, 41.8% had a history of abortion, 3.8% had a history of stillbirth, and 1.9% had a history of an abnormal fetus. Most of the participants did not use any safe contraceptive method. In terms of nutrition, 37.3% were overweight, and 42.1% took supplements such as folic acid and vitamin D. In terms of environmental factors, 22.4% of them were close relatives of their husbands. 68.1% do not exercise and 22.4% suffer from domestic violence (Table 2 ). Table 1 Demographic characteristics and Awareness Rate of participants Variable N (%) Woman education Diploma and less 217(65.75%) Associate Degree 102(30.9%) Academic 11(3.33%) Woman Job Housekeeper 195(59%) Employed 140(48.48%) Preference for Type of delivery Vaginal Birth 130(39.39%) Cesarean Section 200(60.6%) Awareness of preconception care Weak 290(87.8%) Moderate 35(10.6%) Good 5(1.51%) Table 2 Percentages of Risk factors in Preconception Women Dimensions Risk Factor Percent Age Under 18 years 16% Above 35 years 0.07 Family history Birth defects 0.4% mental retardation 0.08% epilepsy 2.54% hearing and visual impairments 0.079% hypertension 23% cardiovascular disease 42.1% liver disease 13.2% thyroid disease 11.2% thrombo-embolic diseases 0.04% Medical History autoimmune diseases 0.6% diabetes mellitus 5.1% hypertension 8.8% epilepsy 0.3% phenylketonuria 1.5% thyroid disease 18.3% asthma 4.5% cardiovascular disease 7.8% thalassemia 2.4% thrombo-embolic diseases 1.2% kidney disease 3.9% depression 8.4% cancer 0.9% Infection’s history STDs 6.3% exposure to blood / blood transfusions 7.8% Vaccination History Complete 87.3% Incomplete 5.4% Unsure 7.3% Gynecologic/obstetric history Contraception use No contraception 4% Withdrawal 62% Barrier 28% Hormonal 6% Infertility 38.2% menstrual cycle disorder 4.7% history of gynecological surgery 0.31% Environmental history Consanguineous marriage 22.5% Smoking 1.53% domestic violence 22.4% financial status (low income) 47.8% exposure to harmful substances (at home and at work) 0.76% pets 2.3% Dental care (checkup within 12 months) Yes 13.7% no 86.3% Rest and Sleep Long standing work 6.2% overwork 0.89% Sleep less than 8 hours per day 21.6% Physical Activity No Exercise 68.1% Little exercise 29.2% Adequate Exercise 2.7% Nutrition history BMI Thin 13.4% Overweight 37.3% obese 12.5% use of supplements (Acid folic, Vit D) 42.1% dietary restrictions 1.02% caffeine consumption 13.2% Vegetarian diet 0.07% In the general health analysis, it was found that 61.5% had physical symptoms, 48.1% had symptoms of anxiety and insomnia, 7.8% had social dysfunction, and 92.2% had depression. In total, 54.6% had poor general health (Table 3 ). Table 3 General health and domestic violence status in women before pregnancy Variable Dimensions N (%) Domestic violence Physical 25(7.5%) Verbal 63(49.09%) Sexual 72(21.81%) Psychological 170(51.6%) General Health Physical symptoms 102(30.9%) Anxiety symptoms and sleep 65(19.69%) Social dysfunction 23(6.96%) Depression 140(42.42%) Discussion The pre-conception period is a critical window in which maternal health can profoundly affect individual and intergenerational health. The present study found that while most participants, who were before the first live childbirth, were at risk concerning a healthy pregnancy, they were unaware of pre-conception care. Khan also found in his qualitative study that few women were aware of the need for pre-conception care and appropriate health behaviors during this period ( 11 ). A study conducted by Bortolus found that women knew little about pre-conception care; according to midwives, only previous traumatic events in the family have caused willingness to receive PCC in some women ( 12 ). In order to increase awareness and thus receive pre-conception care, training programs can be planned for girls and boys in schools and couples in pre-marital counseling classes. According to the present study, approximately 11% of women had a family history of a disease. A prospective cohort study found that women with a family history of autoimmune diseases were less likely to have a live-born child and were more likely to have an abortion or stillbirth ( 13 ). Results showed that 53% of women participating in the study had a current disease, and since diseases can have different effects on maternal and neonatal outcomes during pregnancy, counseling and increased care and treatment before pregnancy can be helpful to reduce consequences. Horn also showed that termination of pregnancy was associated with increased hypertension, type 2 diabetes, and hypercholesterolemia ( 14 ). A cohort study also showed that chronic kidney disease was associated with a higher probability of preeclampsia, preterm birth, and cesarean delivery ( 15 ). Thyroid disorders result in premature birth, gestational hypertension, fetal mortality, and other severe adverse outcomes ( 16 ). Therefore, it is necessary to screen thyroid function during early pregnancy. The findings showed that several women had a history of hyperlipidemia, high waistline, and high BMI, and according to the metabolic syndrome definition, they may fall within the range of this syndrome. A study conducted by Kim et al. (2021) found that pre-pregnancy obesity/central obesity and metabolic syndrome are associated with an increased risk of insulin use in GDM ( 17 ). A study conducted by Zhu et al. (2019) also showed that mothers with central obesity in early pregnancy are at increased risk of GDM ( 18 ). Based on previous studies and the presence of risk factors, it seems necessary to screen women and perform timely interventions. Exercise can be one of the strategies, but unfortunately, most of the women who participated in the study exercised very little, while Wang found in a clinical trial that cycling that initiates early in pregnancy and is performed for at least 30 minutes, three times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women. Moreover, this effect is associated with the finding that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid-second trimester ( 19 ). Intimate partner violence is an essential public, reproductive, and social health concern. It can significantly predict adverse outcomes for both the mother and her infant. Preterm delivery (PTB) and low birth weight (LBW) are its leading causes. Since 22.4% of the women who participated in the present study were under the coercion of their spouse, psychosocial and supportive interventions can be helpful ( 20 ). The infertility rate was 38% in the participants, and given this high percentage, mental disorders, such as the stress and anxiety, and depression that accompany infertility, can aggravate infertility or cause treatment failure. Therefore, supportive-educational interventions to reduce mental disorders and promote health are advisable ( 21 ). A meager percentage of women used contraceptive methods. In the case of unwanted pregnancy, its complications included failure to seek maternity care, low birth weight, preeclampsia, postpartum hemorrhage, preterm labor, and mental disorders such as stress and depression ( 22 ). Therefore, it seems necessary that such women be trained about the decision to get pregnant and the need to refer to the PCC. Findings show that a high percentage (22.5%) of women had consanguineous marriages. Studies have shown that consanguineous marriages increase the risk of genetic diseases, heart disease, tuberculosis, sickle-cell anemia, and asthma in infants, and they also increase the risk of abortion and stillbirth. This study's high rate of consanguineous marriage necessitates planning for screenings before and during pregnancy. According to the findings, more than half of the women preferred cesarean delivery if they became pregnant. Studies have shown that cesarean birth may adversely affect children's sensory perception, sensory integration ability, neuropsychiatric development, and the infant-mother relationship ( 23 ). Also, children born via cesarean section may have an increased risk of developing asthma and obesity, and the risk for abortion, stillbirth, and placental abruption increases in the subsequent pregnancies. It seems that women's desire for a cesarean section can be due to ignorance about the complications of cesarean or previous unpleasant experiences or incorrect information from unreliable sources, which necessitates education and awareness-raising. According to the general health analysis, more than 50% of women had poor general health, primarily associated with anxiety and depression, while previous studies have shown that 10 to 25% of women experienced mild to moderate anxiety or depression during pregnancy ( 24 ). Studies have shown that depression during pregnancy is associated with preterm labor and low birth weight ( 25 ). One study found that children exposed to intrauterine stress had lower levels of development, cognitive skills, and attention at the age of two ( 26 ). Given the high prevalence of mental disorders in our society and the long-term effects of mental disorders on the health of the mother and especially the child, it seems that pre-conception screening and timely treatment are necessary to prevent adverse effects. Limitations This study has two limitations. First, due to the COVID-19 outbreak, the questionnaires were completed online, and there was no face-to-face interaction. Second, due to insufficient funding, laboratory tests were not performed, while they could have helped find high-risk cases. Conclusions Approximately half of the participants claimed to have at least one risk factor for high-risk pregnancies. These people urgently need pre-conception care and training on self-care issues, nutrition promotion, physical activity, and psychological interventions. It seems that designing a guideline and making it compulsory in the health care system can help prevent high-risk pregnancies and, ultimately, maternal and neonatal complications and mortality. Abbreviations Mody Mass Index (BMI), Low Birth Weight (LBW), General Health Questionnaire (GHQ), Pre-Conception Care (PCC), Sustainable Development Goals (SDGs), Gestational Diabetes Miletus (GDM) Declarations Ethics approval and consent to participate This article is the result of a dissertation approved by Kerman University of Medical Sciences with the ethics code IR.KMU.REC.1399.249 and Reg. no (98000163), and adhered to the Declaration of Helsinki and COPE guidelines. Written informed consent was obtained, and participants had the option to withdraw from the study at any time. Consent for publication Not Applicable Availability of data and materials Data are available under reasonable request to the corresponding author. Competing Interests The authors of this study state that there is no conflict of interest. Funding There was no Funding Authors' contributions SH.Z., K.A., M.GH.: Conceptualization, writing – original draft. F.MP., H.M.: Conceptualization. F.Z., F.I.: Writing – review & editing. F.SH.: Methodology. SH.SH.: Resources, writing – review & editing. Acknowledgements We would thank the Deputy of Research of Kerman University of Medical Sciences as well as all the women who participated in this research. References Cunningham F, Leveno K, Bloom S, Spong C, Dashe J, Hoffman B, Casey B, Williams. obstetrics 2018. Azizi A. The prevalence of the causes of high-risk pregnancies in pregnant women of Sonqor city, 2011. the Iranian Journal of Obstetrics, Gynecology and Infertility.2015; 18(153): 10–19. 10.22038/ijogi.2015.4696 Behrman RE, Kliegman RM, Jenson H. Nelson textbook of pediatrics. 21th ed. United States of America: Hal B Jenson; 2019. Malaki AM. 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Maternal stress during pregnancy and early childhood development. Econ Hum Biol. 2021;43:101047. 10.1016/j.ehb.2021.101047 . Epub 2021 Jul 16. PMID: 34340016. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6488251","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449967588,"identity":"8a7dbead-a227-4948-b6f6-cf9e1fbb89f4","order_by":0,"name":"Shahrzad Zolala","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shahrzad","middleName":"","lastName":"Zolala","suffix":""},{"id":449967589,"identity":"4ef1aa57-14cc-42a7-9930-1ad60731b928","order_by":1,"name":"Fatemeh Mollaei Pagdar","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"Mollaei","lastName":"Pagdar","suffix":""},{"id":449967590,"identity":"22a40b3a-64de-4f01-b595-9c3eab9f8c6e","order_by":2,"name":"Hedieh Masoudi","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hedieh","middleName":"","lastName":"Masoudi","suffix":""},{"id":449967591,"identity":"1b2d345d-36ca-4dbf-9eb9-b2173a133a65","order_by":3,"name":"Fatemeh Zaregarizi","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Zaregarizi","suffix":""},{"id":449967592,"identity":"984a4471-be0e-4917-b84c-302fffab0554","order_by":4,"name":"Faezeh Iranmanesh","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Faezeh","middleName":"","lastName":"Iranmanesh","suffix":""},{"id":449967593,"identity":"9eefb16d-a494-48d0-a64d-011cf6f63a47","order_by":5,"name":"Shohreh Shafeeyee","email":"","orcid":"","institution":"Jiroft University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shohreh","middleName":"","lastName":"Shafeeyee","suffix":""},{"id":449967594,"identity":"110645c8-2da6-462c-a838-24fda8e909f9","order_by":6,"name":"Fatemeh Shojaee","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Shojaee","suffix":""},{"id":449967595,"identity":"c965ad39-fa98-44a3-baca-48981038ed86","order_by":7,"name":"Masumeh Ghazanfar pour","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Masumeh","middleName":"Ghazanfar","lastName":"pour","suffix":""},{"id":449967596,"identity":"d7b6037a-ea9b-47b9-a323-13759a8ac91a","order_by":8,"name":"Katayoun Alidousti","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACCQbmhgM8IBYz8wEQX4YILYwQLTzMbAkgPg9RWhjAWhh4DBjANCEg2X6w8cCbisP29uw8n1/dqLHgYWA/fHQDPi3SPIkNB+ecOZzYw8y7zTrnGNBhPGlpN/BpkWNIbDjM23Y4gQeoxTiHDahFgscMvxb+h2At9jzMPM+Mc/4RoUVaAmILYw8zD/Pj3DYitEjOeAjyS3piz2E2M+bcPgkeNkJ+kTiffPjDmwpre/b+w48/53yrk+NnP3wMrxZkwCYBJolVDgLMH0hRPQpGwSgYBSMHAACoSEVi6aipngAAAABJRU5ErkJggg==","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Katayoun","middleName":"","lastName":"Alidousti","suffix":""}],"badges":[],"createdAt":"2025-04-20 08:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6488251/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6488251/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83432569,"identity":"4296fe9b-2be6-414c-bd32-d089f60fca85","added_by":"auto","created_at":"2025-05-26 07:31:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":639477,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6488251/v1/255b28a4-6c89-4696-81a0-ba38b19bcee8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Iranian women Behaviors Associated with Preconception health","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePregnancy may be accompanied by certain diseases that existed before pregnancy; most diseases that significantly affect the person often worsen if they occur in pregnant women. Pregnancy is considered high-risk when the mother or fetus is at higher risk of disability (morbidity) or death (mortality). Many conditions can be corrected by intervention before conception. Nevertheless, prevention measures that help mothers avoid the risks of complications during pregnancy will be successful only if they begin before pregnancy. The prevalence of high-risk pregnancies has been reported to be 20% worldwide. In addition, 50% of perinatal deaths are seen in high-risk pregnancies (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn studies conducted in Iran, among 3157 pregnant women, 39.8% had urinary tract infection, 5.8% had a history of abortion, 3.8% were aged over 35, 2.7% were aged under 18, and 2.4% had abnormal weight gain, 2.4% anemia, and 1.7% hypertension (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMany women who have not received pre-conception care or sufficient prenatal care are at risk for complications threatening themselves and their fetuses during pregnancy (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Jack et al. conducted a comprehensive pre-conception risk assessment on 136 women with negative pregnancy tests; about 95% of these women report at least one problem that could impact future pregnancies. These included medical or reproductive problems (52%), family history of genetic diseases (50%), increased risk of human immunodeficiency virus infection (30%), increased risk of hepatitis B or illicit substance abuse (25%), alcohol consumption (17%), and nutritional risks (54%) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eApproximately 585000 women die every year due to complications in pregnancy and childbirth, with 99% of the deaths occurring in developing countries (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). A study conducted in Kurdistan showed that high-risk pregnancies more than double the odds of infants\u0026rsquo; death (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Care before, during, and after childbirth can save the lives of women and newborn babies. The global maternal death ratio fell by 44% between 1990 and 2015. The goal of the Sustainable Development Goals (SDGs) is to reduce the global maternal mortality rate to less than 70 deaths per 100,000 live births between 2016 and 2030 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe physical, mental, and social health of young couples is associated with family health and creating a healthy generation. The root of many health problems such as abnormalities and adverse pregnancy outcomes should be sought in the pre-marital and pre-conception period (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRaising women's awareness in the pre-conception stage is among the factors affecting the mother and infant's health as it makes mothers more motivated to participate in prenatal care; the results of studies show that women who received prenatal care began prenatal care earlier (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDue to the importance of pre-conception care, the present study investigating health factors associated with high-risk pregnancy\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis descriptive study was conducted on women who referred to Kerman health centers from 2021 to 2022. Participants included women before the birth of the first live baby who were eligible to participate in the study and met the inclusion criteria.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eage 18\u0026ndash;45 and no pregnancy during the study\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eunwillingness to answer and complete the questionnaire after seeing it.\u003c/p\u003e \u003cp\u003eThe minimum sample was calculated as 330 people. After receiving the ethics code and referring to the health centers of Kerman, a list of women who had never given birth to a live baby was prepared.\u003c/p\u003e\n\u003ch3\u003eSample size and sampling\u003c/h3\u003e\n\u003cp\u003eThe sample size of each health center was determined according to the number of women eligible to participate in the study, among whom we randomly selected the desired number to participate in the study. In the next step, we contacted those participants and explained the research purpose. If they wished to participate, written informed consent was obtained from them. Due to the COVID-19 outbreak, the questionnaires were completed online.\u003c/p\u003e\n\u003ch3\u003eMeasuring tools\u003c/h3\u003e\n\u003cp\u003eThe questionnaires included demographic characteristics, pre-conception care, and general health questionnaires. The demographic part included age, occupation, education, race, religion, place of residence, economic status, kinship relation with the spouse, forced or involuntary marriage, and selected contraception method.\u003c/p\u003e \u003cp\u003eThe pre-conception care questionnaire was derived from pre-conception care items in health care system, which included eight areas of family history, medical history, infections, gynecology and obstetrics history, environmental factors, nutrition, clinical examinations, and laboratory tests.\u003c/p\u003e \u003cp\u003eThe General Health Questionnaire (GHQ), a 28-item questionnaire developed by Goldberg and Hiller (1979), consists of four scales (physical symptoms, anxiety and insomnia, social dysfunction, and severe depression), and each scale has seven questions. It measures the psychological state of a person, with a score above 6 on any scale or a total scale above 22 indicating psychological illness. This questionnaire has been validated in various studies, including the study conducted in Iran, and its reliability has been confirmed by a Cronbach's alpha of 0.90 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAfter completing the questionnaires and collecting the data, the collected information was analyzed using SPSS V21. In this study, descriptive statistical tests were used\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of participants was 33.02\u0026thinsp;\u0026plusmn;\u0026thinsp;10.19 years, and the majority had high-school diplomas (67.2%) and were homemakers (59.4%). Most women (54%) preferred cesarean delivery, and 83.6% of women were unaware of pre-conception care (Table. 1). Regarding family history, 73.8% of participants reported a history of diseases such as cardiovascular problems, diabetes, hypertension, liver problems, thyroid, etc., in at least one of their parents or first-degree relatives. Regarding the participants own medical history, 53.2% reported a current illness they were being treated for, and 33.3% had contracted COVID-19. Regarding infections, 7.8% had a history of blood transfusions, and 6.3% had a sexually transmitted infection. Regarding gynecology and obstetrics history, 38.2% were infertile, 41.8% had a history of abortion, 3.8% had a history of stillbirth, and 1.9% had a history of an abnormal fetus.\u003c/p\u003e \u003cp\u003eMost of the participants did not use any safe contraceptive method. In terms of nutrition, 37.3% were overweight, and 42.1% took supplements such as folic acid and vitamin D. In terms of environmental factors, 22.4% of them were close relatives of their husbands. 68.1% do not exercise and 22.4% suffer from domestic violence (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics and Awareness Rate of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWoman education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma and less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217(65.75%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102(30.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(3.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWoman Job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousekeeper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195(59%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140(48.48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreference for Type of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal Birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130(39.39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCesarean Section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200(60.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAwareness of preconception care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e290(87.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(1.51%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentages of Risk factors in Preconception Women\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnder 18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAbove 35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eFamily history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBirth defects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003emental retardation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eepilepsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.54%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ehearing and visual impairments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.079%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ecardiovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eliver disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ethyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ethrombo-embolic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003eMedical History\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eautoimmune diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ediabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eepilepsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ephenylketonuria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ethyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003easthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ecardiovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ethalassemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ethrombo-embolic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ekidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003edepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ecancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfection\u0026rsquo;s history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSTDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eexposure to blood / blood transfusions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVaccination History\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eComplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eIncomplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnsure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eGynecologic/obstetric history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c3\" namest=\"c2\" rowspan=\"4\"\u003e \u003cp\u003eContraception use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo contraception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithdrawal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBarrier\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHormonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eInfertility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003emenstrual cycle disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ehistory of gynecological surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eEnvironmental history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eConsanguineous marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.53%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003edomestic violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003efinancial status (low income)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eexposure to harmful substances\u003c/p\u003e \u003cp\u003e(at home and at work)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003epets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDental care (checkup within 12 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRest and Sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eLong standing work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eoverwork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSleep less than 8 hours per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo Exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eLittle exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAdequate Exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eNutrition history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eThin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eobese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003euse of supplements (Acid folic, Vit D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003edietary restrictions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ecaffeine consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eVegetarian diet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the general health analysis, it was found that 61.5% had physical symptoms, 48.1% had symptoms of anxiety and insomnia, 7.8% had social dysfunction, and 92.2% had depression. In total, 54.6% had poor general health (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral health and domestic violence status in women before pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDomestic violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(7.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVerbal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(49.09%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(21.81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170(51.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGeneral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102(30.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety symptoms and sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(19.69%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(6.96%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140(42.42%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe pre-conception period is a critical window in which maternal health can profoundly affect individual and intergenerational health. The present study found that while most participants, who were before the first live childbirth, were at risk concerning a healthy pregnancy, they were unaware of pre-conception care. Khan also found in his qualitative study that few women were aware of the need for pre-conception care and appropriate health behaviors during this period (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). A study conducted by Bortolus found that women knew little about pre-conception care; according to midwives, only previous traumatic events in the family have caused willingness to receive PCC in some women (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In order to increase awareness and thus receive pre-conception care, training programs can be planned for girls and boys in schools and couples in pre-marital counseling classes.\u003c/p\u003e \u003cp\u003eAccording to the present study, approximately 11% of women had a family history of a disease. A prospective cohort study found that women with a family history of autoimmune diseases were less likely to have a live-born child and were more likely to have an abortion or stillbirth (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Results showed that 53% of women participating in the study had a current disease, and since diseases can have different effects on maternal and neonatal outcomes during pregnancy, counseling and increased care and treatment before pregnancy can be helpful to reduce consequences. Horn also showed that termination of pregnancy was associated with increased hypertension, type 2 diabetes, and hypercholesterolemia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A cohort study also showed that chronic kidney disease was associated with a higher probability of preeclampsia, preterm birth, and cesarean delivery (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Thyroid disorders result in premature birth, gestational hypertension, fetal mortality, and other severe adverse outcomes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Therefore, it is necessary to screen thyroid function during early pregnancy.\u003c/p\u003e \u003cp\u003eThe findings showed that several women had a history of hyperlipidemia, high waistline, and high BMI, and according to the metabolic syndrome definition, they may fall within the range of this syndrome. A study conducted by Kim et al. (2021) found that pre-pregnancy obesity/central obesity and metabolic syndrome are associated with an increased risk of insulin use in GDM (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). A study conducted by Zhu et al. (2019) also showed that mothers with central obesity in early pregnancy are at increased risk of GDM (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Based on previous studies and the presence of risk factors, it seems necessary to screen women and perform timely interventions. Exercise can be one of the strategies, but unfortunately, most of the women who participated in the study exercised very little, while Wang found in a clinical trial that cycling that initiates early in pregnancy and is performed for at least 30 minutes, three times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women. Moreover, this effect is associated with the finding that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid-second trimester (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIntimate partner violence is an essential public, reproductive, and social health concern. It can significantly predict adverse outcomes for both the mother and her infant. Preterm delivery (PTB) and low birth weight (LBW) are its leading causes. Since 22.4% of the women who participated in the present study were under the coercion of their spouse, psychosocial and supportive interventions can be helpful (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe infertility rate was 38% in the participants, and given this high percentage, mental disorders, such as the stress and anxiety, and depression that accompany infertility, can aggravate infertility or cause treatment failure. Therefore, supportive-educational interventions to reduce mental disorders and promote health are advisable (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA meager percentage of women used contraceptive methods. In the case of unwanted pregnancy, its complications included failure to seek maternity care, low birth weight, preeclampsia, postpartum hemorrhage, preterm labor, and mental disorders such as stress and depression (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Therefore, it seems necessary that such women be trained about the decision to get pregnant and the need to refer to the PCC.\u003c/p\u003e \u003cp\u003eFindings show that a high percentage (22.5%) of women had consanguineous marriages. Studies have shown that consanguineous marriages increase the risk of genetic diseases, heart disease, tuberculosis, sickle-cell anemia, and asthma in infants, and they also increase the risk of abortion and stillbirth. This study's high rate of consanguineous marriage necessitates planning for screenings before and during pregnancy. According to the findings, more than half of the women preferred cesarean delivery if they became pregnant. Studies have shown that cesarean birth may adversely affect children's sensory perception, sensory integration ability, neuropsychiatric development, and the infant-mother relationship (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Also, children born via cesarean section may have an increased risk of developing asthma and obesity, and the risk for abortion, stillbirth, and placental abruption increases in the subsequent pregnancies. It seems that women's desire for a cesarean section can be due to ignorance about the complications of cesarean or previous unpleasant experiences or incorrect information from unreliable sources, which necessitates education and awareness-raising.\u003c/p\u003e \u003cp\u003eAccording to the general health analysis, more than 50% of women had poor general health, primarily associated with anxiety and depression, while previous studies have shown that 10 to 25% of women experienced mild to moderate anxiety or depression during pregnancy (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Studies have shown that depression during pregnancy is associated with preterm labor and low birth weight (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). One study found that children exposed to intrauterine stress had lower levels of development, cognitive skills, and attention at the age of two (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Given the high prevalence of mental disorders in our society and the long-term effects of mental disorders on the health of the mother and especially the child, it seems that pre-conception screening and timely treatment are necessary to prevent adverse effects.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has two limitations. First, due to the COVID-19 outbreak, the questionnaires were completed online, and there was no face-to-face interaction. Second, due to insufficient funding, laboratory tests were not performed, while they could have helped find high-risk cases.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eApproximately half of the participants claimed to have at least one risk factor for high-risk pregnancies. These people urgently need pre-conception care and training on self-care issues, nutrition promotion, physical activity, and psychological interventions. It seems that designing a guideline and making it compulsory in the health care system can help prevent high-risk pregnancies and, ultimately, maternal and neonatal complications and mortality.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMody Mass Index (BMI), Low Birth Weight (LBW), General Health Questionnaire (GHQ), Pre-Conception Care (PCC), Sustainable Development Goals (SDGs), Gestational Diabetes Miletus (GDM)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is the result of a dissertation approved by Kerman University of Medical Sciences with the ethics code IR.KMU.REC.1399.249 and Reg. no (98000163), and adhered to the Declaration of Helsinki and COPE guidelines. Written informed consent was obtained, and participants had the option to withdraw from the study at any time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available under reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors of this study state that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no Funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSH.Z., K.A., M.GH.: Conceptualization, writing \u0026ndash; original draft. F.MP., H.M.: Conceptualization. F.Z., F.I.: Writing \u0026ndash; review \u0026amp; editing. F.SH.: Methodology. SH.SH.: Resources, writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would thank the Deputy of Research of Kerman University of Medical Sciences as well as all the women who participated in this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCunningham F, Leveno K, Bloom S, Spong C, Dashe J, Hoffman B, Casey B, Williams. obstetrics 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzizi A. 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PMID: 34340016.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Preconception, Mortality, Morbidity, High risk pregnancy","lastPublishedDoi":"10.21203/rs.3.rs-6488251/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6488251/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA high-risk pregnancy threatens the health or life of the mother or her fetus. Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy. Preconception care can identify and modify biomedical, behavioral, and social risks to the woman's health or pregnancy outcome through prevention and management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present descriptive study was performed on 330 pre-pregnancy women who were eligible to participate in the study and met the inclusion criteria in 2021. demographic characteristics, pre-conception care, and general health questionnaires were used. Data analysis was performed with SPSS 21 software\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of participants was 33.02 ± 10.19 years, and the majority had high-school diplomas (67.2%) and were homemakers (59.4%). Factors influencing on occurring high-risk pregnancy were examined in six dimensions. 10.29% of participants due to Family history, 4.9% for Medical History,6.5% due to Infection history,11.57% because of Gynecologic/obstetric history, 85.08% to Environmental history, and 19.92% due to Nutrition history were at risk of high-risk pregnancy. 24.99% were also in poor general health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately half of the participants claimed to have at least one risk factor for high-risk pregnancies. Since most people have at least one risk factor for high-risk pregnancies, it seems that screening, education, and timely care before pregnancy can reduce maternal and neonatal mortality and complications.\u003c/p\u003e","manuscriptTitle":"Iranian women Behaviors Associated with Preconception health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 06:04:18","doi":"10.21203/rs.3.rs-6488251/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"817d176e-384b-4638-80c7-ea2f5f6e1b63","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T07:23:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 06:04:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6488251","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6488251","identity":"rs-6488251","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}