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Preconception or pre-pregnancy care is one of the approaches for health promotion and preventive medicine. It covers the aspects of biomedical, behavioral, and social health interventions aiming at improving health and reducing behavioral, individual, and environmental factors that could lead to adverse maternal and child health outcomes (1). Among the advantages of prepregnancy care include the fewer incidence of congenital malformation, stillbirth, and neonatal death in diabetic women, as well as reductions in the incidence of preterm birth, low birth weight, and maternal and neonatal complications among pregnant women in general (2,3). This initiative has been shown to be successful regardless of the income status of the countries (1). Malaysia has also adapted this initiative since 2002 (4). Women in their reproductive age should receive prepregnancy care before the occurrence of conception. Considering medical problems or risk factors, these women should receive the required care in order to optimize their health conditions at least three months before conception (5). A local study among women screened in pre-pregnancy clinics reported that almost 70% of them were having at least one risk factor, among whom 35% were overweight and obese and 14% of cases had anaemia (6). Thus, pre-pregnancy care is essential for improving pre-pregnancy health status while reducing the risk factors, leading to more favorable maternal and child health outcomes. Although pre-pregnancy care has been proven as a successful intervention, information on its utilization and knowledge on pre-pregnancy care is inadequate (7). In Malaysia, many women attending pre-pregnancy clinics expressed their initial unawareness of the services and pointed to some neglected areas (8). Thus, it is important to determine its utilization and the level of knowledge and awareness among women in order to improve the service. Accordingly, this study aimed to determine the utilization of pre-pregnancy care services and their associated factors among women with high-risk pregnancy in the northern part of Peninsular Malaysia. Abstract Objectives: This study aimed to determine the utilization of pre-pregnancy care services and their associated factors among women with high-risk pregnancy in the northern part of Peninsular Malaysia. Materials and Methods: This cross-sectional study commenced in 2017 among women diagnosed as high-risk pregnancy in governmental health clinics in the state of Perak, Malaysia. Stratified random sampling was applied and interviewer-guided questionnaires were administered in this regard. A proforma and the validated Pre-pregnancy Care Knowledge and Practice Questionnaire were used, consisting 21 items on knowledge and 16 items on practice. The utilization of pre-pregnancy care services was defined if someone had attended the service at least once prior to the current pregnancy. Finally, logistic regression analysis was conducted using SPSS software. Results: Of 490 women with high-risk pregnancies, 23.9% (n=117) utilized pre-pregnancy care services. Only one-third of them were aware of the offered services (33.1%), received advice to seek these services (30.4%), and were referred to the services (27.3%). There were four significant associated factors for the utilization of pre-pregnancy care services, including maternal age (P = 0.016), planned pregnancy (P < 0.001), family planning practice (P < 0.001), and pre-pregnancy care knowledge (P = 0.030). Conclusions: The utilization of pre-pregnancy care services among women with high-risk pregnancy in this study was low. An increase in maternal age, a planned pregnancy, history of practicing family planning, and women with good pre-pregnancy care knowledge were more likely to utilize pre-pregnancy care services.

Utilization of Pre-pregnancy Care Services Among Women With High-Risk Pregnancy in the Northern Part of Peninsular Malaysia