Introduction 1 2 9 10 11 12 11 13 15 16 Methods A survey study of consecutive patients presenting to primary care practices for an annual well-woman exam was performed in accord with prevailing ethical principles. The selected primary care practices, occupying the same building at the Mayo Clinic Arizona, represented a women’s health general internal medicine practice (5 physicians) and a family medicine practice (9 faculty physicians and 18 family medicine residents). Women were recruited for the study by nursing staff working within the practices, with permission and informed consent completed prior to distributing the survey tool. The Mayo Clinic IRB approved the study. Patients were recruited based on appointment type (e.g., well woman exam, annual Pap exam, and annual preventive medicine exam) and consenting to complete the survey questionnaire at the time of their appointment, but prior to being seen by the physician. The enrollment period was between August 2004 and July 2005. Women were considered eligible for the study if they were between the ages of 18 and 45 years, understood English, and gave their permission. The survey instrument was a four-page questionnaire and required approximately 10 minutes to complete. The survey included questions about demographics, pregnancy intendedness, knowledge and attitudes about preconception care, and personal preferences about sources of health information about preconception care. Data from each survey was entered into a database at the Research Survey Center, Mayo Clinic, Rochester, Minnesota, and the aggregate data made available for analysis to the research team. Results 1 2 2 1 Table 1 n Age   Range: 18 to 45 years    18 to 25 years 24%   26 to 35 years 30%   36 to 45 years 46%  Mean: 33 years  Ethnicity   White 84.8%  Asian 3.6%  African-American 1.3%  Native American 1.4%  Other 9.0% Education (highest level)   11th grade or less 0.4%  Graduated High School 7.5%  Some college or technical school 33.0%  Graduated college 38.5%  Some graduate work 6.7%  Graduate degree 14.0% Household income   Less than $25,000 10.5%  $26,000 to $50,000 19.7%  $51,000 to $75,000 18.6%  $76,000 to $99,000 13.0%  $100,000 to $125,000 13.2%  $126,000 to $150,000 6.8%  $151,000 to $200,000 6.4%  Greater than $200,000 11.8% Table 2 Conception history and planning Plans about getting pregnant   No plans at present time 70.6%  Currently trying 4.6%  Considering in next 1 to 2 years 13.5%  Considering in next 3 to 5 years 8.4%  Have tried, unable to get pregnant 2.8% Ever been pregnant?   Yes 50.7%  No 49.3% If ever pregnant, where previous pregnancies planned?   Yes 47.2%  No 52.8% Affect of optimizing health of mother and pregnancy?   Has a good effect on the pregnancy 98.6%  Has no effect on the pregnancy 0.8%  Has a bad effect on the pregnancy 0.6% Doctor ever spoken to you about preconception health?   Yes 39.0%  No 61.0% Are you interested in receiving preconception health education?   Very interested 34.8%  Somewhat interested 21.6%  Unsure 10.1%  Not at all interested 33.5% If interested or unsure about education, when would you prefer?  ` At the time I become pregnant 7.6%  Before I try to get pregnant 74.8%  During pregnancy 0.7%  Every time I get an annual medical exam 11.9%  Unsure 5.0% Fig. 1 Are you interested in preconception health education?  3 1 4 Discussion Table 3 Patient preferences for sources of preconception information (Percentage ranking the choice as first preference) Primary care physician 51.3% Obstetrician/gynecologist 44.0% Family, friends 0.3% Magazine, newspaper 0.3% Internet/world wide web 3.1% Other 0.7% 2 9 Table 4 a Consumption of certain fish 54.2% Exposure to cat liter 64.9% Folic acid use 79.6% Impact of family and/or genetic history 84.1% Infectious diseases (need to screen for) 89.3% Immunizations (up to date) 91.2% Alcohol use 95.8% Abuse (verbal, sexual and/or physical) 97.2% Medication use (prescription and nonprescription) 97.4% Tobacco use 98.2% Illicit drug use 98.8% a One of the limitations of our study was the homogeneity of our patient population. The majority of our study participants were middle class, Caucasian and had at least some college education. Our findings may not be broadly applicable to women of other socioeconomic backgrounds, ethnicity and educational levels. The lack of diversity of our population reflects the demographics of this community and further study in other populations should be pursued. Recommendations for Improving Preconception Health and Health Care 17