Effect of pre-pregnancy eugenics health examination and education on knowledge-belief-behavior, anxiety, risk-averse behavior childbearing-age women

Abstract

BACKGROUND

Pre-pregnancy eugenic health examination is a key measure for reducing the incidence of congenital malformations in newborns. However, pre-pregnancy adverse factors cannot be fully reduced or eliminated through examination alone. Therefore, it is particularly important to integrate education on reproductive health, eugenics, and pre-pregnancy care into pre-pregnancy health examinations.

AIM

To explore the effects of pre-pregnancy eugenic health examination and education on knowledge, attitude, and behavior, as well as anxiety and risk-aversion behavior in women of childbearing age.

METHODS

This retrospective study included women of childbearing age who received pre-pregnancy eugenic health examinations at Huzhou Maternity and Child Health Care Hospital as the research subjects. A total of 100 women of childbearing age who received pre-pregnancy eugenic health examination and education from January to December 2024 were assigned to the observation group. Using 1:1 baseline matching, 100 women of childbearing age who received “free pre pregnancy eugenics health check ups” from January to December 2023 were selected as the control group. Scores of the Eugenics Health Knowledge-Belief-Behavior questionnaire, Hamilton Anxiety Scale (HAMA), and Health Promoting Lifestyle Profile-II (HPLP-II) were compared between groups before intervention (pre-pregnancy) and after intervention (early pregnancy). The incidence of adverse pregnancy outcomes and neonatal defects was also compared.

RESULTS

Before intervention, there were no statistically significant differences between the two groups in knowledge-belief-behavior, HAMA, or HPLP-II scores (P > 0.05). After intervention, the observation group showed higher knowledge-belief-behavior scores, lower HAMA scores, and higher HPLP-II scores compared with the control group (P < 0.05). The incidence of adverse pregnancy outcomes (premature birth, low birth weight, and macrosomia) and neonatal birth defects was significantly lower in the observation group than in the control group (P < 0.05).

CONCLUSION

Pre-pregnancy eugenic health examination and education improves knowledge-belief-behavior, alleviates anxiety, and improve risk-aversion behavior in women of childbearing age, thereby contributing to improved pregnancy outcomes and reduced neonatal birth defects.

Key Words: Pre-pregnancy eugenic health examination; Health education; Knowledge-belief-behavior; Anxiety; Risk-aversion behavior

Core Tip: Pre-pregnancy eugenic health examination alone may be insufficient to reduce psychology burden or birth defects in women of childbearing age. Therefore, integrating targeted health education enhances knowledge-belief-behavior, promotes risk-aversion behaviors, reduces anxiety, and contributes to improved pregnancy outcomes and reduced neonatal birth defects.

INTRODUCTION

Birth defects refer to structural, functional, or metabolic abnormalities present at birth, arising from complex genetic and environmental factors such as chromosomal abnormalities and gene mutations. These defects can result in congenital malformations, metabolic disorders, and functional impairments (e.g., blindness, deafness, and intellectual disabilities), imposing significant burdens on families and society and affecting parental mental health and parent-child relationships[1]. Therefore, promoting pre-pregnancy education and exams for women of childbearing age is key to reducing birth defects, easing societal burdens, and improving reproductive outcomes[2].

The United States Centers for Disease Control and Prevention stresses improving preconception health knowledge, attitudes, and behaviors among women of childbearing age[3]. Knowledge-belief-behavior is a process: Gain knowledge, form beliefs, strengthen behavior, and turn them into health actions. Knowledge is the foundation, belief provides motivation, and behavior shows action. However, many women of childbearing age often experience anxiety related to pregnancy safety and potential complications. Anxiety is a psychological disorder characterized by excessive worry, tension, unease, and fear, may increase uterine contractions, impair uterine blood flow, disrupt nutrient intake and hormonal regulation, and elevate the risks of miscarriage, preterm birth, fetal malformations and birth defects[4]. Therefore, without effective emotional management before pregnancy, these challenges may hinder the adoption of positive health behaviors. Pre-pregnancy eugenic health examination and education involves assessing physiological, psychological, and behavioral risk factors and implementing preventive and intervention measures to promote health. This approach may enhance knowledge of pregnancy and childbirth, alleviate anxiety[5], and facilitate early prevention of pregnancy-related diseases. Therefore, this study aimed to evaluate the effects of pre-pregnancy health examination and education on knowledge-belief-behavior, anxiety, and risk-aversion behavior in women of childbearing age, and to clarify its value in promoting healthy pregnancy outcomes.

MATERIALS AND METHODS

Research subjects

This retrospective study included women of childbearing age who underwent pre-pregnancy eugenic health examination at Huzhou Maternity and Child Health Care Hospital as the research subjects. The hospital initiated the “pre-pregnancy health check and education for women of childbearing age” program in January 2024. Accordingly, 100 women of childbearing age who received “pre pregnancy eugenics health examination and education” between January and December 2024 were assigned to the observation group. Using 1:1 baseline matching, 100 women who received only “free pre pregnancy eugenics health check ups” between January and December 2023 were selected as the control group.

The inclusion criteria were as follows: (1) Age ≥ 18 years and married; (2) First-time pregnancy preparation; (3) Intention to conceive in the near future; (4) First-time receipt of genetic counseling for eugenics; (5) Normal communication and comprehension abilities; (6) Provision of informed consent and voluntary participation; and (7) Willingness to cooperate with follow-up visits.

The exclusion criteria were as follows: (1) Liver or kidney disease; (2) Cardiovascular or pulmonary disease; (3) Malignant tumors; and (4) Infectious or genetic diseases.

Intervention methods

The control group received “free pre-pregnancy health check-ups” along with health education brochures. Four months before planned conception, participants underwent the following assessments: (1) Medical history inquiry, health guidance and consultation, routine physical examination (spine, limbs, and abdomen), and reproductive system examination; (2) Laboratory tests, including routine blood tests, blood typing, blood glucose, urinalysis (protein, glucose, and leukocytes), vaginal secretion tests (routine leucorrhea, Chlamydia trachomatis, Neisseria gonorrhoeae), hepatitis B serology (five items), and liver, kidney, and thyroid function tests; (3) Viral antibody screening for Treponema pallidum, Toxoplasma immunoglobulins, cytomegalovirus, and rubella virus; (4) Routine gynecological ultrasound; and (5) Human immunodeficiency virus screening. After examination, participants received a health manual for self-study.

The observation group received the same examinations plus structured pre-pregnancy health education, including: (1) Establishment of health records documenting medical history, allergies, genetic background, medication use, lifestyle, and dietary habits; (2) A dedicated consultation service providing individualized counseling based on physiological and psychological status; (3) Organized education sessions for women of childbearing age and their spouses covering pre-pregnancy eugenics, reproductive health, examination necessity, precautions before and during pregnancy, and prevention of adverse pregnancy outcomes and birth defects, delivered through manuals and video materials; (4) Specialized health guidance via a WeChat group managed by an experienced health educator, including psychological counseling and recommendations such as appropriate aerobic exercise and listening to soothing music; and (5) Lifestyle and dietary guidance, including prompt medical consultation for symptoms, adherence to prescribed medication, standardized supplementation (folic acid, nutrients, and trace elements), appropriate exercise, balanced diet, and cessation of smoking and alcohol use during pre-pregnancy.

Observation indicators

Knowledge-belief-behavior: Knowledge-belief-behavior was assessed before (pre-pregnancy) and after (early pregnancy) intervention using a questionnaire. It had 15 knowledge questions, 6 attitude questions, 6 behavior questions. Each correct answer scored 1 point, incorrect 0. Total scores ranged from 0 to 27; higher scores mean better levels.

Anxiety emotions: This was evaluated before and after intervention using the Hamilton Anxiety Scale (HAMA), consisting of 14 items scored on a 0-4 Likert scale. The total score range was 0-56, with higher scores indicating greater severity[6].

Risk-aversion behavior: This was assessed before and after intervention using the Health Promoting Lifestyle Profile-II (HPLP-II), mainly include: Interpersonal relationships (9 items), nutrition (9 items), physical exercise (8 items), health responsibility (9 items), stress management (8 items), mental growth (9 items). Items are scored on a Likert scale (1-4 points), with a total score range of 39-208 points; higher scores indicate stronger health-promoting and risk-aversion behaviors[7].

Adverse pregnancy outcomes and neonatal birth defects: Outcomes of adverse pregnancy included preterm birth (< 37 weeks of gestation), low birth weight (< 2500 g), macrosomia (≥ 4000 g). Neonatal birth defects included structural or metabolic abnormalities occurring in the mother’s uterus before birth, such as congenital heart disease, polydactyly, and cleft lip and palate.

Statistical analysis

Data were analyzed using SPSS 25.0. Categorical data are expressed as n (%) and compared using the χ² test. Normally distributed continuous data are expressed as mean ± SD and compared using Student’s t-test. A P value < 0.05 was considered statistically significant.

RESULTS

Comparison of baseline data between the two groups

The two groups showed no statistically significant differences in age, pre-pregnancy body mass index, nationality, education level, place of residence, family monthly income, abnormal pre-pregnancy examination findings, or working status in early pregnancy (P > 0.05; Table 1).

Table 1 Comparison of baseline data between two groups, mean ± SD/n (%).

Baseline data	Control group (n = 100)	Observation group (n = 100)	t/χ2 value	P value
Age (years)	26.85 ± 1.65	26.94 ± 1.72	0.378	0.706
Pre-pregnancy body mass index (kg/m2)	22.17 ± 2.19	22.31 ± 2.28	0.443	0.658
Ethnicity			0.177	0.675
Han Chinese	86 (86.00)	88 (88.00)
Ethnic minority	14 (14.00)	12 (12.00)
Educational level			0.126	0.939
Junior high school and below	21 (21.00)	23 (23.00)
Technical secondary school/high school	60 (60.00)	59 (59.00)
College degree or above	19 (19.00)	18 (18.00)
Place of residence			0.212	0.645
Town/city	68 (68.00)	71 (71.00)
Rural area	32 (32.00)	29 (29.00)
Monthly family income (Chinese yuan)			0.977	0.614
< 5000	25 (25.00)	24 (24.00)
5000-8000	68 (68.00)	65 (65.00)
> 8000	7 (7.00)	11 (11.00)
Abnormalities found during pre-pregnancy examination			0.907	0.341
Yes	14 (14.00)	19 (19.00)
No	86 (86.00)	81 (81.00)
Early pregnancy work status			2.734	0.255
Resting at home	23 (23.00)	21 (21.00)
Work reduction	44 (44.00)	55 (55.00)
Normal operation	33 (33.00)	24 (24.00)

Comparison of the knowledge-belief-behavior scores for prenatal health care between the two groups

Before intervention, there were no significant differences between the two groups in prenatal health care knowledge, attitude, behavior, or total scores (P > 0.05). After intervention, the observation group demonstrated higher scores across all domains and in the total score than the control group (P < 0.05; Table 2).

Table 2 Comparison of the scores for knowledge-belief-behavior prenatal health care between the two groups (points, mean ± SD).

Knowledge-belief-behavior scale	Phase	Control group (n = 100)	Observation group (n = 100)	t value	P value
Health knowledge rating (points)	Before the intervention	6.32 ± 0.74	6.18 ± 0.85	1.242	0.216
	After the intervention	9.85 ± 1.21a	11.25 ± 1.36a	7.691	< 0.001
Health attitude rating (points)	Before the intervention	3.15 ± 0.32	3.20 ± 0.37	1.022	0.308
	After the intervention	4.21 ± 0.36a	4.95 ± 0.44a	13.020	< 0.001
Healthcare behavior rating (points)	Before the intervention	2.98 ± 0.27	2.93 ± 0.24	1.384	0.168
	After the intervention	3.67 ± 0.43a	4.25 ± 0.53a	8.498	< 0.001
Total rating (points)	Before the intervention	12.42 ± 0.90	12.33 ± 0.93	0.695	0.488
	After the intervention	17.66 ± 1.35a	20.49 ± 1.51a	13.970	< 0.001

^aP < 0.05.

P calculated compared with before intervention in the same group.

Comparison of anxiety scores between the two groups

Before intervention, the HAMA scores did not differ significantly between the two groups (P > 0.05). After intervention, the HAMA scores increased in both groups; however, the increase was smaller in the observation group than in the control group (P < 0.05; Table 3).

Table 3 Comparison of anxiety scores between two groups (points, mean ± SD).

HAMA scale	Phase	Control group (n = 100)	Observation group (n = 100)	t value	P value
HAMA rating (points)	Before the intervention	13.42 ± 1.48	13.58 ± 1.69	0.712	0.477
	After the intervention	15.54 ± 2.95a	14.03 ± 2.05b	4.203	< 0.001

^aP < 0.05.

^bP > 0.05.

P calculated compared with before intervention in the same group. HAMA: Hamilton Anxiety Scale.

Comparison of risk-aversion behavior between the two groups

Before intervention, no significant difference were observed in any of the dimensions or total score of risk-aversion behavior between the two groups (P > 0.05). After intervention, the observation group showed higher scores across all dimensions and in the total score than in the control group (P < 0.05; Table 4).

Table 4 Comparison of risk avoidance behavior abilities between two groups (points, mean ± SD).

HPLP-II scale	Phase	Control group (n = 100)	Observation group (n = 100)	t value	P value
Interpersonal relationships rating (points)	Before the intervention	17.06 ± 2.31	17.15 ± 2.34	0.274	0.785
	After the intervention	18.42 ± 2.45a	20.18 ± 2.66a	4.867	< 0.001
Nutrition rating (points)	Before the intervention	14.46 ± 1.28	14.37 ± 1.18	0.517	0.606
	After the intervention	18.54 ± 1.77a	21.48 ± 1.96a	11.130	< 0.001
Health responsibility rating (points)	Before the intervention	15.67 ± 0.98	15.56 ± 0.85	0.848	0.397
	After the intervention	19.40 ± 1.35a	22.71 ± 1.48a	16.520	< 0.001
Sports activities rating (points)	Before the intervention	13.87 ± 1.19	13.85 ± 1.21	0.118	0.906
	After the intervention	17.45 ± 1.72a	19.23 ± 1.86a	7.026	< 0.001
Stress management rating (points)	Before the intervention	14.92 ± 1.18	14.87 ± 1.04	0.318	0.751
	After the intervention	16.83 ± 1.59a	19.25 ± 1.58a	10.801	< 0.001
Spiritual growth rating (points)	Before the intervention	14.76 ± 0.97	14.68 ± 0.93	0.595	0.552
	After the intervention	17.54 ± 1.26a	20.56 ± 1.79a	13.801	< 0.001
Total rating (points)	Before the intervention	90.79 ± 3.33	90.31 ± 3.35	1.016	0.311
	After the intervention	108.18 ± 4.42a	123.41 ± 4.31a	24.670	< 0.001

^aP < 0.05.

P calculated compared with before intervention in the same group.

Comparison of adverse pregnancy outcomes and neonatal birth defects between the two groups

In the control group, there were four cases of preterm birth, four cases of low birth weight, two cases of macrosomia, and four cases of neonatal birth defects. In the observation group, there was one case of preterm birth and one case of low birth weight. The total incidence of adverse pregnancy outcomes (preterm birth, low birth weight, and macrosomia) and neonatal birth defects was significantly lower in the observation group than in the control group (P < 0.05; Table 5).

Table 5 Comparison of adverse pregnancy outcomes and incidence of neonatal birth defects between two groups, n (%).

Group	n	Adverse pregnancy outcomes				Birth defects in newborns
		Premature birth	Low birth weight infants	Macrosomia	Overall incidence rate
Control group	100	4 (4.00)	4 (4.00)	2 (2.00)	10 (10.00)	4 (4.00)
Observation group	100	1 (1.00)	1 (1.00)	0 (0.00)	2 (2.00)	0 (0.00)
χ2 value					5.674	4.082
P value					0.017	0.043

DISCUSSION

Women of childbearing age, particularly during critical career development stages, are susceptible to compromised preconception health due to work-family conflict, life pressures, and psychological stress. However, many of such women lack relevant awareness of pre-pregnancy health and only begin to focus on maternal and fetal health after pregnancy is confirmed. Therefore, relying solely on routine prenatal care has limited effectiveness in preventing adverse pregnancy outcomes[8,9]. Studies have shown that pre-pregnancy health education can reduce or eliminate risk factors before pregnancy, lower the incidence of pregnancy complications, reduce the occurrence of high-risk pregnancies, improve pregnancy outcomes, and shift the prevention of birth defects to an earlier stage[10,11]. Therefore, implementing planned pre-pregnancy education during eugenic health examinations is essential.

Pre-pregnancy eugenic health examinations include physical, laboratory, and imaging examinations. The examinations facilitate the identification of high-risk factors and provide routine guidance or diagnosis, thereby reducing the risk of neonatal birth defects to a certain extent[12]. However, without targeted pre-pregnancy health education, exams and routine guidance alone often fail to achieve optimal outcomes. They rarely turn women from passive examinees into active health self-managers, thus limiting the effectiveness of eugenic health care strategies[13]. Teshome et al[14] stressed the need for pre-pregnancy counseling platforms to strengthen health education and support. In this study, after intervention, the observation group had higher knowledge-belief-behavior scores and a smaller increase in HAMA scores during early pregnancy than the control group. This shows that adding structured pre-pregnancy health education to routine exams improves health-related knowledge and behaviors while reducing anxiety caused by early pregnancy changes (e.g., hormone fluctuations, nausea, vomiting, and fatigue)[15]. The observed effects may be due to several factors. A dedicated pre-pregnancy education platform allowed comprehensive assessment of patients’ physical, living, and psychological conditions, enabling personalized education. Content covered pre-pregnancy and pregnancy precautions, risks of infectious and genetic diseases, and prevention of birth defects. Also, using digital tools like WeChat allowed timely, targeted guidance, improving knowledge transfer and behavior change[16,17]. Psychological counseling for women with poor mental health helped relieve negative emotions, promote healthy behaviors, and reduce anxiety. In contrast, relying only on traditional pre-pregnancy exams and brochures without professional support may increase anxiety and uncertainty[18], weakening the cognitive and executive skills needed for effective health behavior planning.

Pre-pregnancy health behaviors are vital for maternal and infant health[19]. Stephenson et al[20] noted that proper nutrition and a healthy lifestyle before pregnancy benefit both mother and child. In this study, the observation group had higher HPLP-II scores (indicating better risk-aversion) after intervention than the control group. This improvement likely came from adding structured “pre-pregnancy health education”, which advised women to seek timely medical care for discomfort, avoid inappropriate medication, take folic acid and nutrients as recommended, and maintain a balanced diet without overeating[21]. These measures help shift from risk awareness to risk management. Thus, the observation group showed a clear advantage in planning and sustaining risk-aversion behaviors related to health responsibility, stress management, and nutrition. In contrast, routine pre-pregnancy exams and brochures alone often fail to turn general knowledge into personalized skills or boost motivation for behavioral change, especially self-efficacy. Thus, improving risk-aversion behaviors requires empowerment-based strategies centered on structured health education. Pre-pregnancy and early pregnancy are the most cost-effective window for preventing birth defects and adverse pregnancy outcomes[22]. Higher risk-aversion capacity in women of childbearing age leads to better pregnancy outcomes and fewer neonatal birth defects. In this study, the observation group had lower rates of adverse outcomes (preterm birth, low birth weight, macrosomia) and neonatal birth defects than the control group. These findings show that adding health education to pre-pregnancy exams influences knowledge, attitudes, behaviors, reduces anxiety, and promotes risk-aversion leading to better pregnancy outcomes and fewer birth defects. This is likely due to stronger health responsibility, better nutrition, and proactive planning, ultimately contributing to reduced adverse pregnancy outcomes. These results support including structured health education in pre-pregnancy exams.

This study has several limitations: (1) This study adopts a retrospective, non-randomized historical control design, which introduces inevitably leads to inherent selection bias and time temporal period biases. For example, the annual changes in the public health information environment, policy implementation intensity, and overall general health awareness after following the corona virus disease 2019 pandemic may also act become as important confounding factors that affecting cannot the be outcome fully of controlled women of childbearing age. In consequently, the current retrospective design, these confounding factors related to time periods cannot be completely excluded or quantitatively controlled. Therefore, the universality generalizability and robustness of the conclusion findings are limited; (2) The work status is closely related associated to with psychological stress, physical load workload, and healthy behaviors choices, which may indirectly affect the intervention compliance and intervention effectiveness in women of childbearing age. The additionally, differences in pre-pregnancy abnormal detection rates may lead reflect to subtle inconsistencies in baseline health status in consistencies between cohorts, and potentially the introducing subtle baseline differences may have potential clinical confounding effects. Therefore, in future research studies, relevant factors should be strictly balanced to these reduce variables confounding interference; (3) Due to the small sample size limits the stability of findings; notably, the 0% incidence rate of birth defects in the observation group is not stable. Generally, given the typical baseline birth defect rates is of 1%-3%. This and zero rate result may be reflect due to sampling bias or missed detections. Therefore, larger future studies will further required expand to the validate sample these size results to support this; and (4) Post-intervention evaluation assessment was only conducted only in early pregnancy, which may limit not the comprehensively assessment of the intervention long-term effectiveness sustainability. Especially of changes in health knowledge cognition, health attitudes, and health-related behaviors often require longer periods of adaptation and consolidation to achieve stable outcomes. In addition, there although was difference statistically significant difference in HAMA scores between the two groups was statistically significant, but the absolute difference was only (1.5 points) indicating relatively limited clinical differences relevance. Overreliance on statistically significant results may overestimate the actual improvement in anxiety among women of childbearing age. Therefore, future research should include multi-stage, long-term follow-up to better evaluate lasting intervention effects.

CONCLUSION

Pre-pregnancy prenatal health check-ups examinations and education can enhance the knowledge, attitude, and practice behavior of among women of childbearing age, alleviated the trend increase in increasing anxiety, also and encourage promote them to adopt risk-avoiding aversion behaviors. Pre-pregnancy exams and education improve knowledge, attitude, and behavior in women of childbearing age, reduce anxiety, and promote risk-aversion behaviors. The changes are associated with improved pregnancy outcomes and reduced neonatal birth defects, supporting the value of integrating health examinations and education into pre-pregnancy care.