Concluded that there was little evidence that women intending to be pregnant were more likely to engage in positive health behaviours. The high level of pregnancy planning in our study is in keeping with other data from the UK when LMUP scores are compared across similar age groups. Use of the LMUP in a number of high throughput screening inhibitor studies shows that around two thirds of pregnancies leading to births in the UK are planned ; therefore a majority of women who give birth are in a position to benefit from the direct targeting of pre-pregnancy care. Other studies have reported low awareness among women or reproductive age about folic acid and the conditions that it can prevent Our study indicates that engagement between women and health professionals about preconception health and care is often lacking leading to multiple missed opportunities to improve maternal and child health. There is specific guidance for professionals on pre-pregnancy care relating to conditions such as diabetes, epilepsy and obesity,but more general guidance on pre-pregnancy health and care does not seem to be reaching the right settings. Guidelines alone are not sufficient to change professional behaviour. Preconception health does not fall neatly within a particular medical specialty and despite guidance there is no standardised provision of care in the UK which may explain why responsibility for providing preconception care appears confused and delivery patchy. Another reason may be the lack of studies showing clear benefits of interventions starting before pregnancy on birth outcomes, or how to implement such interventions effectively. Such studies are challenging as they need to identify women before conception. A recent study of barriers to the implementation of preconception care by general practitioners in Australia concluded that lack of time was the biggest barrier. Other barriers were similar to those reported here including women not presenting at the preconception stage, competing preventive care issues, the cost associated with extending consultations to include preconception care and the lack of appropriate resources. Perceived facilitators to delivery of care included checklists, patient leaflets, waiting room posters and the availability of preconception care consultations. Awareness of preconception health issues, pregnancy planning and uptake of interventions before pregnancy care are related but distinct issues. All three are required to improve preconception health and pregnancy outcomes. In our study, women who received health professional input did not have greater educational attainment than women with no health professional input; they were more likely to have a relevant medical condition, and more likely to adopt positive behaviour changes. Together these findings suggest that focusing on pre-pregnancy intervention by health professionals would not merely benefit the women with specific medical disorders, but could be an effective approach to addressing important health inequalities relating to smoking, alcohol and other risk behaviours.