A randomised trial of pre-pregnancy advice from health professionals would provide stronger evidence for or against this interpretation. Much of the literature on preconception health and care derives from research during pregnancy that shows the adverse effects of various medical conditions and lifestyle behaviours during pregnancy on birth outcomes e.g. obesity, diabetes. Recent studies that asked women about their pre-pregnancy health behaviour are consistent in showing that women with unintended pregnancies are less likely to take folic acid or other micronutrient supplements before conception and more likely to participate in unhealthy behaviours, such as smoking, being exposed to second-hand smoke, NVP-BEZ235 drinking alcohol, and using illicit drugs in the pre-pregnancy period. In all of the studies, these associations remain after adjustment for the socio-demographic characteristics associated with unintended pregnancy itself. Studies of preconception health are seldom carried out before conception because of the difficulty of identifying women who are planning a pregnancy and likely to become pregnant within a reasonable time frame. The UK Southampton Women Study, which recruited 12,445 non-pregnant women aged, is the only study to have followed women to pregnancy, if it occurred. Of the 238 women who became pregnant within three months of recruitment, 23% had said they were not anticipating this event leaving the remainder who were in some sense planning a pregnancy. Nearly half of the latter group were taking folic acid at recruitment, but only 3.3% were following recommendations for folic acid and alcohol intake. The authors concluded that only a small proportion of women planning a pregnancy follow recommendations for nutrition and lifestyle. Three studies from the USA report similar findings. All three recruited large samples and asked non-pregnant women about their current pregnancy intentions. In their Californian study, Green-Raleigh et al., found that women planning pregnancy in with the next year were less likely to report smoking, more likely to report taking a multivitamin regularly, and more likely to have seen a health professional in the last year than women planning a pregnancy more than one year in the future. However, there was little difference in alcohol consumption. Of the women planning a pregnancy, 8.2% were smokers, 55.3% drinking alcohol, and only 55.3% taking a multivitamin. In their analysis of the US-wide Behavioural Risk Factor Surveillance System, Xaverius et al found that women intending pregnancy were much the same as other non-pregnant women with regards to alcohol use, binge drinking, heavy drinking, and smoking, but much more likely to be taking folic acid . Chuange et al reported very similar findings from a population-based cohort study in Central Pennsylvania. Women intending to become pregnant differed little from other non-pregnant women in terms of their alcohol use, smoking, fruit and vegetable consumption, and physical activity, but were significantly more likely to be taking folic acid.