Abstract: Objective To retrospectively analyze the relationship between risk factors and pregnancy outcomes in pre-pregnancy health examination at six project sites in Hebei Province, so as to provide scientific basis for early intervention of risk factors before pregnancy for couples of childbearing age.Methods The couples who received pre-pregnancy eugenics examination from January 1, 2014 to December 31, 2016 in six counties and cities of Hebei Province were selected as the research objects and the records of on-thespot investigation were recorded in the family files of prenatal health examination, including demographic characteristics, living habits, disease history, medication situation, fertility history, occupation, environmental exposure history, genetic risk factors, physical examination and laboratory examination. Using the method of cohort study, the pregnancy outcome was followed up by telephone, and the related factors were analyzed by chi-square test and Logistic regression analysis.Results There were 8821 pregnant couples, including 7720 cases of normal birth, 231 cases of premature birth, 229 cases of low birth weight, 289 cases of macrosomia, 94 cases of stillbirth, 17 cases of fetal malformation and 241 cases of spontaneous abortion. The total adverse pregnancy rate was 12.5%. The incidence of severe adverse pregnancy outcomes such as stillbirth, spontaneous abortion and fetal malformation induced abortion was 4.0%. Smoking, drinking, physicochemical harmful substances, overweight and obesity were significantly higher in the adverse pregnancy outcome group than in the normal birth group (P<0.05). The adverse pregnancy outcome was related to exposure of multiple risk factors in both men and women.Conclusion Pre-pregnancy examination can help couples who plan to get pregnant to avoid all kinds of risk exposure. It can reduce the incidence of adverse pregnancy, and it is also an important defense line to effectively reduce birth defects. The effect is remarkable.