Objective To investigate the current status of and factors associated with preconception health examination among females of early pregnancy in a district of Shanghai, so as to increase the participation rate and provide suggestions and evidences for improving preconception care.

Methods An equal proportional sampling method was used to recruited 808 females who registered for early pregnancy in 2022 from 13 communities in a district as study subjects. A retrospective questionnaire survey was conducted to investigate their participation in preconception health examinations.

Results The self-reported preconception health examination rate for females of early pregnancy registration in a district of Shanghai was 34.90%, of which 26.48% were self-paid and 8.42% were free. Cognitive bias in preconception examination (39.35%) and unplanned pregnancy (37.07%) were primary reasons for not participating preconception examination. Multivariate analysis showed that among demographic characteristics, females with older age ( > 35 years) (OR = 2.097, 95% CI: 1.080 − 4.072), planned pregnancies (OR = 12.894, 95% CI: 6.801 − 24.448), and first-time pregnancies (OR =3.080, 95% CI: 1.846 − 5.137) had higher rates of preconception health examinations. In terms of pre-pregnancy preparation, women who had overall understanding of the National Free Preconception Health Examination Project (OR = 1.893, 95% CI: 1.138 − 3.148), who were familiar (OR = 2.152, 95% CI: 1.254 − 3.693) or highly familiar (OR = 2.886, 95% CI: 1.261 − 6.606) with preconception care, and who were familiar (OR = 2.840, 95% CI: 1.201 − 6.714) or highly familiar (OR = 3.022, 95% CI: 1.113 − 8.209) with folic acid also had higher rates of preconception examination. With regard to attitudes, women who agreed (OR = 10.521, 95% CI: 4.433 − 24.973) or strongly agreed (OR = 16.086, 95% CI: 6.908 − 37.460) with the perception that “Couples should have preconception examination before planning a pregnancy”, and who disagreed with the perception that “Preconception examination is not necessary if you attend routine health check every year” (OR = 3.980, 95% CI: 1.721 − 9.208) had higher participation rates.

Conclusion The rate of preconception health examination among females of reproductive age in a district of Shanghai needs to be improved. It is necessary to strengthen in-depth advocacy of the National Free Preconception Health Examination Project and preconception care, improve understanding of planned pregnancy and preconception care, and emphasize the difference between preconception health examination and regular health check, which might be helpful to increase the participation rate of preconception health examination and ensure the implementation of preconception care services.