Association Between Maternal Microbiome Knowledge and Birth Preferences: A Survey-Based Study

Background and Aim: Maternal microbiome's influence on pregnancy and newborn health is great. There is low public awareness of this. The aim of the present study was to explore pregnant women's knowledge about the maternal microbiome and their birth choices and medical intervention attitudes in relation to this knowledge. Methods Cross-sectional study was carried out among pregnant women presenting in prenatal clinics in three large Iranian cities, Tehran, Shiraz, and Isfahan, in the period from March to May 2025. After literature review and expert consultation, a structured questionnaire was developed to measure participants' demographic status, knowledge regarding microbiome (20 questions in four domains), and birth preference (12 questions). Validity and reliability of the tool were established by expert panel review and pilot study (CVI = 0.91; Cronbach's α = 0.88). 384 valid responses were obtained using convenience sampling. Descriptive statistics, chi-square tests, t-tests, ANOVA, and logistic regression were used to analyze the data. Results Participants' microbiome knowledge was moderate (M = 24.66, SD = 4.73), with higher scores related to preference for vaginal delivery (p < 0.05) and non-hospital birthplaces. Vaginal delivery preferences (n = 243) scored slightly higher on microbiome knowledge than cesarean section preferences (n = 141). Microbiome knowledge was negatively correlated with attitudes towards medical intervention (r=–0.28, p < 0.01). Logistic regression found microbiome data (OR = 1.08, p = 0.021), greater education (OR = 1.32, p = 0.037), and internet use as an information source (OR = 1.51, p = 0.038) to be independent predictors of vaginal birth preference. ANOVA determined significant differences in score by educational level (p < 0.01). Conclusions Pregnant individuals who are more knowledgeable about the maternal microbiome will be more likely to endorse less interventional and more natural birth practices. Strategic educational interventions, particularly through online media, have the potential to bridge knowledge gaps and ensure informed birth choices.