About 810 women died every day in 2017 from preventable causes related to pregnancy and childbirth. To reduce the risks of maternal and fetal complications during pregnancy, knowledge about preconception care must be increased. Preconception care is closely linked to maternal and infant health. This study aimed to examine the level of knowledge, attitudes, and utilization of preconception care among women in Al Ahsa, Saudi Arabia. A cross- sectional study was conducted between June 27 and September 30, 2021, in three governmental hospitals and three private hospitals from the outpatient department of Al Ahsa, Saudi Arabia. In this study, the participants were recruited using a simple randomization technique. The estimated sample size is 386. Data were collected by using a modified structured questionnaire adapted from similar studies. The questionnaire contains three sections. The validity and reliability of the tool were accomplished. This study was approved by the Institutional Review Board (IRB) of the KFHH, and a letter of informed participation, along with the purposes of the study, was provided with the administered questionnaire. Near to half of the study participants, 166 (43%) had good knowledge, and 186 (48.2%) had fair knowledge on preconception care whereas 34 (8.8%) had poor knowledge on preconception care. Regarding the utilization, most participants 170 (44%) did not receive complete preconception care. The majority of participants (73.6%) said that women don't undertake complete preconception care due to a lack of knowledge. The level of education of participants is strongly correlated with preconception care awareness. The findings concluded that fewer than half of Saudi women in Al Ahsa were aware about preconception care. In general, responders do not use preconception care services due to a lack of knowledge about how these services may affect maternal and neonatal health.