Background: Preconception care refers to specific actions taken by an individual or couple to improve their health before becoming pregnant. Preconception care (PCC) is considered primary prevention for the future baby and secondary prevention for prospective mothers. Preconception care utilization in Nepal was very low. Studies on these issues are a newer concept in Nepal and also in Pokhara Metropolitan. Objectives: To assess the utilization of preconception care and associated factors among reproductive-age group women in Pokhara Metropolitan. Methods: A community-based cross-sectional study design was conducted from January 2024 to September 2024. The total study participants were 384 reproductive-age women. Data were collected by using pre-tested interviewer-administered questionnaires and entered into Epi-data version 3.1 then exported to the Statistical Package for Social Sciences (SPSS) and analyzed in IBM SPSS version 22 software. Descriptive analysis was done showing the frequency and percentage and bivariate analysis was done through a chi-square test and multivariate analysis was done through binary logistic regression to find out the factors associated with the utilization of preconception care. Finally, Statistical significance between dependent and independent variables was assessed by odds ratios and 95% confidence intervals. Results Only 0.3% of participants utilize all preconception care components before their last pregnancy. The acceptance level of utilization of the PCC component was 44.5%. The commonest item received by the participants was taking a healthy diet (49.2%), checking weight (43.8%), and blood group screening (53.4%). Age of the respondent AOR=13.89; CI (2.49-77.33), religion AOR=3.1;CI(1.43-6.95), occupations of respondents AOR=2.58; CI(1.67-3.99), knowledge of PCC AOR=5.12; CI(2.99-8.77), attitude towards PCC AOR=1.92; CI(1.18-3.12), heard about PCC AOR=3.15; CI(1.77-5.59) minutes to reach health facilities AOR=2.4; CI (1.32-4.35) health insurance use before pregnancy AOR=2.68 ;CI(1.71-4.19), and waiting time at health facilities AOR=1.60;CI(1.02-2.50) were identified as a factors associated with utilization of PCC. Conclusion: The utilization of preconception care among the respondents was low. Respondents' age, religion, occupation, knowledge of PCC, attitude toward PCC, heard about PCC, minutes to reach health facilities, insurance use before pregnancy and waiting time at health facilities are predictors for the utilization of PCC. These findings highlight the need for targeted interventions to improve awareness and change in attitude towards PCC help to increase PCC services utilization thereby enhancing maternal and child health outcomes.