Preconception

For patients that are interested in conceiving, a preconception visit with an obstetrical provider is an excellent way to help achieve the healthiest pregnancy possible for the patient and their unborn child.


The goals of a preconception visit include identifying potential risk factors, education, and initiation of interventions to promote optimal maternal and fetal health. A visit will include a full health history, a physical exam, and a possible laboratory evaluation.


After assessing for risk factors, patients will talk with their provider about possible interventions that can reduce the risk of pregnancy complications, fetal growth abnormalities, and congenital disorders.



Common interventions include:

  • Abstinence from alcohol, tobacco, and recreational drugs

  • Weight reduction for patients with an elevated BMI

  • Changing to medications that are safe in pregnancy

  • Behavioral changes to reduce the risk of exposure to teratogens

  • Control of chronic conditions such as high blood pressure, diabetes, depression, or asthma

  • Screening for heritable genetic conditions and a referral to a counselor

  • Assessing immunization status

  • Screening for infectious diseases based on risk factors, including sexually transmitted infections, toxoplasmosis, and Zika

  • Assessing a patient’s exposure to violence and abuse to ensure that they and their children are in a safe home environment

Things you can do at home include:


1. Starting a prenatal vitamin.

These can be purchased over the counter and should include at least 400 micrograms of folic acid to prevent neural tube defects. The optimal time to start prenatal vitamins is before you become pregnant. Some prenatal vitamin brands will market folate or methylfolate. These are not the same as folic acid, and folic acid is the only well-studied supplement that has been proven to prevent neural tube defects.


2. Begin tracking your menstrual cycles.

This can be done with a calendar or a phone app. Tracking your periods can give you information about if your cycle length is normal (21-35 days), regular (variation between 7-9 days is normal depending on age), and when you are most likely to ovulate. In a normal 28-day cycle, where the first day of your period is day 1, ovulation occurs on day 14. The 5 days leading up to ovulation, the day of, and the day after, comprise your fertility window. You can also use an ovulation predictor kit to determine when you are about to ovulate. These kits can be more difficult to use if you have irregular cycles.


3. Focus on your diet and exercise.

Proper diet and exercise improve overall health and can help prevent hypertensive complications and gestational diabetes during pregnancy. Some food safety considerations include washing raw fruits and vegetables, eating pasteurized eggs and dairy, thoroughly cooking all meat, seafood, and shellfish, and limiting servings of fish with high concentrations of methyl mercury (shark, swordfish, tilefish, king mackerel, and some tuna). Formal nutritional counseling can be a great source of education and information to help you make healthy food choices. If you are unsure about what exercise routine to begin, look for one that can be continued throughout your pregnancy. This could include yoga, brisk walking, jogging, swimming, biking, and using fitness equipment like the treadmill or elliptical. The recommended physical activity goal is 30-60 minutes, 5 or more days a week.


Thinking about expanding your family is an exciting time. If you are considering becoming pregnant, make an appointment to see your obstetric provider for a preconception appointment so that you can work together to optimize your pregnancy for the healthiest outcomes possible.