Preconception Checkup: Preparing for Pregnancy

A preconception checkup serves multiple purposes:

Identify potential issues early:

• Conditions that might affect fertility
• Health problems to address before pregnancy
• Medications that need changing
• Lifestyle factors to modify

Optimize your health:

• Ensure vaccinations are current
• Start appropriate supplements
• Address nutritional deficiencies
• Reach healthy weight if needed

Reduce pregnancy risks:

• Control chronic conditions before conception
• Identify genetic carrier status
• Address modifiable risk factors
• Plan for any known challenges

Give yourself information:

• Understand your fertility status
• Know what to expect
• Make informed decisions about timing
• Reduce anxiety from unknowns

Who should have one?

Everyone trying to conceive benefits, but particularly:

• Women over 35
• Those with chronic health conditions
• People with family history of genetic conditions
• Those who've had pregnancy complications before
• Anyone who wants proactive information

When to have it:

Ideally 3-6 months before trying, allowing time to:

• Complete any testing
• Make lifestyle changes
• Ensure vaccinations are effective
• Optimize any chronic conditions

Your GP can provide comprehensive preconception care:

Medical history review:

Your history:

• Previous pregnancies and outcomes
• Menstrual history
• Past medical conditions
• Current medications
• Mental health history
• Previous surgeries
• STI history

Family history:

• Genetic conditions
• Birth defects
• Pregnancy complications
• Twins or multiples

Physical examination:

• Blood pressure
• Weight and BMI
• General health assessment
• Cervical screening if due

Blood tests often included:

Immunity checks:

• Rubella (German measles)
• Varicella (chickenpox)
• Possibly hepatitis B

Screening:

• Blood type and Rhesus factor
• HIV
• Syphilis
• Hepatitis B and C (if risk factors)
• Full blood count (checking for anaemia)

Baseline health:

• Thyroid function
• Diabetes screening if risk factors
• Vitamin D (often low)

Vaccinations:

• MMR booster if not immune to rubella
• Chickenpox vaccine if not immune
• Flu vaccine (can have during pregnancy too)
• Pertussis (whooping cough) discussed for pregnancy
• COVID vaccine if not up to date

Medication review:

Some medications are unsafe in pregnancy. Your GP can:

• Review all current medications
• Switch to pregnancy-safe alternatives
• Adjust doses as needed

Beyond basic health, you might want fertility-specific information:

"Fertility MOT" or baseline testing:

For women:

AMH (Anti-Müllerian Hormone):

• Indicates ovarian reserve
• One blood test, any day of cycle
• Gives sense of egg quantity (not quality)
• Helpful for planning timeline

Antral Follicle Count:

• Ultrasound count of small follicles
• Done in early part of cycle
• Another measure of ovarian reserve

Day 21 progesterone:

• Confirms ovulation is occurring
• Done 7 days before expected period

For men:

Semen analysis:

• Assesses sperm count and quality
• Simple test, results in days
• Gives baseline information

Who should consider this:

• Women over 35 wanting information
• Anyone with concerns about fertility
• Those wanting to understand their timeline
• People considering delaying conception

What these tests can and can't tell you:

They can:

• Give a snapshot of current status
• Identify obvious issues
• Help with family planning decisions
• Guide urgency of trying

They can't:

• Guarantee conception
• Predict exact time to pregnancy
• Measure egg quality directly
• Account for all factors

Where to get them:

• Some GPs offer basic tests
• Private fertility clinics offer comprehensive packages
• NHS may test if trying without success

Preparing your body for conception:

Supplements to start:

Essential:

• Folic acid 400mcg daily (or 5mg if higher risk)
• Start at least 1 month before trying, ideally 3 months

Consider:

• Vitamin D (especially in northern climates)
• Omega-3 if not eating fish regularly
• General prenatal vitamin

Weight management:

Why it matters:

• Both underweight and overweight can affect ovulation
• Obesity increases pregnancy risks
• Healthy weight improves outcomes

What to do:

• Achieve a BMI between 18.5-30 ideally
• Lose weight gradually if needed
• Don't crash diet
• Focus on healthy eating rather than restriction

Substances to address:

Stop:

• Smoking (affects fertility and pregnancy)
• Recreational drugs
• Any non-essential medications without doctor approval

Reduce:

• Alcohol (ideally stop when actively trying)
• Caffeine (under 200mg/day)

Exercise:

• Regular moderate exercise is beneficial
• Excessive intense exercise may affect ovulation
• Start sustainable habits now

Mental health:

• Address anxiety or depression before pregnancy
• Review mental health medications with doctor
• Build support networks
• Consider counselling if helpful

For partners:

Male partners should also:

• Stop smoking
• Reduce alcohol
• Maintain healthy weight
• Consider antioxidant supplements
• Avoid excessive heat to testicles

Understanding genetic carrier testing:

What is carrier screening?

Tests to see if you carry genes for inherited conditions. Carriers are healthy but can pass conditions to children if both parents carry the same gene.

Common conditions screened:

• Cystic fibrosis
• Sickle cell disease
• Thalassemia
• Tay-Sachs disease
• Spinal muscular atrophy
• Fragile X syndrome

Who should consider it:

Definitely discuss if:

• Family history of genetic conditions
• Certain ethnic backgrounds with higher carrier rates
• Consanguineous relationship (related by blood)
• Previous affected child

Many couples choose it:

• For peace of mind
• To know options before pregnancy
• To be prepared

How it works:

• Blood test for one or both partners
• Tests for most common mutations
• Results in 1-3 weeks
• Genetic counsellor explains results

If both partners are carriers:

Options include:

• Natural conception with testing in pregnancy
• PGT (preimplantation genetic testing) with IVF
• Donor eggs or sperm
• Adoption
• Accepting the risk

Availability:

• NHS offers some screening based on risk
• Private expanded carrier panels available
• Discuss with GP or genetic counsellor

Optimizing existing conditions before pregnancy:

Diabetes:

• Achieve excellent blood sugar control before conception
• HbA1c under 48mmol/mol ideally
• Switch to pregnancy-safe medications
• Higher folic acid dose usually needed (5mg)
• Plan pregnancy; don't conceive with poor control

Thyroid conditions:

• Ensure thyroid levels are optimal
• TSH ideally under 2.5 before conception
• Levels will be monitored throughout pregnancy
• Medication often needs adjusting

High blood pressure:

• Get blood pressure well-controlled
• Switch to pregnancy-safe medications
• ACE inhibitors must be stopped before conception
• May need preconception counselling about risks

Epilepsy:

• Review medications with neurologist
• Some anti-epileptics increase birth defect risk
• May need medication changes
• Higher folic acid dose needed (5mg)

Autoimmune conditions:

• Optimise control before conception
• Review medications for pregnancy safety
• Plan pregnancy during stable period
• Rheumatologist should be involved

Mental health conditions:

• Review medications with doctor
• Some are safe; some aren't
• Don't stop medications without guidance
• Mental health in pregnancy matters

General principle:

Any chronic condition should be optimised before conception. The stability of your condition and safety of medications matter more than having zero issues.