Preparing for Pregnancy: Your Preconception Review Guide

Planning for pregnancy can begin before a positive pregnancy test. The months before conception provide an opportunity to review general health, existing medical conditions, medicines, vaccinations, reproductive history and lifestyle factors that may be relevant to pregnancy.

A preconception review does not involve the same investigations for every person. What needs to be discussed depends on age, health history, previous pregnancies, menstrual patterns, current treatment and individual circumstances.

What Is a Preconception Review?

A preconception review is a medical consultation carried out before pregnancy to assess factors that may be relevant to conception and pregnancy.

A gynaecologist may review the woman’s medical and reproductive history, current medicines, menstrual cycles and previous pregnancies alongside general health considerations.

During a consultation at a gynaecology clinic, topics may include:

• Existing medical conditions
• Previous pregnancies and pregnancy complications
• Menstrual history
• Current medicines and supplements
• Vaccination history
• Family medical history
• Weight and nutrition
• Exercise
• Smoking and alcohol use
• Mental well-being
• Fertility concerns
• Cervical screening history
• Plans for conception

Start With Your Medical History

One of the main purposes of a preconception consultation is to identify health conditions that may require review before pregnancy.

This is particularly relevant for people living with long-term conditions.

Having a medical condition does not necessarily mean that pregnancy cannot be considered. However, the condition and its treatment may need to be reviewed before conception.

Depending on the circumstances, management may involve another medical specialist working alongside the doctor providing obstetric care.

Review Your Medicines Before Trying to Conceive

Medicine review is another important part of pregnancy planning.

Some prescription medicines, over-the-counter products, supplements, traditional medicines and herbal preparations may require consideration when pregnancy is being planned.

Patients should tell their doctor about everything they are taking, including:

• Prescription medicines
• Over-the-counter medicines
• Vitamins
• Nutritional supplements
• Herbal products
• Traditional medicines

Do not stop taking a prescribed medicine without first discussing it with the pregnancy doctor managing your condition.

In some situations, treatment may need to continue during pregnancy. In others, the dose or medicine may need to be reviewed before conception.

Bringing an up-to-date medication list to the appointment can make this discussion easier.

Begin Folic Acid Before Pregnancy

Folic acid is commonly recommended before conception and during the early stages of pregnancy.

It is involved in the development of the baby’s brain and spinal cord during early pregnancy. Because this development begins soon after conception, supplementation is generally started before a person becomes pregnant rather than waiting for a positive pregnancy test.

For lower-risk pregnancies, 400 micrograms of folic acid daily is generally sufficient. Supplementation is commonly continued through the first 12 weeks of pregnancy.

Some women may require a different dose depending on their medical history, medicines or other risk factors. The appropriate dose should therefore be discussed with a healthcare professional.

Check Whether Your Vaccinations Are Up to Date

Vaccination history can also be reviewed before pregnancy.

Particular attention may be given to immunity against infections that can have implications during pregnancy.

Rubella

Rubella infection during pregnancy can affect the developing baby. Women planning pregnancy should therefore know whether they have adequate immunity.

If there is uncertainty about immunity, a doctor may recommend appropriate testing or vaccination before conception.

Varicella

Varicella, or chickenpox, can also cause complications during pregnancy.

Women without previous vaccination or evidence of immunity can discuss whether vaccination should be considered before they start trying to conceive.

Certain live vaccines, including MMR and varicella vaccines, are not given during pregnancy. When vaccination is required before conception, the healthcare professional can advise how long to wait before attempting pregnancy.

Review Your Weight, Nutrition, and Physical Activity

Preconception care also provides an opportunity to review general health habits.

Body weight at either end of the range may have implications for fertility, menstrual function and pregnancy. Rather than focusing on a specific appearance or number on the scales, the aim is to consider overall nutritional and metabolic health.

A review may include:

• Current weight and body mass index
• Usual diet
• Physical activity
• Nutritional deficiencies
• Existing metabolic conditions
• Eating patterns

Regular physical activity and a balanced diet can form part of preparation for pregnancy.

Women who have concerns about their weight or nutritional status can discuss whether changes are appropriate before conception rather than making restrictive dietary changes without medical guidance.

Stop Smoking and Alcohol When Planning Pregnancy

Smoking and alcohol use should be discussed as part of preconception planning.

Women planning pregnancy are advised to stop smoking and drinking alcohol.

The preconception period also provides time to seek appropriate support where stopping smoking, alcohol or another substance is difficult.

Exposure to second-hand smoke may also be worth discussing within the household so that both partners can consider their habits before pregnancy.

Do Not Overlook Mental Well-Being

Preparing for pregnancy involves more than physical health.

Women with a current or previous history of depression, anxiety or another mental health condition can discuss this during a preconception review.

This is particularly important where medication is being taken.

Mental health medicines should not be stopped suddenly without medical advice. A doctor can consider the woman’s mental health needs alongside pregnancy plans and determine whether any changes to treatment need to be discussed.

Preconception planning can also provide an opportunity to consider:

• Current stress levels
• Sleep
• Emotional support
• Previous pregnancy-related emotional difficulties
• Existing mental health treatment

Mental and physical health can therefore be reviewed together when preparing for pregnancy.

Discuss Your Menstrual and Reproductive History

Menstrual patterns can provide useful information during a preconception consultation.

The doctor may ask about:

• Cycle length
• Regularity of periods
• Heavy menstrual bleeding
• Painful periods
• Periods that are infrequent or absent
• Previous gynaecological conditions
• Previous pelvic surgery

Conditions such as polycystic ovary syndrome, endometriosis, fibroids and disorders affecting the fallopian tubes can sometimes have implications for fertility.

Having one of these conditions does not mean that pregnancy will necessarily be difficult. Its relevance depends on the condition and the individual’s circumstances.

Women with irregular or absent periods may wish to raise this before trying to conceive, particularly if there are concerns about ovulation.

Review Previous Pregnancies

For someone who has been pregnant before, the previous pregnancy and delivery history can help guide preconception care.

It may be important to tell the doctor about a history of:

• Pregnancy loss
• Preterm birth
• Pregnancy-related high blood pressure
• Gestational diabetes
• Caesarean delivery
• Problems involving the placenta
• Cervical problems
• Other pregnancy or delivery complications

Previous complications do not necessarily recur in another pregnancy. However, knowing about them can help the healthcare team determine whether assessment or planning is required before conception or during a subsequent pregnancy.

Women with previous significant pregnancy complications or existing medical conditions may sometimes require pre-pregnancy input from another relevant specialist.

Consider Your Family Medical History

The health history of both prospective parents may also form part of the discussion.

A doctor may ask whether either family has a history of:

• Known inherited disorders
• Birth defects
• Blood disorders
• Developmental conditions
• Other significant familial medical conditions

Family history does not mean that a condition will be passed to a child.

However, when a relevant history is identified, the doctor can determine whether genetic counselling or clinical genetic testing should be considered.

Testing should be selected according to medical need rather than undertaken simply because pregnancy is being planned.

Is Pre-Pregnancy Testing Always Necessary?

No. A preconception review does not automatically mean undergoing a large panel of blood tests or fertility investigations.

Testing should generally be selected according to the individual’s history and clinical circumstances.

Depending on the situation, a doctor may consider:

• Blood pressure assessment
• Weight and BMI measurement
• Blood tests for an existing condition
• Immunity testing
• Sexually transmitted infection testing
• Cervical screening if clinically appropriate and due
• Assessment related to menstrual or fertility concerns

A woman with no known medical problems may require a different review from someone with diabetes, irregular periods, previous pregnancy complications or a family history of an inherited condition.

Should You Check Your Fertility Before Trying?

Routine preconception care and fertility assessment are not necessarily the same thing.

A person does not automatically require ovarian reserve tests, ultrasound scans or other fertility investigations before trying to conceive.

However, fertility may be worth discussing earlier when there are relevant concerns, such as:

• Irregular or absent periods
• Known endometriosis
• PCOS affecting ovulation
• Previous pelvic surgery
• Known fallopian tube problems
• A medical condition that could affect fertility
• Previous treatment that may have affected reproductive function

Age is also relevant because female fertility declines over time, particularly from the mid-thirties onwards.

Women aged 35 and above who are planning pregnancy may therefore consider discussing fertility and pregnancy planning with a doctor rather than waiting for a prolonged period before seeking advice.

Pregnancy Planning Involves Both Partners

Preconception health is not solely a woman’s responsibility.

The health of the male partner can also be relevant to conception.

Both partners can consider:

• Smoking
• Alcohol use
• General health conditions
• Medicines
• Nutrition
• Physical activity
• Sexual health
• Family history
• Fertility concerns

Where pregnancy does not occur as expected, fertility assessment generally considers both partners rather than focusing on the woman alone.

Questions to Bring to Your Preconception Review

Preparing a few questions before the appointment can make it easier to cover the issues that matter to you.

Consider asking:

• Are any of my medical conditions relevant to pregnancy?
• Should any of my medicines be reviewed?
• What dose of folic acid should I take?
• Are my vaccinations up to date?
• Do I need any tests before trying to conceive?
• Are my menstrual cycles likely to affect conception?
• Does my previous pregnancy history change how another pregnancy should be managed?
• Is my family history relevant?
• When should I seek fertility assessment?
• When should I arrange my first appointment after becoming pregnant?

The answers will depend on individual medical and reproductive circumstances.

Preparing for pregnancy involves reviewing more than the timing of conception. Existing health conditions, medicines, vaccinations, folic acid, reproductive history, lifestyle and previous pregnancy experiences can all be relevant before trying for a baby.

A preconception review allows these factors to be considered according to the individual’s health rather than following the same testing or preparation plan for everyone.

Addressing questions before conception can also help women understand what may require further assessment and when to move from preconception planning into antenatal care once pregnancy begins.

Frequently Asked Questions

When should I have a preconception review?

A review can be considered before starting to try for pregnancy, particularly if you have an existing medical condition, take regular medication, have irregular periods or have experienced complications during a previous pregnancy.

Should I stop my medication before trying for pregnancy?

Do not stop prescribed medication without speaking to the doctor managing your condition. Some medicines may need to be reviewed, while others may need to continue.

Do I need fertility tests before trying to conceive?

Not routinely. Fertility investigations are generally considered according to age, menstrual history, existing reproductive conditions and how long a couple has been trying to conceive.

Should my partner attend a preconception appointment?

A partner’s health and family history can also be relevant to conception and pregnancy planning. Whether both partners need to attend depends on the reason for the consultation.

When should I see a doctor if I am not becoming pregnant?

Medical advice can be considered if pregnancy has not occurred after one year of regular unprotected intercourse. Women aged 35 and above or people with medical or reproductive conditions affecting fertility may consider seeking advice earlier.

This article is for general information only and should not replace medical advice from a qualified healthcare professional.