Preconception check-ups aim to look for any problems that could affect your baby and to help you get ready before the baby is born.
If you're planning on becoming pregnant, see your doctor or midwife for a preconception appointment. They can provide advice and information about how best to prepare yourself before conception. Your doctor may also offer tests that will check whether there are any health conditions present that could cause problems during pregnancy.
Most women won't need all of these tests – if in doubt, ask your doctor what you specifically need. Very few women will need more than one test.
How often should I come for preconception care?
The frequency of visits will depend on your individual circumstances and needs:
- If you're planning to conceive in the next six months, your doctor or midwife will probably arrange one appointment. You may be invited back for more detailed information later on.
- If you've been trying to get pregnant without success, you may need three appointments over a period of six months before further tests can be carried out.
- Women who are 35 years and older (or younger depending on their circumstances), plus women with medical conditions or other factors which could affect pregnancy, should see their doctor or midwife at least once a month until conception is achieved (and even during pregnancy). This is because they're at greater risk of having problems during pregnancy. Your doctor can also provide advice about how best to prepare yourself for parenthood.
What tests will be carried out?
The tests you have before and during pregnancy depend on your individual circumstances, but are likely to include:
- Blood pressure check – this checks for raised blood pressure which could put you or your baby at risk during pregnancy. Your doctor may also ask about any high blood pressure you've had in the past, as women who have had this condition before are more likely to develop it again during pregnancy. Some medications can raise blood pressure, so it's best to discuss them with your doctor first. Other causes of raised blood pressure should also be investigated by your doctor.
- Antenatal records check – this looks at whether there are any medical conditions present that might affect the health of a pregnant woman (for example, diabetes) and/or her baby (syphilis).
- Screening for sexually transmitted infections (STIs) – these check for conditions such as chlamydia. They're important because some STIs can cause problems during pregnancy and in the unborn child. If left untreated, they could cause miscarriage or stillbirth, or lead to health problems in a newborn baby such as blindness.
- Cervical screening test – this checks for abnormal cells which may lead to cancer of the cervix (neck of the womb). It's not part of a preconception visit but can be done at the same time if appropriate.
- Blood tests – these check levels of certain substances in your blood including folic acid; hepatitis B; HIV; rubella immunity (German measles); some genetic conditions such as sickle cell disease or thalassaemia, which both run in some ethnic groups.
- Ultrasound scans – these check for any abnormalities with your ovaries, womb and kidneys which might affect your baby's health. They also provide information about the size of the baby, how far along you are with pregnancy, plus the position of the placenta.
What else will they do?
Your doctor may recommend one or more additional tests to help you get ready for pregnancy:
- Your doctor may offer a prescription for folic acid pills to help reduce the risk of neural tube defects (serious birth of the brain and spine) in your baby.
- He or she may ask about whether you've ever taken medication that could harm your baby. This is to help you plan ahead, so that you can stop taking any drugs that shouldn't be used during pregnancy and, if necessary, take a prescribed prenatal vitamin containing folic acid. Your doctor will discuss this with you in more detail.
Is there anything I need to do before going for my preconception checkup?
Here's some advice on what preparations are recommended before the visit:
- Stop smoking. Smoking increases the risk of complications such as miscarriage and stillbirth, premature birth and small babies (low birth weight). It also increases the chance of conditions such as asthma, ADHD and behavioural problems in children. Although stopping may be difficult, it's important to try.
- Make sure you're up to date with immunisations. Immunisation against hepatitis B, for example, is recommended for all infants and children under 5 years old – but adults who have never been immunised should also consider having the vaccine to minimise the risk of passing on the infection to their unborn child.
- Tell your doctor about any medicines you take – prescription or over-the-counter, as well as those you take regularly as complementary therapy such as herbal remedies or nutritional supplements. Your doctor will give you advice on how best to manage these during pregnancy if they're absolutely necessary. Remember that many herbal remedies haven't been scientifically tested and some could even be harmful.
- Ask your doctor about any previous medical conditions you've had which may affect your pregnancy.
- If you have a partner, it's best to both attend the preconception visit together. This is because it's easier for doctors to detect potential problems if both partners are present and can give full information about family history.
Does my partner need one too?
Your partner will also be offered a number of tests including:
- Testing for sexually transmitted infections (STIs) – these check for conditions such as chlamydia. They're important because some STIs can cause problems during pregnancy and in the unborn child. If left untreated, they could cause miscarriage or stillbirth, or lead to health problems in a newborn baby such as blindness, deafness or learning difficulties.
- Blood tests – these check for conditions such as congenital adrenal hyperplasia (CAH). This is a genetic condition that can cause the body to produce too much male hormone, resulting in physical abnormalities of the genitals that are often wrongly identified as being female.
What happens during the visit?
Your preconception visit will take about an hour at least, but you won't be in the consulting room on your own — your partner will also be invited to say something about his or her health and lifestyle, and any medications he or she takes regularly.
- Your doctor will discuss your medical history with you – including any illnesses, childhood diseases (particularly measles), allergies, previous operations and treatments you've had, whether you smoke and how much alcohol you drink. He or she may ask about other things such as staying fit and healthy (e.g., eating a balanced diet) and any complementary therapies such as acupuncture now or previously taken.
- Your doctor will check your height, weight, blood pressure plus listen to your heart using a stethoscope to make sure it's beating normally. A urine sample will be asked for too.
- You'll be asked about your future plans if you have any – including whether you'd like to have children and when. Your doctor will also ask about previous pregnancies, miscarriages or abortions.
- The doctor may insert a small device into your vagina in order to measure the size of your uterus plus check that you've got no polyps in the cervix. He or she will then perform another test – possibly involving a vaginal swab – to detect for infections such as chlamydia and gonorrhoea (the 'drip' method). A blood test can also be done at this time to check for STIs such as syphilis and HIV infection. This is important because some STIs can cause problems during pregnancy and in the unborn child. If left untreated, they could cause miscarriage or stillbirth, or lead to health problems in a newborn baby such as blindness, deafness or learning difficulties.
What should I do next?
Make your mind up about contraception – this will help you plan for starting a family. You can talk to your doctor about hormonal contraceptives (the pill, injection and implant), intrauterine contraceptive devices (IUCD) and barrier methods such as condoms. It's also sensible to consider having immunisations against infections such as hepatitis B before becoming pregnant – especially if you're not sure whether you've previously been vaccinated against them.
Do we need both of us to come?
You'll need at least one partner to attend the preconception visit. This is because it's easier for doctors to detect potential problems if both partners are present and can give full information about family history.
Do we need to come?
Yes, you should try and arrange at least one appointment together – preferably nearer your estimated date of conception (EDC). This is because it's easier for doctors to detect potential problems if both partners are present and can give full information about family history. If you're not having a baby just yet, then keep up-to-date with your regular checkups – it will be important that any potential health issues can be detected early on so they don't affect your chance of conceiving or carrying the child successfully after conception has occurred.
Here's a list of the questions your practitioner will ask:
- How old are you now?
- What is your family history?
- When did you start menstruating?
- How long do you usually menstruate and how often do you get a period (are they regular or not)?
- Do you know if any of your relatives have had any problems with their pregnancies such as stillbirth, preterm labour, preeclampsia, etc.?
- Do you know what happened to the children born with those pregnancies? Were they healthy or were there any birth defects or disabilities? Have they been able to conceive again successfully, and if so at what age(s)? Any miscarriages in between these successful births?
- Are both men and women in your family fertile – meaning having lots of children – or infertile meaning no children or problems conceiving?
- How many pregnancies have you had, what happened to them and what was the outcome of each? Have any miscarriages occurred between these pregnancies?
- What are your plans for future pregnancies if you already don't have a child right now with your husband/partner? When do you plan to become pregnant (after which period)? Do you wish to conceive naturally without involving medicine, machines or other techniques such as artificial insemination, IVF treatment etc.? Would you be open to using some kind of medicine, machine or technique if nature doesn't work well enough on its own?
- What do you think of increasing the woman's intake of folic acid before getting pregnant?
- Are you currently taking any medications or nutritional supplements, or have you been on these recently?
- Have you had surgery under general anaesthesia lately? If so for what condition was it done and how long ago did it happen? Are there any complications from this procedure that we should know about now (i.e. ongoing problems)?
- Do you smoke and/or drink alcohol to excess (more than five drinks a day)? Do either of your partners smoke and/or drink alcohol to excess? Are both men and women in your family fertile – meaning having lots of children – or infertile meaning no children or problems conceiving?
- Do you use street drugs such as marijuana, cocaine or methamphetamines?
- Do you have any allergies to medications or foods?
- Does either of your partners have any allergies to medications or foods?
- What is your occupation and schedule (e.g. night shift)? Do you work on your feet all day long and if so: what kind of shoes do you wear, how many hours a day do you stand etc.? How much physical activity do you get during the year? How often do you go out in the bright sun for more than one hour at a time without wearing sunscreen lotion with SPF 15+? What activities did/do you participate in for exercise (e.g., gym workouts, jogging/running, cycling, etc.)?
- What type of diet do you follow (vegetarian, low-fat, high meat)?
- What is your current weight and height? How much do you weigh now compared to when you got pregnant with your last child? What is your blood pressure (BP) reading at the moment (write down the numbers if it's not given to you)?
- Do you remember how many centimetres/inches tall each parent was in inches or centimetres at the time when he /she was born /when that baby conceived in his mother's tummy before birth?
- Have any of your previous pregnancies been complicated by gestational diabetes, pre-eclampsia, premature labour, small baby syndrome, low birth weight or other complications besides the time when your water broke early?
The preconception checkup is a visit to assess what preparations need to be done before trying to conceive. It's typically an appointment given by a doctor or other health care provider, but can also just be a talk with your friend who has successfully conceived and delivered one or more children.
Preconception planning aims to ensure that you will have the best possible chance of conceiving well and having a healthy baby when you choose to try getting pregnant. The questions above are examples only: every health care provider will base their own questions on their country's medical guidelines and standard procedures. The questions may vary depending on whether you already have children; if so how many, etc. If you already know certain things about yourself (e.g. history of diabetes in your family, etc.), you may want to share these with the healthcare provider before the visit.
When visiting a healthcare provider for a preconception check-up it is important to remember that they are obligated by law not to disclose any information about you without your written consent. The only exception is when they believe there is an imminent risk for you or your baby's health (e.g. if you tell them you plan on getting pregnant but also say "I might try shooting myself in the stomach tomorrow with my dad's hunting rifle.")