What should men and women consider before pregnancy?

Preconception Considerations for Men and Women

Both men and women should undergo comprehensive preconception health optimization to reduce maternal and fetal morbidity and mortality, including management of chronic medical conditions, lifestyle modifications, and medication adjustments before attempting conception. 1, 2

Medical Conditions Management

For Women:

• Diabetes: Optimize glycemic control before conception as uncontrolled diabetes increases risk of congenital malformations by three-fold 2

  • Target HbA1c < 6.5% before conception
  • Switch to pregnancy-safe medications

• Thyroid Disease: 1, 2

  • Hypothyroidism: Achieve euthyroid state before pregnancy; expect to increase levothyroxine dose by 30% by 4-6 weeks gestation
  • Hyperthyroidism: Achieve euthyroid state before pregnancy to reduce maternal and neonatal morbidity

• Hypertension: 2

  • Replace ACE inhibitors and ARBs with pregnancy-safe alternatives before conception
  • Target blood pressure < 140/90 mmHg

• Epilepsy: 1, 2

  • Consider changing from teratogenic anti-epileptic drugs (especially valproic acid)
  • Supplement with 4 mg folic acid daily at least one month before conception

• Rheumatic Diseases: 1

  • Aim for remission or low disease activity before conception
  • Continue pregnancy-compatible medications: hydroxychloroquine, chloroquine, azathioprine, cyclosporine, tacrolimus, sulfasalazine, colchicine

• Heart Disease: 1, 3

  • Consult with cardiologist and maternal-fetal medicine specialist before conception
  • Women with class III or IV heart disease are at substantially higher risk than those with class I or II

• Thrombophilia: 1, 2

  • Replace warfarin with heparin before conception
  • Consider genetic testing for inherited thrombophilia

For Men:

• Chronic Medical Conditions: 1

  • Achieve disease control before conception
  • Review medications for potential effects on sperm quality

• Infertility Evaluation: 4, 5, 6

  • Semen analysis for men with infertility concerns
  • Evaluation of sperm DNA integrity and other functional parameters
  • Consider medical or surgical interventions before proceeding to assisted reproductive technologies

Medication Review

• Teratogenic Medications: 1, 2, 7
  • Isotretinoin (Accutane): Must be discontinued at least one month before conception with effective contraception during use
  • Anti-epileptic drugs: Consider alternatives to valproic acid
  • Warfarin: Switch to heparin before conception
  • ACE inhibitors/ARBs: Replace with pregnancy-safe alternatives

Lifestyle Modifications

• Weight Management: 1, 2

  • Obesity increases risks of neural tube defects, gestational diabetes, preeclampsia
  • Achieve healthy BMI before conception

• Substance Use: 1, 2

  • Alcohol: Complete cessation before and during pregnancy
  • Tobacco: Quit before conception (only 20% successfully quit during pregnancy)
  • Recreational drugs: Discontinue before conception

• Environmental Exposures: 1, 2

  • Minimize workplace hazards and environmental toxins
  • Avoid hyperthermia (hot tubs) which may increase risk of early miscarriage

Nutritional Considerations

• Folic Acid Supplementation: 1, 2

  • Women: 400-800 μg daily for at least 3 months before conception
  • High-risk women (epilepsy, previous neural tube defect): 4 mg daily

• Prenatal Vitamins: 2

  • Begin daily multivitamin with adequate folic acid, iron, calcium, and vitamin D

• Special Dietary Considerations: 2

  • Post-bariatric surgery: Two multivitamins daily plus additional supplements

Reproductive Planning

• Contraception: 1

  • Use effective contraception until ready for pregnancy
  • Discontinue hormonal contraception with adequate time to establish regular cycles

• Fertility Assessment: 5, 6

  • Consider evaluation if age > 35 years or risk factors for infertility
  • Men: Semen analysis if concerns about fertility
  • Women: Assess ovulatory function and tubal patency if indicated

Immunizations and Infections

• Vaccinations: 1, 2

  • Ensure rubella immunity to prevent congenital rubella syndrome
  • Consider hepatitis B vaccination for at-risk individuals
  • Update all routine immunizations

• Infection Screening: 1, 2

  • Screen and treat sexually transmitted infections
  • Test for other relevant infections based on risk factors

Mental Health Considerations

• Psychological Readiness: 2
  • Assess and address mental health conditions before conception
  • Review psychiatric medications for pregnancy safety
  • Ensure adequate support systems are in place

Practical Approach to Preconception Care

1. Schedule preconception consultation at least 3-6 months before planned conception
2. Complete comprehensive medical evaluation
3. Optimize management of chronic conditions
4. Review and adjust medications
5. Begin appropriate supplementation
6. Make necessary lifestyle modifications
7. Update immunizations
8. Consider genetic counseling if indicated by family history
9. Develop a reproductive life plan with healthcare provider

Common Pitfalls to Avoid

• Delaying preconception care until already pregnant, when many interventions are less effective
• Assuming all medications are safe during pregnancy without thorough review
• Overlooking male factors in preconception planning
• Inadequate folic acid supplementation before conception
• Failing to achieve optimal control of chronic conditions before pregnancy

Remember that preconception care should be a continuous process initiated before pregnancy and conducted throughout pregnancy and the postpartum period 1. Both partners should be actively involved in preconception planning to ensure the best outcomes for mother and child.