What preconception care measures should women take to optimize their chances of a healthy pregnancy?

Preconception Care for Women Trying to Become Pregnant

Women trying to become pregnant should take a daily supplement of 400-800 mcg of folic acid, achieve a healthy body weight, manage chronic medical conditions, avoid teratogenic medications, update immunizations, and adopt healthy lifestyle behaviors before conception to optimize maternal and fetal health outcomes. 1, 2

Essential Preconception Health Measures

Nutritional Optimization

• Take 400-800 mcg of folic acid daily at least 3 months before conception to reduce neural tube defects 1, 2
• High-risk women (history of neural tube defects, epilepsy on anticonvulsants) should take 4 mg of folic acid daily 2
• Maintain a balanced diet rich in folate-containing foods, calcium, and vitamin D 2
• Begin prenatal vitamins before conception 2

Weight Management

• Achieve a healthy BMI (19.8-26.0 kg/m²) before pregnancy 1, 2
• Obesity increases risks of neural tube defects, gestational diabetes, and preeclampsia 2
• Women who have undergone bariatric surgery should:
  • Prevent pregnancy during rapid weight loss 1
  • Take two multivitamins daily plus additional supplements (iron, folic acid, vitamin D, B12) 2

Chronic Disease Management

• Diabetes: Achieve good glycemic control before conception to reduce congenital malformation risk 1, 2
• Hypertension: Switch from ACE inhibitors/ARBs to pregnancy-safe alternatives 2
• Thyroid disease: Achieve euthyroid state before pregnancy 2
• Epilepsy: Consider changing from teratogenic anti-epileptic drugs, especially valproic acid 2
• Rheumatic diseases: Aim for remission or low disease activity before conception 2

Medication Review

• Discontinue or switch teratogenic medications (isotretinoin, valproic acid, warfarin) to pregnancy-safe alternatives 2
• Review all prescription, over-the-counter medications, herbs, and supplements 1
• Avoid FDA pregnancy category X medications and most category D medications 1

Immunizations and Infection Prevention

• Update immunizations, including:
  • Rubella and varicella (if not immune)
  • Hepatitis B
  • Tdap (tetanus, diphtheria, pertussis)
  • Influenza (if planning pregnancy during flu season)
  • HPV (if indicated) 1, 2
• Screen and treat sexually transmitted infections 2
• Practice safe sex and proper hygiene to prevent infections 1

Lifestyle Modifications

• Quit smoking (using the five A's: Ask, Advise, Assess, Assist, Arrange) 1
• Avoid alcohol and recreational drugs 2
• Minimize exposure to environmental toxins and workplace hazards 2
• Avoid hyperthermia (hot tubs, saunas) to reduce early miscarriage risk 2
• Maintain regular physical activity 1

Preconception Planning

• Develop a reproductive life plan with specific goals about childbearing 1
• Schedule preconception consultation 3-6 months before planned conception 2
• Use effective contraception until ready for pregnancy 2
• Assess and address mental health conditions 2
• Review psychiatric medications for pregnancy safety 2
• Establish a support system to reduce stress during pregnancy 2

Common Pitfalls to Avoid

1. Waiting until pregnancy is confirmed: Nearly half of pregnancies are unintended, and critical fetal development occurs before most women know they're pregnant 1, 3
2. Overlooking partner health: Men's health factors (diabetes, smoking, STIs) can affect fertility and pregnancy outcomes 1
3. Neglecting dental health: Periodontal disease is associated with adverse pregnancy outcomes 1
4. Focusing only on folic acid: While essential, comprehensive preconception care includes multiple interventions beyond folic acid supplementation 2
5. Delaying management of chronic conditions: Optimal control of conditions like diabetes and hypertension should be achieved before conception 1, 2

By implementing these evidence-based preconception measures, women can significantly improve their chances of having a healthy pregnancy and baby, reducing risks of maternal and fetal morbidity and mortality 2.