What preconception measures should a patient take?

Preconception Care Planning for Pregnancy

To optimize pregnancy outcomes, patients should develop a reproductive life plan, take daily folic acid supplements, maintain a healthy weight, update vaccinations, manage chronic conditions, and avoid harmful substances at least 3 months before attempting conception. 1

Essential Preconception Measures

Reproductive Planning

• Develop a reproductive life plan addressing timing and spacing of pregnancies 1
• Begin preconception care at least 3 months before attempting pregnancy 1
• Consider genetic screening based on family history, ethnic background, and age 1

Nutritional Optimization

• Take daily folic acid supplement (400 mcg) to prevent neural tube defects 2
• Maintain healthy BMI (19.8-26.0 kg/m²) through proper nutrition and exercise 1
• Consume adequate fruits and vegetables (2 servings fruit, 3 servings vegetables daily) 1
• Avoid vitamin A and D excess which can be harmful during pregnancy 3
• For patients with history of bariatric surgery, delay pregnancy for at least 12 months post-procedure 2

Medical Condition Management

• Optimize control of chronic conditions:
  • Diabetes: Target A1C <6.5% before conception 2
  • Hypertension: Review medications (avoid ACE inhibitors) 3
  • Epilepsy: Review anticonvulsant medications for teratogenic potential 3
  • Thyroid disease: Ensure proper management before conception 4
  • Psychiatric conditions: Review medications for pregnancy safety 4

Medication Review

• Review all prescription and over-the-counter medications 5
• Avoid FDA pregnancy category X medications 1
• Discontinue teratogenic medications or switch to safer alternatives 3
• Discuss any herbal supplements, particularly St. John's Wort which can interfere with hormonal contraceptives 5

Infection Prevention and Immunizations

• Update immunizations:
  • Hepatitis B
  • Rubella (MMR)
  • Varicella
  • Tdap
  • Influenza (if planning pregnancy during flu season)
  • HPV 1, 6
• Complete screening for:
  • HIV
  • Syphilis
  • Gonorrhea
  • Chlamydia
  • Hepatitis B 7, 3
• Receive counseling on preventing TORCH infections (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes) 1, 3

Lifestyle Modifications

• Discontinue tobacco use (implement 5 A's: Ask, Advise, Assess, Assist, Arrange) 1
• Eliminate alcohol consumption 3
• Stop recreational drug use 3
• Avoid environmental toxins (solvents, pesticides) 3
• Maintain regular physical activity 1
• Practice proper dental hygiene including flossing 1

Special Considerations

For Male Partners

• Review medications that may affect fertility 1
• Screen for STIs and provide treatment if needed 1
• Avoid tobacco, alcohol, and substance use which can affect sperm quality 1
• Assess occupational hazards that may impact fertility 1
• Discuss family genetic history 1

Mental Health and Social Support

• Screen for depression and anxiety 7
• Assess for intimate partner violence 1, 4
• Evaluate housing security 7
• Consider occupational and financial issues related to pregnancy 3

Common Pitfalls to Avoid

1. Waiting until pregnancy is confirmed: Many critical developmental events occur in the first weeks after conception, often before pregnancy is recognized 1

2. Overlooking medication review: Some common medications are teratogenic and must be changed before conception 3

3. Inadequate folic acid timing: Folic acid supplementation should begin at least one month before conception to prevent neural tube defects 3

4. Neglecting partner health: Male factors can significantly impact fertility and pregnancy outcomes 1

5. Focusing only on physical health: Mental health optimization is equally important for pregnancy outcomes 7, 4

6. Ignoring vaccination status: Some vaccines are contraindicated during pregnancy but crucial for maternal-fetal health 6

By implementing these comprehensive preconception measures, patients can significantly reduce risks and improve outcomes for both mother and baby.