What are the initial steps to take before trying to conceive?

Initial Steps to Take Before Trying to Conceive

Before trying to conceive, start taking folic acid supplementation (400 mcg daily), achieve a healthy body weight, optimize management of any chronic medical conditions, review medications for teratogenic effects, update immunizations, and undergo appropriate screening for infections. 1

Nutritional Preparation

• Folic acid supplementation: Begin taking 400 mcg of folic acid daily at least 3 months before conception to reduce neural tube defects risk by nearly 75% 1, 2

  • Higher dosage (4-5 mg daily) is recommended for women with specific risk factors:
    • Previous pregnancy affected by neural tube defects
    • Taking folic acid antagonists
    • Obesity (BMI >35)
    • Diabetes mellitus
    • Family history of neural tube defects 1

• Healthy weight: Aim for a BMI between 18.5-24.9 kg/m² 1

  • Women who are overweight or obese have increased risks of:
    • Diabetes and gestational diabetes
    • Hypertension
    • Macrosomia and shoulder dystocia
    • Operative delivery
    • Congenital anomalies
    • Intrauterine growth restriction
    • Spontaneous abortion and stillbirth
    • Preeclampsia and eclampsia 1

Medical Optimization

• Chronic disease management:

  • Diabetes: Achieve optimal glycemic control before conception, ideally A1C <6.5% to reduce congenital anomalies risk 1

    • Poor glycemic control during early pregnancy directly increases risk of congenital anomalies 1

  • Hypothyroidism: Ensure proper management as dosage requirements increase during early pregnancy 1

  • Hypertension: Optimize blood pressure control and review medications for pregnancy safety 3

• Medication review: Assess all current medications for teratogenic potential 1

  • Switch from teratogenic medications to safer alternatives when possible
  • Examples of medications requiring review:
    • Anti-epileptic drugs (especially valproic acid)
    • Warfarin
    • ACE inhibitors
    • Statins
    • Isotretinoin 1, 3

Preventive Care

• Immunization update: Ensure you're current on:

  • Hepatitis B
  • Rubella (MMR)
  • Varicella
  • Tdap (tetanus, diphtheria, acellular pertussis)
  • Influenza
  • HPV (if indicated) 1

• Infection screening: Get tested for:

  • Sexually transmitted infections (chlamydia, gonorrhea, syphilis)
  • HIV
  • Hepatitis B
  • Periodontal disease 1

Lifestyle Modifications

• Substance use cessation:

  • Stop smoking before pregnancy (only 20% successfully quit during pregnancy) 1
  • Eliminate alcohol consumption 1
  • Avoid recreational drugs 1

• Environmental assessment:

  • Evaluate workplace exposures to toxicants (healthcare, dry cleaning, printing, manufacturing, agriculture)
  • Assess household exposures to heavy metals, solvents, pesticides
  • Avoid mercury exposure by limiting consumption of large fish (shark, swordfish, tilefish, king mackerel) 1

Genetic and Family Planning

• Genetic screening: Consider screening based on:

  • Family history of congenital anomalies
  • Ethnic background
  • Age
  • Carrier testing for conditions like cystic fibrosis when appropriate 1

• Reproductive life plan: Develop a plan for:

  • When you want to conceive
  • Spacing between pregnancies
  • Family planning goals 1

Mental Health and Social Support

• Mental health screening: Address:
  • Depression and anxiety
  • Intimate partner violence
  • Major psychosocial stressors 1

Common Pitfalls to Avoid

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

2. Overlooking folic acid supplementation: Neural tube closure occurs by 28 days after conception, making pre-pregnancy supplementation essential 1

3. Neglecting chronic disease optimization: Conditions like diabetes significantly increase risk of birth defects when poorly controlled at conception 1

4. Assuming all medications are safe: Many common medications are teratogenic and require substitution before conception 1

5. Delaying immunizations: Some vaccines (like rubella) must be given before pregnancy and require waiting periods before attempting conception 1

By following these comprehensive preconception steps, you can significantly improve your chances of a healthy pregnancy and reduce risks of complications for both you and your baby.