Preconception Counseling

What is preconception counseling?

Preconception counseling is a visit with your healthcare provider where you discuss plans for becoming pregnant. A healthy pregnancy begins well before you get a positive result on a pregnancy test. Getting counseling before you’re pregnant can reduce the risk of something going wrong during pregnancy that harms you or the fetus.

The goals of preconception counseling include:

• Helping you get pregnant safely.
• Keeping you and the fetus as healthy as possible.
• Reducing your risk of pregnancy complications.

Nearly half of all pregnancies are unplanned, so many people never receive the benefits of preconception counseling. But it’s so important. Preconception counseling can prepare you for having a successful pregnancy and a healthy baby.

What is included in preconception counseling?

Your healthcare provider will review risk factors that may increase your chances of pregnancy complications and educate you on solutions. They can also connect you with the resources you need.

Preconception counseling involves:

• Risk assessments. Your medical history and family medical history (and that of your partner) provide clues about potential pregnancy risks. Lifestyle factors, like diet and tobacco or alcohol use, also provide clues. Your provider will help you identify potential risks so you can lessen them whenever possible.
• Interventions. You may need to adjust current treatments or your lifestyle to prepare your mind and body for pregnancy. Your provider can educate you on what steps to take.
• Referrals. Your provider can connect you with resources to help you conceive. For example, your pregnancy plan may involve healthcare resources like sperm banks or surrogates. You can discuss your options during preconception counseling.

When should preconception counseling occur?

This appointment should happen at least three months before you start trying to get pregnant.

Ideally, preconception counseling should be an ongoing part of care for anyone with reproductive potential who wants to become pregnant now or in the future.

The American College of Obstetricians and Gynecologists (ACOG) recommends that providers — including primary care physicians and OB/GYNs — routinely ask patients during appointments, “Would you like to become pregnant in the next year?” The goal is to take a proactive approach to improve pregnancy outcomes.

What happens during a preconception counseling appointment?

A preconception counseling appointment may include exams and tests to check your health and a medical history to identify risk factors. Your provider can also educate you on improving your chances of becoming pregnant.

• Physical exam. Your provider may perform an exam to assess your general health. They may check your vital organs (like your heart and lungs) and vital signs (like your blood pressure). They may perform a pelvic exam.
• Tests. You may need lab tests to check for signs of infections, diseases or conditions that need treatment. You may need genetic tests for you and your partner to detect conditions that can be inherited, like Tay-Sachs or sickle cell disease.
• Medical history. Your provider will review your conditions, medications and prior surgeries. They’ll also review your OB/GYN history, including your use of birth control, how regular your periods are and any previous pregnancies.
• Family history. Your family history can provide insights into any genetic conditions or disorders you may pass on to a child. It’s important to review your partner’s medical and family histories for the same reasons. (Sperm banks also collect this information from donors during the screening process.)

Your healthcare provider can also provide guidance based on your pregnancy plans. They can help you recognize:

• The best time to try to conceive. Your provider can help you chart when you ovulate (release an egg) each month so you know when you’re most likely to get pregnant.
• When it’s safe to try for another baby. Depending on factors like your age and health, trying to conceive too soon after giving birth (or having a miscarriage) can increase your risk of pregnancy complications. Your provider can advise you on when it’s safe to try again.
• Your ideal timeline and circumstances for having a baby. You may want a child but feel you’re not ready yet. Your provider can help you identify the factors to keep in mind as you plan for the future. For example, they can explain the impact of your age on your fertility. You can discuss the financial and social resources that should be in place before trying for a baby. For example, providers look for signs of intimate partner violence. They can help you find help, so you’re in a safer, more supportive place.
• Which vaccinations to get. Your provider can advise you on which vaccinations to complete before pregnancy to protect yourself and your future baby (such as the MMR vaccine).
• How to manage preexisting medical conditions. Your provider can help you address any conditions you have to optimize your health.

Knowing when you are (and aren’t) ready to tackle parenthood is just as important as knowing how to increase your chances of a healthy pregnancy.

How will my provider assess my risks?

Your healthcare provider will assess various factors that may shape your pregnancy experience and outcomes.

Chronic diseases

Several chronic diseases can increase your risk of pregnancy complications. Your healthcare provider will review your conditions so you understand how pregnancy may affect your treatment plan. For example, you may need to change medications or adjust your dosage. You may need to plan for more provider visits to monitor your health.

Chronic conditions that can pose pregnancy risks include:

• Asthma.
• Depression.
• Diabetes.
• Heart disease.
• High blood pressure.
• Kidney disease.
• Thyroid disease.

It’s essential that you don’t change your treatments (like abruptly stopping taking your medicine) without your provider saying it’s safe.

Discuss what may change and what will stay the same with your provider.

Genetic conditions

Medical and family histories are especially useful in identifying conditions you may pass on to a child. You may need genetic testing or counseling to understand your child’s likelihood of inheriting a genetic condition. Based on the risks, your provider can recommend solutions.

For example, preimplantation genetic testing can check if an embryo (fertilized egg) inherited genes from you or your partner that predisposes them to a genetic condition. You can discuss these options during preconception counseling.

Infections

Your provider may screen you for infections, including sexually transmitted infections (STIs) that can harm you or the fetus. Infections that can raise your risk of pregnancy complications include:

• Hepatitis B.
• HIV.
• Measles.
• Rubella.
• Tetanus.
• Varicella (chickenpox).
• Zika virus.

It’s important to be up to date on your immunizations before pregnancy. Some vaccines, like the flu shot, hepatitis B shot and Tdap shot, are safe during pregnancy. Others involve a waiting period where you shouldn’t try to conceive after getting vaccinated. Doing so may pose risks to you or the fetus.

Your provider can ensure you’re immunized on a safe timeline if you’re trying to become pregnant.

Medications, herbs and supplements

Your provider will review all medications you’re taking — including prescriptions and over-the-counter (OTC) drugs, herbs and supplements — to ensure they’re safe to take during pregnancy. They’ll also educate you about getting the necessary vitamins and minerals to stay healthy.

They may put you on a prenatal vitamin with 400 to 800 micrograms (mcg) of folic acid. Folic acid can prevent congenital (birth) defects from affecting a fetus’s spinal cord and brain (neural tube defects). It’s best to start them three to six months before getting pregnant.

Diet and exercise

You’ll discuss your diet and activity levels and what changes you may need to make before and during pregnancy. For example, your provider will advise you on the best sources of nutrition during pregnancy and how many calories you’ll need daily. They can also tell you what foods to avoid, like fish that may contain high levels of mercury. Your provider can also discuss how much weight gain is appropriate during pregnancy.

They’ll also let you know what exercises are safe during pregnancy. Generally, you should get 30 minutes of moderate-intensity exercise five days a week. But you shouldn’t exercise to the point of exhaustion or attempt workouts that put you at risk of falling. Your provider can guide you.

Weight

You may need to make lifestyle changes or see a dietitian if your weight is considered high or low. Having underweight (BMI less than 18.5) increases your risk of preterm delivery or having an underweight baby. Having obesity (BMI greater than 30) increases your risk of:

• Gestational diabetes.
• Gestational hypertension (high blood pressure).
• Delivery complications.

Your provider can help you develop a plan for reaching a weight that’s healthy for your pregnancy.

Smoking, alcohol and substance use

Stopping smoking, alcohol and substance (recreational drug) use is essential as you prepare your body for pregnancy. Substance use is linked to many pregnancy complications, including fetal death. Drinking during pregnancy may cause fetal alcohol syndrome. Like substance use, smoking can cause developmental issues in the fetus and even lead to miscarriage or stillbirth. Even exposure to secondhand smoke can raise the risk of harming the fetus.

In contrast, stopping smoking can reduce the risk of certain pregnancy complications by at least 20%.

Your provider can give you resources, like smoking cessation programs, to help you make these changes.

Toxins

Toxins in your home or work environment can pose risks during pregnancy. Your provider will assess your exposure risk. Dangerous substances that can affect your pregnancy include:

• Arsenic.
• Asbestos.
• Fluoride.
• Lead.
• Pesticides.
• Workplace chemicals.
• Rodent droppings.

What happens after my preconception counseling appointment?

Your caregiver may recommend a mix of lifestyle changes and healthcare suggestions, including:

• Losing or gaining weight.
• Establishing a nutritious diet.
• Developing a healthy exercise plan.
• Quitting smoking or drinking.
• Updating your immunizations.
• Avoiding or learning how to better manage stress.
• Taking recommended vitamins (including prenatal vitamins).
• Seeing specialists for health problems before conceiving.
• Not taking medications that harm you or the fetus (always speak to your provider before starting or stopping a medication).

Is there a checklist or guidelines for what’s included in preconception counseling?

There isn’t a single set of guidelines that everyone uses. Instead, various organizations — including the Centers for Disease Control (CDC) and the American College of Obstetricians and Gynecologists (ACOG) — provide checklists that cover topics to address during preconception counseling, including:

• Family planning (the desire to become pregnant).
• Medical conditions.
• Family history.
• Medications.
• Disease screening.
• Immunization status.
• Nutrition and exercise.
• Prenatal vitamins.
• Exposure to toxins.
• Substance use (drugs, alcohol and tobacco).
• Safe environment (exposure to intimate partner violence).

Your healthcare provider will cover a range of topics that address your health holistically. Many factors matter when it comes to having a healthy pregnancy.

A note from Cleveland Clinic

Think of preconception counseling as a wellness visit — for a future, pregnant version of yourself. Like the annual OB/GYN visits that keep your reproductive system healthy by reducing your disease risk, preconception counseling keeps your pregnancy healthy by reducing your risk of complications. Reach out to your primary care provider or OB/GYN If you’d like to become pregnant now or in the future. Ask about preconception counseling. The best start to a healthy pregnancy is knowing how to have one well before you get that positive result.