Preconception checkup: Why you need one and what to expect

To give your baby the best start in life, it's a good idea to get your own health squared away before you get pregnant. Think about preconception care as preventive medicine for you and for the child you're planning to conceive.

A complete medical history and physical exam a few months to a year before you start trying to conceive will help you determine what steps you may still need to take to become physically and emotionally ready to have a baby. They'll also give your practitioner an important baseline to refer to during your pregnancy.

Taking your history and providing counseling

The first thing your healthcare practitioner will do is ask a long list of questions about your health and lifestyle. (If you already have a relationship with your practitioner, he may know much of this information and be looking for you to fill in the blanks.)

Your practitioner will look for any current or past conditions that might affect your ability to get pregnant or your health and your baby's health once you do get pregnant. (See our Preconception counseling checklist for a complete list of the questions you can expect.)

Your caregiver will then share any medical concerns he has, help you figure out how to address them, and answer any questions you have.

Gynecological history

Your practitioner will ask you about your periods. (If you're not already keeping a menstrual calendar, now is a good time to start.) He'll also ask what kind of birth control you're using. With certain methods, such as Depo-Provera, it may take a relatively long time for your fertility to return. Ask about switching methods if you'd like to conceive soon.

Next he'll ask about your Pap smears and whether you've ever had a sexually transmitted infection (STI). Many STIs can be "silent" – meaning they don't cause any symptoms – but they can cause problems in pregnancy (or fertility problems in the case of pelvic inflammatory disease).

If you're not in a monogamous relationship, or if you or your partner has a history of multiple sexual partners, it's especially important to be screened for STIs now.

Obstetric history

Your practitioner will ask if you've been pregnant before. (This includes ectopic pregnancies and abortions.)

A previous ectopic pregnancy could make you less fertile. And if you get pregnant after an ectopic pregnancy, your caregiver may recommend a very early ultrasound to make sure this pregnancy isn't ectopic.

A history of recurrent miscarriage might mean that you should have chromosomal testing or be checked for certain health problems.

She'll also want to know if you've had any pregnancy complicatios, how you delivered your babies and if there were any postpartum complications.

She'll ask if you had any mental health issues (such as postpartum depression) during or after any of your pregnancies.

Finally, she'll ask if you've given birth to a baby who had any problems. If you've had a baby with a neural tube defect, such as spina bifida, taking a much higher daily dose of folic acid before and during your next pregnancy reduces the risk of this happening again.

Medical history

Your practitioner will want to know if you have any medical conditions that could complicate your pregnancy, such as asthma, diabetes, high blood pressure, blood clotting disorders, and thyroid disease.

If you have a chronic medical condition, your practitioner can help you manage it or refer you to a specialist who can.

The type or dose of medication you're taking to treat a chronic condition may need to be adjusted before and during pregnancy. (However, do not stop taking medication you've been prescribed unless advised to do so by your caregiver.)

She'll also want to know if you've ever had surgery or been hospitalized for any other reason or had problems with anesthesia.

Medications and allergies

Your practitioner will want to know if you have any allergies and what drugs (prescription and over-the-counter), vitamins, herbs, or other supplements you take.

It's a good idea to make a complete list of everything you take (including how much and how often). You might want to bring the bottles with you to your appointment.

This information helps your caregiver make sure that you're not taking anything that would be unsafe during pregnancy and that you're not taking too much of anything. (For example, megadoses of certain vitamins, such as vitamin A, can be dangerous for a developing baby.)

If you're not already taking folic acid, your practitioner will advise you to start taking 400 micrograms a day (alone or in a multivitamin), beginning at least one month before you start trying to get pregnant. Taking folic acid before conception can significantly reduce your baby's risk of neural tube birth defects, such as spina bifida.

Because half of pregnancies in the United States are unplanned, experts recommend that women of childbearing age take 400 micrograms of folic acid every day

Vaccination history

Contracting certain diseases during pregnancy could put your baby at risk for serious birth defects or other complications. Bring your immunization record along (if you have one) so your practitioner will know whether your vaccines are up-to-date.

Here are the recommended immunizations:

• Rubella (German measles). If you don't have documented evidence of immunity to rubella, you'll be tested for immunity. You'll need to wait a month to get pregnant after you receive a rubella shot.
• Chicken pox. If you haven't had chicken pox or been vaccinated against it, you'll be tested for immunity. The chicken pox vaccine requires two doses, given four to eight weeks apart. You'll need to wait a month to get pregnant after you receive a chicken pox shot.
• The one-time Tdap vaccine, which includes a tetanus booster as well as a booster for pertussis (whooping cough) and diphtheria.
• The current flu vaccine (if it's flu season).
• If you're 26 or younger and haven't had the HPV shot, your practitioner may recommend that you get one now.
• Hepatitis B. If you haven't been immunized and are at risk for getting the disease.

Let your practitioner know if you plan to travel out of the country in the near future or during your pregnancy. Additional vaccines may be required if you travel to other parts of the world, and some are unsafe to get once you're pregnant.

Emotional and social history

Your practitioner will want to know if you have a history of mental health problems, such as depression or an eating disorder.

If you're being treated with any medications, you may need to switch to a different medication. Also, trying to get pregnant and pregnancy itself can cause emotional ups and downs, and your healthcare provider can be more helpful if he's aware of your feelings.

He'll also ask if you've ever been a victim of domestic violence or are currently in an abusive relationship. Abuse can take many forms – it can be physical (hitting, slapping, kicking), verbal and psychological (involving threats or constant putdowns or wanting to control everything), sexual, or any combination of the above.

Abuse affects millions of women in the United States each year. While revealing such information may seem difficult, it's critically important to be honest, since abuse often escalates during pregnancy. (What's more, studies have shown that abusive partners often become abusive parents once they have children.)

Your practitioner will be able to direct you to any resources you need, which may include counseling, legal and social services, domestic violence hot lines, and safe havens. You can also contact the National Domestic Violence Hotline – where help is available 24/7 ­– by calling (800) 799-7233 (799-SAFE) or by visiting the group's websiteOpens a new window.

Lifestyle questions

Your practitioner will review your diet to make sure you're getting the nutrients you need. If you've been inactive, she'll recommend that you start an exercise program now. And if you're over- or underweight, she'll help you make a plan to attain a healthy weight before you get pregnant.

She'll also advise you on what to avoid eating, like certain fish that might contain too much mercury, and how to avoid infections like listeriosis and toxoplasmosis that can cause problems for your developing baby. Among other things, you'll want to steer clear of unpasteurized milk or cheese, as well as raw or undercooked fish, meat, or eggs, and some deli items.

Your practitioner may advise you to limit your coffee or tea consumption, as some studies suggest that too much caffeine can be bad for the health of your baby.

She'll also ask if you smoke or drink alcohol or use drugs. If you need help quitting smoking, drinking, or any other addiction, talk to your healthcare practitioner and ask for a referral to a program or counselor.

She'll want to know if you or your partner are exposed to any environmental hazards at home or work. Some toxic substances may put your pregnancy or your baby at risk. If you have any concerns about health hazards at your workplace, be sure to discuss them with your healthcare provider.

She'll ask if you use hot tubs and saunas because raising your body temperature too high early in pregnancy can interfere with your baby's development. It can also make it harder to get pregnant.

Your caregiver may suggest that you pay special attention to your oral hygiene. Your gums are more likely to become inflamed during pregnancy, so brushing and flossing are especially important now. And some studies suggest that women with severe gum disease are at higher risk for preterm delivery (and a low-birth-weight baby). If you're due for a checkup and cleaning, make an appointment to see your dentist now.

Genetic carrier screening

Your practitioner should offer you genetic carrier screening before you start trying to conceive to see whether you or your partner is a carrier for serious inherited illnesses such as cystic fibrosis, sickle cell disease, and others. If both you and your partner are carriers, your child will have a 1 in 4 chance of having the disease.

You can meet with a genetic counselor who will be able to tell you more about your risk and help you sort out your reproductive choices. This may be the single most important thing you can do to help ensure a healthy baby, and all it requires is a saliva or blood sample from each of you. It's even covered by most health insurance policies.

Physical and gynecological exam

Your practitioner may do the following:

• A standard head-to-toe physical exam, including measuring your height, weight, and blood pressure – unless you've had a physical exam recently.
• Examine your genital area for any suspicious lesions that may indicate an infection or other problem.
• Swab your vagina to check for vaginal infections, such as trichomoniasis or yeast, if you've had any abnormal discharge, itching, or burning.
• Insert a speculum into your vagina and examine your cervix and vagina.
• Do a Pap smear (if it's been more than a year since your last one) to screen for cervical cancer or other abnormal cell changes, and possibly screen for gonorrhea and chlamydia.
• Do a pelvic exam by inserting her fingers into your vagina and checking your ovaries, uterus, and cervix for any masses, tenderness, or other problems.

Urine tests

Your practitioner may ask for a urine sample. If you have sugar in your urine, you'll have a glucose tolerance test to check for diabetes. Uncontrolled blood sugar can have dire consequences for a developing baby, so if you have diabetes, it's recommended that you see a diabetes specialist well before you try to conceive.

If you have symptoms of a urinary tract infection (such as burning, frequent, or painful urination), your urine sample will be sent to a lab for a culture.

Blood tests

Your healthcare provider might order:

• A complete blood count to see whether you need to take iron supplements. (Being pregnant can make iron-deficiency anemia worse.)
• A blood test if it's not clear whether you're immune to rubella or chicken pox
• A test for syphilis
• A test for HIV
• A test for herpes if your partner has a history of herpes but you've never had symptoms
• A test for hepatitis B if you're at risk for it. (If you don't have it, you can be vaccinated against it before you get pregnant.)

You may also consider requesting a screening to see if you have antibodies to cytomegalovirus (CMV). Read our article about how CMV can be dangerous to your unborn baby and what you can do to avoid contracting this mild virus during pregnancy if you haven't already been infected. This is especially important if you have a child in daycare since it would be easy for your child to pick up CMV there and pass it to you.

Your provider should call you with the results from these tests within a few weeks.

Your questions

Your preconception visit is a good time to talk about any problems or concerns you may have.

Don't be bashful. No matter how embarrassing your question may seem, your healthcare provider deals with these issues all the time and should be able to give you good advice and refer you to any other specialists or counselors you need to see.