A Guide to Preconception Health Considerations

Jodie Lisenbee, BS, CD(DONA); University of North Carolina at Charlotte
Alicia Dahl, PhD, MS; University of North Carolina at Charlotte
Shu-Fang Shih, PhD, MSc, MBA; Virginia Commonwealth University
Claire Lunde, BS, BA; University of Oxford

 

Taking proactive steps to prepare for a healthy pregnancy before becoming pregnant can dramatically improve outcomes for mothers and infants. We’ve compiled a list of commonly asked questions and offer brief science-based guidance to help inform your decision-making processes during the preconception period.

What can I do to enhance my preconception physical health?

• Take a daily vitamin that contains folic acid. Starting folic acid supplementation prior to conception can reduce the risk of neural tube defects during the initial stages of pregnancy.
• Build up your calcium and iron stores during preconception, as calcium deficiency can negatively impact the fetus’s bone density, which may lead to osteoporosis later in life.
• Women with excess weight are at higher risk for infertility, miscarriage, and complications. If you struggle to maintain a healthy weight, consider talking with a dietitian about a weight loss plan during preconception. Always consider sustainable weight-related behaviors.
• Exercise is beneficial. Try activities that involve all major muscle groups. Incorporate movement that strengthens your core and back muscles to support the physical bodily changes that occur during pregnancy. 
• Routine dental cleanings and check-ups every six months paired with ongoing oral self-care are important. There have been studies indicating a possible link between gum disease and preterm birth or low infant birthweight. 
• Sleep is a nutrient just like the healthy food you eat every day. Without enough sleep, you may experience:
  • Sugar cravings
  • Afternoon fatigue
  • High blood sugar
  • Insulin resistance
  • And even diabetes

 All listed above may lead to a high-risk pregnancy. 

• Toxins, pollutants, and some materials in your environment may be harmful to your reproductive health and increase pregnancy risks. These could include common household items, heavy metals, or chemicals in the workplace.

Does my psychological well-being during the preconception period matter? 

• Yes! Good mental health and prompt management of mental distress are associated with better physical health. High levels of stress before and during pregnancy have been linked to poor birth outcomes and long-term consequences for children’s health and development. 
• Connect with trusted family members, friends, and the community to ensure you’ll have social support during pregnancy and postpartum.
• This is an especially important time to practice meaningful self-care, physically and mentally!

When should I reduce my alcohol, tobacco, and drug consumption? 

• Even before conception, limiting the number of alcoholic drinks you consume can help prepare your body for a healthy pregnancy. Drinking during pregnancy can lead to serious complications so limiting alcohol even days or weeks before you know you’re pregnant is essential.
• Breaking a tobacco addiction takes time, so give yourself a head start and consider quitting before trying to conceive. Also consider ways to avoid second-hand smoke, which will be important during pregnancy. If you're an active smoker and conceive unexpectedly, consult your doctor about effective strategies to quit.
• Preconception marijuana use may be associated with higher rates of infertility and risk of negative pregnancy outcomes. Other drugs, including opioids (even prescription pain medications!), can also lead to fertility challenges and fetal health issues such as congenital heart defects. 

When is the right time to have a baby? 

All roads to parenthood look a little different. In fact, nearly half of pregnancies in the U.S. are unplanned. When possible, it can be helpful to account for the following factors:

• Assess your financial health and budget accordingly. The cost of prenatal, childbirth, maternal, and newborn care will vary depending on a variety of factors (e.g., cesarean versus vaginal delivery), and parents are often surprised at the costs.
• Health insurance makes a difference. Take another look at your coverage, including co-pay, deductible, and amount covered after the deductible has been met. If currently uninsured, consider applying for Medicaid for Pregnant Women, which covers services related to pregnancy.
• The Family Medical Leave Act requires employers to grant 12 weeks of unpaid, job-protected leave for eligible employees, but benefits and eligibility vary widely. Check with your employer to understand the details of your leave policy. 

What should I talk to my healthcare provider about prior to conceiving? 

• Discuss your health history, which includes:
  • Any prior pregnancies
  • Chronic health conditions
  • Psychiatric conditions
  • Current treatments
  • Your family’s health history
• Disclose any medications you are currently taking, as some may need to be adjusted during pregnancy. 
• Ensure that your vaccinations are up-to-date. The annual flu shot is especially important for women who are or will be pregnant during flu season.
• Make a plan for how and when to stop contraception. It’s important to allow your normal menstrual cycle to resume prior to conception if using hormone-based birth control.
• Consider genetic counseling. If certain health conditions run in your family, you may want professional help understanding your genetic carrier status or how medical conditions may contribute to birth defects or other infant health issues. 
• Paternal health is important too. Men are encouraged to consult their doctors during the preconception period to ensure that both members of the partnership are in excellent health prior to conceiving.

Further Reading

Johnson, K., Posner, S., Biermann, J., Cordero, J., Atrash, H., Parker, C., . . . Curtis, M. (2006). Recommendations to Improve Preconception Health and Health Care -- United States: Report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. Morbidity and Mortality Weekly Report: Recommendations and Reports, 55(6), 1-CE-4. http://www.jstor.org/stable/24842326

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