Preconception counseling visit 101


It is easy to get caught up in the excitement of planning for a baby’s arrival. But, often, we do not think about planning for the actual pregnancy. This is where your OB/Gyn should come in. If you are ready to start a family, consider scheduling a preconception counseling visit with your doctor.

The purpose of this visit is to perform a risk assessment and work on optimizing your health before conception. Some of the critical the development of your baby’s organs, or organogenesis, occurs before a woman is seen for her first prenatal visit, and approximately 30 percent of women do not initiate prenatal care until the second trimester. Additionally, despite a multitude of contraceptive options, nearly 50 percent of pregnancies are unintentional. Preconception counseling can help identify and modify risk factors to help achieve a healthy pregnancy for both mother and baby.

Once you have your appointment scheduled, you should be prepared to discuss some of the following topics. It is in your best interest to be open and honest about your history as accurate information is important with regards to assessing fertility and pregnancy risk.

  • It is important to have accurate, up-to-date information on your personal and family’s medical history.
  • If you are going to a new practice, try to obtain records from your previous physician bring to the office.
  • Be prepared to discuss any chronic medical conditions you have and any medications (including prescription, over-the-counter, supplements and herbs) you take.
  • Family history, particularly in light of any hereditary or genetic conditions, will be addressed.
  • This visit will likely also discuss personal history of infections, vaccinations, environmental exposures (both at work and home), nutritional status and substance use (i.e. tobacco, alcohol).
  • A comprehensive gynecologic history will be obtained including age of your first menstrual period (menarche), regularity of menstrual cycles, timing of your most recent period and any history of gynecologic infections or surgeries.

A physical exam may or may not be required depending on if you are up to date on your annual exam. This may include a Pap smear based on the American Society for Colposcopy and Cervical Pathology guidelines and screening for sexually transmitted infections. Testing may be done to confirm immunity to varicella and rubella if your vaccination status is uncertain. Genetic counseling and testing may be offered based on family history, or can be done at your request. What should you do if you have babies on your mind? Start a prenatal vitamin with at least 400 mcg of folic acid. Ideally, you want to be taking your prenatal for a few months before conception to minimize the risk of neural tube defects. If you smoke or drink alcohol, quit now! Both can have adverse outcomes on a developing pregnancy. Try to cut back on caffeine to limit your intake to 200-300 mg per day. If you have any chronic medical conditions, schedule an appointment with your primary physician and discuss plans for pregnancy to see if medications need to altered or how you can optimize your condition. Be sure to track your menstrual cycles and keep them in a calendar or an app on your phone. This is crucial information with regards to fertility and pregnancy dating. If you are carrying a little extra weight, now is a great time to start a diet and exercise routine. Obesity can have adverse effects on fertility and pregnancy outcomes. Exercise is also a great way to maintain physical and mental health during pregnancy. And, most importantly, talk to your OB/Gyn about your plans for pregnancy so they may help guide you through the process! Establishing a good patient-physician relationship early can help ease some of the anxiety that comes along with pregnancy. For more information, please see the following resources: