Preconception check-up: Why you need one and what to expect

Preconception check-up: Why you need one and what to expect
Approved by the BabyCenter Medical Advisory Board

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What's below:
• Taking your history and providing counseling

• Physical and gynecological exam

• Urine tests

• Blood tests

• See also
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In order to give your baby the best start in life, you'll want to get your own health squared away before you get pregnant. Think about a visit to your practitioner for preconception care as preventive medicine for you during your pregnancy and for the child you're hoping to conceive. A complete history and physical exam three 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 and will give your practitioner an important baseline to use as a guide during your pregnancy. Here's a rundown of what you can expect at a preconception visit.

Taking your history and providing counseling
The first thing your practitioner will do is to ask you a long list of questions about your health and lifestyle in order to consider how any current or past conditions may affect your pregnancy. (If you already have a relationship with your practitioner, she may already know much of this information and will just be looking for you to fill in the blanks.) She'll be looking for anything that might influence your ability to get pregnant or affect your health and the baby's health once you do get pregnant. (See our Preconception counseling checklist for a more complete list of the questions you may be asked.) She'll let you know about any concerns she has about your situation and help you figure out how to address them. And she'll answer any questions you have. Here's a summary of what you'll be asked and why.
Gynecological history
Your practitioner will want to know if you have regular periods, how long they last, and when the last one was. (If you're not already keeping a menstrual calendar, now is a good time to start.) She'll ask what kind of birth control you've used in the past and what you're using currently. (With certain methods, such as Depo-Provera, it may take your fertility a relatively long time to return, so ask about switching methods if you'd like to try to conceive in the near future.)

She'll also want to know if you've ever had an abnormal Pap smear or any sexually transmitted diseases such as chlamydia, gonorrhea, syphilis, HPV, or herpes. (If your partner has ever had an episode of genital herpes, be sure to let your practitioner know as well.) Many STDs can be 'silent' — meaning they don't cause any symptoms — but they can cause problems in pregnancy (or fertility problems if you develop 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 now. It's a good idea for all women planning a pregnancy to be tested for HIV, too.

Obstetric history
Your practitioner will want to know about any prior pregnancies, including any preterm births, miscarriages, ectopic pregnancies, or abortions. For pregnancies that ended with births, she'll want to know how you delivered your baby, whether ******lly, with the help of forceps or a vacuum, or if you had a cesarean section and why. Your practitioner will also be interested in any complications you had during the pregnancy, birth, and postpartum, and whether the baby had any problems.

All this information helps her to anticipate the kind of care you might require in your next pregnancy so she can do everything possible to ensure that you and your baby are healthy. For example, a prior ectopic pregnancy may affect your fertility or would mean that you'd want to have a very early ultrasound to check that it hasn't happened again. A history of recurrent miscarriage might mean that you should have chromosome testing or be checked for certain health problems. Finally, if you've ever had a baby with a neural tube defect, such as spina bifida, you'd want to take a greatly increased daily dose of folic acid before and during your next pregnancy to reduce the risk of that happening again.

Medical history
Your practitioner will want to know whether you have any medical conditions such as asthma, diabetes, high blood pressure or any other condition that may affect your pregnancy, so she can help you manage it properly or refer you to a specialist who can. (Women with serious chronic conditions should not stop taking their medications, but the type or dose may need to be adjusted before and during pregnancy.) Be sure, too, to let her know if you've ever had surgery or been hospitalized for any other reason, and about any drug, latex, food, or other allergies you have.

She'll also ask what drugs (prescription and over-the-counter), vitamins, herbs, or other supplements you take to make sure that you're not taking anything that would be unsafe during pregnancy. (It's a good idea to bring the bottles with you to your appointment.) She'll recommend that you start taking 400 micrograms of folic acid a day (alone or in a multivitamin) at least one month before you start trying to get pregnant. Taking folic acid can significantly decrease your baby's risk of neural tube birth defects, such as spina bifida. If you're taking a multivitamin, be aware that megadoses of certain nutrients, like vitamin A, can be dangerous for a fetus.

Vaccination history
She'll want to know which vaccinations you've had, so bring your immunization record along if you have one. If you don't have documented evidence of immunity to rubella (German measles), you'll be tested and vaccinated if necessary (as long as you're not already pregnant). If you're not sure if you've ever had chicken pox or been vaccinated against it, you'll likewise be tested for immunity and vaccinated as long as you're not pregnant. (The chicken pox vaccine requires two doses, given four to eight weeks apart.) Contracting either of these illnesses during pregnancy could put your baby at risk for serious birth defects or other complications. With either vaccine, you'll need to postpone getting pregnant for one month after you get the shots.

And if it's been more than ten years since your last tetanus booster, you'll need another now. Also, if you haven't been immunized against hepatitis B and are at risk for getting the disease, your practitioner will start the vaccine series now. Finally, let your practitioner know if you plan to travel out of the country in the near future or during your pregnancy. (Other vaccines are required to travel to different parts of the world, and some of them are unsafe to get during pregnancy, so it's best to be prepared ahead of time.)

Emotional and social history
Your practitioner will want to know if you've ever had any mental health problems, such as depression or eating disorders, and whether you're being treated with any psychiatric 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 she's aware of your feelings.

In addition, your provider should ask if you've ever been a victim of domestic violence or if you're 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), sexual, or any combination of the above. Abuse affects millions of women in the U.S. 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 the resources you need, which may include counseling, legal, and social services, domestic violence hot-lines, and safe havens.

Lifestyle questions
If you drink, smoke, or use drugs, your practitioner will strongly suggest that you stop once you're pregnant or preferably before you start trying. Some studies even suggest that too much caffeine can affect the health of your baby. If you're following a special diet, she'll make sure you're getting the nutrients you need; if you've been a couch potato, 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 about what to avoid eating, like certain fish that might contain too much mercury, and how to avoid potentially dangerous infections by not eating unpasteurized milk or cheese, and raw or undercooked fish, meat, or eggs.

If you have any pets or do any gardening you may be at risk for toxoplasmosis, which is relatively harmless in adults but can be dangerous to developing fetuses. A blood test can determine whether you've had it and are therefore immune. If you're not, be sure to wear gloves when gardening, have someone else change the litter box, avoid sandboxes, and avoid eating undercooked meat. (It's also a good idea to wash your hands thoroughly after playing with your pets, when you come inside from the garden or park, and after handling raw meat.) Finally, your caregiver will ask about any environmental hazards you or your partner may be in contact with at home or work to make sure you aren't being exposed to any toxic substances that may affect your pregnancy. And she'll warn you away from hot tubs and saunas once you start trying to get pregnant since raising your body temperature too high early in pregnancy can affect your baby's development.

Genetic screening
You may be referred to a genetic counselor if you or your partner have any risk factors, including a family history of genetic disease, if you've had recurrent miscarriages, or if you'll be 35 or older when you give birth. And depending on your ethnic background and family history, you may be tested to see whether you're a carrier for certain genetic diseases (see below). Genetic screening and counseling before pregnancy can help reassure you that your child will not be at risk for certain diseases or it can give you the opportunity to discuss your options (such as prenatal testing) if you're considered at increased risk for these problems.

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



Physical and gynecological exam
Unless you've had one recently, your practitioner should do a standard head-to-toe physical exam, including measuring your height, weight, and blood pressure. She'll also examine your genital area for any suspicious lesions that may indicate an infection or STD. Then she'll insert a speculum into your ****** and examine your cervix and ****** as well. If it's been more than a year since your last Pap smear, she'll do one now to screen for cervical cancer or abnormal cell changes. During this exam she may also take a cell culture on a cotton swab to check for gonorrhea and chlamydia. If you've had any abnormal discharge or itching, she may also take a culture for ******l infections, such as trichomoniasis. After removing the speculum, your practitioner will do a pelvic exam by inserting her fingers into your ****** and checking your ovaries, uterus, and cervix for any masses, tenderness, or other problems.

Urine tests
Your practitioner may ask for a urine sample. She'll check it for signs of a urinary tract infection (UTI). If the sample looks suspicious or if you have any symptoms (such as frequent, painful urination), she'll send the sample to a lab for a culture. (If it's positive, she'll prescribe antibiotics to clear up the infection.) If you have sugar in your urine, your caregiver will order a glucose tolerance test to check for diabetes. Uncontrolled blood sugar can have dire consequences for a developing embryo, so if you have diabetes, you should see a diabetes specialist well before trying to conceive.

Blood tests

Your provider may order a complete blood count to see if you need to take iron supplements, since being pregnant can exacerbate iron-deficiency anemia. If you're not sure about your rubella or chicken pox immunity, she'll order a blood test to check. If you haven't been tested for syphilis or HIV, she may suggest that you get tested for these STDs. If you're at risk for hepatitis B, you may be tested for that as well. (If you don't have it, you can be vaccinated against it before you get pregnant.) You may also be tested for immunity to toxoplasmosis. And depending on your ethnic background and medical history, you may be tested to see whether you're a genetic carrier for diseases like cystic fibrosis, sickle-cell anemia, Tay-Sachs disease, or thalassemia. Your provider should call you with the results from these tests within a few weeks

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Preconception checklist: Questions you'll be asked at your check-up
Approved by the BabyCenter Medical Advisory Board

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As soon as you start thinking about trying to get pregnant, you'll want to see your practitioner for a check-up to help you determine what steps you may still need to take to become physically and emotionally ready. The first thing your caregiver will do is ask you a long list of questions about your health and lifestyle in order to consider how any current or past conditions may affect your pregnancy. (If you already have a history on file with your practitioner, she may only ask you to fill in any missing information.) Here's a list of the questions you're likely to be asked. (See What to expect at your preconception check-up for a description of what else will happen at this appointment and why.)

Gynecological history
+ When did your last menstrual period start?
+ Are your periods regular?
+ What kind of birth control are you using now, and what kinds have you used in the past?
+ Have you ever had an abnormal Pap smear?
+ Have you or your partner ever been diagnosed with a sexually transmitted disease?
+ Have you ever been diagnosed with pelvic inflammatory disease?
+ Have you ever been tested for HIV?
+ Are you currently in a monogamous relationship?
+ Have you ever been told you have any uterine abnormalities?
+ If you were born before 1972, do you know if your mother took DES when she was pregnant with you?
+ Have you ever had any kind of gynecological surgery?
+ Have you ever been treated for infertility?


Obstetric history
NOTE: If you've ever had any complications during a pregnancy, labor, or delivery that your practitioner is unaware of, bring the related medical records with you to your check-up. + Have you ever been pregnant before? If so,
+ Have you ever had a miscarriage? If so, how many weeks pregnant were you? Did you have a D&C? Were there complications? Do you know the cause?
+ Have you ever had an ectopic pregnancy? If so, how many weeks pregnant were you? Did you have surgery?
+ Have you ever had an abortion? If so, in which trimester? Were there any complications?
+ For each child you've given birth to: What was the birth date? Place of birth? How many weeks gestation? Gender? Birth weight? What kind of delivery? Any labor or delivery complications?
+ Have you ever had preterm labor or delivery?
+ Have you ever had a cesarean section?
+ Have you ever had any pregnancy complications, such as preeclampsia, gestational diabetes, or placental problems?


Medical history
+ Have you ever had any serious medical problems?
+ In particular, do you have diabetes, hypertension, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease (including asthma), thyroid disease, cancer, or a connective tissue disease, such as lupus or rheumatoid arthritis?
+ Has anyone in your family ever had diabetes, hypertension, a stroke, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease (including asthma), thyroid disease, cancer, or a connective tissue disease, such as lupus or rheumatoid arthritis?
+ Do you have any digestive problems?
+ Have you ever been hospitalized for any reason?
+ Have you ever had any operations? When and why? Have you ever had any problems with anesthesia?
+ Have you ever had a blood transfusion?
+ Are you being treated for any conditions right now?
+ What prescription or over-the-counter medications are you taking (including any herbs, vitamins, or supplements) and at what dose?
+ Are you allergic to any drugs? Any other allergies?
+ Have you been exposed to any infectious diseases? Is there anyone in your household who has (or had) hepatitis? Tuberculosis?


Vaccination history
NOTE: If you have a record of your immunizations, bring it with you to your appointment. + Have you ever had chicken pox or been vaccinated against it? + Did you complete your childhood vaccinations for measles, mumps, and rubella? Have you ever been tested for rubella immunity? + Have you ever been vaccinated against hepatitis B? + When was your last tetanus booster? + Are you planning a trip out of the country that might require other vaccines?

Emotional and social history
+ Have you ever suffered from any mental or emotional problems, including depression or eating disorders?
+ Have you ever been a victim of domestic violence? In your current relationship, do you ever feel threatened or are you physically or verbally abused? Have you ever been kicked, hit, or slapped? Have you ever been forced to have sex against your will?


Lifestyle questions
+ Do you smoke or use tobacco products, or are you exposed to second hand smoke?
+ Do you drink alcohol? How much and how often?
+ Do you use recreational drugs?
+ Do you drink coffee or other caffeinated beverages?
+ Do you see a dentist regularly?
+ Do you exercise regularly?
+ Do you have trouble maintaining a healthy weight?
+ Do you follow any particular kind of diet or have any dietary restrictions?
+ Do you eat a lot of fish?
+ Do you ever eat raw or undercooked meat, fish, or eggs?
+ Do you have any pets or do any gardening?
+ Do you regularly use hot tubs or saunas?
+ What do you do for a living? Do you or your partner live or work near any possible hazards, such as paints or solvents, pesticides, radiation (x-rays), lead, or mercury? Do you or your partner have any hobbies (such as ceramics) that might expose you to toxic substances?


Genetic screening
+ Has anyone in your family or your partner's family ever had:
— Hemophilia or other bleeding disorders?
— Tay-sachs disease?
— Blood diseases such as sickle cell anemia or thalassemia? Sickle cell trait?
— Muscular dystrophy?
— Down syndrome or mental retardation? Other developmental delays?
— Cystic fibrosis?
— Birth defects such as spina bifida or heart or kidney defects?
— Phenylketonuria (PKU)? — Huntington's chorea? + Does you partner have other children from a previous relationship? If so, do they have any problems?
+ What is your ethnic background?
+ What is your partner's ethnic background?
+ Is there anything else I haven't asked you that you think might be important?

Diet & Weight: Pregnancy
Iron: It’s good for your blood
Approved by the BabyCenter Medical Advisory Board

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What's below:
• Why do I need iron and how much do I need?

• Should I take a supplement?

• What are the best food sources?

• What are signs of a deficiency?

• See also
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Why do I need iron and how much do I need?
Iron is essential to you and your baby's good health — it helps blood cells carry oxygen to cells for energy and growth, and builds bones and teeth.
It's hard for most women to get enough iron, and when you're pregnant, your need for this crucial mineral doubles because your body must produce extra blood to support your growing baby.

During pregnancy, you'll need 27 milligrams (mg) a day, substantially more than the 18 mg a day for nonpregnant women.



Should I take a supplement?
Probably. Even if you're a healthy eater, diet alone probably won't give you enough, and anemia is a common problem for pregnant women. Most prenatal vitamins contain iron — and that helps but many women still need more. Depending on your circumstances, your doctor or midwife may recommend a daily ferrous iron supplement (30 to 60 mg) in the second and third trimesters.
FYI Iron supplements can cause constipation so eat more fiber and drink more liquids — but not at the same time you take the pill. You'll absorb more iron if you take the supplements on an empty stomach or with a glass of orange juice (vitamin C boosts iron absorption).

What are the best food sources?
There are two types of iron — heme iron, found in animal sources and absorbed most easily by the body, and nonheme iron, found in plants. You absorb only 3 to 8 percent of iron in vegetables and grains and 20 percent in meat, poultry and fish. Eat a small amount of heme iron-rich foods with larger amounts of nonheme iron-rich foods throughout the day to give your body the best chance of taking in the most iron.

Other tips: You should be eating foods rich in vitamin C, such as orange juice, at every meal for general good health — as a bonus, that vitamin C will help your body absorb iron. Cooking in a cast-iron skillet can help you get even more of the mineral. Also cut back on caffeine or drink it between meals because it decreases iron absorption.

Sources of heme iron:

Lean red meats. Choose sirloin, rounds, or loins over ground beef.

• 3 oz. each (about the size of a deck of cards): about 1.9 mg

Sources of nonheme iron:

• 1/2 cup lentils: 3.3 mg

• 1/2 cup boiled spinach: 3.2 mg

• 1 tablespoon blackstrap molasses: 2.5 mg

• 1/2 cup black, kidney, pinto, or navy beans: 1.8 mg

• 3/4 cup iron-fortified cereal: 1.8 mg

• 10 halves dried apricots: 1.7 mg

• 1/2 cup chickpeas: 1.6 mg

• 1/2 cup boiled beet greens: 1.4 mg

What are signs of a deficiency?
Parents Talk


Have an opinion about this? Add your comments to the bottom of this page.



Some symptoms of iron deficiency anemia include fatigue, rapid heart beat, palpitations, sallow skin, and hair loss. If you're iron deficient, you may also be very sensitive to cold. Iron deficiency is very common in the United States and around the world. Pregnant women in particular are at risk because of the extra blood the body must produce to nourish the fetus. Vegetarians are at risk, too, because iron from plant sources (nonheme iron) is not as easily absorbed as iron from meat (heme iron).

What is pregnancy anemia and what can be done about it?

Expert: Russell Turk, M.D. [See Biography]

Question: I'm 28 weeks pregnant and a recent blood test showed I'm anemic. Why did this happen? Will it hurt my baby? Must I take iron supplements to remedy the situation? My practitioner recommended them in addition to my prenatal vitamins, but I'm afraid they will make me even more constipated.
Russell Turk: Many pregnant women develop mild anemia, a deficiency of red blood cells, which carry oxygen around your body. Throughout pregnancy, and especially during the second trimester, the average woman's blood volume increases by 33 percent; though the total amount of red blood cells also increases, in most women they are diluted, a problem sometimes called physiologic anemia. This is most likely the culprit in your case, since you were not anemic in the first trimester or before you became pregnant. Women are usually screened for the condition early in their pregnancy, then again between 24 and 28 weeks.

Fortunately, your condition probably won't harm you or your baby. In fact, pregnant women usually become anemic as a result of normal changes in their bodies. The condition may also be caused by iron deficiency, blood loss, and hereditary illnesses such as sickle cell disease, which can develop both before and during pregnancy.

Most pregnant women can get enough iron during the first trimester from food (green leafy vegetables are great sources) and prenatal vitamins. But in the second and third trimesters, you may need iron supplements to make sure you are getting enough of the mineral, since studies show that anemia may slightly increase the risk of preterm birth. Women who are overweight, are carrying twins (or more babies), or are unable to take prenatal vitamins regularly may also benefit from taking extra iron. Supplements can cause constipation in some women, but drinking lots of fluids, exercising moderately, and including plenty of fiber in your diet should help. Your healthcare provider may also recommend a stool softener.

Although many women lose a lot of blood when they give birth, most women do not continue to be anemic. However, if your anemia doesn't subside, you should continue to take iron supplements.

Diet & Weight: Pregnancy
Prenatal vitamin supplements: Do you need one?
Approved by the BabyCenter Medical Advisory Board

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What's below:
• What is a prenatal supplement?

• Do I need to take one? Why?

• What nutrients will be in my supplement?

• See also
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What is a prenatal supplement?
A prenatal supplement is a multivitamin you take daily to increase your nutritional intake of vitamins and minerals important to you and your baby during pregnancy. Neither the Food and Drug Administration nor the American College of Obstetricians and Gynecologists (ACOG) has set guidelines for what has to be in a multivitamin for it to be called a prenatal supplement, but your doctor or midwife will probably advise you to take one once you're planning to conceive or learn you're pregnant.
As a general rule, most prenatal supplements contain a greater amount of folic acid, iron, and calcium than you'll find in a standard multivitamin. Pregnant women need more of these nutrients than the average woman, especially folic acid, which reduces a baby's risk of neural tube birth defects such as spina bifida.

You can buy prenatal supplements at the drugstore, or your doctor or midwife can write you a prescription. Depending on your needs (if you're expecting multiple babies, for example, or if you've given birth before to a baby with neural tube defects), you may be prescribed a supplement with even greater amounts of certain nutrients.



Do I need to take one? Why?
Not all experts agree. ACOG, for one, thinks a balanced diet will supply all the vitamins you need through your pregnancy. But most healthcare providers will recommend that you take a supplement from the time you decide to start trying to get pregnant through your pregnancy.
Why? It's difficult to meet your pregnant body's increased needs for nutrients through diet alone. Your body is making so much extra blood that you need about 30 to 60 mg of iron every day (15 to 45 mg more than the Recommended Daily Allowance (RDA) of 15 mg), and you need extra folic acid (at least 400 mcg) starting even before you get pregnant.

What nutrients will be in my supplement?
Besides iron (30 mg) and folic acid (between 400 and 600 mcg) a good prenatal supplement should contain the following:

• vitamin C

• vitamin D

• B Vitamins — thiamine, vitamin B6, riboflavin, niacin, and B12

• calcium

• potassium

• vitamin A

• copper

• pantothenic acid

• zinc

• vitamin E

Prenatal vitamins usually also contain a stool softener, such as docusate sodium, since large amounts of iron may cause constipation.

FYI: Take our folic acid quiz to learn more about this important nutrient.