Before You Are Pregnant: The Pre-Conception Visit

November 08, 2009

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Before You Are Pregnant: The Pre-Conception Visit

by Marjorie Greenfield, M.D.
reviewed by Laura Jana, M.D., F.A.A.P.

Since a baby's organs begin to form within 17 days after conception, a lot will have happened by the time of your first prenatal visit at 6 to 10 weeks gestational age. In the best of all possible worlds, every couple planning to get pregnant would consult with their obstetrical practitioner at least three months before conception in order to better identify avoidable risks to both the baby and the mother.

A pre-conception visit often is useful for recognizing factors that can affect the timing or decision to become pregnant. This is particularly true for women with significant health problems (like diabetes, epilepsy, phenylketonuria, and congenital heart disease) and for couples with genetic risk factors. Getting information about how to take care of yourself before and right after conceiving can save a lot of "woulda-coulda-shoulda" second-guessing later on and will maximize your chances of having a problem-free pregnancy and a healthy baby.

What can I expect?
At the appointment, you and your partner will be asked about your medical, family, and reproductive health history. You will receive individualized information about how to be at your healthiest before conception, and you will get a chance to see how well you and your obstetrical practitioner communicate. You'll get the most out of the visit if you think about your medical and family history ahead of time and bring concerns and questions to your practitioner. The following list of topics that might be covered during this meeting will help you to have an active role in your pre-conception appointment:

Risk assessment: In addition to medical, reproductive, and family histories, your practitioner also might address your nutritional state, medication use, exposure to drugs/alcohol/cigarettes, and personal and social issues.

Genetic concerns: This includes possible referral for genetic testing or counseling before pregnancy, as some tests are more accurate in women who are not yet pregnant. The test for Tay-Sachs disease, done for people of Eastern European Jewish backgrounds, is a good example. If both parents are carriers, the baby will have a 25 percent chance of having a devastating neurological problem. Bring along a copy of your family tree, if you can, noting the regions of the world your ancestors came from and any known medical problems they might have had (cancer, heart disease, diabetes, etc.). This visit is also a good time to consider testing for cystic fibrosis carrier status.

Immunizations: Although most women of reproductive age have been immunized against rubella (German measles), the immunity can wear off, leaving them susceptible to this infection while pregnant. If you need to be re-immunized, it must be done at least three months before becoming pregnant, since immunization is not considered safe in pregnancy.

Risk of hepatitis B: Your risk of hepatitis B will be assessed and blood work checked if needed. Women at risk, such as healthcare workers and women with multiple sexual partners, should be immunized.

Laboratory testing: This can be done based on your potential risk(s). If you have any concerns about HIV, this is a good time to get checked.

Timing: Your practitioner might talk about when to stop using contraception and the benefits of spacing out pregnancies. New information indicates that closely spaced pregnancies may increase the chances of a baby being born prematurely or at a low birth weight.

Information on when to start prenatal care and the frequency of visits for your individual situation can be planned out. If carrying a child is expected to pose risks to your health, this visit can give you a realistic idea of the demands the pregnancy may make on you and your family.

One final note
Consider keeping a written record of your periods while trying to become pregnant. Knowledge of your last menstrual period gives the most accurate estimate of your due date and allows the best planning for your pregnancy.


RELATED INFORMATION

			Choosing a Practice for Your Pregnancy Care
			Folate Supplements Before and During Pregnancy
			Practitioners Involved with Childbirth
			Getting Pregnant
			Pregnancy Care
			Infertility

Created March 12, 2001
Reviewed March 16, 2001

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