Preconception Visit: The Who, What, Where, When and Why

Not all women know about the preconception visit and most women have their first pregnancy appointment after they are already pregnant. However, the preconception visit is important to establish your health and prepare your body for a pregnancy. In the ideal world,  preconception counseling would happen at every visit, but due to time restraints providers aren’t able to cover everything at every visit.

Who needs a preconception visit?

Anyone considering pregnancy in the next 3-6 months. I assume most people reading this blog fall into that category. A preconception visit isn’t reserved just for people with medical problems. Everyone should have one, regardless of risk factors. In fact, you wont know if you have any risk factors until you see your provider for a preconception visit. If you are pregnant already, and you missed this visit that’s ok. But if you are ahead of the curve continue reading to see what benefits a preconception visit can have for you.

Where do you go for a preconception visit?

This could be your regular doctor or your obstetrician, nurse practitioner or midwife. Women’s health providers (OB/GYN doctors, midwives and women’s health nurse practitioners) are typically better prepared for preconception visits. But if you don’t have a doctor or midwife or you can’t get an appointment, your general doctor can do it for you. The preconception visit is a good opportunity to try out a new doctor or midwife. It can be your trial run while there is no expectation that you’re coming back because you aren’t pregnant yet. 

When should you schedule your visit?

Ideally a few months before trying to get pregnant. And if you are looking at a very popular practice, it may take a couple months just to get an appointment. A few months will give you enough time to make any necessary changes. For example, if you need to start thyroid medication, it takes 6 weeks before you will see a change in your thyroid levels. If you are taking medications that are contraindicated in pregnancy, it may take your body a few months to find a suitable substitute.

What can you expect from a preconception visit?

1. Your Medical history

Your provider is going to want to know your complete medical history. This can help identify any complicating factors that may warrant a visit to a specialist and any medical problems requiring further work-up. Even things in your past are important to share with your provider.

2. Family History

It is important to look at your family history to evaluate if your baby is at high risk for having a genetic disorder. If your provider identifies a high risk he or she can refer you to a genetic counselor who can explain the risk to you and offer further testing.

4. Your social history.

This part of your visit is identifying modifiable risk factors. These are things you can change in your lifestyle to optimize your pregnancy.

Smoking– The first thing your provider will ask is about tobacco use. Tobacco is associated with many negative outcomes such as decreased fertility and preterm birth. If you do currently smoke your provider can provide you with some resources to help you quit.

Alcohol– No level of alcohol is safe. Although it is possible that a small exposure to alcohol may not harm your baby, your provider wants to ensure that you have either quit drinking or that you will be able to quit once you are pregnant.

Other illicit drugs– Prescription or not, drugs present your baby with many risks. Currently, the risk from marijuana has not been clearly identified, but if you are found to have any level of drugs in your urine you can risk loosing custody of your baby. Therefore it is important to disclose any drug use to your provider.

Living situation– Your provider wants to make sure that you and the baby are safe. He or she will ask about where you live, your current relationship, your support system and will screen for any signs of abuse.

Employment– Some jobs put the pregnant woman at risk to certain occupational exposures. In my case, I know that I work in a hospital and I am often exposed to x-rays, chemotherapy and CMV. By telling your provider you work in the hospital as a nurse, he or she will be able to counsel you to request to care for patients without CMV (cytomegalovirus), to refuse oncology patients receiving chemotherapy and to make sure you step away from x-rays. Other work exposures can include cleaning products and pesticides.

4. Your mediations

You also want to review all your medications. Depending on medication, your provider will recommend to continue, stop or change the medication. By medications I mean everything you are taking- this includes vitamins and supplements as well. If you are still taking birth control, your provider will counsel you on when to quit. You can also check out my article on when to stop birth control. If you are not already taking a prenatal vitamin, your provider will recommend or prescribe you one.

5. Immunization history

Pregnant women have an incredible ability to pass their immunity on to their baby through the placenta. When a woman gets a vaccination, she is not only protecting herself, but she is also protecting the baby. On the other end, when a woman gets an infection she can pass the infection to the baby. Rubella (german measles) and Varicella (chicken pox) during pregnancy puts the fetus at greatest risk. Infection with Rubella is known as Congenital Rubella Syndrome (CRS) and can cause the baby to be born with hearing loss, blindness, and cognitive defects. Congenital Varicella is extremely rare and is also associated with birth defects.

If you don’t have a history of receiving the vaccine, or you are unsure, your provider can order a blood test to check your immunity. If you are non-immune you can receive the vaccination before pregnancy but make sure you wait at least a month after vaccination before TTC.

The other important vaccination to get pre-pregnancy or in early pregnancy is the flu vaccine. The flu vaccine will protect you from getting the flu during pregnancy, which can be very dangerous. Pregnant women are more likely to have severe cases of the flu. The flu vaccine is safe to get during pregnancy though, so if you miss it pre-pregnancy it is not a big issue.

The Tdap vaccine is important during pregnancy. But it is recommended between 27 and 36 weeks of pregnancy. So you can hold off on Tdap for now.

6. Physical Exam

Your provider will check your vitals signs. He or she is specifically looking at your blood pressure to make sure you don’t have baseline hypertension. The doctor/midwife will also check your height and weight to calculate your BMI and identify if you could benefit from weight gain or weight loss. The rest of the exam is provider specific. Some will listen to you heart and lungs, assess your thyroid, do a breast exam, or do a pelvic exam.

7. Labs- depending on risk factors and provider preference

  • HIV
  • STIs (gonorrhea, chlamydia, syphilis)
  • Immunity titers- rubella, varicella.
  • Genetic carrier testing
  • Fasting glucose or hemoglobin A1C in women with diabetes risk factors
  • CMV, toxoplasmosis, lead level, tuberculosis screening only in high-risk populations.

8. Counseling

Depending on your risk factors, your provider will provide counseling. If your BMI is above 25 your provider will discuss the benefits of weight loss for obtaining a healthy pregnancy. Your provider may also test for type 2 diabetes and refer you to a nutritionist. If you are smoking or using other drugs, your provider will counsel you to quit and may refer you to a smoking cessation program.

Why Should you Schedule Your Preconception Visit?

I hope this article has shown you the importance of your preconception health. Your health in the months prior to pregnancy and the first trimester of pregnancy are the most important for the development of a healthy baby. There are many benefits of a preconception visit, from trying out potential doctors & midwives to getting vaccinations. After all, once you are pregnant you can expect to be going to the doctor or midwife every 1-4 weeks for the rest of your pregnancy.