Planning for parenthood: Preconception care

When looking to start a family, there are things you can do to take care of your health and wellbeing during what can feel like quite an anxious time.

Preconception care involves identifying and modifying any risk factors ahead of pregnancy. It focuses on improving both the short- and long-term health for parents and children by looking at medical, behavioural and lifestyle factors.

The World Health Organisation (WHO) highlights that preconception care improves the health of women and men while reducing the chances that their child will be born prematurely, have low birth weight, birth defects or other birth-related conditions that could hinder optimal child development.¹ (WHO also states that preconception care brings health benefits to adolescents, women and men, irrespective of their plans to become parents.¹)

Every ‘body’ is different

Before making any changes to your lifestyle, diet, behaviour, or medication, please ensure you speak with your GP or healthcare provider. They will provide personalised preconception care advice based on your specific circumstance and needs.

What does preconception care involve?

• Ensuring you’re up to date with all vaccinations.
• Ensuring sexual health checks and cervical screenings are up to date. (If an STI is present, ensuring effective management of it.)
• Maintaining healthy weight through a balanced diet alongside regular (moderate intensity) exercise.
• Avoiding smoking, alcohol, and recreational drugs, as they can affect fertility and the health of your future baby. This includes avoiding passive smoking via friends and loved ones.
• A carbon monoxide detector at home will help you check your exposure from faulty appliances.
• Using contraception for family spacing. If taking contraceptives, decide when you’ll stop and familiarise yourself with manufacturer’s advice on how long it may take your body to get pregnant after stopping the medication. Your GP or pharmacist can discuss this with you and advise.
• Taking vitamin D and folic acid supplements (women).

You should take a 400-microgram supplement of folic acid every day before you get pregnant, and every day afterwards, up until you're 12 weeks pregnant. This helps the neural tube develop, which becomes your baby’s brain and spine.

You may need to take a 5-milligram (mg) supplement of folic acid if:

• You or the baby's other biological parent have a neural tube defect.
• You previously had a pregnancy affected by a neural tube defect.
• You or the baby's other biological parent have a family history of neural tube defects.
• You have diabetes.

Your doctor may also recommend a 5mg supplement if you take certain medicines, such as anti-epilepsy medicine or anti-retroviral medicine for HIV.²

It’s also important to discuss any questions or concerns with your healthcare provider, such as:

• Any medications you’re taking to ensure they are safe to use before, during and after pregnancy (including breastfeeding).
• Understanding if there are any potential risks to you during pregnancy based on your specific health circumstances.
• How to manage any chronic conditions, such as diabetes or high blood pressure.
• Any allergies you have, or past medical history.
• Previous pregnancy, birth, miscarriage or how long you and your partner have been trying to conceive. (Women who have had multiple miscarriages may require further investigations such as blood tests, scans or be prescribed aspirin during subsequent pregnancy. It’s important to liaise with your GP when you decide to try again.)
• Addressing and managing any mental health conditions and / or social needs prior to pregnancy.

Preconception care also raises awareness of any potential risks, and the options available to manage those risks. You’re then able to make an informed decision about your pregnancy.

Where to start?

In the UK, preconception care is typically provided free of charge through the NHS. However, the specifics can depend on various factors such as your location and individual circumstances.

The best starting point is to see your GP or healthcare provider, who can give individualised guidance based on your personal situation.

Preconception care should ideally be started at least three months before attempting to conceive. This allows enough time for a woman's body to adjust to any lifestyle changes and for any necessary medical evaluations or treatments to be completed.

This care should be continued throughout preconception and beyond, as many of the lifestyle changes and medical recommendations also apply to a healthy pregnancy and postpartum recovery.

Understanding your menstrual cycle and ovulation period

This is an important part of taking control of your reproductive health and preparing for pregnancy. Knowing when you ovulate can help you determine the best time to conceive, increasing your chances of getting pregnant.

Additionally, irregular menstrual cycles can sometimes be a sign of underlying health issues that could affect fertility or pregnancy, so it's important to pay attention to your cycle and bring any concerns to your healthcare provider. 

What can impact fertility?

• Age: Fertility declines with age, especially for women after the age of 35.
• Weight: Being overweight can affect hormone levels and ovulation, which can impact fertility.
• Smoking, alcohol, and drug use: These substances can damage reproductive organs and reduce fertility.
• Medical conditions: Certain medical conditions such as polycystic ovary syndrome (PCOS), endometriosis, fibroids, previous cancer treatment, problems with sperm production and quality, varicocele, chromosomal defect and thyroid disorders can affect fertility.
• Infections: Sexually transmitted infections (STIs) and other infections can cause damage to the reproductive system and impact fertility.
• Stress: High levels of stress can disrupt hormone levels and can potentially affect ovulation and fertility. Managing stress and maintaining a healthy lifestyle can be beneficial for overall wellbeing and may indirectly support fertility. Practicing mindfulness, meditation, deep breathing exercises and maintaining a healthy work-life balance can also help to reduce stress levels.
• Previous surgeries or treatment to reproductive organs: For example, pelvic surgery, previous termination of pregnancy, cervical surgery, prostate surgery, bariatric surgery, vasectomy, ovary removal, tubal ligation, or hysterectomy.

If you have concerns about any of the above areas and its impact on your fertility, seek personalised advice from your GP.

LGBT+ families

The number of LGBT+ families is growing. There are several ways you could become pregnant if getting pregnant by having sex isn’t an option for you. Possible ways to become a parent include:

• donor insemination,
• IUI (intrauterine insemination),
• surrogacy adoption or fostering,
• co-parenting.

The NHS³ provides a lot of helpful information including useful resources to find out more about each area. These options can be explored by anyone, including single people and same sex couples.

IUI and IVF can sometimes be accessed through the NHS, however this depends on things such as your age and BMI. Your GP or local integrated care board (ICB)⁴ will be able to confirm what might be available to you.

Surrogacy isn’t available on the NHS.

While some of these methods don't involve your own biological pregnancy, they do involve bringing a new child into your life and home. Preconception care can help ensure that you're in the best possible health to care for a child, and it can also help identify and address any potential health issues that could affect your ability to care for a child.

This might include things like getting up-to-date on vaccinations, addressing any chronic health conditions, quitting smoking, and ensuring that your home environment is child-friendly.

Keep talking and supporting

The preconception phase can be a time of emotional strain for couples dealing with fertility challenges. Open communication and providing mutual support to each other during this time is so important.

Professional guidance is available, including counselling, fertility coaching, support groups and fertility clinics offering medical assistance. Charities and organisations can also provide information and support for individuals and couples. Your GP can signpost reputable sources to find the most suitable support for your specific needs.

Useful websites

• Planning your pregnancy – NHS
• Tommy’s
• British Fertility Society
• Fertility Network UK
• Human Fertilisation & Embryo Authority (HFEA)
• Fertility support charities, organisations, online communities – BBC
• Miscarriage Association
• SurrogacyUK
• LGBT Foundation

References

1. Preconception care: Maximising the gains for maternal and child health – WHO
2. Planning your pregnancy – NHS
3. Ways to become a parent if you’re LGBT+ – NHS
4. Find your local integrated care board (ICB) – NHS