Getting pregnant for the first time is a very exciting time! While some people will achieve pregnancy quite easily, for many this is a process that can take many months (or even years).
I’ve created a checklist that you should follow before getting pregnant, which can help you to conceive quickly, and make the pregnancy as safe as possible for both you and your baby.
I recommend that everyone make an appointment to see an obstetrician prior to trying to conceive to ensure each of the following factors is addressed:
My Preparing for Pregnancy Checklist
Let’s look at these points in more detail:
1. Evaluate your weight and lifestyle
The first thing to consider is your weight. Being either underweight or overweight can affect your chances of conception, and also increases the risks to you and your baby in pregnancy.
Main risks of being underweight before pregnancy
The main risks of being underweight include:
Subfertility (delay in conceiving)
Fetal growth restriction (poor growth of fetus in the womb)
Preterm birth (babies born before 37 weeks of pregnancy)
Main risks of being overweight before pregnancy
The risks to pregnancy of being overweight include:
Subfertility
Pregnancy loss
Gestational diabetes (high blood sugar levels during pregnancy)
Pre-eclampsia (high blood pressure during pregnancy)
Fetal growth restriction
Macrosomia (larger than average newborn)
Preterm birth (premature birth)
Shoulder dystocia (baby’s shoulder gets stuck behind the pubic bone during birth)
Caesarean section (delivery of baby by the use of surgery)
Postpartum haemorrhage (excessive blood loss following childbirth)
Breastfeeding difficulties
Body Mass Index (BMI)
Those trying to fall pregnant should aim to have a BMI of between 18.5 and 24.9 prior to conceiving. Whilst it is often difficult to reach an optimal weight, a combination of a healthy diet and regular exercise are important steps in achieving this.
Lifestyle
The following should be avoided pre-conception and during pregnancy:
Smoking
Alcohol
Illicit drugs
There is no safe level of consumption of these substances in pregnancy and use can increase the risk of:
Miscarriage
Fetal abnormalities
Fetal growth restriction
Preterm birth
Pregnancy loss
Cardiovascular disease
Cancer
2. Take daily dietary supplements
While many people already take a daily multivitamin, there are specific vitamins and minerals needed in higher doses during the early stages of pregnancy. It is therefore important that you commence dietary supplementation at least 4 weeks prior to conception, to allow enough time for the body to store these elements. There are many pre-conception and pregnancy multivitamins available - whichever you choose, it is vital that the supplement you take contains (at least) the following:
Folate
Taking a supplement that contains at least 0.4mg of folate daily reduces the risk of neural tube defects (most commonly spina bifida or anencephaly) in the developing fetus by at least 70%.
People who should take a higher (5mg) dose of folate:
Prior affected pregnancy
Neural tube defect (or those whose partner has a neural tube defect)
Taking anti-epileptic medication
Pre-existing diabetes
BMI > 35
The folate-containing multivitamin should be commenced at least one month prior to conception and continued throughout the first trimester.
Iodine
A supplement containing at least 150mcg of iodine is important for your developing baby’s brain development.
3. Optimise all pre-existing medical conditions
A number of pre-existing medical conditions can have a significant impact on fertility and also increase complications for both you and your baby.
This includes conditions such as:
Diabetes mellitus
Thyroid disease
Lupus
Kidney disease
Epilepsy
Asthma
Hypertension
For each of these conditions, optimal control pre-pregnancy will often make it less likely that the condition deteriorates during pregnancy.
It may also result in fewer pregnancy complications such as:
Pre-eclampsia
Fetal growth restriction
Preterm birth
Stillbirth (fetal death after 20 weeks of pregnancy)
4. Review medications to ensure they are safe in pregnancy
Check if any medication that you’re on can be harmful during pregnancy. If it is, stop taking it during the preconception period as it’s vital that it’s not in your system when your baby’s organs are beginning to form, which can happen as early as four weeks gestation.
All medication in Australia falls into a risk category ranging from A (safe during pregnancy) to X (shouldn’t be taken during pregnancy). Consult your obstetrician to make sure any drugs you’re taking are safe to be used during pregnancy.
5. Review obstetric history
The preconception visit is the perfect time to discuss your obstetric history and review any prior pregnancies:
Is there a history of pregnancy loss, and if so, is there an identifiable cause that can be treated and thus prevented from recurring?
Is there a history of preterm birth or mid-trimester delivery? This usually necessitates interventions in future pregnancies, but occasionally some of these interventions are more safely performed prior to another pregnancy.
What was the mode of delivery in previous pregnancies? This may impact upon the timing of a future pregnancy. For example, for patients who have had a caesarean section and are hoping for a VBAC (vaginal birth after caesarean section) next time, there should be an inter-delivery interval of at least 18 months.
Were there any significant complications in previous pregnancies, such as severe pre-eclampsia, severe intrauterine growth restriction or gestational diabetes? If so, certain blood tests may need to be performed, and a discussion about preventative measures should take place.
Have any children been born with significant genetic conditions? If so, IVF with PGD (preimplantation genetic diagnosis) may be considered.
6. Review gynaecological history
This is the time to look at any relevant information relating to your uterus, ovaries, cervix, pelvis and vagina - both in terms of structure but also function. The following factors should be considered:
Is there a history of relevant gynaecological conditions, such as PCOS (polycystic ovarian syndrome), endometriosis and/or very irregular or long menstrual cycles? If so, your chance of spontaneous conception may be reduced and interventions (both lifestyle and medical) may enhance your chance of ovulation and achieving a successful pregnancy.
Cervical screening tests (previously known as a pap smear) - this is the best method to screen for cervical abnormalities and cancer. This is an opportune time to ensure these are up-to-date, and if not to perform one. As this test involves touching your cervix, it is ideally performed pre-pregnancy so to avoid spotting during pregnancy.
7. Review and optimise mental health
Mental health issues are incredibly common, with anxiety and depression being particularly prevalent in our community. For many, trying to conceive, pregnancy and the postpartum period can all be incredibly stressful and anxiety-provoking times, with a rollercoaster of emotions experienced by many couples at different stages - people with pre-existing mental health issues are especially vulnerable. It is normal for anxiety to manifest during those periods, even if not previously experienced in adulthood.
Mental health management plan
For existing conditions, mental health concerns should be identified and treated pre-pregnancy. Research shows that people with an active management plan in place (along with appropriate support networks) will have greater success in following antenatal guidelines and bonding with their newborn.
Antidepressants
Use of medications such as antidepressants must be reviewed carefully - there are benefits that must be weighed against the potential side effects to the fetus. For some, continuation of these medications is vital. Others will wean off medication (under the supervision of a doctor prior to pregnancy).
Seek professional help
The decision to continue or discontinue psychiatric medications must be made in consultation with an obstetrician and mental health professional. Importantly, counselling and psychotherapy often provide an excellent alternative or adjunct to medications - your obstetrician should be able to liaise with the appropriate people to ensure holistic care is provided.
8. Ensure vaccinations are up to date
Certain “live” vaccines should be avoided during pregnancy because of a theoretical risk of the virus contained within the vaccine crossing the placenta and infecting the fetus. For this reason, you should be vaccinated against certain harmful infections prior to becoming pregnant.
Immunity should be checked for the following infections:
Varicella zoster virus (chicken pox)
If acquired during pregnancy, this can cause a constellation of neurological abnormalities in the baby
Rubella (German measles)
This can cause a classic triad of cataracts, deafness and heart abnormalities in the baby
Immunity is checked via a blood test; if you are found to be non-immune to these infections, you should ideally be vaccinated at least 4 weeks prior to conception.
9. Consider genetic carrier screening
The diagnosis of a severe genetic condition in a child can be truly devastating. Genetic carrier screening is done via a blood test that provides information (the ‘carrier status’) about each parent as to whether or not they are carrying a genetic mutation that might affect their future children.
Importantly, parents do not need to be affected by or display the condition themselves in order to pass the mutation on - it is most often ‘carried’ in the family silently, and 90% of babies born with an inherited genetic disease have no prior record of it in their family.
Genetic carrier screening should now be offered to all couples, ideally prior to conceiving, to see if either parent carries any significant mutations in their genes. This testing usually only needs to be done once as results will apply to every future pregnancy between this couple.
Common conditions tested
The three most common conditions tested for are:
Cystic fibrosis
Spinal muscular atrophy
Fragile X Syndrome
Where at risk pregnancies are identified, a plan with your obstetrician (in conjunction with a genetic counsellor) will be made, specific to your particular carrier status. Not all conditions have the same outcome for the future child, and many options are available to couples.
10. Optimise conditions for conception
In order to optimise your chance at falling pregnant as quickly as possible, there are two important things to understand:
Timing of ovulation
For those with regular menstrual cycles, this is relatively easy to determine. The cycle is divided into two phases:
Follicular phase
Luteal phase
Ovulation occurs at the junction of these two phases. The luteal phase is relatively constant, lasting approximately 14 days. The follicular phase is far more variable. As a result of this, ovulation will occur approximately 14 days before the first day of your next period. For those with a 28-day cycle, this will be day 15 (counting day 1 as the first day of your period). For those with irregular cycles, this is far more difficult to ascertain. Here, it is useful to use an ovulation prediction kit, which detects a surge in a hormone called LH which rises 24-36 hours before ovulation.
Sperm
Sperm can live for up to 5 days in the female genital tract before being fertilised, whereas an egg dies within 12-24 hours of ovulation. Therefore, intercourse occurring between 5 days prior to, and on the day of, ovulation may lead to a pregnancy (this is considered your “fertile window”). More specifically, the highest probability of conception occurs when intercourse takes place one or two days prior to ovulation and on the day of ovulation.
Dr Shemer’s analogy for child conception
I want you to think of conceiving a child as being like the paparazzi trying to capture the perfect shot of the best dressed star as they walk down the red carpet at the Grammy Awards. If they know this star is arriving at 9pm, then the paparazzi will be there long before that so they can be at the front of the queue, poised to snap the best photos. Now think of your egg as the star, and the sperm as the paparazzi. You want the sperm lying in wait to fertilise the egg as soon as it’s released! Therefore, I advise patients trying to conceive to have unprotected sex at least every second day during their fertile window to maximise the chance of conception.
11. BONUS TIP - How to prepare for pregnancy after 30
In Australia, the number of pwoplw choosing to have children in their 20s has been steadily declining and instead many people are choosing to become pregnant later in life. Many people successfully have healthy children in their 30s, but it’s important to know that the risk of subfertility, miscarriage, Down syndrome and other pregnancy complications increases. Some couples may need to try for a lot longer before conceiving compared to in their 20s, which is why the key here is to see an obstetrician BEFORE trying to fall pregnant.