Patient information · Women's health
Planning a pregnancy
the three months before matter more than most people realise
Much of what determines a healthy pregnancy happens before conception. The baby's neural tube closes by around week six, often before a pregnancy is confirmed, and several common medicines need changing well in advance. Three months of preparation is a reasonable target.
Speak to us before conceiving if you take
- medicines for epilepsy — particularly sodium valproate, which causes serious harm
- isotretinoin (Roaccutane) — and for a month after stopping
- methotrexate, mycophenolate or other immunosuppressants
- ACE inhibitors, ARBs or statins
- warfarin or certain other anticoagulants
- lithium or certain antipsychotics, or any regular medicine at all
Never stop a prescribed medicine without advice — uncontrolled epilepsy, severe mental illness or high blood pressure in pregnancy can be more dangerous than the medicine. The point is to plan the switch in advance rather than react to a positive test.
Start now
- Folic acid 400 micrograms daily from three months before conception until 12 weeks of pregnancy, to prevent neural tube defects.
- A higher 5mg dose is recommended if you have diabetes, epilepsy on certain medicines, coeliac disease, sickle cell or thalassaemia, a BMI over 30, a previous baby with a neural tube defect, or a family history.
- Vitamin D 10 micrograms daily throughout pregnancy and breastfeeding.
- Avoid vitamin A supplements and liver — high-dose vitamin A causes birth defects. Check any multivitamin is pregnancy-specific.
Checks worth having
- Rubella immunity — rubella in early pregnancy causes serious birth defects. If you are not immune you need MMR, and must avoid pregnancy for one month afterwards, so this has to be done in advance.
- Blood group and antibodies, and a full blood count and ferritin — iron deficiency is very common and easier to correct before pregnancy.
- Thyroid function — requirements rise early in pregnancy and untreated thyroid disease affects outcomes.
- Diabetes screening if you have risk factors; blood glucose control before conception significantly reduces risk.
- Sexual health screening — untreated chlamydia can affect fertility and pregnancy.
- Cervical screening brought up to date, since it is deferred during pregnancy.
- Vitamin D and B12, particularly on a vegan or restricted diet.
Conditions to optimise first
- Diabetes — aim for good control before conceiving; this is one of the highest-value preparations there is.
- High blood pressure — several common medicines are unsuitable and need switching.
- Epilepsy — medication review well in advance, with a neurologist.
- Mental health — plan medication with a clinician rather than stopping abruptly; relapse in pregnancy carries its own risks.
- Weight — a BMI over 30 or under 19 affects fertility and pregnancy outcomes.
- Asthma, thyroid disease, inflammatory conditions — better controlled before than during.
Lifestyle
Do
- Stop smoking and vaping — both partners
- Stop alcohol entirely; no level is known to be safe
- Continue exercising; regular activity is beneficial
- Review caffeine — keep under 200mg a day
- Check food safety advice: soft cheeses, pâté, raw fish and undercooked meat
Avoid
- Recreational drugs, including cannabis
- Anabolic steroids and testosterone in the male partner
- High-dose supplements and unregulated herbal products
- Toxoplasma exposure — cat litter, unwashed vegetables
- Waiting for a positive test to make these changes
For the male partner too
Sperm take around 74 days to develop, so changes made three months before conception affect the sperm that matter. Stopping smoking, reducing alcohol, avoiding anabolic steroids and testosterone, avoiding excessive heat and getting weight into a healthy range all improve sperm quality and pregnancy outcomes. Pre-conception care is not solely a woman's task.
Why come to us. Pre-conception care is one of the highest-value things in medicine and is almost never offered proactively. We provide a single unhurried appointment covering the lot — rubella immunity, full blood count, ferritin, thyroid, vitamin D, B12 and glucose taken in-house, a full review of every medicine you take, MMR and other vaccination given here if needed, and a written plan for both partners. Seven days a week, no referral, and results explained in person.
One appointment, the whole pre-conception workup
Bloods, immunity checks, vaccination and medication review. No referral.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.