Preconception Counseling

If you’re thinking about becoming pregnant, you should have a preconception counseling appointment to discuss your plans with your doctor. They'll give you advice on your overall well-being and specific steps to help ensure a healthy pregnancy. 

Even if you don’t have immediate plans to get pregnant — but may sometime in the future — preconception counseling is a good idea. Nearly half of all pregnancies are unplanned, so being on top of your health can benefit you and your unborn child. 

Here’s what you need to know about preconception counseling.

What Is Preconception Counseling?

Preconception counseling is an appointment where you talk about your plans for becoming pregnant. Your doctor will take your information and give you advice on ways you can help ensure a healthy pregnancy.

Those steps might include:

• Changing some behaviors (like smoking).
• Getting more exercise.
• Getting to or maintaining a healthy weight.
• Managing chronic diseases during pregnancy.
• When to stop contraception.

What are the aims of preconception counseling?

The goal of preconception counseling is to ensure the healthiest possible outcome for you and your unborn child. Your doctor will help identify any risks you might have that could interfere with that goal. They'll also make recommendations to help you prepare for pregnancy.

Your doctor will refer you to any resources you might need, such as fertility care or an obstetrical specialist.

What are the 4 components of preconception care?

There are four components of preconception care that most impact pregnancy. As part of preconception counseling, your doctor will review these with you. 

Maternal assessment

This includes your family history, your obstetrical history, a general physical exam, and questions about your lifestyle and behavior.

Vaccinations

Your doctor will go over your vaccine records, checking that you’ve been immunized against rubella, varicella, and hepatitis B.

Screenings

Screening for sexually transmitted infections (STIs), which can affect your baby, is part of preconception counseling. Your doctor will also screen for genetic disorders, such as cystic fibrosis and sickle cell disease.

Counseling

Your doctor will give you advice on lifestyle choices you can make to have a healthier pregnancy. Their recommendations will include eating a healthy diet, taking prenatal vitamins, not smoking, and managing your weight. Your doctor can also tell you specific steps to take to get your body ready for pregnancy.

Who should I see for preconception counseling?

For preconception counseling, you should see an obstetrician (ob-gyn) — a doctor with special training in pregnancy and childbirth.

Can you just be an obstetrician and not a gynecologist?

No. To be an obstetrician, you must also be a gynecologist.  

Gynecology is the field of medicine that deals with women’s health, especially reproductive health. Obstetrics is the field of medicine that deals with pregnancy and childbirth. Being an obstetrician includes both specialties.

In other words, you can be a gynecologist without being an obstetrician, but you can’t be an obstetrician without being a gynecologist.

When Should I Have Preconception Counseling?

Ideally, you should have preconception counseling several months before you start trying to get pregnant. 

At a routine annual visit, your ob-gyn may ask if you’re planning to get pregnant during the following year. I you say yes, they know to follow-up with preconception counseling before pregnancy occurs.

Nearly half of all pregnancies aren't planned. It stands to reason that if women routinely get preconception counseling, they'll have healthier pregnancies. Preconception counseling should ideally be part of regular, ongoing care for anyone who wants to become pregnant in the future.

What Happens at a Preconception Consultation?

A preconception counseling visit involves a physical exam, talking with your doctor, and taking some tests. You’ll have the opportunity to ask your doctor any questions you have about conception and pregnancy.

Here are some of the basic components of a preconception visit. 

Physical exam

Your doctor will conduct a physical exam to observe your overall health. They will check your vital signs (pulse, blood pressure, temperature, weight, and height). They may perform a pelvic exam.

Tests

You’ll get screened for any diseases or conditions that might need treatment, like sexually transmitted infections (STIs). Your doctor may also recommend genetic testing for inherited conditions that you might pass along to your child. 

Medical and family history

Your doctor will take a detailed medical history. They’ll ask about your gynecological history, your periods, what kind of birth control you use, and if you’ve been pregnant before. They will also ask about your family’s medical history, and your partner’s.  

Guidance on having the healthiest pregnancy possible 

During a preconception counseling appointment, your doctor may give you advice about:   

• Alcohol consumption — There's no known safe amount of alcohol use during pregnancy. Drinking alcohol during pregnancy can lead to growth and central nervous system problems, low birthweight, and behavioral problems. If you have an alcohol use disorder, your ob-gyn can point you in the right direction to get help.
• Diet — It’s important to get the right nutrients when you’re pregnant. Eating healthfully can help prepare your body before conception.
• Exercise — Pregnancy, labor, and delivery are hard on your body, so it’s best to be in good physical condition before you get pregnant. Your doctor can tell you how much and what kind of moderate exercise is best — usually 30 minutes, five times a week. (Overdoing it can throw your menstrual cycle off, making it harder to get pregnant.)
• Genetic conditions — Your doctor may recommend genetic counseling to see how likely it is that you have an inherited condition. If you undergo in vitro fertilization (IVF), genetic specialists can test an embryo before implantation to see any inherited diseases appear.
• How closely to space your pregnancies — If you’ve already had a baby, your doctor can give you advice on the safest time between pregnancies. Having pregnancies too close together can lead to preterm birth and complications. The ideal time between pregnancies is 18 months.
• Managing chronic conditions— Your doctor will counsel you on being pregnant while managing diseases like asthma, depression, or high blood pressure. For some conditions (seizure disorders, diabetes, heart disease, and autoimmune diseases), they may refer you to a high-risk obstetrical specialist. You may need to adjust or change medications with pregnancy.
• Medicines, herbs, and supplements — It’s important to tell your doctor everything you take, even over-the-counter (OTC) medicines and supplements. They can advise you on which ones are safe to take during pregnancy.
• Prenatal vitamins — Your doctor can recommend the best prenatal vitamin for you to take. You should start taking them last least one month before conception, and then throughout your pregnancy. Prenatal vitamins should have 400 to 800 micrograms of folic acid to prevent brain and spinal cord birth defects.
• Smoking — If you smoke, try to quit before you attempt to get pregnant. Smoking affects every part of your body and can lead to birth defects, premature births, and low birthweight babies. If your partner smokes, encourage them to quit, too; secondhand smoke can also harm the developing baby.
• The best time to conceive — Your doctor can tell you how to track your ovulation cycle for the best chance of conception.
• The impact of age on fertility — A woman’s fertility takes a sharp decline after 35 and drops further after age 40. Older women are also more likely to have complications during pregnancy and childbirth, and a higher risk of miscarriage.
• Toxins at work or home — Various chemicals and pollutants can cause a problem with pregnancy or the health of your baby. Your doctor can go over these substances, which include lead, pesticides, and workplace chemicals.
• Vaccinations — Certain vaccinations can keep you and your baby healthy during pregnancy, such as rubella, varicella, and hepatitis B. You can get some vaccines when you’re pregnant (like the flu shot) but you shouldn’t try to conceive too soon after others.
• Weight — It’s best to be a healthy weight (neither overweight nor underweight) when you get pregnant. Being underweight increases your chance of having a preterm delivery or underweight baby. Being obese or overweight puts you at risk of having gestational diabetes, high blood pressure, and other complications of delivery.

Why Choose UPMC for Preconception Counseling?

We're a leader in preconception, prenatal, and maternity care. Our caring medical team can help with testing, lifestyle recommendations, and referrals to other experts. If you’re pregnant — or planning to become pregnant — we can help you every step of the way.

We offer preconception cystic fibrosis screening, as well as targeted screening based on ethnicity and family history. We follow CDC recommendations for preconception STI screenings, offering screenings for gonorrhea, chlamydia, hepatitis B and C, HIV, and syphilis.

By UPMC Editorial Staff. Last reviewed on 2024-09-05.