Components of Preconception Care

Ask about reproductive intentions at every visit and ascertain risk of an unplanned pregnancy.

For women not actively seeking to become pregnant, discuss current contraceptive methods and any concerns or problems with that method.3

Preconception Checklist1,2,3


  • Folic acid supplement (400 mcg routine, 4 mg previous neural tube defect)
  • Carrier screening (racial/ethnic background/family history):
  • Sickle cell anemia
  • Cystic fibrosis
  • Thalassemia
  • Tay-Sachs disease

Screen for Infectious Diseases, Treat, Immunize, Counsel

  • HIV
  • Syphilis
  • Gonorrhea/Chlamydia
  • Hepatitis C in those with tattoos and/or body piercings
  • Immunizations:
    • Rubella, varicella, hepatitis B
    • Influenza vaccine if woman will be pregnant during influenza season
  • Toxoplasmosis – avoid raw meat, cat litter, garden soil
  • Cytomegalovirus, parvovirus B19 (fifth disease):
  • Frequent hand washing
  • Universal precautions for child health care

Environmental Toxins

  • Smoking cessation
  • Screen for alcoholism and use of illegal drugs
  • Occupational exposures – Material Safety Data Sheets from employer
  • Household chemicals – avoid paint thinners/strippers, other solvents, pesticides
  • Radiation exposure in early pregnancy

Medical Assessment

  • Evaluate overall health and opportunities for improving health
  • Determine if woman suffers from any undiagnosed or uncontrolled medical problems (e.g. diabetes, thyroid disease, dental caries or gum disease, heart disease, asthma)
  • Diabetes – optimize control
  • Hypertension – avoid ACE inhibitors, angiotensin II receptor antagonists
  • Epilepsy – consider increased dose of folic acid
  • DVT – switch from warfarin (Coumadin) to heparin
  • Acne – stop isotretinoins (e.g. Accutane)
  • Depression/anxiety and other mental health issues-discuss current benefit/risk medication data


  • Recommend regular moderate exercise
  • Avoid hyperthermia (hot tubs)
  • Counsel to maintain a healthy weight
  • Assess risk of nutritional deficiencies:
    • Vegan
    • Pica
    • Milk intolerance
    • Calcium or iron deficiency
  • Avoid overuse of:
    • Vitamin A (limit to 3,000 IU per day)
    • Vitamin D (limit to 400 IU per day)
    • Caffeine (limit to two cups of coffee or six glasses of soda per day)
  • Screen for domestic violence
  • Screen for social issues (e.g. place to live, child care, transportation)
  • Counsel on the use of over-the-counter medications, nutritional supplements, and naturopathic substances

Assess Any Complications from Previous Pregnancies

  • Cesarean section
  • Premature delivery
  • Hypertensive disorder of pregnancy
  • Diabetes
  • Rh incompatibility
  • Postpartum hemorrhage
  • Thrombotic event (DVT/PE)

More information:


  1. Freda MC, Moos MK, Curtis M. The history of preconception care: evolving guidelines and standards. Maternal and Child Health Journal 2006;10(5S): S43-S52.
  2. Brundage SC. Preconception health care. Am Fam Physician 2002; 65:2507-14.
  3. The importance of preconception care in the continuum of women's health care. ACOG Committee Opinion No.313. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005; 106:665-6.