Prepregnancy (preconception) management focuses on optimizing a person’s health before conception to improve fertility, reduce pregnancy complications, and support better outcomes for parent and baby.
Identifying and managing medical, lifestyle, and environmental risks early
Ensure adequate nutrition and supplementation
Review medications and vaccines
Address genetic and family-history concerns
Promote healthy weight, physical activity, and avoidance of toxins
Folic acid / folate 400–800 mcg daily (higher doses, often 4 mg, if prior neural-tube defect, certain medications, or diabetes)
Start ideally ≥1 month before conception and continue through first trimester
Chronic conditions Optimize control of diabetes, hypertension, thyroid disease, asthma, epilepsy, autoimmune disorders
Aim for tight glycemic control (e.g., HbA1c target individualized) and stable blood pressure before pregnancy
Medications
Review all prescription, OTC, and herbal products; switch teratogenic drugs when possible.
Drugs of concern: certain ACE inhibitors, some anticonvulsants, isotretinoin, warfarin.
Vaccinations
Update MMR, varicella, Tdap, influenza, COVID-19, hepatitis B as indicated
Live vaccines (MMR, varicella) should be given ≥1 month before conception
Weight & nutrition
Achieve healthy BMI when possible; balanced diet rich in fruits, vegetables, protein, iron, calcium
Eat a balanced diet; consider iron, vitamin D, iodine as advised
Both underweight and obesity increase risks.
Consider bariatric surgery timing if relevant
Lifestyle
Stop smoking/vaping, limit or eliminate alcohol, avoid recreational drugs, moderate caffeine
Get regular moderate exercise
Manage stress and sleep well
Screen for HIV, hepatitis B/C, syphilis, chlamydia/gonorrhea as appropriate; treat as needed
Rubella and varicella immunity should be confirmed
Genetic / carrier screening Offer carrier screening (e.g., cystic fibrosis, spinal muscular atrophy, hemoglobinopathies) based on ancestry and preferences
Mental health
Screen for depression, anxiety, substance use; stabilize treatment
Untreated mental-health conditions can affect pregnancy and postpartum period
Environmental & occupational
Minimize exposure to heavy metals, solvents, radiation, certain pesticides
Ideal: 3–6 months (or longer) before attempting conception
Relevant for anyone planning pregnancy, including those with prior pregnancy complications, chronic illness, advanced maternal age, or recurrent loss.
Dental checkup (gum disease has been linked to pregnancy complications)