A Guide to Your Preconception Visit

Ready to start a family? Scheduling a visit with your ob-gyn before you start trying to conceive is a must. Considering that 50 percent of all pregnancies in the U.S. are unintended (meaning they happened without planning) and that your baby starts developing even before you know you're pregnant, a preconception visit is one of the most significant things you can do for your future child. "Meeting with your ob-gyn is an important first step for couples planning to conceive," says Michele Hakakha, M.D., F.A.C.O.G., and author of Expecting 411: Clear Answers & Smart Advice for Your Pregnancy. "It's a time when patients can sit down with their practitioners to go over key issues to ensure a healthy start to a pregnancy." Before you go, read our guide to help you prepare for your visit.

Your doctor will want to go over all aspects of your health history. To make the process easier, take a list that contains a thorough family history; you may need to call a few relatives to inquire about possible genetic issues or inherited diseases. You should also have a list of all the medications, herbs, and vitamins you're taking, plus any records you may have from previous physician visits, including a vaccination history and recent blood work. And don't forget to bring your partner with you along with his family medical history.

In addition to your medical history, you should be prepared to answer questions about any previous high-risk pregnancies (preterm labor, preeclampsia, diabetes, etc.), miscarriages, abortions, and other gynecological issues, such as fibroids. Being honest and straightforward about your current and past health will ensure that your doctor can offer you the best advice and guidance.

Your doctor will discuss your everyday habits, and will want to know about any habits, like smoking and drinking, that can affect developing babies, so he can try to help you quit or correct the problem before you get pregnant. "It's also important to make sure that a woman is close to her ideal body weight; if she's not, discussing the risks of being overweight or severely underweight is important," says Marra Francis, M.D., an ob-gyn at Obstetrics and Gynecology of The Woodlands, in The Woodlands, TX. Your practitioner will also inquire about your home life, asking about the health of other children; any pets; use of pesticides; and your work life, to monitor any potential dangerous exposures such as X-rays and prolonged sitting, standing, or lifting.

You expect your doctor to record the basics such as your height, weight, and blood pressure, but a preconception visit doesn't typically include an exam. If you're up-to-date with your annual exam (recent Pap smear and breast exam) and you don't have any current or previous issues that would warrant an exam, such as a history of fibroids or endometriosis, you shouldn't need one. If you're due for your annual, though, you can plan for a full vaginal, pelvic and breast exam, as well as a Pap smear.

You'll also need urine and blood tests. The blood tests will check for varicella (chicken pox), rubella (we're often vaccinated against as children in the measles, mumps, and rubella [MMR] vaccine, but over time, our immunity can fade), blood type and Rh factor, and sometimes vitamin D and the thyroid hormones. It's a good idea for your partner to get a blood test to confirm his blood type

Even though you know the basics of the birds and the bees, you probably have a lot of questions about trying to conceive. Be sure to go to your visit with a list of questions you want to ask, no matter how intimate or silly you think they are -- your doctor has probably heard them all before. You may want to discuss how and when to stop birth control, when to start trying (never mind the myth that you need to wait three months after stopping birth control to start trying to conceive, says Dr. Francis) and when during your cycle you are most fertile. Your doctor will be able to offer you advice to help you get on your way.

You can be sure that you'll walk away from your visit with some homework to start or maintain a healthier lifestyle. Routine exercise is recommended before and during pregnancy. "However, like everything else in life, too much of a good thing can be bad," says Dr. Hakakha. "My general rule is to stay away from exercise that has forceful jarring movements or has the potential for a sudden fall." She suggests limiting caffeine to two servings a day and quitting smoking.

Finally, starting a prenatal vitamin prior to conceiving is a vital first step. Most women don't know they're pregnant until they're already four weeks along -- the time at which most over-the-counter urine pregnancy tests can detect pregnancy hormones. By that time, the baby's spine and skull have already closed, and not having enough folic acid in your diet can lead to defects in this process. Also, most of the baby's organs are already in full development. Dr. Hakakha recommends that women of childbearing age who aren't using a hormonal birth control method take a prenatal vitamin, or at the very least, 400 micrograms of folic acid.

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