Preconception Checkup: What Tests Do You Need Before Pregnancy?

Why does timing matter — why not just start trying?

The first several weeks of a pregnancy are the period of highest sensitivity to nutritional deficiencies, uncontrolled chronic illness, and medication exposures — often before a person even knows they are pregnant. Optimizing health in advance reduces these risks. For example, adequate folate in the weeks before conception significantly reduces the risk of neural tube defects, and folate from food alone is often insufficient. 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 200: Early Pregnancy Loss.Folic acid supplementation before and in early pregnancy to reduce neural tube defect risk

Three to six months before trying gives time to adjust medications that are not safe in pregnancy, complete any needed vaccinations, address chronic conditions like diabetes or thyroid disease, and build folate stores.

What does the visit cover?

A thorough preconception visit typically includes:

Medical and reproductive history - Chronic conditions (diabetes, hypertension, thyroid disease, epilepsy, autoimmune disorders) - Previous pregnancies, losses, or complications - Family history of genetic conditions or birth defects - Current prescription and over-the-counter medications and supplements

Medication review Some medications — including certain seizure drugs, blood thinners, isotretinoin (for acne), and some psychiatric medications — require dose adjustment or switching before and during pregnancy. Your clinician will review everything you take.

Mental health Screening for depression and anxiety before pregnancy matters: untreated mood disorders carry their own risks to pregnancy outcomes, and the preconception visit is a good time to establish support. 2Ref 2American College of Obstetricians and Gynecologists (2023).Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4.Importance of mental health screening as part of perinatal care, including the preconception period

Lifestyle discussion - Smoking cessation (strongly recommended before conception) 3Ref 3American College of Obstetricians and Gynecologists (2020).Tobacco and Nicotine Cessation During Pregnancy: ACOG Committee Opinion, Number 807.Recommendation for smoking cessation before and during pregnancy - Alcohol: no safe level has been established in pregnancy; stopping before trying is the guideline recommendation - Body weight: both underweight and significant obesity affect fertility and pregnancy outcomes - Occupational or environmental exposures

What lab tests are standard before trying to conceive?

Standard preconception lab work varies by individual history, but a typical panel includes:

| Test | Why it matters | |---|---| | Complete blood count (CBC) | Rules out anemia; iron stores support a healthy pregnancy | | Blood type and Rh factor | Rh-negative people may need Rh immunoglobulin during pregnancy | | Rubella (German measles) immunity | If not immune, vaccination is needed — and pregnancy must wait a month after the MMR vaccine | | Varicella (chickenpox) immunity | Same reasoning; vaccination if not immune | | Thyroid-stimulating hormone (TSH) | Thyroid conditions are common and affect fertility and fetal development | | Chlamydia and gonorrhea screening | Untreated STIs can affect fertility and early pregnancy; screening is recommended 4Ref 4US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. (2021).Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement.STI screening as part of routine women's health and preconception care | | HIV screening | Recommended for all adults; important for pregnancy planning 5Ref 5US Preventive Services Task Force; Owens DK, Davidson KW, Krist AH, et al. (2019).Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement.HIV screening recommended for all adults, relevant to preconception planning | | Hepatitis B and C | Status affects management during pregnancy | | Blood glucose or hemoglobin A1c | Especially if overweight or with family history of diabetes 6Ref 6US Preventive Services Task Force (2021).Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement.Diabetes screening as part of preconception health evaluation | | Carrier screening | Offered based on ethnicity or family history (cystic fibrosis, sickle cell, spinal muscular atrophy, fragile X, and others) |

What supplements are recommended before conception?

Folic acid (folate): The standard recommendation is 400–800 micrograms of folic acid daily, starting at least one month before conception and continuing through the first trimester. People with a prior neural tube defect-affected pregnancy or who take certain medications (including some for epilepsy) may be prescribed a higher dose — your clinician determines the right amount for you. 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 200: Early Pregnancy Loss.Folic acid supplementation before and in early pregnancy to reduce neural tube defect risk

Prenatal vitamin: Many clinicians recommend starting a prenatal vitamin before conception to ensure adequate iron, iodine, and vitamin D alongside folate. Check that your prenatal contains iodine, as not all do.

What to avoid over-supplementing: High doses of vitamin A (retinol, not beta-carotene) can cause birth defects. Avoid supplements containing more than the recommended daily allowance of preformed vitamin A.

Does my partner need a preconception visit too?

Male-factor issues account for roughly half of infertility cases, and sperm quality is affected by health habits including smoking, heavy alcohol use, heat exposure, and certain medications. 7Ref 7Schlegel PN, Sigman M, Collura B, De Jonge CJ, Eisenberg ML, Lamb DJ, Mulhall JP, Niederberger C, Sandlow JI, Sokol RZ, Spandorfer SD, Tanrikut C, Treadwell JR, Oristaglio JT, Zini A (2021).Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I.Male-factor contribution to infertility and the value of preconception health optimization for male partners A preconception visit for the male partner — typically with a primary care clinician or urologist — can cover general health, medication review, and discussion of habits that affect sperm quality. Semen analysis is not routine before trying to conceive but may be offered if there is a prior fertility concern or risk factor.

When should a fertility specialist be involved from the start?

A reproductive endocrinologist or fertility specialist (rather than a general OB-GYN) is the appropriate first stop if: - You have a known condition affecting fertility (PCOS, prior tubal surgery, prior cancer treatment) - You are over 35 and concerned about ovarian reserve - You have had two or more pregnancy losses - Your partner has a known semen abnormality

For most people, an OB-GYN, midwife, or even a well-prepared primary care clinician can handle a preconception visit. Gale can help you prepare questions and organize your history before the appointment.