Pre-Pregnancy Checklist

November 2, 2021

Preparing to get pregnant has some similarities to training for a race. You want to be in your very best health to reach the finish line with your precious cargo.

“It’s never too early to start prenatal care,” says Daniel R. Bradke, MD, OB/GYN at Memorial Hermann Medical Group Kingwood OB/GYN.  “Pre-pregnancy planning can help reduce risks of adverse outcomes to both mother and baby.”

Here are 12 tips from Dr. Bradke to improve your odds of a successful, healthy delivery:

1. Start taking prenatal vitamins as soon as you decide to get pregnant.

“There’s never a bad time to start taking your prenatal vitamins,” says Dr. Bradke.

Such supplements are rich in folic acid, calcium, iron and vitamins A, B and D. “Folic acid in particular is vital to the development of your baby’s brain, spine and central nervous system,” Dr. Bradke says.

Most women need to take 400 micrograms daily, but check in with your OB/GYN. Some women—including those who have seizure disorders or have given birth to children with brain or spine deformities —may need to take as much as 4 milligrams daily.

2. Quit smoking and drinking alcohol—period.

Don’t wait till you’re pregnant, Dr. Bradke says. “Stop bad habits now.”

Those substances are strongly linked to low-birthweight infants and higher rates of placenta abruption, preterm labor and ectopic pregnancy, he says.

Women who smoke during pregnancy may have children who later in life are obese or have colic and asthma.

“No level of alcohol is acceptable throughout pregnancy,” Dr. Bradke says. “Alcohol use leads to cognitive defects and behavioral problems that could be lifelong for the child.”

3. Bring your partner to meet with your obstetrician as part of pre-pregnancy counseling.

Your partner also can be counseled on healthy habits and reproductive expectations. Raising children is a team sport. So is pregnancy. Your partner can support you throughout.

Plus, your doctor needs to know the medical history of both partners, including if previous generations had premature or underweight babies.

Your OB/GYN will want to know about both partners’ family history of cancer, bleeding disorders or inherited syndromes and may refer you to a genetic counselor.  

Blood tests and ultrasounds during pregnancy also may reveal major genetic syndromes, including Down syndrome, Turner syndrome or Edwards’ syndrome. These chromosome defects can cause developmental delays or other more serious medical issues. Screening for genetic syndromes is recommended, usually starting around 10 weeks into the pregnancy.

4. Exercise and eat well.

For a healthy pregnancy and delivery, future moms should be at a healthy weight. That lowers the danger of gestational diabetes and preeclampsia. The latter can cause high blood pressure or liver and kidney damage in the second half of a pregnancy. Unless your doctor advises otherwise, moderate intensity exercise for 30 minutes 5 days a week is healthy for mother and child.

5. Review your personal health history with your OB/GYN.

Chronic conditions such as fibroids, diabetes, substance use, hypertension or psychiatric ailments need to be managed carefully. Some medications used to treat these conditions may harm developing fetuses.

If you have high blood pressure or a history of preeclampsia, your obstetrician may ask for a urine protein sample to serve as a baseline to compare to later samples in pregnancy to screen for preeclampsia. Your doctor also may ask you to keep a daily log of your blood pressure and ask to see it weekly. You also may be prescribed baby aspirin (81 milligrams) as studies show this to slow the progression to preeclampsia.

6. Get a pap smear.

If you have cervical cancer, you will need a multidisciplinary team to take care of you. This usually includes high-risk obstetricians including gynecologic oncologists.

7. Get up-to-date on any vaccines you need.

Ideally, you should be fully vaccinated for hepatitis, measles, mumps, rubella (MMR), and tetanus, diphtheria and pertussis (Tdap). Some, including for MMR, should be given at least a month prior to pregnancy.

You also should get a flu shot versus the nasal flu vaccine. Live viruses in the latter should not be given until after pregnancy.

You also should be vaccinated against COVID-19. These vaccines are supported by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine. Pregnant women who have not been vaccinated have a higher death rate than those who are vaccinated.

Your doctor may suggest waiting until you’re between 27 and 36 weeks pregnant to protect yourself and your baby from pertussis, also known as whooping cough. You should get the shot no matter how recently you previously received it. If you did not get the Tdap vaccine before delivery, the U.S. Centers for Disease Control and Prevention recommends you get it promptly after giving birth.

8. Discontinue birth control.

Once you and your doctor have a pre-pregnancy plan, you can discontinue birth control. “Then you can ovulate on the next cycle,” Dr. Bradke says. “Also, stop birth control if you learn you’re already pregnant.”

9. See your OB/GYN as soon as you suspect you’re pregnant.

One reason is you’ll need an ultrasound to rule out an ectopic pregnancy, which happens in 2 percent of pregnancies, or one in 50. These pregnancies are outside the uterus, typically in the fallopian tubes.

“The tube could rupture, causing bleeding into your abdomen, which is a surgical emergency and could be fatal,” says Dr. Bradke.

10. Consider tracking your ovulation to boost your chances of becoming pregnant.

“Ovulatory predictor at-home kits sometimes are accurate, and sometimes not,” Dr. Bradke says. “The best tests to determine whether you’re ovulating are of your blood.”

Your highest chance of becoming pregnant is to have intercourse 3 to 4 days before your expected ovulation and through that week.

11. Talk with your doctor about fertility concerns based on your age and personal history.

The length of time you should try to conceive before considering fertility treatments is based on your age and whether you have certain medical conditions. Generally, if you’re 35 or over and have been trying to get pregnant for 6 months or longer, you should consider seeing a fertility specialist.

If you’re younger than 35 and have had unprotected sex for a year without success, then it may be time to see a specialist.

Regardless, “If you’re having trouble getting pregnant or you’re concerned something is wrong, speak to your doctor as soon as possible.”

12. Don’t assume you cannot carry to term because you’ve miscarried previously.

Ten percent to 15 percent of pregnancies miscarry. “After three miscarriages, we worry there may be a physical anomaly or genetic syndrome causing them,” Dr. Bradke says. “But just because you’ve had a miscarriage doesn’t mean you’ll have another.”

Seeking early care from your OB/GYN provides your best chance for a healthy pregnancy, while building a close bond with your doctor, another partner in parenthood.

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