During our years in practice, we’ve seen an increasing number of patients who visit their doctor for preconceptional counseling. During this visit, your doctor can recommend a prenatal vitamin, explain the timing of intercourse to maximize fertility, review your medical problems, take a family history, and perform a basic physical exam and tests. More importantly, a preconceptional visit gives both you and your doctor a chance to control the things you can control in a pregnancy and increase your chances for a healthy baby.

Take Prenatal Vitamins
Surprisingly, perhaps the most important time to take prenatal vitamins is before you even get pregnant. We recommend that our patients start a comprehensive prenatal vitamin formula—or at least take the proper amount of folic acid—two to three months before they try to conceive. Luckily, many cereals are fortified with folic acid and it is found in its natural form, metafolin, in orange juice, spinach, asparagus, and pinto beans. An average American diet provides 200 to 250 micrograms of folic acid daily. However, because the recommended amount of folic acid in pregnancy is 600 micrograms, women of child-bearing age should add a multivitamin or prenatal vitamin to their regimen.1 Most multivitamins contain 400 micrograms of folic acid, and prenatal vitamins have 800 to 1,000 micrograms (1,000 micrograms is equivalent to 1 milligram).

Low levels of folic acid are linked to the development of birth defects such as neural tube defects (NTDs) and cleft lip and palate. Spina bifida, a NTD, results from the incomplete closure of the baby’s spine, or neural tube, which occurs during the week after conception.

Quite often, women don’t even know that they’re pregnant at that time. Affecting one to two babies per thousand, spina bifida causes paralysis and deformities of the legs. Similarly, folic acid plays a role in facial development, and women with low levels have a higher risk of having a baby with cleft lip and palate, which occurs in one in seven hundred infants. Neural tube defects and cleft lip and palate are birth defects a mom-to-be can help prevent. Consuming the correct amount of folic acid prior to pregnancy and during the first trimester decreases the incidence of these birth defects by 75 percent.

Following is the recommended folic acid intake:

Mothers at low risk: 0.6 milligrams per day
Mothers on seizure medication: 4 milligrams per day
Mothers with a previous fetus with a neural tube defect: 4 milligrams per day2

Some new prenatal vitamins and supplements contain the natural, active form of folic acid, metafolin. Folic acid is synthetic and must be broken down by enzymes in the body to be active, but metafolin does not require these metabolic steps. About half the population has an enzyme deficiency that limits the ability to metabolize folate. A blood test can be performed to see whether a patient has an abnormality in the gene that metabolizes folic acid. For these women, metafolin is a better choice.

The other ingredients in prenatal vitamins are similar to a general multivitamin: B-complex vitamins, vitamins C, D, and E, and the minerals zinc, iron, calcium, and copper. Some also contain a stool softener and DHA, an omega-3 fatty acid. The brand that you use is a personal decision. The variety on the market now is impressive: You can find chewable vitamins, vanilla-flavored vitamins, two small pills versus one large pill, and some with ingredients to alleviate nausea. We recommend finding something that doesn’t make you nauseous, is easy to swallow, and tastes good.

If you’re already pregnant and didn’t load up on prenatal vitamins, relax. Remember, at least 50 percent of pregnancies are unplanned and everything still turns out fine because most women get the vitamins they need through their diet. But if you have the opportunity to plan and start prenatal vitamins in advance, you can increase the chances of having a healthy baby.

Maintain a Healthy Weight
“Doctor, I’m thinking about having a baby but I’m concerned that I’m too heavy. Is this something I should worry about?” The answer to this question is an unfortunate, yet definite, yes. Losing weight is difficult, but returning your body to a healthy weight before pregnancy is one of the best things you can do for yourself and your baby.

Optimize Your Health
As mentioned, preconceptional counseling involves sharing your gynecologic history and undergoing a pelvic exam. Your doctor will inquire about your menstrual cycles. Are they heavy? Are they regular? Are they painful? Irregular cycles may indicate that you are not ovulating and that you may need medication to help you get pregnant. Heavy or painful periods are associated with fibroids or endometriosis, which may also influence fertility. If you have a history of a sexually transmitted infection, such as chlamydia or gonorrhea, or a severe pelvic infection, you may have scar tissue that prevents pregnancy. This problem can be further evaluated by using a special X-ray called a hysterosalpingogram (HSG) to see whether the fallopian tubes are open. During the pelvic exam, the doctor will check for the presence of uterine fibroids and ovarian cysts. If either is discovered, surgery may be required before you attempt to become pregnant.

Ideally, all existing medical conditions—diabetes, chronic hypertension, lupus, thyroid disease, seizure disorder, and any other chronic medical issues—should be well controlled before conception. Doing so will minimize the chance of pregnancy complications such as birth defects, miscarriage, and preterm delivery.