Planning a pregnancy: what to start taking, and when

Most of the advice about pregnancy arrives once somebody is already pregnant. Some of the most useful things, though, work best in the months beforehand, which means the people who benefit most are the ones who think about it early. If you are planning a pregnancy this year, this is worth ten minutes now.

Folic acid, and why the timing is everything

Folic acid substantially reduces the risk of neural tube defects, which affect the development of the baby's brain and spine. The catch is that the neural tube closes within the first four weeks of pregnancy, often before somebody knows they are pregnant at all. Starting folic acid after a positive test is therefore later than ideal.

The standard advice is to start at least one month before conception and continue through the first twelve weeks. Because roughly half of pregnancies are not precisely planned, many clinicians suggest that anybody who could become pregnant and is not actively preventing it should be taking it anyway. It is inexpensive and extremely safe.

A higher dose is recommended for some people, including those with diabetes, those taking certain epilepsy medicines, and those who have had a previously affected pregnancy. That is a conversation to have specifically rather than assuming the standard dose applies.

Iron, and why it matters before as well as during

Pregnancy increases iron requirements considerably, and starting from a low level makes anaemia in later pregnancy much more likely. Anaemia leaves you exhausted, makes blood loss at delivery more serious, and is associated with poorer outcomes for the baby.

If you have heavy periods, follow a diet with little red meat, or have been told you were anaemic before, it is worth having your iron checked before you conceive rather than waiting for a routine test at the first antenatal visit. Building up a store takes months, not days.

Medicines to review before, not after

Some medicines are not suitable in pregnancy, and for several of them the safest alternative needs to be established and settled before conception rather than switched at the last moment. That includes certain treatments for epilepsy, blood pressure, acne, arthritis and mental health.

The message is emphatically not to stop anything on your own. Stopping a medicine abruptly is frequently more dangerous to both of you than continuing it, and for many conditions there is a well-established pregnancy-safe option. Come and plan it with us and your doctor, with time in hand.

The rest of the preparation

• Stop smoking, and ask for help if that is hard — it is the single biggest difference you can make.
• Stop alcohol, since no amount has been shown to be safe in pregnancy.
• Get long-term conditions such as diabetes, asthma or blood pressure well controlled first.
• Check your vaccinations are up to date, because some cannot be given during pregnancy.
• See a dentist, as gum disease is linked to problems in pregnancy and treatment is simpler beforehand.
• Aim for a healthy weight, gradually rather than through a crash diet.

What not to take

Avoid supplements containing vitamin A in the retinol form, which includes some general multivitamins and cod liver oil, because high levels can harm a developing baby. Choose a supplement designed for pregnancy instead, where the formulation accounts for this. Be cautious with herbal preparations too; natural does not mean tested in pregnancy, and for most of them nobody knows.

If you are unsure about anything on your shelf, bring it in. It takes a moment to check and it saves a great deal of worry.

The three months before

• Start folic acid, and iron if it is recommended for you.
• Have long-term conditions well controlled.
• Stop smoking and alcohol, and ask for help if that is hard.
• Check vaccinations, since some cannot be given in pregnancy.
• See a dentist, and bring your medicines list to us.

Questions we are asked about this

When exactly should I start folic acid?

At least a month before you start trying, and ideally as soon as you stop contraception. The part of development it protects happens in the first four weeks, often before a pregnancy is known about, so starting after a positive test is later than ideal.

Do I need a higher dose?

Some people do, including those with diabetes, those taking certain epilepsy medicines, those with a high body weight and those who have had a previously affected pregnancy. Ask rather than assuming the standard dose applies to you.

Should my partner take anything?

Sperm take around three months to develop, so the three months before conception matter for men too. Stopping smoking, moderating alcohol, keeping a healthy weight and avoiding excessive heat all help. No supplement has strong evidence, but general health does.

Can I keep taking my regular medicines?

Many are fine and some need changing, but the change should be planned before conception rather than made in a hurry afterwards. Do not stop anything on your own: for several conditions, stopping is the more dangerous option for both of you.

This article is general information from the Dantrio Pharmacy team. It cannot take the place of advice from a pharmacist or doctor who knows your medical history. If you feel seriously unwell, seek medical help straight away.