Preconception Health

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The Centers for Disease Control and Prevention (CDC) states that the essence of preconception health involves getting and staying healthy overall.

What is Preconception Health?

Preconception health refers to a person’s health before pregnancy. It centers around taking steps in the present to protect a person’s health and that of a baby if conception occurs. Preconception health may reduce adverse pregnancy-related outcomes by promoting health before pregnancy, leading to healthier pregnancies and improved long-term health outcomes for children.

Though it focuses on promoting the health of the birthing parent and their baby, anyone can benefit from the principles of preconception health regardless of their interest in having a baby. The Centers for Disease Control and Prevention (CDC) states that the essence of preconception health involves getting and staying healthy overall. It includes actively choosing healthy habits to encourage a healthy lifestyle.

Importance of Preconception Health

Despite the advances in medicine and prenatal care in recent years, the birth outcomes in the United States are worse than those of many other developed countries. For instance, you can compare trends in birth weight, an important metric of birthing outcomes. The Boston Children's Hospital reports that 7.6% of newborns in the US are born at a low birthweight. This statistic can be compared with the 4.68% of low birthweight babies born in Northern Europe, according to a 2021 NIH-published study written by Diego Erasun, MD. Unfortunately, the disparities go even further than that when we consider race: the March of Dimes Perinatal Data Center found that Black babies in the US were at an average of 14.3%, or twice as likely, to be born with a low birthweight during 2022-2024. Preconception health can help healthcare providers and families create a plan to reduce adverse pregnancy outcomes such as low birth weight and to help support fetal development. 

In addition to fetal health, maternal conditions such as gestational diabetes are increasingly prominent in the United States, especially regarding Black women. Gestational diabetes is one of the most common complications of pregnancy and is associated with an increased risk for type 2 diabetes. In a study describing blood sugar and screening services among different racial groups, Julie K. Bower, PhD, found that Black women had a 63% higher risk for diabetes compared to their white counterparts. Dr. Bower made note that delays in identifying high blood sugar and diagnosing diabetes in ethnic minority groups may reflect poor follow-up of abnormal screening test results. Preconception health includes having conversations with healthcare providers to help manage factors such as pre-pregnancy blood sugar, blood pressure, and weight management. These assessments are helpful in reducing the risk of adverse maternal health. 

Fortunately, the CDC has found that preconception health and overall health care can make a difference. Preconception care offers family physicians and their patients an opportunity to discuss risk factors to minimize complications before pregnancy and to promote a safe and healthy pregnancy.

Planning for Pregnancy

Preconception health provides the opportunity for intentional family planning. If you are interested in becoming a parent, it is never too early to start preparing for pregnancy. Taking action before conceiving can help improve fertility, support a healthy pregnancy, and reduce the risk of complications for the pregnant person and the developing fetus. The following steps are recommended by the CDC and the American College of Obstetricians and Gynecologists (ACOG):

  • Make a Plan and Take Action. There are many things to think about when it comes to preparing for pregnancy and starting a family. Making a plan to guide you through the steps of preparing yourself for pregnancy allows you to think ahead, strategize, and gather information that can make a big difference in your journey towards a healthy pregnancy. To help you prepare for getting pregnant, the CDC has prepared a downloadable checklist. Click here to access the checklist.
  • Learn Your Family History. Understanding your family history can help identify potential genetic risks that may affect pregnancy. Sharing this information with your healthcare providers can allow for proactive planning, such as appropriate screening and counseling. 
  • See Your Doctor. Express to your healthcare provider your interest in getting pregnant. Part of this conversation should discuss your family history, medications, and chronic medical conditions. Some medical conditions, such as seizure disorders, high blood pressure, depression, and diabetes, can complicate pregnancy; however, it does not mean that you cannot have a healthy pregnancy and baby. Preconception counseling allows for care to be started and more closely monitored before pregnancy to reduce pregnancy-related risks.
  • Take 400 Micrograms of Folic Acid Every Day. Folic acid is a B vitamin. The CDC urges everyone who can become pregnant to take folic acid because it can help prevent major birth defects in the developing fetus’s brain and spine early in pregnancy. Additionally, researchers such as Madhusudan Dey, PhD, found that low levels of folic acid during pregnancy are strongly correlated with adverse outcomes such as miscarriages, preterm delivery, and maternal anemia. For more on folic acid or the impact of other vitamins on pregnancy, click here to visit our Pregnancy and Nutrition webpage.
  • Reach and Maintain a Healthy Weight. Being underweight, overweight, or obese can affect fertility and increase the risk of complications such as gestational diabetes, preterm birth, and high blood pressure during pregnancy, including preeclampsia. If you have concerns about your weight, talk with your healthcare provider about healthy ways to achieve and maintain a weight that supports pregnancy.
  • Regular exercise. There are multiple ways to stay active, including yoga, gardening, walking, Pilates, dancing, and more. Not only is regular exercise helpful for improving fertility, but it is also beneficial for overall health. ACOG recommends 150 minutes of moderate physical activity each week, which can be broken down into 30-minute sessions five days per week. Talk to your healthcare provider about exercises that are appropriate for you.
  • Get Mentally Healthy. Mental health encompasses your emotional, psychological, and social well-being. Though feelings such as anxiety, sadness, and stress are normal, if these feelings are interfering with your everyday functioning, do not be afraid to reach out for professional help. Your mental health matters.
  • Stop Drinking Alcohol, Smoking, Illegal Drugs, and Harmful Substances.  Though easier said than done, for a better pregnancy outcome, it is crucial to stop unhealthy habits such as using tobacco, alcohol, marijuana, and illegal drugs. Using these substances may create or increase risk factors during pregnancy that can result in conditions such as premature birth or birth defects. Stopping before pregnancy can allow time to seek help if needed, and it decreases the risk of serious problems for the birthing person and their fetus. Please speak to your healthcare provider if you need help quitting. 

Additionally, some medications, vitamins, and herbal remedies can be harmful to a fetus and should not be taken during pregnancy. Bring a list of your medications or the medication bottles with you to your appointment. Doing so will allow the provider to determine the safety of each medication and whether or not you should take them while pregnant. 

Preconception Counseling

Preconception counseling is health-promoting education that allows for risk assessment, intervention, and medical care before pregnancy to reduce the risk of negative maternal and fetal outcomes. This counseling optimizes the person’s health prior to and during pregnancy, and it enhances the clinician’s ability to identify modifiable risk factors to improve pregnancy outcomes, according to Lisa Bayer, MD, MPH. Identifying the potential risks as early as possible is especially important because, as the American College of Obstetricians & Gynecologists (ACOG) makes clear, major organs of the fetus develop within the first eight weeks of pregnancy. 

The Importance of Nutrition

Another important aspect of preconception health is proper nutrition. Sufficient nutrient intake starting from preconception throughout pregnancy is critical for healthy outcomes. Having a nutritional balance can help prepare the body for a healthy pregnancy and fetus. Pregnancy places specific nutritional burdens on the bodies of pregnant people, Tonni Oberly, MPH, explains. These burdens include an increased demand for iron, folate, calcium, vitamin D, and protein. 

  • Iron: A crucial component during preconception because it is a building block for hemoglobin, which carries oxygen throughout the body, including to the developing fetus. Iron-rich foods include beef, turkey, liver, beans, and lentils. It is also helpful to eat foods that can help your body better absorb iron, such as orange juice, grapefruit, strawberries, and peppers. Ask your doctor if you need a prenatal supplement with iron as well.
  • Folate: Also known as folic acid, helps prevent birth defects involving the brain and spinal cord. The Office of Disease Prevention and Health Promotion recommends a supplement that has 400 to 800 mcg of folic acid. Folate can also be found in leafy greens, asparagus, beans, peas, and fortified breakfast cereals. 
  • Calcium: Adequate calcium intake can lower the risk of hypertensive disorders such as preeclampsia and is essential for developing the fetus’s bones and teeth. Good sources of calcium are milk and other dairy products, kale, and broccoli. 
  • Vitamin D: This vitamin is associated with improved implantation, continued fetal development, and overall reproductive health, according to a 2022 NIH-published study by Dr. Szabolcs Várbíró, Ph.D and his team. Fortified milk and breakfast cereals, fatty fish such as salmon and Atlantic mackerel, fish liver oils, and egg yolks are recommended by the NIH as good sources of vitamin D. For a list of fish that should be avoided due to high mercury levels, especially while pregnant, click here to visit the FDA’s “Advice about Eating Fish” webpage.
  • Protein: According to the World Health Organization, an important component of a preconception diet is protein. Sufficient protein intake plays a role in fetal growth and development, promotes recommended gestational weight gain, and improves pregnancy outcomes.  

Some people, particularly those from low-income communities, may have difficulty meeting these nutritional needs. Lisa Bodnar, MPH, PhD, reports that poor nutritional health disproportionately impacts low-income, food-insecure women and can affect their reproductive health and ability to carry healthy pregnancies to term. Besides affecting the mother, food insecurity can also compromise fetal health outcomes. Jasmine Fledderjohann, PhD, and Ana Augusto, PhD, show that it can lead to a possible increased risk for the following:  

  • Premature birth
  • Low birth weight 
  • Neonatal mortality, or the death of an infant within its first 28 days of life
  • Early discontinuation of breastfeeding 
  • Impaired infant and child cognitive development

For more information about food justice, nutrition, and reproductive health, click here to visit our Food Justice and Reproductive Health webpage.

Environmental and Social Factors

Preconception health expands into environmental and social considerations because these factors can influence the health and well-being of the pregnant person and fetus. For instance:

  • Intimate partner violence: Also known as domestic violence, intimate partner violence can be harmful to everyone, including children. The CDC reports that over two-thirds of people who experience violence by a current intimate partner during pregnancy also experienced it before pregnancy. Your OB/GYN or other obstetric care provider can help you find resources in your state that offer aid. In addition, you can call the toll-free, 24-hour National Domestic Violence hotline at 800-799-SAFE (7233) and 1-800-787-3224 (TTY). 
  • Substance use: Your partner and anyone else in your household should abstain from substance use around you when you are pregnant or trying to conceive. Being exposed to this type of environment may be dangerous to your health or influence you to participate in the use. Additionally, in a review of recent studies, Sarah LaPointe, Ph.D, found that smoking, drinking alcohol, and using drugs may damage sperm cells, make it harder to conceive, and have harmful prenatal effects. Researchers such as Vaishnavi D. Dhage, MPH, have reported that passive smoking, also referred to as secondhand smoking, is linked to lower fertility rates in women. For assistance with cessation of substance use, please reach out to your healthcare provider for support.
  • Your immediate surroundings: At home, at work, or in the community, you may be exposed to harmful chemicals that may impact your reproductive health and the health of a fetus. Some toxic chemicals to be aware of are pesticides, lead, and common classes of endocrine-disrupting chemicals (EDCs) such as phthalates, dioxins, and parabens. Routes of exposure can include eating contaminated foods, breathing polluted air, and applying certain chemical-based personal care products to your skin. They can even pass to a fetus through the placenta or to a baby via breastmilk. Sources of these chemicals can come in many forms, including, but not limited to, lotions, shampoos, makeup, plastic food storage containers and water bottles, nonstick cookware, as well as clothing, mattresses, and furniture that have been treated to be waterproof, greaseproof, or fireproof. For more information about EDCs and their adverse impacts on reproductive health, click here to visit our Environmental Justice webpage.

Overall, preconception health focuses on improving a person’s physical, mental, and emotional well-being before pregnancy to encourage healthier outcomes for pregnant people, fetuses, and babies. It includes healthy lifestyle choices such as managing chronic conditions, receiving proper nutrition, and reducing harmful actions. Preconception health also includes having important open dialogues with your medical providers, gathering information about family history, and assessing environmental, social, and nutritional factors before pregnancy. Ultimately, by identifying and addressing health concerns early, the risk of adverse pregnancy-related complications may be significantly reduced.