How to Prepare for Pregnancy: A Preconception Checklist

How to prepare for pregnancy: see a clinician for a preconception checkup, take 400 mcg of folic acid daily starting at least a month ahead, and get your vaccines, medicines, health conditions and habits in good shape before you start trying.

Planning ahead gives your body the best start for a pregnancy. The CDC recommends folic acid for anyone who could become pregnant, and many other steps, such as updating vaccines or adjusting a medicine, take time to fit in before you conceive.

This preconception checklist covers the checkup, vitamins, vaccines, medicines, habits, food safety, mental health, genetic screening, hazards, cycle tracking, your partner’s health and practical planning, with a timeline you can follow.

How to Prepare for Pregnancy: The Short Answer

Many of these steps take weeks to settle in. The CDC notes that the neural tube, which becomes the baby’s brain and spine, forms in the first few weeks of pregnancy, often before you know you are pregnant, so the habits you build now protect that early window.

This checklist works whether you are planning with a partner, on your own, with a donor or through a fertility clinic. The health steps are the same, and your clinician can fit the timing to your plan.

Book a Preconception Checkup

A preconception visit is an appointment with your primary care clinician, ob-gyn or midwife before you start trying. The CDC suggests bringing a written list of questions. According to the CDC and MedlinePlus (NIH), the visit usually covers:

• Health history: current and past conditions and past pregnancies.
• Family health history: MedlinePlus notes you may be referred to a genetic counselor.
• Every medicine you take: prescriptions, over-the-counter medicines, herbs, supplements and vitamins.
• Vaccines: MedlinePlus says blood tests may be needed to check immunity.
• Long-term conditions: MedlinePlus says problems such as asthma or diabetes should be stable before pregnancy.
• Mental health and safety at home: the CDC notes clinicians can help if you are in a stressful or abusive environment.

NICHD (part of the NIH) also suggests a reproductive life plan: how many children you hope to have and roughly when, including a partner’s plans. If you are already pregnant, our first trimester guide covers your first prenatal visits.

Start Folic Acid and a Prenatal Vitamin

The CDC says that if you could become pregnant, the U.S. Public Health Service recommends 400 mcg of folic acid every day, starting at least one month before conception and continuing through pregnancy. NICHD describes starting about three months ahead and notes studies showing this can reduce neural tube defect risk by up to 70 percent.

• Sources: the CDC explains folic acid is the form in vitamins and fortified foods such as many breakfast cereals. NICHD notes natural folate in foods is absorbed less well.
• Higher doses: if you have had a pregnancy affected by a neural tube defect, the CDC says to talk with your doctor first, because a higher dose is recommended. Take it only as your clinician directs.
• More is not always better: MedlinePlus cautions against high doses of vitamins A, D, E and K.

Many people get folic acid from a prenatal vitamin, which Mayo Clinic suggests starting a few months before conception. Our guide to prenatal vitamins covers what to look for on the label.

Vaccines, Medicines and Chronic Conditions

Vaccines. NICHD says the rubella and chickenpox (varicella) vaccines are recommended before pregnancy and suggests asking about boosters. Other vaccines can be given during pregnancy. If you need one now, ask how long to wait before trying.

Medicines. MedlinePlus advises limiting medicines and supplements you do not truly need and says your clinician may recommend changes. Do not stop a prescribed medicine on your own; ask first so any switch is planned safely.

Chronic conditions. NICHD says diabetes, high blood pressure, infections, asthma, seizure disorders and phenylketonuria (PKU) should be controlled before and during pregnancy, and links good control to lower miscarriage and stillbirth risk. If you have a thyroid condition, depression or any other diagnosis, follow the CDC’s advice: discuss every current condition with your clinician before you try.

Quit Smoking, Alcohol and Drugs, and Cut Back on Caffeine

The CDC advises stopping smoking, alcohol and drug use before pregnancy, warning they can cause premature birth, birth defects and infant death. MedlinePlus adds they can make conception harder and raise miscarriage risk. For help quitting smoking, the CDC lists 1-800-QUIT-NOW. Mayo Clinic says no amount of alcohol has been proved safe in pregnancy, and since you may not know you are pregnant for a few weeks, stopping while you try is simplest.

Caffeine. You do not have to quit coffee. Mayo Clinic says your clinician may advise keeping caffeine under 200 mg a day in pregnancy, and estimates about 95 mg in an 8-ounce cup of brewed coffee. MedlinePlus notes that more than 2 cups of coffee a day may make conception harder. Mayo Clinic also advises skipping herbal teas unless your clinician approves (see chamomile tea during pregnancy).

Food Safety, Weight and Physical Activity

MedlinePlus recommends a balanced diet of fruits, vegetables, grains, dairy and protein foods. Once you are trying, eat as if you might already be pregnant. Mayo Clinic advises:

• High-mercury fish: skip bigeye tuna, king mackerel, marlin, orange roughy, swordfish, shark and tilefish. Lower-mercury fish are fine at about 8 to 12 ounces a week (see eating shrimp while pregnant).
• Raw or undercooked foods: avoid sushi and raw oysters, and cook meat, poultry and eggs fully.
• Deli meats and hot dogs: heat until steaming or avoid them.
• Unpasteurized products: avoid soft cheeses unless labeled pasteurized, and unpasteurized juice.

Weight. The CDC says being underweight, overweight or obese each carries pregnancy risks, and Mayo Clinic notes either can cause ovulation problems. MedlinePlus advises working toward your goal before conceiving, since you should not try to lose weight during pregnancy. See our pregnancy weight gain guide for what comes next.

Activity. If you are not exercising now, MedlinePlus suggests 30 minutes of brisk exercise 5 days a week. If you already exercise, check your routine with your clinician.

Mental Health, Family History and Carrier Screening

The CDC says that if worry, sadness or stress does not go away and interferes with daily life, talk with your clinician about treatment. If you take medicine for a mental health condition, discuss it at your visit rather than stopping it. MedlinePlus also encourages good sleep and time to relax.

Start gathering your family health history now. The CDC says you may be referred for genetic counseling, especially after several miscarriages, fertility problems, or a genetic condition or birth defect in a previous pregnancy.

Carrier screening checks whether you carry a gene change you could pass on. Cleveland Clinic says it is recommended if you are considering pregnancy, and that a standard panel includes cystic fibrosis, fragile X syndrome, sickle cell disease, Tay-Sachs disease and thalassemia. Testing before pregnancy leaves time to weigh options such as IVF with genetic testing or donor eggs or sperm. If both biological parents carry the same recessive condition, each child has a 25 percent chance of having it. If you use a donor, ask your clinic what screening the donor has had.

Hazards at Home and Work, and Your Partner’s Health

The CDC advises avoiding harmful chemicals and toxic substances at home and at work, naming synthetic chemicals, some metals, fertilizer, bug spray, and cat or rodent feces. It notes these can harm the reproductive systems of both men and women. Let someone else change cat litter if you can, and if your job involves chemicals or other exposures, talk it through with your clinician.

Your partner’s health. If you have a partner, preparation is shared. The same hazard checks apply to both of you, and Mayo Clinic notes that fertility problems in either partner are a reason to see a professional sooner. A partner who quits smoking and cuts back on alcohol makes your changes easier too. In a same-sex couple or with a donor, the person carrying the pregnancy follows this checklist, and the other biological parent still matters for family history and carrier screening. Our 2 weeks pregnant guide has ideas for partners.

Tracking Your Cycle and Fertile Window

Mayo Clinic says having sex regularly from 3 to 4 days before ovulation until 1 day after gives the best odds. An egg can be fertilized for about 12 to 24 hours, while sperm survive about 3 to 5 days.

• Cervical mucus: clear, slippery discharge often appears just before ovulation.
• Basal body temperature: it rises slightly around ovulation; fertility is highest in the 2 to 3 days around the rise.
• Ovulation tests: home kits detect a hormone surge about 24 hours before ovulation.
• How often: Mayo Clinic says sex daily or every other day is linked to the highest pregnancy rates.

How long to try. Mayo Clinic says most healthy couples who have sex often get pregnant within a year. If you are under 35, try for a year before seeing a professional; at 35 or older, seek help after 6 months. For the earliest weeks, see 4 weeks pregnant.

How to Prepare for Pregnancy: A Timeline, Plus Money and Leave

• Insurance: check what your plan covers for prenatal care, birth, newborn care and any fertility care.
• Leave: ask human resources what leave and benefits you qualify for. Rules vary by employer and state.
• Budget and support: list the costs you can see coming (our baby registry checklist helps), and decide early who will help after birth, whether you are parenting solo or together.

After a positive test, see when to tell people you are pregnant.

Related Betteroo Guides

• Prenatal Vitamins
• 2 Weeks Pregnant
• 4 Weeks Pregnant
• First Trimester Guide
• hCG Levels by Week
• When to Tell People You Are Pregnant

When to Talk to Your Doctor

You do not need a problem to book a preconception visit. Make an appointment:

• A few months before trying: to start folic acid, update vaccines and adjust medicines (CDC, NICHD).
• Before trying, if you have a chronic condition: such as diabetes, high blood pressure, asthma, seizures, thyroid or mental health conditions, or take regular medicine.
• After a pregnancy affected by a neural tube defect: to discuss your folic acid dose (CDC).
• If your family has genetic conditions or several pregnancy losses: ask about genetic counseling and carrier screening.

See a clinician or fertility specialist after 12 months of trying if you are under 35, or 6 months if 35 or older (Mayo Clinic), and sooner if either partner has a known fertility problem. If you plan to use donor sperm or eggs, you can contact a fertility clinic from the start.

Call 911 or go to an emergency room for severe belly or pelvic pain, heavy bleeding or fainting. If you might be pregnant, read about ectopic pregnancy symptoms. If you are having thoughts of harming yourself, call or text 988. This article is general education, not medical advice.

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