How to get your body ready for a baby

To give yourself the best chance of conceiving, it's worth making a few simple changes to improve your overall health before trying to conceive. Staying healthy, eating well and giving up alcohol will not only increase your chances of getting pregnant (NHS 2020a) but also set you up for a healthy pregnancy.

Should I reach a healthy weight before trying for a baby?

It's a good idea. Being a healthy weight will improve your chances of conceiving. A healthy body mass index (BMI) is between about 19 and 25 (NICE 2021).

If you have a BMI or 25 or more, losing weight will reduce the risk of complications during pregnancy for you and your baby, especially if your BMI is 30 or higher. It may improve your fertility too (NICE 2021).

Just be aware that BMI isn’t a perfect measurement as it only looks at weight compared to height. It can’t tell how much of your weight is fat, muscle or bone. And it doesn’t take into account your age or sex. It’s still used by your midwife and doctor though, because it’s a straightforward way of assessing someone’s weight.

If you do have a high BMI, losing just five to 10 per cent of your body weight could increase your chances of conceiving and significantly reduce the risk of complications during pregnancy (NICE 2021). At 14 stone, or 196 lbs, this means losing 10 to 20 lbs.

Adopting a balanced diet and keeping fit now will also give you a great start to pregnancy.

If your BMI is less than 18.5, talk to your doctor about healthy ways to increase it. You're more likely to have an irregular menstrual cycle if you have a low body weight (NHS 2019b). This can make it harder to conceive, particularly if you're missing periods.

Fortunately, in many cases, achieving a healthy weight will get your cycle back on track (NHS 2019b).

Women who are underweight before pregnancy are more likely to have premature babies and babies with low birth weights. Sadly, they’re also more likely to have an early miscarriage (NICE 2021). So it makes sense to achieve a healthy weight now, to give your baby the best possible start.

Should I stop smoking, drinking and taking drugs before trying for a baby?

Yes. Smoking and drinking alcohol can both cause serious health problems for your baby if you do conceive. They also increase your risk of miscarriage (NHS 2020a, NHS 2020b).

Drugs, including marijuana, ecstasy, cocaine and heroin, can have a serious impact on your unborn baby, from miscarriage and low birth weight, to developmental problems after they’re born (NICE 2021).

When you become pregnant, you're unlikely to realise straight away. So it's well worth quitting these harmful substances now, so you can protect your baby in those crucial first days and weeks.

Quitting smoking can be tough, but you're up to four times more likely to succeed with the right help (NHS 2018a). You can self-refer to your local stop smoking services, who will work with you to develop a tailored plan to help you quit. You can also visit the NHS Better Health website, download their app, or call their helpline on 0300 123 1044 (England only).

There hasn't been enough research for us to be sure whether vaping using e-cigarettes can make it harder for you to conceive. We do know that consuming nicotine alone, such as in patches and lozenges, is safer than smoking cigarettes. But we don't know what effects the other chemicals in e-cigarettes may have (PHE 2020) and whether vaping damages your lungs. So to play it safe, it's best to try to quit smoking altogether.

When it comes to alcohol, you should avoid it completely. No amount of alcohol is safe during pregnancy and the more you drink, the higher your baby's risk of long-term health problems (NHS 2020b).

If you take any illegal drugs, or new psychoactive substances (NPS) such as M-CAT, be sure to tell your GP. They will have seen it all before, so won't judge you. Instead, they'll refer you for some extra support, to help you give your baby a healthy start in life (NICE 2021).

You can also contact the drugs advice service FRANK for friendly, confidential advice and support.

Should I see my GP before trying for a baby?

If you're fit and healthy, there's no reason to see your GP before trying. But if you have any concerns, visiting your local surgery before you stop using contraception may be a good idea. Most surgeries provide a special check-up for couples who are trying for a baby, known as preconception care.

Your check-up won't necessarily be with your GP. You may see a midwife or a practice nurse instead. Some private health insurance companies also offer these kinds of checks.

However, it's important to see your GP or specialist if you have a long-running medical condition such as epilepsy, asthma or diabetes (NHS 2020a).

If you're taking any medication, you may need to make some changes to your treatment. This is because some types of medicine, such as sodium valproate (for epilepsy) (NHS 2021a) or isotretinoin (for acne) (NHS 2022), aren't safe to take when you're pregnant. However, you should never stop taking any medication without discussing it with your doctor first (NHS 2020a).

If you're changing your treatment, your body may need time to adjust. So ideally, make an appointment with your doctor at least three months before you want to conceive. The earlier you do this the better though as specialist referral may be needed and there may be a wait of several months before you get an appointment.Some over-the-counter medicines, such as ibuprofen, aren't recommended as safe to use during pregnancy (NHS 2018b). Ask a pharmacist if you're not sure what to buy.

What should I expect at a preconception care check-up?

If you do decide to have a pre-pregnancy check-up, your GP or nurse will probably ask you about:

• whether you have any problems with your periods
• your general health, such as diet, exercise and lifestyle
• the date of your last cervical screening (smear test)
• your emotional wellbeing
• whether your job involves working with hazardous substances
  (NICE 2021, Willacy 2020)

Your doctor will also want to know about any existing health conditions you may have, such as:

• diabetes
• asthma
• high blood pressure
• epilepsy
• thyroid problems
• heart problems
• mental health issues
  (NICE 2021, Willacy 2020)

Other things you should discuss at your pre-pregnancy appointment include:

• Any genetic conditions in your family. Tell your GP if you have a family history of any hereditary conditions such as sickle cell disease, thalassaemia or cystic fibrosis, so they can arrange further support and advice (NICE 2021, Willacy 2020).
• Your contraception. In most cases, the contraception you've been using shouldn't affect how long it takes to conceive. But if you've been using the contraceptive injection, it may take up to one year after your last injection for your fertility levels to return to normal (NICE 2021).

Your doctor may also ask about any terminations, miscarriages or ectopic pregnancies you've experienced (Willacy 2020). Talking about painful experiences can be distressing. But your doctor needs to know what's happened in your past so they can ensure that you get the best care and advice now.

Should I have any medical tests before trying for a baby?

You may need to, but it depends on your circumstances and general health. Ask your GP or practice nurse whether you need to have a test done before you become pregnant. Common tests and screening before pregnancy include:

Screening tests for STIs

If you've ever had unprotected sex (including oral sex), it's worth being tested for sexually transmitted infections (STIs), even if you don't have any symptoms (NHS 2021b). Untreated STIs can cause problems with fertility and complications in pregnancy.

Knowing if you have an STI can help you find the right treatment, and reduce the risk of passing it onto your partner or baby when you do conceive (Your Fertility 2021). STIs that may affect your fertility, or a future pregnancy, include:

• hepatitis B
• chlamydia
• gonorrhoea
• genital herpes
• genital warts
• syphilis
• HIV
  (NHS 2021b, Your Fertility 2021)

Your GP may be able to do these tests at your usual surgery, or you can go directly to a sexual health clinic (sometimes called genito-urinary medicine or GUM clinics). Your sexual partner should also be screened for STIs.

Having treatments for STIs before you conceive can greatly increase your odds of a successful pregnancy. Your GP, pharmacist or sexual health clinic will let you know which treatments you should finish before trying to conceive, as some treatments aren’t safe during pregnancy.

Cervical screening

If you're due for a cervical screening (sometimes known as a smear test) within the next year, your GP will advise that you have it as soon as possible, before becoming pregnant (NICE 2021). This is because cervical screening isn't usually done during pregnancy, as the natural changes to your cervix make the results difficult to interpret (NHS 2018c).

Blood tests

If you have a pre-pregnancy check-up, and your GP or nurse is concerned that you may be anaemic, they'll advise you to have a blood test. This is because women who are anaemic sometimes need to take extra iron supplements during pregnancy (NHS 2021c).

Depending on your ethnic background and medical history, you may also need a test for genetic disorders such as sickle cell disease and thalassaemia (NICE 2021). This test will tell you how likely it is that you'll pass the condition on to your baby (NICE 20121).

If you're not sure if you're immune to rubella, you may be offered a blood test to check for sure (NICE 2021).

Should I have any vaccinations before trying for a baby?

Many preventable infections can cause miscarriage or birth defects, so make sure your vaccinations are up to date.

If you're not sure what vaccinations you have already had, your local surgery can check in your medical records. A practice nurse can also take a blood test to find out whether you've been vaccinated against certain diseases, such as rubella (NHS Inform 2021).

If you need to be vaccinated with a live viral vaccine, as for rubella, you should wait one month after the vaccination before trying to conceive (NICE 2021). This is a precaution, as it's thought that your body needs time to get rid of the injected virus. Speak to your practice nurse if you have any worries.

If you're in a high risk group for hepatitis B, you can choose to be vaccinated against that disease as well (NICE 2021). If this is the only vaccination you have, you'll be able to start trying straight away. You can safely have the flu vaccine and the coronavirus vaccine and any boosters while you’re trying to conceive or when your pregnant.

Should I take any supplements while trying for a baby?

As soon as you decide to try for a baby, start taking a daily supplement containing 400 micrograms (mcg) of folic acid. Taking folic acid has been found to greatly reduce the risk of neural tube defects, such as spina bifida (NICE 2021).

It's particularly important to have enough folic acid in the early weeks of pregnancy. This is when your unborn baby's brain and nervous system are first developing. You may not even realise you're pregnant at this point, which is why you should start taking folic acid as soon as you start trying.

You can buy folic acid supplements from pharmacies and supermarkets. If you choose to take folic acid as part of a multivitamin, make sure it's suitable for pregnant women and doesn't contain vitamin A. Too much vitamin A could harm your baby if you conceive while taking it (NHS 2020b).

Some women, who are at a higher risk of having a baby with a neural tube defect, need a higher dose of folic acid. Speak to your GP about getting a prescription for a 5mg (5000mcg) supplement if you:

• have a family history of neural tube defects, or your partner does
• have previously conceived a baby with a neural tube defect
• have diabetes
• take medicine for epilepsy
• take medicine for HIV
• have a BMI over 30
  (NHS 2020c, NICE 2021)

Like all adults, you'll also need a daily supplement containing 10mcg of vitamin D (NHS 2020c).

More advice on getting ready for pregnancy

• Pre-pregnancy health checklist
• Pre-pregnancy lifestyle checklist
• What you need to know about giving up contraception