The preconception period is one of the highest-impact windows in your reproductive health. Most women do not know what it involves until they are already pregnant — often too late for some of the most important interventions.
By Dr. Neha Sain · Gynaecologist, MS (Obstetrics & Gynaecology)
The conversation I wish I could have with every woman happens before pregnancy, not during it. By the time a positive test appears, the embryo is already several weeks old. The neural tube — which becomes the brain and spinal cord — closes in the first 28 days after conception. The heart begins beating before most women know they are pregnant. The organs that will define your child's health for life are being laid down in a window when many women are still unsure whether they want to take a test.
This is why preconception care matters. And in India, it is dramatically underutilised.
Schedule a preconception consultation first
Before you do anything else, book an appointment with a gynaecologist specifically to discuss your plans. Not a routine check-up — a preconception consultation, with the explicit goal of assessing and optimising your health before conception occurs.
What this covers: a review of your menstrual history (because cycle irregularities are much easier to address before pregnancy than during), blood pressure and BMI assessment, a panel of blood tests (I will go through these below), a review of any medications you are taking, a discussion of your family history for genetic conditions, and an honest conversation about what the timeline for trying is likely to look like given your specific health picture.
A 2019 study published in the Indian Journal of Community Medicine found that only 11.4% of urban Indian women and 3.8% of rural women received any preconception care before their last pregnancy. These are preventable gaps, and they have consequences.
The blood tests that matter before pregnancy
Full blood count (CBC). Anaemia is extraordinarily common in Indian women — the National Family Health Survey (NFHS-5) found that 57% of women aged 15–49 in India are anaemic. Anaemia in early pregnancy is associated with preterm birth, low birth weight, and increased maternal risk. Identifying and treating iron deficiency before pregnancy, rather than scrambling to correct it during the first trimester, is straightforwardly better for both mother and baby.
Thyroid function (TSH). Hypothyroidism is common in Indian women and, when undetected, significantly increases miscarriage risk and affects foetal brain development. Optimising thyroid function before conception is essential. If you are already on thyroxine, your dose may need adjustment before and during pregnancy — your thyroid function should be checked before you start trying.
Blood group and Rh factor. If you are Rh-negative, you will need anti-D immunoglobulin injections at specific points in pregnancy and potentially after delivery. Knowing this in advance allows proper planning.
Random blood sugar or HbA1c. India has one of the highest rates of diabetes and pre-diabetes globally. Uncontrolled diabetes in early pregnancy — before most women know they are pregnant — is a significant cause of foetal anomalies. If you have risk factors (family history of diabetes, PCOS, previous gestational diabetes, BMI over 25), a glucose assessment before conception is essential.
TORCH screen. Testing for immunity to rubella and hepatitis B status. If you are not immune to rubella and are not already vaccinated, vaccination is recommended before trying — with a one-month wait before attempting conception.
Vitamin D level. Deficiency is present in 70–90% of Indian women, despite living in a sunny country, because our clothing and indoor lifestyles limit skin exposure. Vitamin D deficiency in pregnancy is associated with gestational diabetes, pre-eclampsia, and compromised foetal bone development. Testing and supplementing before pregnancy rather than starting supplementation after a positive test is the better approach.
Folic acid: start now, not when you see a positive test
I cannot overstate this. Folic acid prevents neural tube defects — conditions like spina bifida and anencephaly that are caused by failure of the neural tube to close in the first 28 days of pregnancy. Since most women do not know they are pregnant at 28 days, the folic acid must already be in the system.
The standard recommendation is 400–800 micrograms daily, beginning at least one month before trying to conceive and continuing through the first trimester. Women with a family history of neural tube defects, a previous affected pregnancy, diabetes, or who are on anti-epileptic medication are prescribed a higher dose (4–5mg) — which requires a prescription and should be discussed with your gynaecologist.
Please do not rely on your prenatal vitamin alone without checking the folic acid content. Many Indian "pregnancy vitamins" contain lower doses than recommended.
Vaccination: what to check and update
Rubella (German measles). Rubella infection in the first trimester causes severe foetal anomalies including blindness, deafness, and heart defects. If you are not immune (established by a blood test) and have not been vaccinated, the MMR vaccine should be given at least one month before trying to conceive. This is non-negotiable.
Varicella (chickenpox). If you have never had chickenpox and have not been vaccinated, vaccination before pregnancy is recommended. Varicella in pregnancy can cause foetal varicella syndrome and is serious.
Hepatitis B. Complete a full course if your vaccination status is incomplete or unknown.
COVID-19. Current evidence supports vaccination before pregnancy. If you are due a booster, complete it before trying.
Review every medication and supplement you take
This is the step most commonly skipped, and it is genuinely important. Several common medications are contraindicated in pregnancy and need to be stopped — ideally with a substitute found — before conception, not after.
The most significant: isotretinoin (Accutane — used for acne) is severely teratogenic and must be stopped at least one month before trying, with two forms of contraception used during that period. Methotrexate (used in arthritis and some skin conditions) must also be stopped, with a washout period. Certain blood pressure medications (ACE inhibitors, ARBs) are harmful in pregnancy and need to be changed. Some anti-epileptic drugs carry foetal risk and require specialist review before conception.
Never stop a prescribed medication without speaking to your doctor first. Abrupt discontinuation of some medications — particularly psychiatric medication and anti-seizure medication — is more dangerous than continuing them. The goal is a planned, supervised switch or dose review, not stopping cold.
Your partner's health matters too
I am going to say something that often surprises people: male factor infertility accounts for approximately 50% of fertility difficulties in couples. The man's health in the preconception period directly affects conception rates, miscarriage risk, and potentially the child's health.
Your partner should stop smoking and alcohol (both reduce sperm quality significantly — alcohol reduces sperm count and motility; smoking damages sperm DNA), avoid excess heat to the testes (saunas, very hot baths, keeping a laptop on the lap), maintain a healthy weight, and consider a male fertility supplement containing zinc, selenium, folic acid, and vitamin C. Sperm takes approximately 74 days to develop, so changes made now affect conception three months later.
A word on mental health before you start
Pregnancy is demanding in ways that are hard to anticipate. If you are currently managing anxiety, depression, or have a history of significant mental health difficulty, the preconception period is the right time to address it — not because you need to be "fixed" before you deserve to become a parent, but because being in the strongest possible psychological position before the additional demands of pregnancy, birth, and new parenthood is a genuine act of self-care and care for your future child.
If there is anything in your situation — your cycle, your health history, your specific tests — that you would like to discuss in detail, you can reach me through a Smart Consultation. I will give you a thorough, honest, practical response.
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