Most pregnancy advice starts at the positive test. But a growing body of evidence, and any experienced OB or pharmacist will tell you the same, shows that the preconception window is when many of the most important health decisions get made. The neural tube closes at 28 days after conception. Folic acid takes weeks to build to protective levels in the body. Some medications need to be adjusted before you even start trying.
This checklist is written with one goal: help you walk into pregnancy as prepared as possible.
Step 1: Start a Prenatal Vitamin Now
This is the first recommendation because it is the most time sensitive one. The body does not build folate reserves overnight. Clinical guidance from St. Louis Children's Hospital, Houston Methodist, and the CDC consistently recommends starting at least two to three months before you plan to conceive.
What to look for in a prenatal vitamin:
- At least 400, 600 mcg of folate (folic acid or L methylfolate)
- 27 mg of iron
- 150, 220 mcg of iodine
- 600+ IU of vitamin D
- DHA (200, 300 mg, either in the prenatal or as a separate softgel)
If nausea is already a concern, take your prenatal at bedtime with a small snack. If iron causes stomach upset, ask your pharmacist about a formula with chelated iron (ferrous bisglycinate), which is gentler.
Step 2: Schedule a Preconception Appointment
A preconception visit with your OB/GYN is not the same as a first prenatal visit. It is a planning appointment, a chance to review your health history, update vaccinations, screen for genetic carrier status, and discuss any medications that may need to change.
Key topics to cover at this appointment:
- Review all prescription and OTC medications for pregnancy safety
- Screen for rubella, varicella, and hepatitis B immunity, some vaccines cannot be given during pregnancy, so getting them before is important
- Pap smear if overdue
- Blood work: CBC, thyroid, blood sugar, blood type, and Rh factor
- Discussion of family history for genetic conditions
- HIV status
Do not skip this appointment. Many problems that complicate pregnancies, like uncontrolled thyroid disease, poorly managed blood sugar, or certain medication exposures, can be addressed in advance when the preconception visit happens.
Step 3: Review Your Medications With a Pharmacist
This step is often overlooked because people assume their doctor handles it. Sometimes they do. But pharmacists are trained specifically in drug safety during pregnancy and can catch things that fall through the cracks.
Medications to specifically flag before pregnancy:
- ACE inhibitors and ARBs (for blood pressure), not safe during pregnancy, need to be switched
- Statins (for cholesterol), typically discontinued during pregnancy
- Certain antidepressants and mood stabilizers, dose and timing matter, never discontinue without guidance
- Retinoids (including prescription acne medications like isotretinoin), must be discontinued well before conception
- Valproate (for seizures or migraines), strongly linked to neural tube defects, usually needs to be transitioned
- Methotrexate (for arthritis or skin conditions), must be stopped months in advance
Also flag any supplements: high dose vitamin A, herbal products, and some adaptogens have not been studied in pregnancy and should be reviewed.
Step 4: Update Vaccinations
Some vaccines cannot be given during pregnancy, including the MMR (measles, mumps, rubella) and varicella (chickenpox) vaccines. If your immunity to either is low or unknown, getting vaccinated before conception is the safe window.
Vaccines to verify or receive before trying to conceive:
- Rubella, check your immunity (blood test). If not immune, vaccinate and wait one month before trying
- Varicella, same approach; chickenpox during early pregnancy carries serious risks
- Hepatitis B, if not previously vaccinated, the series can be started now
- Tdap, if not current, get it now; you will need it again during each pregnancy
Flu vaccine: get the current season's flu shot annually. It is safe during pregnancy but can be timed to before conception as well.
Step 5: Assess Lifestyle Factors Honestly
These are not lectures, they are clinical inputs. Pharmacists and physicians need to know about them to give accurate guidance.
- Stop alcohol completely. No safe level during pregnancy has been established. The window for damage includes the first few weeks, before most women know they are pregnant.
- Stop smoking. Smoking is associated with miscarriage, ectopic pregnancy, low birth weight, and placental complications. Nicotine replacement therapy should be discussed with your provider.
- Review caffeine intake. Most guidelines suggest keeping caffeine below 200 mg per day during pregnancy. A cup of coffee is approximately 100 mg.
- Get to a healthy weight if possible. Obesity is associated with increased risk of gestational diabetes, preeclampsia, and neural tube defects. Even modest improvements before conception reduce risk.
- Start moderate exercise if not already active, 30 minutes most days is the standard recommendation for healthy adults.
Step 6: Track Your Cycle
Understanding your menstrual cycle before you start trying gives you useful data. Specifically, knowing the average length of your cycle and when ovulation occurs helps you time intercourse during the fertile window.
Ovulation predictor kits (OPKs) are available at most pharmacies and measure the LH surge that precedes ovulation by 12 to 36 hours. For a typical 28 day cycle, testing starting around Day 10 is a reasonable starting point. If you have irregular cycles, earlier testing or an OB consultation is advisable.
Step 7: Know Your Genetics (Optional, but Valuable)
Carrier screening, genetic testing that checks whether you carry variants associated with conditions like cystic fibrosis, sickle cell disease, fragile X syndrome, or spinal muscular atrophy, is now widely available. It does not mean you have these conditions; it means you might pass a variant to your child if both parents are carriers.
This is a conversation for your OB or a genetic counselor, but it is worth raising at your preconception appointment, especially if you have a family history of any genetic condition or if your partner has one.
When to Talk to a Pharmacist
Call or come in before or while you are trying to conceive if:
- You take any prescription medications and have not had them reviewed for pregnancy safety
- You are unsure which prenatal vitamin to choose or whether your current one covers your needs
- You are taking any herbal supplements or OTC products you want to verify are safe
- You have a chronic health condition (diabetes, thyroid disease, autoimmune condition) that needs preconception management review
You can shop pharmacist selected prenatal supplements at Fairview Pharmacy, and we are always available for a quick consultation call.
This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.