Some of the most important weeks of a pregnancy happen before most women know they are pregnant. The baby’s brain, spine and heart form in the first eight to ten weeks, often before the first antenatal visit. The steps that protect them - the right dose of folic acid, good sugar and thyroid control, and safe medicines - work far better when they are already in place at conception.
A pre-conception visit is a single unhurried appointment, ideally three months before you start trying, where your health, your partner’s relevant history and any previous pregnancies are reviewed. For women with diabetes, thyroid disease, high blood pressure, epilepsy, an autoimmune condition or a previous difficult pregnancy, it is one of the most useful appointments of the entire journey.
Dr. Devang Patel brings his FNB training in high-risk pregnancy and perinatology to these visits at Divine Women’s Hospital, Gota, so that any risk factor is identified early and a clear plan is in place before the pregnancy begins. Couples are welcome to come together, and consultations are in Gujarati, Hindi or English.
Why planning ahead changes outcomes
Many pregnancy complications have roots that can be addressed beforehand. High blood sugar at conception raises the risk of miscarriage and heart and spine defects several-fold; untreated hypothyroidism is linked with miscarriage and effects on the baby’s development; and some common medicines can harm the baby in the first weeks.
Planning also gives time for things that cannot be done once pregnant, such as the rubella vaccine, and for decisions that need calm discussion, such as what to do if both partners carry thalassaemia trait.
What the visit covers
- Your medical history, regular medicines, allergies and any surgery, especially on the uterus
- Details of any previous pregnancies, miscarriages, caesareans or complications
- Your menstrual cycle, and any history of PCOS, endometriosis or infertility
- Family history of diabetes, high blood pressure, genetic conditions or birth defects, and whether partners are related
- Weight, BMI, blood pressure and a general and breast examination
- Folic acid, vitamins, vaccinations and diet
- Smoking, tobacco chewing, alcohol, work hazards and stress
- Your fertile window and when to seek help if pregnancy does not happen
Folic acid, vitamins and diet
Folic acid taken before conception and through the first twelve weeks reduces the risk of neural tube defects such as spina bifida by up to 70%. Most women need 400 micrograms daily, started ideally three months before trying. A higher dose of 5 mg is advised after a previous baby with a neural tube defect, with diabetes, with certain anti-epileptic medicines, with a BMI of 30 or more, and in some women with thalassaemia trait or sickle cell disease.
Iron and vitamin B12 deficiency are common in vegetarian Indian diets, and are easier to correct before pregnancy adds extra demand. Good everyday sources include dal, rajma, chana, green leafy vegetables, jaggery in moderation, and curd or milk for B12. Use iodised salt. A balanced, varied diet matters more than any single food or supplement.
Tests before pregnancy
Tests are chosen around your history. The common ones, and why they matter, are below.
| Test | Why it is done | If abnormal |
|---|---|---|
| Haemoglobin and blood indices (CBC) | Detects anaemia and hints at thalassaemia trait (low MCV) | Iron or B12 treatment; further thalassaemia testing |
| HbA2 by HPLC | Identifies thalassaemia and sickle cell carriers | Partner tested; genetic counselling if both carriers |
| Blood group and Rh type | Plans for Rh-negative mothers | Antibody monitoring and anti-D in pregnancy |
| TSH (thyroid) | Thyroid problems affect fertility and the baby | Thyroxine started or adjusted; aim TSH below 2.5 |
| Fasting sugar or HbA1c | Detects diabetes or prediabetes | Sugar control first; aim HbA1c below 6.5% |
| Rubella IgG | Checks immunity to German measles | MMR vaccine, then wait one month |
| HIV, hepatitis B, hepatitis C, syphilis | Infections that can pass to the baby | Treatment and vaccination plans |
| Pap or HPV test | Cervical screening if due | Further evaluation before pregnancy |
Thalassaemia and genetic screening
Beta-thalassaemia trait is common in Gujarat, particularly in some communities, and most carriers feel completely well. If both partners are carriers, each pregnancy has a one in four chance of thalassaemia major, a serious condition needing lifelong transfusions. An HbA2 level above 3.5% on HPLC indicates trait; if the woman is a carrier, her partner is tested promptly.
Sickle cell trait is common in some tribal communities of Gujarat and is detected on the same test. Couples who are related by blood, or who have a family history of a genetic condition, are offered genetic counselling. Knowing in advance means there is time to understand options, including early prenatal testing.
One blood test for both partners before pregnancy can prevent a lifelong illness in a child.
Medical conditions and medicines
Women with diabetes, high blood pressure, thyroid disease, epilepsy, heart or kidney disease, or autoimmune conditions such as lupus or APLA benefit most from planning. The aim is for the condition to be stable before conception, with medicines that are known to be suitable in pregnancy.
- ACE inhibitors and ARBs for blood pressure are switched to pregnancy-suitable alternatives
- Sodium valproate is avoided where at all possible, under neurologist guidance
- Isotretinoin for acne must be stopped at least one month before trying
- Methotrexate needs to be stopped about three months before conception
- Warfarin is changed to heparin injections in early pregnancy
- Statins are usually paused before trying
- Never stop a medicine on your own: bring all prescriptions so each can be reviewed safely
After a previous difficult pregnancy
A previous pregnancy complication is a reason for planning, not a reason for fear. After pre-eclampsia, low-dose aspirin from 12 weeks reduces the chance of recurrence. After a preterm birth, cervical length scans and progesterone may be planned. After gestational diabetes, sugar is checked before trying, because many women develop type 2 diabetes in the following years.
After a caesarean, an interval of at least 18 months between birth and the next conception lowers the risk of scar problems and allows a planned discussion about VBAC. After stillbirth or recurrent miscarriage, the investigation results are reviewed and the next pregnancy is mapped out from the start.
Weight, age, lifestyle and fertility
Both a low BMI (below 18.5) and a high BMI (30 or more) make conception harder and pregnancy riskier. Losing even 5–10% of body weight improves ovulation in PCOS and lowers the risk of gestational diabetes and high blood pressure. Smoking, tobacco chewing and alcohol should stop before trying, for both partners.
About eight in ten couples conceive within a year of regular unprotected intercourse every two to three days. Fertility falls gradually after 35, so women over 35 are advised to seek help after six months of trying, and sooner if periods are irregular or there is known endometriosis or tubal disease.
How the visit is organised at Divine Women’s Hospital
The appointment with Dr. Devang Patel is planned as an unhurried consultation, and both partners are welcome. Blood tests are done the same day where possible, and a follow-up visit brings the results together into a written plan. If a specialist opinion is needed, for example from a physician or neurologist, this is arranged before you start trying.
When you do become pregnant, your early pregnancy care, NT scan and antenatal visits can continue with the same doctor at the same hospital in Gota.
Your care, step by step
- HistoryYour health, medicines, cycle, previous pregnancies and family history are reviewed, with your partner if possible.
- TestsBlood tests and, if indicated, a pelvic ultrasound are arranged according to your history.
- OptimiseFolic acid, vaccinations, medicine changes and weight, sugar or thyroid targets are put in place.
- Results visitResults are explained, including any carrier findings, and your partner is tested if needed.
- Plan for pregnancyYou leave with a clear plan, including when to start trying and when to book your first pregnancy visit.
When to book a visit
- You plan to start trying for a pregnancy in the next few months
- You have diabetes, high blood pressure, thyroid disease, epilepsy or an autoimmune condition
- A previous pregnancy had complications such as pre-eclampsia, preterm birth, stillbirth or loss
- You or your partner are thalassaemia or sickle cell carriers, or are related by blood
- You have PCOS, irregular periods or a BMI of 30 or more
- You are over 35 and planning a pregnancy
Warning signs - get same-day care
- A positive pregnancy test with one-sided lower abdominal pain, which may suggest an ectopic pregnancy
- Fainting, dizziness or shoulder-tip pain in early pregnancy
- Heavy vaginal bleeding with clots in early pregnancy
- Vomiting so severe that you cannot keep fluids down for a day
- High fever or a rash illness in early pregnancy
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: Folic acid is only needed once pregnancy is confirmed.
The neural tube closes by about six weeks, often before a missed period is noticed. Folic acid protects the baby only when it is started months earlier.
Myth: Thalassaemia testing is only for people who look pale or weak.
Carriers usually feel completely well and have normal energy. Only a blood test can tell.
Myth: All medicines must be stopped before trying for a baby.
Stopping some medicines suddenly, such as those for epilepsy or thyroid, can be dangerous. Each one is reviewed and adjusted safely.
Frequently asked questions
When should I start folic acid before pregnancy?
Ideally three months before you start trying, and at least one month before, continuing until twelve weeks of pregnancy. Most women need 400 micrograms daily; some need 5 mg.
What tests should I do before planning a pregnancy?
Usually a blood count, thalassaemia screening, blood group, thyroid function, blood sugar, rubella immunity and screening for HIV, hepatitis B and C and syphilis. A Pap smear is done if due. Extra tests depend on your history.
How long should I wait to conceive after the rubella vaccine?
Pregnancy should be avoided for one month after the MMR vaccine. This is why immunity is checked before, rather than during, pregnancy.
Does my husband need any tests?
Often, yes. If you are a thalassaemia carrier, your partner should be tested. His health, medicines, smoking and alcohol also affect sperm quality, and a semen analysis is advised if conception does not happen within the expected time.
How long does it usually take to get pregnant?
About eight in ten couples conceive within a year. If you are under 35 and have been trying for a year, or 35 and over and trying for six months, an evaluation is recommended, sooner if periods are irregular.
Can I take my regular medicines while trying to conceive?
Many are safe, some need a dose change and a few must be switched before conception. Do not stop anything on your own; a pre-conception visit is the right time to review each prescription.
How long after a caesarean can I plan another pregnancy?
An interval of at least 18 months between the birth and the next conception is generally advised, to allow the scar to heal well and to lower the risk of complications.
When is my fertile window?
Ovulation usually happens about 14 days before the next period, so in a 28-day cycle around day 14. The fertile window is the five days before ovulation and the day itself. Intercourse every two to three days covers it without the stress of timing.
I have PCOS. Should I plan differently?
Yes. Weight, sugar and thyroid are checked, folic acid dose is reviewed, and ovulation is assessed. If periods are irregular, help to ovulate may be offered early rather than waiting a year.
Should I get any vaccines before pregnancy?
If you are not immune to rubella or chickenpox, those vaccines are given first, with a one-month wait before conceiving. Hepatitis B vaccination is advised if you are not protected. Flu and Tdap vaccines are given during pregnancy itself.