Preconception counseling.  Often preconception counseling is not done, as half of pregnancies are unplanned. But, when I have a woman come to the office to discuss what she should do in anticipation of pregnancy or I see a woman of childbearing age who is not using contraception… here are some points to follow.

• Folic acid supplementation. Prenatal vitamins are available cheaply and over the counter.  Take one daily until a woman is done childbearing.
• Chronic disease management. Hypertension, diabetes, depression and anxiety.
• Teratogenic medications should be stopped.
• Discuss family and genetic history (like sickle cell, hemophilia, Down’s syndrome).
• Update vaccines as needed.
• Assess for physical, sexual, and emotional abuse.
• Sexually transmitted infection counseling and testing.
• Weight should be maintained in a healthy BMI (between 20 and 25)
• Advise to stop smoking, as this is linked with miscarriage and small for gestation age infants.