Preconception consultation: health check before pregnancy
In brief
The preconception consultation (pre-pregnancy check-up) is a medical appointment planned before stopping contraception, to prepare for pregnancy in good health. The HAS (French National Authority for Health) recommends prescribing folic acid (0.4 mg per day) as soon as a pregnancy is planned and up to 12 weeks of amenorrhoea (weeks since the last menstrual period), because a Cochrane review showed that this supplementation reduces the risk of neural tube defects (spina bifida) by about 70%. This consultation is also an opportunity to check blood tests and vaccinations, and to adjust in advance any long-term treatment that is incompatible with pregnancy.
What is a preconception consultation?
It is a consultation dedicated to the plan for pregnancy, carried out before conception. It can be performed by a gynaecologist, a general practitioner or a midwife. It is distinct from the first pregnancy consultation, which takes place once the pregnancy has started.
Its value rests on a simple observation: the embryo's organs form very early, often before the pregnancy is known. The neural tube, which will become the spinal cord and the brain, closes towards the end of the first month of pregnancy. Some preventive measures are therefore only effective if they are taken before conception.
The HAS recommendations on planning a pregnancy describe the information to give, the prevention messages and the tests to offer on this occasion.
When should it be planned?
Ideally a few months before stopping contraception:
- at least one month before conception, to start folic acid;
- two to three months before if a vaccination is needed, because some live vaccines require pregnancy to be avoided for a period after the injection;
- even earlier in the case of a chronic illness (diabetes, epilepsy, high blood pressure, thyroid disease, autoimmune disease, treated psychiatric disorders), in order to adapt the treatment with the specialist doctor.
It is also useful after a complicated pregnancy (pre-eclampsia, gestational diabetes, preterm birth, recurrent miscarriage, caesarean section) to discuss the measures to take in the next pregnancy.
The preconception consultation takes place at the practice; the average waiting time for an appointment is one week to 10 days, except during holiday periods. Appointments can be booked via Doctolib or by calling 01 43 79 59 79.
What happens during the consultation?
The interview
The doctor reviews:
- medical, surgical and gynaecological history (uterine surgery, endometriosis, fibroids, irregular cycles);
- previous pregnancies and how they went;
- family history, in particular genetic diseases known in the family of either parent;
- medicines taken regularly, including self-medication and food supplements;
- lifestyle: tobacco, alcohol, cannabis and other substances, diet, physical activity, occupational exposure to toxic products.
The clinical examination
It includes measuring blood pressure, weight and calculating body mass index, as well as a gynaecological examination if necessary. Cervical cancer screening is brought up to date if it is overdue.
Why is folic acid so important?
Folic acid (vitamin B9) is involved in the closure of the embryo's neural tube. A Cochrane review covering 5 trials and more than 7,000 women showed that daily folic acid supplementation around conception clearly reduces the risk of neural tube defects (relative risk 0.31), both in women with no previous history and in those with a previous history (reduced risk of recurrence). However, no clear effect has been shown on other birth defects.
| Situation | Daily dose | Duration |
|---|---|---|
| General case | 0.4 mg (400 µg) | From the time the pregnancy is planned, ideally at least 1 month before conception, up to 12 weeks of amenorrhoea |
| Previous pregnancy with a neural tube defect | Higher dose | Same duration, on medical prescription |
| Other at-risk situations (certain antiepileptic drugs, diabetes, obesity, bariatric surgery) | Dose to be discussed with the doctor | Same duration |
Folic acid is taken as a tablet, on prescription.
Which blood tests are offered?
The HAS recommendations provide for several tests, depending on each woman's situation:
| Test | Purpose |
|---|---|
| Rubella serology | Check immunity, unless two vaccinations are documented |
| Toxoplasmosis serology | Know the immune status, unless there is written proof of immunity |
| HIV screening | Offered systematically |
| Hepatitis B | Anti-HBs antibodies if vaccinated, otherwise HBs antigen |
| Hepatitis C, syphilis | Depending on risk factors (transfusion, exposure, drug use) |
| Blood group (ABO, full rhesus, Kell) | If the blood group card is not complete |
| Chickenpox (varicella) | Questions about previous history; serology if in doubt |
| Cytomegalovirus (CMV) | Blood test now recommended by the HAS before conception when a pregnancy is planned: see the article CMV and pregnancy |
Other tests may be offered depending on your history and situation.
Which vaccines should be updated before pregnancy?
The preconception period is the right time to check the vaccination record, because some vaccines are contraindicated during pregnancy.
- Rubella (MMR vaccine): in the absence of immunity, after checking that you are not pregnant. This live vaccine must not be given in pregnancy: effective contraception is needed after each dose, for the duration given to you when you are vaccinated and in the article Vaccines and pregnancy. Being vaccinated without knowing you were pregnant is not a reason to end the pregnancy.
- Chickenpox (varicella): in women with no history of chickenpox who are seronegative, after a negative pregnancy test, with effective contraception after each dose, for the duration given to you when you are vaccinated.
- Diphtheria, tetanus, polio, whooping cough (pertussis): updated according to the vaccination schedule; catch-up vaccination against whooping cough also concerns the future baby's close family and household.
- Hepatitis B: if the woman is not immune.
The vaccines recommended during pregnancy itself (flu, COVID-19, whooping cough, RSV depending on the period) are detailed in the article Vaccines and pregnancy.
Should a current treatment be changed?
Some medicines carry a risk of birth defects or complications for the future baby. Others, on the contrary, must not be stopped abruptly, because the untreated disease is itself dangerous for the pregnancy.
According to the HAS, any prescription for a woman considering pregnancy must take the benefit/risk balance into account, and long-term treatments (antiepileptic drugs, antidiabetic drugs, antihypertensive drugs, anticoagulants, psychotropic drugs) should be adapted beforehand, ideally with the specialist doctor. Sodium valproate, for example, is strictly regulated in women of childbearing age.
It is not advisable to stop a treatment on your own when planning a pregnancy: the right approach is to discuss it with the doctor before stopping contraception. Self-medication should be avoided as soon as pregnancy is being considered.
What lifestyle advice is given?
- Tobacco: stopping before pregnancy is the most beneficial; help to quit can be offered, including for the partner.
- Alcohol: no amount of alcohol is risk-free during pregnancy; stopping is advised as soon as pregnancy is planned.
- Weight: significant overweight or underweight can reduce fertility and increase certain risks during pregnancy; support can be offered.
- Diet: prevention of toxoplasmosis and listeriosis if the woman is not immune.
- Physical activity: regular and adapted.
- Occupational exposures: to be reported to the occupational health doctor where applicable.
What if pregnancy takes a while?
In a couple having regular intercourse, pregnancy most often occurs within the first year. According to ACOG (American College of Obstetricians and Gynecologists), an infertility assessment of the couple is offered if there is no pregnancy after 12 months of unprotected intercourse under the age of 35, after 6 months over the age of 35, and without delay over the age of 40. The preconception consultation can also identify situations that justify an earlier opinion: very irregular cycles, known endometriosis, previous pelvic or tubal surgery.
The consultation fee is €120 to €150 (doctor contracted in sector 2 with unrestricted fees, not a member of OPTAM). Students are charged the Sécurité sociale (French social security) rate, and patients covered by the Complémentaire santé solidaire (C2S, formerly CMU) or the AME (state medical aid) are seen without additional fees.
Frequently asked questions
Is the preconception consultation compulsory?
No, it is not compulsory, but it is recommended by the HAS for any woman planning a pregnancy. It makes it possible to put in place preventive measures that are only effective if they start before conception.
Should my partner come?
Their presence is useful, especially for family history, vaccination of the household (whooping cough) and stopping smoking. It is not essential.
I am already pregnant and have not taken folic acid: what should I do?
It is advisable to start folic acid as soon as possible, up to 12 weeks of amenorrhoea, and to mention it at the first pregnancy consultation. The absence of supplementation does not mean that the baby will have a birth defect: the baseline risk remains low.
Should I have hormone tests before trying to get pregnant?
Not systematically. A hormone test or an assessment of ovarian reserve is only useful in certain situations (irregular cycles, age, medical history), to be discussed with the doctor.
How soon after stopping the pill can I conceive?
Fertility generally returns quickly after stopping hormonal contraception. There is no need to wait several cycles, except after certain live vaccines (rubella, chickenpox), which require a waiting period.
When should I start folic acid?
As soon as you plan a pregnancy, ideally at least one month before conception, and up to 12 weeks of amenorrhoea, according to the HAS. The usual dose is 0.4 mg per day; a higher dose is prescribed after a pregnancy affected by a neural tube defect.
References
- Haute Autorité de santé. Projet de grossesse : informations, messages de prévention, examens à proposer [Planning a pregnancy: information, prevention messages, tests to offer]. Document d'information pour les professionnels de santé [Information document for healthcare professionals], 2009 (mis en ligne en 2010, actualisé en 2013) [published online in 2010, updated in 2013]. https://www.has-sante.fr/jcms/c_1360649/fr/projet-de-grossesse-informations-messages-de-prevention-examens-a-proposer
- De-Regil LM, et al. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev, 2015. doi:10.1002/14651858.CD007950.pub3 — PMID 26662928
- American College of Obstetricians and Gynecologists. Infertility Workup for the Women's Health Specialist: ACOG Committee Opinion, Number 781. Obstet Gynecol, 2019. doi:10.1097/AOG.0000000000003271 — PMID 31135764
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
A question about your situation?Appointments at the practice or by video consultation, usually within one week to 10 days.
Book an appointmentGeneral information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.