Preconception health

When a couple decides to start a family, many thoughts come to mind: what will pregnancy, birth and parenting be like? Therefore, family planning should start before a positive pregnancy test. Preconception health is the period before actually being pregnant. As about 40% of all pregnancies worldwide are unplanned, preconception health is relevant for everyone of reproductive age; for women as well as their Partners[1,2].

During this period, couples should aim to improve their health to not only increase fertility, but also to foster a positive pregnancy experience, lower the risks for preterm birth, diabetes and other complications and to raise a healthy baby[3].

Therefore, we identified five preconception health aims:

For both partners, a stress-reduced environment increases the chance for a healthy pregnancy, parent- and childhood. Mental health can improve birth outcomes and lower the risk for pregnancy complications[4], as well as enhance the overall pregnancy experience. Having a mentally healthy partner has a positive influence on the mother’s well-being – and therefore on the unborn child, too[5].

Our advice: When experiencing symptoms of depression, anxiety or other mental illnesses, medical consultation is advised.

A balanced diet should be based on calorie-free beverages, vegetables, fruit, pulses and wholegrain products. Additionally, but in moderate amounts, dairy products, meat, oily sea fish and eggs should be part of the diet. It is not necessary to exclude sweets, snacks and sugary beverages completely; they should, however, be consumed in small amounts only. Plant-based oils are generally healthier than animal-based sources of fat. Alcohol should be avoided entirely[6].

If women follow a balanced diet, there is generally no need for supplements during the preconception period, except for folic acid. This vitamin is immensely important for the development of the baby’s neural tube, especially in the first trimester. However, only a few food items contain folic acid. In addition to a balanced diet, most European countries therefore recommend the supplementation of 400µg folic acid per day starting at least four weeks before conception[7].

For vegetarians and vegans, the intake of certain other micronutrients might be critical, especially iodine and vitamin B12. They should discuss their options and possible need for additional supplementation with their gynaecologist[6].

Our advice: A balanced, healthy diet as well as folic acid are recommended to increase a positive pregnancy outcome.

A healthy body weight is an important factor for a healthy pregnancy. A healthy body weight is defined as a Body Mass Index (BMI) between 18.5 and 25 kg/m².

If you want to calculate your BMI please go to the BMI calculator  of the UK National Health Service

Maternal overweight, defined as a BMI of 25 kg/m² or greater, increases the risk for diabetes as well as hypertension and pre-eclampsia, and is linked to further complications like maternal morbidity, preterm births, macrosomia as well as childhood overweight[2]. Overweight in men is associated with adverse outcomes concerning conception, i.e. lower testosterone levels and reduced fertility as well as poor sperm Quality[5].

Maternal underweight with a BMI of 18.5 kg/m² or less is associated with increased risks for other severe outcomes, such as stillbirth, preterm birth and intrauterine growth Retardation[2].

Our advice: To reduce the risk for pregnancy complications, both women and men should reach and maintain a healthy body weight before the pregnancy.

Adults should be physically active for 20 to 40 min every day. Physical activity does not necessarily refer to sports, it can also be included in everyday life, e.g. 10 minutes of brisk walking during the lunch break, taking the stairs and not the escalator, as well as cycling to work. With regard to the preconception period, physical activity increases fertility and health-related quality of life. It also simultaneously decreases the prevalence of depression and insulin resistance for women with Polycystic Ovary Syndrome (PCOS) and helps to maintain a healthy bodyweight[8].

Our advice: Once pregnant, physical activity should remain part of the daily routine.

Vaccinations prevent certain diseases that can be life-threatening for an unborn baby, e.g. measles, rubella, chickenpox and whooping cough. Having the vaccination status checked before getting pregnant is especially important, only so-called live vaccines are contraindicated for pregnant women[6].

Our advice: Vaccinations need to be kept up to date. Have your doctor check your vaccination status and give you booster vaccinations, if necessary.

To avoid passing on caries to their child, women and their partners should additionally have a dental check-up during the preconception period. Both partners need to consult the dentist and improve dental care, if necessary[6].

A woman who is planning to become pregnant should discuss her current treatment with her doctor, as many medicines should not be taken during pregnancy. The doctor can then assess which medications should be continued, stopped or changed to medications which are safer during pregnancy. Adults with chronic diseases should aim for an optimal medication regime to achieve a good metabolic control and avoid potentially harmful situations for the baby. For example, increased blood sugar levels in pregnant women with diabetes type 1 or 2 can cause congenital malformations in babies[9]. Additionally it was shown that diabetes and hypertension reduce the men’s quality of sperm[1].

Smoking should be avoided completely by women and their partners also during the preconception period, as smoking influences fertility negatively and can harm the unborn baby[6].

 Our advice: When thinking about getting pregnant, a consultation with a healthcare professional is recommended.

You may also be interested in our factsheet Why the first 1000 days of life matter

More information on lifestyle factors during pregnancy

1. Shawe J, Patel D, Joy M, Howden B, Barrett G, Stephenson J. Preparation for fatherhood: A survey of men’s preconception health knowledge and behaviour in England. PloS One. 2019;14(3):e0213897.
2. Snyder T, Martinez H, Wuehler S, De-Regil L. The Biology of the First 1,000 Days. 2018. 423-438 S.
3. Tydén T. Why is preconception health and care important? Ups J Med Sci. November 2016;121(4):207.
4. Witt WP, Wisk LE, Cheng ER, Hampton JM, Hagen EW. Preconception mental health predicts pregnancy complications and adverse birth outcomes: a national population-based study. Matern Child Health J. Oktober 2012;16(7):1525–41.
5. Frey KA, Navarro SM, Kotelchuck M, Lu MC. The clinical content of preconception care: preconception care for men. Am J Obstet Gynecol. 2008;199(6):S389–95.
6. Koletzko B, Cremer M, Flothkötter M, Graf C, Hauner H, Hellmers C, u. a. Diet and Lifestyle Before and During Pregnancy – Practical Recommendations of the Germany-wide Healthy Start – Young Family Network. GebFra – DGGG-Gesellschaftsausgaben. 14. Dezember 2018;(06):1262–82.
7. Cawley S, Mullaney L, McKeating A, Farren M, McCartney D, Turner MJ. A review of European guidelines on periconceptional folic acid supplementation. Eur J Clin Nutr. 9. September 2015;70:143.
8. Harrison CL, Brown WJ, Hayman M, Moran LJ, Redman LM. The Role of Physical Activity in Preconception, Pregnancy and Postpartum Health. Semin Reprod Med. 20. Juni 2016;34(02):e28–37.
9. American Diabetes Association. Preconception Care of Women With Diabetes. Diabetes Care. 1. Januar 2003;26(suppl 1):s91–3.