13 things to do before trying to get pregnant

You've decided to take the plunge into parenthood. But wait just a second – or even a month or more. To give yourself the best chance for a healthy pregnancy and a healthy baby, there are some important things to do before you head down the road to conception.

Schedule a preconception visit

You don't need a doctor or midwife lined up to deliver your baby yet, but call your ob-gyn, midwife, or family practice doctor now for a preconception checkup. At your visit, your healthcare provider will probably:

• Review your personal and family medical history (to find out if your baby might be at higher risk for certain genetic conditions)
• Evaluate your present health and any medications or supplements you're taking. Certain medications and supplements are unsafe during pregnancy, and some may need to be switched before you even try to conceive because they're stored in your body's fat and can linger there.
• Discuss diet, weight, exercise, and any unhealthy habits you may have (such as smoking, drinking, or taking drugs)
• Recommend a prenatal vitamin
• Make sure you're up to date on your immunizations and test you for immunity to childhood diseases such as chicken pox and rubella
• Perform a pelvic exam and take a Pap smear, if it's been at least a year since you had a checkup
• Test you for sexually transmitted infections if you're at risk
• Answer any questions you have

In addition, you may be referred to a specialist if you have certain medical conditions (such as asthma, diabetes, or high blood pressure) that need to be controlled before you get pregnant.

Your provider should offer you genetic carrier screening before you start trying to conceive to see whether you or your partner is a carrier for serious inherited illnesses such as cystic fibrosis, sickle cell disease, and others. If both you and your partner are carriers, your child will have a 1 in 4 chance of having the disease.

You can meet with a genetic counselor who will be able to tell you more about the condition and help you sort out your reproductive choices. This may be the single most important thing you can do to help ensure a healthy baby, and all it requires is a saliva or blood sample from each of you. It's even covered by most health insurance policies.

Take prenatal vitamins

It's not too early to start taking prenatal vitamins to make sure you get enough of the vital nutrients your body needs for a healthy pregnancy and baby. These include iron, calcium, omega-3 fatty acids, and – perhaps most importantly – folic acid.

By taking 400 micrograms (mcg) of folic acid a day for at least one month before you conceive and during your first trimester, you can cut your chances of having a baby with neural-tube defects such as spina bifida and anencephaly.

Check the label on your prenatal vitamins to make sure they contain the 400 mcg of folic acid you need. If they don't, or if you decide not to start taking your prenatal vitamin yet, you'll want to at least take a folic acid supplement.

Also check to make sure that you don't take more than the recommended daily allowance of 770 mcg RAE (2,565 IU) of vitamin A, unless most of it's in a form called beta-carotene. Getting too much of a different kind of vitamin A can cause birth defects.

If you're unsure about what to take, ask your healthcare provider to recommend a supplement.

Give up bad habits – and get help if you need it

If you smoke or take drugs, now's the time to stop. Many studies have shown that smoking or taking drugs can lead to miscarriage, premature birth, and low-birth-weight babies. Keep in mind that some drugs can stay in your system even after their noticeable effects have worn off.

What's more, research suggests that tobacco use can affect your fertility and lower your partner's sperm count. In fact, studies have shown that even secondhand smoke may reduce your ability to get pregnant.

Moderate drinking (that's one drink a day for women) is considered fine while you're trying to conceive, but you'll want to avoid excessive or binge drinking at this time. And once you're pregnant, experts recommend that you stop drinking altogether since no one knows exactly what potential harmful effects even the smallest amount of alcohol has on a developing baby.

Stopping unhealthy habits can be very difficult. Don't hesitate to talk with your healthcare provider. She can talk with you about tools to help you quit smoking or refer you to a program to help you stop taking drugs, for example. Your local health department may also be able to help by putting you in touch with counselors, group programs, and other assistance.

Eat well

Start making smart food choices now so your body will be stocked up with the nutrients you need for a healthy pregnancy.

Each day, try to eat:

• At least 2 cups of fruit and 2 1/2 cups of vegetables
• Plenty of whole grains
• Foods that are high in calcium – like milk, calcium-fortified orange juice, and yogurt
• A variety of protein sources, such as beans, nuts, seeds, soy products, poultry, and/or meats

Note: If you're a big fan of fish, start watching your intake. While fish is an excellent source of omega-3 fatty acids (which are very important for your baby's brain and eye development), protein, vitamin D, and other nutrients, some fish also contains high levels of mercury, which can be harmful.

Most experts agree that pregnant women should eat some fish, and that the best approach is to avoid those fish that are highest in mercury and limit your consumption of all fish. The U.S. Food and Drug Administration (FDA) recommends that women of childbearing age not eat:

• shark
• swordfish
• king mackerel
• marlin
• orange roughy
• bigeye tuna
• tilefish
• more than one serving (6 ounces) of solid white canned tuna per week
• fish caught in local waters, unless you're certain there are no contaminants

Aim for a healthy weight, and exercise

Weight. You may have an easier time conceiving if you're at a healthy weight. Having a low or high body mass index (BMI) makes it harder for some women to become pregnant.

Getting to a healthier weight now can help you get your pregnancy off on the right foot. Women with a high BMI are more likely to have pregnancy or delivery complications, while women who start with a low BMI and fail to gain enough weight are more likely to deliver underweight babies. Talk to your healthcare provider about the best way to achieve your weight goals.

Exercise. An exercise program is an important part of fitness. This typically includes 30 minutes or more of moderate exercise, such as walking or cycling and weight training, on most days of the week. To increase flexibility, add stretching or yoga, and you'll have a well-rounded fitness program. Once you're pregnant, it's recommended to continue exercising unless you have certain pregnancy complications.

If exercising hasn't been a priority for you lately, ease into an exercise routine. Start with something tame, like walking 10 to 20 minutes a day. Add more activity into your daily routine by taking the stairs instead of the elevator or parking your car a few blocks away from work.

Boost your mental health

Your mental health is an important part of your overall health. Here are some areas to address:

Stress. While we don't know the exact connections between stress and fertility, we do know that high stress levels can affect your hormone function, which can in turn affect your menstrual cycles. We also know that stress isn't healthy, and your goal right now is to become as healthy as possible.

So do what you can to reduce stress in your life. Eliminate unnecessary stressors, and explore methods for reducing stress, such as yoga, meditation, massage, and deep-breathing exercises. Take time to destress with long walks, quiet time, and exercise. Getting enough sleep can help you better cope with stress throughout the day and contribute to your overall health, too. If you need help dealing with stress, your healthcare provider can refer you to a therapist.

Depression. Women who suffer from depression are more likely to have problems with fertility than women who don't, says Alice Domar, director of the Domar Center for Mind/Body Health at Boston IVF.

Domar suggests that all women, but especially those with a personal or family history of depression, do a mental health check before they get pregnant. If you notice signs of depression, such as a loss of interest and pleasure in things that you used to enjoy, a change in appetite or sleep patterns, a loss of energy, or feelings of hopelessness and worthlessness, ask your provider for a referral to a therapist or psychiatrist for a consultation.

The two most effective treatments for depression are psychotherapy and medication, and many patients do best with a combination of both. A psychiatrist can help you find an antidepressant that's safe to take while you're trying to conceive and during your pregnancy. You may also want to try stress management techniques, such as yoga and meditation, because research suggests these can help depressed women conceive.

Domestic violence. Physical harm or emotional abuse by a partner is unlikely to get better during pregnancy or after your baby is born. If you're the victim of domestic violence, reach out for help through your healthcare provider or by getting in touch with the National Domestic Violence Hotline at (800) 799-7233.

Visit the dentist

When you're preparing for pregnancy, don't forget about your oral health. Hormonal shifts during pregnancy can make you more susceptible to gum disease. Higher progesterone and estrogen levels can cause the gums to react differently to the bacteria in plaque, resulting in swollen, red, tender gums that bleed when you floss or brush. There's also some evidence that severe periodontal disease is associated with pregnancy problems such as preterm birth and low birth weight.

The good news is that women who take care of their periodontal health before they get pregnant cut down on their chance of experiencing gum problems in pregnancy. See your dentist for a checkup and cleaning now if you haven't done so in the past six months.

Reduce environmental risks

You may not be able to entirely eliminate all environmental dangers, but you can do your best to keep as many of them as possible out of your life now. Some jobs can be hazardous to you and your unborn child, for example. If you're routinely exposed to chemicals or radiation, you'll need to make some changes before you conceive.

Also, keep in mind that some cleaning products, pesticides, solvents, and lead in drinking water from old pipes can be dangerous for a developing baby. Talk to your provider about your daily routine, and see if you can come up with ways to avoid or eliminate hazards in your home and workplace.

Consider money matters

According to the U.S. Department of Agriculture, middle-income families will spend $233,610 to raise a child from birth through age 17. (With projected inflation costs factored in, the price tag rises to $284,570.) Find out how much you're likely to spend with our Cost of Raising a Child Calculator.

For the more immediate future, you'll want to prepare for the cost of your pregnancy and delivery.

If you have health insurance, give the company a call and find out:

• What kind of prenatal coverage they offer
• If the doctor or midwife you have in mind is in your plan or how much it would cost to see her out of network
• What your deductibles are for prenatal visits and delivery. If you have a high deductible, try to put a little aside now so you won't be slammed with exorbitant bills when the baby arrives.
• What tests and procedures your insurance covers. (Preconception and prenatal care visits and many prenatal tests should be completely covered thanks to the Affordable Care Act.)

If you're lucky enough to have a choice of plans, compare coverage and providers.

Think your decision through

Having a child is a lifetime commitment. Before you try to conceive, consider whether you and your partner are ready to take on this responsibility. Some key questions:

• Have you considered what lifestyle changes you'll need to make once there's a child in the family?
• Have you thought through how you and your partner will divide household labor and childcare responsibilities and how you'll balance work and family?
• Are you prepared to parent a special-needs child if you have one?
• Are you and your partner equally committed to becoming parents?
• If you and your partner have religious, ideological, or cultural differences, have you discussed how they will affect how you raise your child?
• Do you have family members or close friends you can count on for support?
• Do you have financial resources, and is your financial situation (your income, job) stable?
• Is your housing secure?
• Are you prepared for the impact pregnancy and childbirth can have on you physically and mentally?

Have you spent much time with children? If not, visit friends or family who have small children to get a feel for what life is like with a baby or toddler. Talk with parents of young children about their parenting experiences – what are the challenges they're facing? What are the most difficult parts of parenting (as well as the joys)?

Figure out when you ovulate

Some women just stop using birth control when they're ready to get pregnant and let fate decide when they'll conceive. Others chart their periods and track symptoms to try to pinpoint their fertile days each month.

You can use our Ovulation Calculator to get a rough estimate of when you're most fertile. If you want to be more exact, start charting your basal body temperature (BBT) and the changes in your cervical mucus. Tracking these symptoms over several months can help you figure out when you're ovulating during each cycle.

Ovulation predictor kits can also help you figure out when you're ovulating by detecting hormones in your urine, or changes in chloride in the saliva or on the skin, that signal ovulation is about to occur. These kits cost about $17 to 50 per cycle and are available at drugstores.

Toss your birth control

So you're ready to bid adieu to birth control. For some people, ditching contraception is as easy as moving the condoms or diaphragm to the back of the dresser drawer. But going off hormonal contraception can require a bit more planning.

All you have to do to reverse the effects of the Pill, the patch, or the ring is to stop using them. You don't even have to wait for the end of a monthly cycle to stop. You'll most likely get your period within a few days. If you have an IUD, it can be taken out any time and your fertility will typically be the same as it was before you had it inserted.

For many women, fertility returns as soon as they stop using these methods, but some may take a month or so to start ovulating again. You'll know ovulation is back to normal when you're getting your period regularly.

If you're using the birth control shot (Depo-Provera), it can take up to a year after your last shot for you to start ovulating again, even if your period returns to normal sooner

Some healthcare providers recommend using a barrier method and waiting until you have a couple of normal periods before trying to conceive, because this can help you establish a more accurate due date. But it's completely safe to start trying right away if you want to. And if you do get pregnant before your periods become regular again, don't worry – you can have an early ultrasound to date your pregnancy.