We all know how many tests and check-ups women are subjected to when they’re expecting. But doctors advise that here are exams women should have even before they get pregnant.
If you’ve made the decision to try to get pregnant, the first thing you should do with your partner—even before you start enjoying sex without protection—is visit your ob/gyn’s office. “Preferably, you want to do this at least a few months before your first month of trying,” advises Peter Uzelac, MD, an assistant professor of obstetrics and gynecology at the University of Southern California in Los Angeles. “That would give you enough time if you need to see a genetic counselor, if you have a history of obstetrical problems, or if you have to get a medical problem under control.”
Once you and your partner sit down with your doctor, he will likely ask you a long list of questions about your lifestyle (Do you smoke? How much do you drink? Do you exercise regularly?); your medical histories (Do you have diabetes? Have you had surgery?); and finally your families’ medical histories (Any relatives with high blood pressure? How about genetic diseases such as Down syndrome?). “This helps to identify anything in the family with an impact on reproduction,” explains James Goldbeg, MD, co-director of the prenatal diagnosis center at California Pacific Medical Center in San Francisco.
Based on the answers you give, your ob/gyn can then determine your risk for various conditions that may affect both your ability to conceive and when you do get pregnant, your health and your child’s. Any chronic illness, such as diabetes or hypertension, will need to be overseen by a specialist during your pregnancy.
Checking Up on Your Lifestyle, Past and Present
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One of the subjects you’ll cover in that first pre-pregnancy medical visit is sexually transmitted diseases (STDs). Since a number of STDs can impair fertility, it’s important to be honest about your past and current sexual behavior. Depending on your history, you may be screened for gonorrhea, chlamydia, syphilis, herpes, and/or bacterial vaginosis (gardnerella). These diseases need to be treated before you get pregnant, or ruled out as causes if you’re having difficulty conceiving.
Depending on your job, you may need to take other precautions. If, for example, you work with elderly people and/or in a hospital, you should get a hepatitis B vaccine, says Annette Perez-Delboy, MD, an assistant clinical professor, department of obstetrics and gynecology, Columbia University College of Physicians and Surgeons in New York City and a specialist in high-risk pregnancy. You should also get the vaccine if you frequently travel to high-risk countries.
A preconceptional check-up is also a good time to take care of routine health exams that may be difficult or inadvisable during pregnancy. “If a woman has not had a Pap smear in the last one to two years, I would do one,” says Elena Gates, MD, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. “And if I’m doing a Pap I generally do a pelvic exam as well.”
If you’re 40 or over and haven’t had a recent mammogram, your physician might suggest one now, as per American Cancer Society guidelines for all women. “During pregnancy it can become much more difficult to evaluate the breasts,” explains Dr. Goldberg. And most women would prefer not to risk the radiation exposure while pregnant.
Immunity and Other Issues
Your doctor will review your vaccination history during this pre-conception appointment, so come prepared with a list of shots and the dates you received them. “I check everyone for rubella [German measles] immunity, even if they were immunized as a child,” says Dr. Gates. “If a woman is not immune, she can be vaccinated before she gets pregnant. Rubella can cause birth defects if a woman develops it during the first three months of pregnancy.”
The American College of Obstetricians and Gynecologists (ACOG) advises that if immunizations for measles, mumps, and rubella are needed, they should be done at least three months prior to pregnancy. The varicella (chicken pox) vaccine, also important, should be given at least a month before conceiving.
Beyond the common tests above, your talk with the doctor may reveal a family history and possible risk of a hereditary condition. In that case, you may need to make an appointment with a genetic counselor to determine just how great the risk is and what precautions you can take.
In all these cases, having an exam to evaluate your current state of health, your immunological status, and your genetic history before you get pregnant can give you and your doctors the information you need to help ensure a healthy pregnancy and a healthy baby.
A version of this article originally appeared in the Spring 2005 issue of Conceive Magazine.
Related Topics: Boost Fertility; Fertility Health
