Much of what determines how a pregnancy goes is settled before it begins. Preconception care simply means getting a few things in order in the months before you start trying — and most of it is straightforward.

Here are the five things we prioritise.

1. Your age and the timing of pregnancy

Fertility and pregnancy outcomes are both influenced by age. Conceiving within the ideal window — broadly the twenties into the early thirties — is associated with the highest chance of conceiving and the lowest rates of complications.

This is not a reason for anyone to panic, and plenty of women have healthy pregnancies later. But if you know you want children and the timing is within your control, it is a genuine factor worth weighing rather than something to leave unexamined. If you are already over 35 and planning a pregnancy, come and talk to us early rather than waiting a year to see what happens.

2. Folic acid

Start folic acid before you conceive, ideally about three months beforehand, and continue through the first trimester. It substantially reduces the risk of neural tube defects such as spina bifida, and the protection depends on it being in your system during the earliest weeks — often before you know you are pregnant.

Some women need a higher dose, including those with diabetes, a high BMI, epilepsy on certain medicines, or a previous affected pregnancy. Ask us if any of these apply to you.

3. Your weight

Getting to a healthy body weight before pregnancy improves fertility and lowers the risk of gestational diabetes, high blood pressure and pre-eclampsia. Both being significantly overweight and being underweight can affect ovulation.

The aim is a steady, sustainable change made before conception rather than dieting during pregnancy, which is not recommended. Small, consistent adjustments to what you eat and how much you move are what work.

4. Your vaccinations

Check that you are up to date before conceiving, since some vaccines are best given beforehand rather than during pregnancy. Rubella immunity matters particularly, as rubella infection in early pregnancy can seriously affect a baby. Tetanus and influenza vaccination should also be discussed, along with any others relevant to you — including routine COVID-19 vaccination if you are due.

5. Any existing medical conditions

If you have a long-term condition — diabetes, high blood pressure, thyroid disease, epilepsy, heart disease — the time to optimise it is before pregnancy, not after. Some medicines need changing to safer alternatives, and some conditions need to be well controlled before conception for the best outcome.

Do not stop any regular medicine on your own. Come and discuss it with us, and we will make any changes safely.

Screening for infections such as HIV and syphilis is part of preconception assessment, and in Sri Lanka screening for congenital and rheumatic heart disease is also recommended.

Practical steps in Sri Lanka

  • Register in the eligible couple register with your local public health midwife. This gives you access to preconception services including examination, screening and counselling.
  • Plan when to stop contraception. Ask us about timing — it differs between methods.
  • Understand your fertile window. Knowing when you ovulate helps you time intercourse. Our fertile period calculator can help.
  • Consider seeing a gynaecologist for a more detailed assessment, particularly if you have an existing condition, are over 35, or have had difficulty conceiving before.
  • Stop smoking and alcohol before you start trying, not after you find out.

The bottom line

Preconception care comes down to five things: think about timing and your age, start folic acid three months ahead, get to a healthy weight, check your vaccinations, and get any existing condition well controlled. Register with your public health midwife, and come and see us if you have a medical condition or any concerns about conceiving. For more on eating well from the outset, see our guide to nutrition in pregnancy.

References

  1. National Health Service. Planning your pregnancy [Internet]. NHS; [cited 2026 Jul 22]. Available from: https://www.nhs.uk/pregnancy/trying-for-a-baby/planning-your-pregnancy/
  2. National Health Service. Vitamins, supplements and nutrition in pregnancy [Internet]. NHS; [cited 2026 Jul 22]. Available from: https://www.nhs.uk/pregnancy/keeping-well/pregnancy-vitamins-and-supplements/
  3. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NG257. London: NICE; 2026. Available from: https://www.nice.org.uk/guidance/ng257
  4. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016. Available from: https://www.who.int/publications/i/item/9789241549912