Table 3.

Preconception advice

Pre-existing medical problems*

• Stabilise medical conditions and ensure that medical control is optimal

• Check that drugs needed are safe for use in pregnancy and do not affect sperm function

• Where appropriate, refer woman to an obstetric physician for advice on implications of the condition in pregnancy

Weight

• Check BMI

• Advise on weight gain or loss where BMI is < 20 or > 30

Smoking

• Advise both partners to stop smoking

Recreational drugs

• Advise both partners to stop using recreational drugs

Folic acid

• Women who are trying to conceive should take folic acid supplements (0.4 mg) daily to reduce the risk of neural tube defects. Women with a history of neural tube defect or epilepsy should take 5 mg daily

Virology screening

• Screen for rubella immunity and offer immunisation to those not immune

• Consider screening for HIV and hepatitis B and C in groups at risk

Prenatal diagnosis

• Tell older women about options for prenatal diagnosis

Timing of intercourse

• Check couple's understanding of ovulatory cycle and relate most fertile days to the length of woman's cycle

• Advise that intercourse occurs regularly. Two to three times a week should cover the most fertile time

Factors affecting fertility

• Discuss any factors in either partner's history that might warrant early referral for specialist infertility advice

^*For example, hypertension, diabetes, epilepsy, thyroid disorder, cardiac problems, and drug history