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Planning for pregnancy

Being healthy before pregnancy increases your chances of having a healthy pregnancy and healthy baby, as well as reducing complications for your health.

The following topics aim to provide practical information on many aspects of health and wellbeing which will be useful if you are thinking about becoming pregnant. Pregnancy is a great opportunity to make positive health changes.

An image that shows the different stages of how a baby develops - the first graphic is of the egg, as it then develops into a foetus and then into a fully formed baby.

Before pregnancy

A woman’s chance of becoming pregnant decreases with age, particularly after the age of 35 because both the number and quality of eggs get lower. A man’s ability to have a baby also declines with age, though not as much as women’s. If the male partner is over 40, this can make it harder for the woman to get pregnant, especially if she is also over 40. However more than 8 in 10 of couples will conceive within a year if the woman is under 40 years of age, and they have regular sex (every 2 to 3 days) without using contraception.

Top tips

  • At any age, it is a good idea to be as healthy as possible before you get pregnant.

  • See your GP if you haven’t conceived after a year of trying or within six months of trying to conceive if you are over 36.

During pregnancy

While most women have healthy pregnancies and babies, the chance of complications in pregnancy increases with age. Such complications include miscarriage, pre-eclampsia (high blood pressure and protein in the urine) or having a baby with a chromosomal abnormality, for instance Downs syndrome. All women, regardless of their age, have a chance of having a baby with a chromosomal abnormality, however this chance increases with maternal age.

All women are offered antenatal screening to detect baby’s that have a high chance of conditions such as Downs syndrome.

Top tips

  • It is important that you attend all your antenatal care appointments so problems can be spotted as early as possible.

Before pregnancy

Fertility begins to improve quickly when you and your partner go smokefree. After 12 months of trying, women who are smokefree are twice as likely to be pregnant than women who smoke tobacco. Even smoking a small number of cigarettes a day can make getting pregnant more difficult. Second-hand smoke (breathing in tobacco smoke from others) is also likely to reduce your chances of conceiving. Smoking has been shown to reduce the quality of both the egg and sperm.

During pregnancy

Smoking in pregnancy is damaging to the health of you and your baby in many ways. Smoking in pregnancy is the biggest risk factor for stillbirth and infant death. Carbon monoxide (CO) monitoring is used by midwives for all women during pregnancy to detect harmful level of carbon monoxide. This may be due to smoking, exposure to secondhand smoke or to unsafe levels of carbon monoxide from other sources, including faulty cooking and heating appliances. 

Top tips

  • Ideally, it is best for both you and your partner to stop smoking before you try to become pregnant. However, if you are pregnant, it is still important to stop smoking. The earlier you stop smoking the healthier you and your baby will be.

  • If you are pregnant, let your midwife know that you or our partner smokes as they can help you to get the right support to stay smokefree. You may also want to encourage others whose secondhand smoke you are exposed to e.g. family members or friends, to get support.

Before pregnancy

Drinking a lot of alcohol, or drinking alcohol frequently, can affect fertility in both men and women. The UK Chief Medical Officers recommend that if you are pregnant or planning to become pregnant, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum.

If having treatment to assist fertility, studies have also shown that even light drinking can reduce the chances of success. Drinking excessively can damage the egg and sperm.

During pregnancy

There is no known safe level of alcohol to drink during pregnancy. The UK Chief Medical Officers guideline suggest the risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy. Drinking during pregnancy can cause a baby to develop fetal alcohol syndrome (FAS) which is a serious condition. For further information on drinking while pregnant click on this link.

Top tips

  • If you are planning to become pregnant and would like support to reduce or stop drinking alcohol, including if you are worried that you might be dependent on alcohol, speak to your GP or the specialist alcohol treatment service in your area (using the link above).

  • Once you stop contraception it is best to avoid alcohol as you may get pregnant straight away.

  • If you are pregnant, let your midwife know how much alcohol you drink including if you are worried that you might be dependent on alcohol as they can discuss this with you and help you to access support if it might help.

Before pregnancy

Using drugs, such as cannabis, cocaine, and new psychoactive substances (also known as ‘legal highs’) can affect fertility in both men and women.

Cannabis is the most commonly used recreational drug. In women, heavy cannabis use can cause hormones to be unbalanced so women who use it are more likely to find it difficult to get pregnant.

Some prescription drugs can also lead to dependence and are not suitable to take during pregnancy.

 

During pregnancy

Illegal drugs may cause serious problems in pregnancy and affect your baby’s growth and development. Some prescription drugs can also lead to dependence and are not be suitable to take during pregnancy.

 

Top tips

  • Once you stop contraception it is advised to avoid taking illegal drugs (and new psychoactive substances) as you may become pregnant at any point.

  • If you would like support to quit, including if you are worried that you might be dependent on drugs, speak to your GP or the specialist drug treatment service in your area. If you are pregnant, let your midwife know what drugs you are taking and how, as they can help you to access support.

  • Talk to Frank is a good source of information, both about the different types of drugs, and the local help available if you are concerned about your drug use.
  •  If you are concerned that you are dependent on a prescription medication, speak to your midwife or a doctor so they can help you get the right support.

Before pregnancy

If you’re planning to get pregnant, eating a healthy, balanced diet will help you stay well throughout pregnancy and be good for your baby’s health. The best foods for getting pregnant are the same as those for general well-being. For both men and women, being overweight or underweight can affect fertility, cause health problems during pregnancy and during birth, as well as affect the future health of a child. Men can also improve the chances of a pregnancy with a healthy, balanced diet because sperm quality can be affected.

If you are trying to get pregnant eating a healthy, varied diet will help you to get most of the vitamins and minerals you need. All women need to take folic acid tablets (see section on folic acid below for further information) before getting pregnant to offer protection against neural tube defects such as spina bifida in the early stages of pregnancy. It is almost impossible to get enough folic acid through your diet to give the most protection.

During pregnancy

When pregnant, guidelines recommend you and your baby will benefit from a healthy diet in which you get five portions of fruit or vegetables each day (with at least 3 portions of vegetables). A healthy balanced diet will give you most of the vitamins and minerals you need for your developing baby and help keep you and baby healthy and strong ahead of birth. Some foods should be avoided during pregnancy to minimize the risk of food poisoning which can be harmful to you and your baby (see link below for more information on specific foods). A poor diet can also damage your teeth. Hormonal changes during pregnancy can make gums more vulnerable to plaque, leading to inflammation and bleeding. The best way to prevent or deal with gum problems is to practice good oral hygiene. Pregnant women, or women who have had a baby in the past 12 months are entitled to free NHS dental care (you'll need a Maternity Exemption Certificate from you midwife or doctor).

Top tips

Before and during pregnancy

  • Aim to eat a variety of healthy foods every day. Making some improvements to your diet will have a positive effect, do as much as you can. Talk to your midwife for advice if needed.
  • Most women should take 400mcg of folic acid every day for two months before trying for a baby and until 12 weeks pregnant. You will need a higher dose of folic acid tablets if you have some health conditions such as diabetes, epilepsy or have a BMI (Body Mass Index) over 30. See the section on folic acid below for further information.
  • Do not eat for two - during the last three months of pregnancy you may need an additional 200 calories a day.
  • Weight gain during pregnancy varies greatly. For more information on what to expect see the 'weight gain in pregnancy' section by clicking here.
  • Practice good oral hygiene during pregnancy (ask your midwife how to apply for a Maternity Exemption Certificate).

Before pregnancy

Being a healthy weight is helpful if you are planning to have a baby. Your BMI (Body Mass Index) is a measure that uses your height and weight to work out if your weight is in a healthy range. A BMI Calculator is available on this link

Having an unhealthy (overweight or underweight) BMI can affect your fertility, cause health problems during pregnancy and during birth, as well as affect the future health of a child.

High BMI

Having a high BMI can reduce your chances of getting pregnant. The ideal BMI for getting pregnant is between 18.5 and 24.9. This is known as the healthy range. If you have a high BMI, bringing it closer to the healthy range before trying for a baby will help you get pregnant as well as improving the health of your future pregnancy and child. If you have a high BMI bringing it down, even by 1 or 2 points, can make a positive difference.

A high BMI in a man can also affect the quality and quantity of their sperm, which can contribute to difficulty conceiving.

Low BMI

Having a BMI below 18.5 is classed as underweight, which can make it harder to get pregnant.

Having a low BMI can also cause periods to become irregular or stop. This can be a sign that ovulation is not happening (releasing an egg from your ovary each month), which is needed to get pregnant. If you are not having periods, putting on weight to get to a healthy BMI may help this.

Top tips
  • Everyone regardless of BMI should aim to eat a healthy, balanced diet as well as being physically active (see nutrition and physical activity sections below for further information). Before pregnancy, if you have a high BMI, bringing your BMI down 1 or 2 points towards the healthy range will reduce your risks and increase your chances of conceiving.
  • If you are finding it difficult to achieve a healthy weight before pregnancy:
  • Speak to your GP who may be able to help you access weight management or other specialist support around increasing/losing weight. Some services accept self-referrals which you may be able to find details of on the Internet for a service in your area.
  • See section below for information explaining more about folic acid. For women who have a BMI over 30, a higher daily dose of folic acid is needed (5mg daily). Ask your pharmacist or GP if you are unsure what dose may be suitable for you. The GP will need to write a prescription for you.
  • If you are unsure what your BMI is, you may find this calculator helpful - to access it, click on this link.

Before pregnancy

Exercise/being active can boost your chances of becoming pregnant. Women who do regular, moderate exercise typically get pregnant more quickly than women who don’t exercise regularly. Any activity which raises your heart rate, makes you breathe faster and makes you feel warmer counts.

Being active by doing regular moderate exercise before you get pregnant can reduce your risk of having problems in pregnancy, such as gestational diabetes or pre-eclampsia (high blood pressure and protein in the urine) that might harm you or your baby.

Feeling low or anxious can be common if you are trying to become pregnant. Staying active can help to boost your mood and lessen stress. If feeling low or anxious persists, visiting a GP can help to get the right support.

During pregnancy

Being active during pregnancy is safe and healthy for mother and baby, however if you play a sport where there is contact/risk of contact or potential risk of falling (especially in later stages when balance/centre of gravity alters due to larger baby bump) you should avoid these and opt for a non-contact sport or activity. As your bump gets bigger you may find that you feel light headed or dizzy lying on your back. This is because the weight of your bump presses on the main blood vessel bringing blood back to your heart and this can make you feel faint. It is best to avoid lying on your back if you experience light headedness.

Being active by doing regular moderate exercise during pregnancy can help lead to a healthy pregnancy and birth. It can reduce risk of having problems in pregnancy, such as gestational diabetes or pre-eclampsia.

Feeling low or anxious can be common during pregnancy. Staying active can help to boost your mood and lessen stress. If feeling low or anxious persists, speaking to your midwife or visiting a GP can help to get the right support.

Top tips

Before pregnancy

  • If you have always been moderately active, continuing to exercise at the same level before pregnancy is safe and healthy.
  • If you have not been active before, start to build up your level of activity now. Start by finding ways to build small amounts of physical activity into your daily routine, for instance by walking to work.
  • Before pregnancy, the Chief Medical Officer suggests to aim for at least 150 minutes or moderate intensity activity per week or at least 75 minutes of vigorous intensity activity per week, or a combination of both. Also aim to minimise time spent being inactive. For more information on Physical activity click on this link.

During pregnancy

Before and during pregnancy

Folic acid (a vitamin) is important as it reduces the risk of birth defects known as neural tube defects, including spina bifida (a serious spinal problem).

While folic acid is contained within certain foods, even a healthy diet does not contain enough folic acid for pregnancy. Taking folic acid tablets is therefore very important.

Every woman of reproductive age needs enough folic acid every day to help make new cells, whether planning to get pregnant or not.

It is advised that all women take folic acid tablets before getting pregnant to offer protection against neural tube defects such as spina bifida in the early stages of pregnancy.

Some women, including those with diabetes, epilepsy, rheumatoid arthritis, or who have a BMI over 30, need to take a higher dose of 5mg of folic acid (instead of 400mcg). This is available free of charge through your doctor.

All women are offered an ultrasound scan and to look for conditions such as spina bifida.

Top Tips

Before pregnancy

Vitamin D helps us to absorb the right amount of calcium and phosphate which are needed to keep bones, teeth and muscles healthy.

We get vitamin D from sunlight and it is also found in some foods. Most of us don’t get enough vitamin D from our diet and we rely on the summer sunlight on our skin to make enough vitamin D for the winter months.

During pregnancy

Vitamin D is especially important in pregnancy as it helps your baby’s bones, teeth, kidneys, heart and nervous system to develop. All pregnant women are advised to take a 10 microgram supplement of vitamin D each day to give your baby enough vitamin D for the first few months of life.

Without it, there is a risk that your child will have soft bones, which can lead to rickets (a disease that affects bone development in children).

Some women are more likely to need vitamin D than others. You may have an even higher risk of vitamin D deficiency if you; always cover your skin, use high-factor sun block, have dark skin, spend very little time outside, have a BMI above 30.

During pregnancy, do not take vitamin A supplements or any supplements containing vitamin A (retinol), as too much could harm your baby.

Action

If you are pregnant, discuss with your GP or midwife if you are not sure what dose of vitamin D is right for you and consider buying a pregnancy appropriate 10 microgram supplement.

If you are buying a multivitamin supplement, ensure the supplement is specific to pregnancy.

If you are eligible for Healthy Start vitamins, they contain vitamin D. Find out more on the Healthy Start website.

Before and during pregnancy

High levels of caffeine before and during pregnancy can result in babies having a low birth weight. Too much caffeine can also increase the risk of miscarriage. Advice is to limit caffeine intake to 200mg a day.

Top tips

Reduce caffeine intake to under 200mg a day. Decaffeinated drinks may be a helpful alternative. Be aware that chocolate, energy drinks and cola, as well as tea and coffee contain caffeine.

These are common sources of caffeine:

  • Mug of instant coffee = 100mg
  • Mug of filter coffee = 140mg
  • Mug of tea = 75mg
  • Can of cola = 40mg
  • Can (250ml) of energy drink: up to 80mg
  • Bar (50g) of plain chocolate = less than 25mg
  • Bar (50g) of milk chocolate = less than 10mg

This caffeine calculator may be useful to estimate how much caffeine you are consuming.

Before pregnancy

Planning for a baby can be a big change in someone's life. It can also lead to worries about money, family relationships, as well as a range of other things. Being anxious from time to time is normal, but if it does not go away then it is important to talk to someone about it.

Those who experience difficulty in becoming pregnant may experience an impact on their emotional health and wellbeing too. Partners may become anxious which can increase risk of sexual dysfunction. The process of treatment to assist conception too can be a source of stress, anxiety and depression.

For individuals with an existing mental health condition, sometimes becoming pregnancy can trigger this condition to become worse, in other cases there will be no change - everyone is different. Mental health conditions are often managed with medications. Doctors and specialists can help with decisions about how mental health conditions can be managed during pregnancy. This may include ensuring that conditions are as stable as possible before pregnancy and checking suitability of medications for mother and baby. It may be helpful for mental health conditions to be monitored closely during pregnancy.

During pregnancy

For information on mental health during pregnancy, click here.

Top Tips
  • Take care of your emotional health as you try to become pregnant, including through being active, eating well, finding ways to relax and avoiding drugs and alcohol.
  • Take notice of your emotional health. Try to talk to someone you trust if you are feeling stressed, anxious or are experiencing symptoms of your mental health condition, whether that be your partner, a friend or family member or your doctor who may be able to help you access support. Remember that changes to emotional wellbeing at this time are not unusual.
  • For individuals who are taking medication for mental health conditions and who are planning to become pregnant, talk to a doctor or specialist letting them know your plans, ideally before stopping contraception.
  • Do not stop taking medication before speaking to a doctor or specialist as it could be dangerous. They will work with you to find the most suitable medication for managing your mental health condition in pregnancy.
  • Remember, pregnant women, or women who have had a baby in the past 12 months are entitled to free prescriptions (you'll need a Maternity Exemption Certificate).

Before pregnancy

Close management of diabetes (type 1 or type 2 diabetes) before pregnancy can help reduce risks of pregnancy loss or birth defects. Suitability of some medications which are part of diabetes management may need to be reviewed ahead of pregnancy and therefore it is important to speak to your doctor before trying to become pregnant.

During pregnancy

Individuals who have diabetes (either type 1 or type 2) can experience diabetes related complications unlinked to pregnancy (known as microvascular and macrovascular complications). However, the combination of diabetes and pregnancy can increase the risk of developing these problems, or making existing problems worse.

Due to hormonal changes, pregnancy can sometimes cause rapid progression of diabetic retinopathy (a microvascular complication), which affects the small blood vessels in the retina of the eye. Checks to identify diabetic retinopathy therefore need to be undertaken more frequently during pregnancy.

In addition, women who have not previously had diabetes can experience gestational diabetes, a condition characterised by high blood sugar during pregnancy. Gestational diabetes resolves after pregnancy, but increases a woman’s chance of developing Type 2 diabetes subsequently.

Top Tips
  • It is important to speak to your diabetes specialist as soon as you start thinking about stopping your contraception. The earlier the better, 6–12 months before thinking about having a baby is ideal. There are important steps which your specialist can help with to make sure you are ready before you conceive. This includes reviewing how your blood glucose levels are controlled, reviewing suitability of medication for pregnancy, and prescribing a higher dose of folic acid (5mg daily) to take while you are trying to get pregnant.
  • Aim to keep good control of your diabetes and blood pressure during pregnancy, as well as not smoking, as this will reduce the chance of complications associated with diabetes developing or progressing.
  • Ensure you know how frequently to attend diabetic eye screening during pregnancy. This is usually every 3 months, starting within the first 6 weeks of pregnancy.

Find more information about diabetic retinopathy screening in pregnancy by clicking here (this information is available in multiple languages).

Before pregnancy

Many people take medications prescribed by their GP Suitability of some medications may need to be reviewed for use during pregnancy. For other medications, the health condition may need to be carefully monitored. This will depend on the specific health condition and therefore it is important to talk about plans for pregnancy with your doctor, only taking your medications with their advice. Over the counter medicines, complementary medicines or other supplements also need to be considered, talk to your pharmacist for more information.

Depending on the health condition, sometimes a higher dose of folic acid may need to be prescribed (5mg daily rather than 400mcg) to take while trying to get pregnant and for during pregnancy, according to your doctor's advice.

Find more information on some pre existing medical conditions here.

During pregnancy

Management of health conditions can change during pregnancy. You may be regularly reviewed during pregnancy so that your condition can be closely monitored.

Top Tips
  • Speak to a doctor or pharmacist? about plans to try for a baby so that your treatment can be checked for safety in pregnancy.
  • Your doctor will talk to you about:
    • Prescribing a higher dose of folic acid (5mg daily) to take while you are trying to get pregnant
    • Any medications you are taking so their suitability can be reviewed
    • How your condition may affect pregnancy and vice versa
    • How you will be cared for during pregnancy.
  • Remember, pregnant women, or women who have had a baby in the past 12 months are entitled to free prescriptions (you'll need a Maternity Exemption Certificate).

Before pregnancy

Sexually transmitted infections (STIs) are conditions that are passed from one person to another through sexual contact. Many STIs have no or only mild symptoms. This means that there is a group of people who are living with STIs that they do not know they have, increasing their risk of passing their infection on to other sexual partners.

Many STIs can affect chances of getting pregnant. For instance, chlamydia and gonorrhoea are two of the most common STIs. Either can lead to infertility in men and women if not treated.

Syphilis, another STI, can be treated but if a woman becomes pregnant when she already has syphilis, (or becomes infected while pregnant), it can be very dangerous for the baby. Click here for more information about syphilis.

HIV and Hepatitis B can also be passed on by sexual contact (as well as by other routes of transmission). For those living with HIV or Hepatitis B, it is important to talk to your specialist doctor or nurse. They can advise about conceiving safely, minimising the risk of passing the infection on to the baby and planning specialist care which may be needed during pregnancy and birth. Click here for more information about HIV and Hepatitis B.

Most STIs can be treated with antibiotics, special creams or shampoos. But some treatments are not suitable if you are pregnant and therefore it’s a good idea to get checked before trying for a baby.

During pregnancy

For more information on how sexually transmitted infections may affect your pregnancy. click here.

You will be screened for HIV, Hepatitis B and syphilis as part of the Infectious Diseases in Pregnancy Screening programme. This is part of routine antenatal screening and is offered, and recommended, for all pregnant women in England in every pregnancy.

Top Tips
  • Before trying for a baby, if you have any reason to believe you or your partner may have an STI, contact your local Sexual Health service about getting a sexual health screen. For many services, you will be able to access a sexual health screening test that will be posted to your home. In some areas you may need to go to your local sexual health clinic for a check-up.
  • For people living with HIV or Hepatitis B, talk to your specialist doctor or nurse as they can advise about conceiving safely and it will be necessary to plan specialist care needed during pregnancy and birth.
  • Find more information about infectious disease screening in pregnancy here (this information is available in multiple languages).

Before pregnancy

If you're planning a pregnancy, it’s a good idea to check if you are up to date with your cervical screening and if necessary, have the test before getting pregnant. Cervical screening aims to identify abnormal cells which can sometimes lead to cervical cancer. Having this test before becoming pregnant means that any further tests or treatment can be arranged around pregnancy.

All women aged 25 to 49 who are registered with a GP get a letter inviting them for cervical screening every three years. If you’re planning a pregnancy there’s no need to wait for a letter.

During pregnancy

Cervical screening is not advised during pregnancy as it makes the results of the test harder to interpret.

Top Tips

Contact your GP practice to find out if your cervical screening test is due, telling them about your pregnancy plans. If you have not had a cervical screening test in the last three years (if you are between 25 and 49 years) make an appointment before you begin trying to get pregnant.

Before pregnancy

Rubella (also known as German measles) is rare but it can be dangerous to the unborn baby if you catch it while you’re pregnant. It can cause hearing loss, eye conditions, heart defects, brain damage or pregnancy loss. This can be prevented by making sure you have had two doses of the MMR vaccination, which includes rubella, before you start trying for a baby. Click here for more information about Rubella and the MMR vaccination.

During pregnancy

The MMR vaccine is a live vaccine (it contains a weak form of the virus to make your body develop immunity) and therefore it is not given during pregnancy.

Top Tips

If you have not had two MMR vaccinations, or you have no way of being certain that you were vaccinated, ask your GP for these doses one month apart and with the second dose at least a month before pregnancy.

Before pregnancy

Sickle cell disease and thalassaemia affect haemoglobin, a part of the blood that carries oxygen around the body. Individuals living with sickle cell disease or thalassaemia need specialist care throughout their lives.

For women living with thalassaemia who are having regular blood transfusions and iron chelation it may take several years for women to become physically fit enough to have a successful pregnancy.

Suitability of some medications which are part of thalassaemia and sickle cell disease management and those used for pain relief during sickle cell crises (painful episodes) may need to be reviewed before pregnancy and therefore it is important to speak to your specialist doctor before trying to become pregnant.

It may also be possible to be referred for specialist genetic counselling before pregnancy to understand the chances of genetic conditions being passed on.

During pregnancy

Sickle cell disease in pregnancy affects each woman differently but woman may experience more frequent painful episodes.

Sickle cell disease can make some pregnancy related complications more common, including pregnancy loss, blood clots and high blood pressure. Thalassaemia can also increase the risk of blood clots during pregnancy.

Top Tips

Before pregnancy:

If you or your baby’s father have someone in your family with sickle cell disease or thalassaemia talk to your specialist or GP about the chance of passing the condition onto your baby and treatment during pregnancy.

Your doctor will talk to you about:

  • Any medications you are taking so their suitability can be reviewed
  • How your condition may affect pregnancy
  • How you will be cared for during pregnancy

During pregnancy:

All pregnant women in England are offered a blood test to find out if they carry a gene for thalassaemia.

Those at high risk of being a sickle cell carrier are offered a test for sickle cell. If the mother is found to be a carrier, screening is also offered to the father. Both parents need to carry a gene for these conditions for it to be passed on to the baby. If one parent carries a gene, the baby may also be a carrier of the condition.

If the result shows your baby has sickle cell disease or thalassaemia, you'll be offered an appointment with a health professional to understand more about it and to talk through choices.

Find more information about sickle cell and thalassemia screening in pregnancy here (this information is available in multiple languages).