Pre-conception care in Mumbai is provided by Dr. Vaishali Joshi, FRCOG, Senior Consultant Obstetrician & Gynaecologist at Kokilaben Dhirubhai Ambani Hospital, Andheri West, who runs dedicated pre-conception clinics. A pre-pregnancy check-up is the single most cost-effective appointment in obstetrics: the baby's organs form in the first eight weeks, often before a woman knows she is pregnant, so the health you bring to conception matters more than almost anything done afterwards.
Most antenatal care begins at six to eight weeks of pregnancy. By that point, the neural tube has already closed and organ formation is well under way. This is why pre-conception care exists as a distinct thing: several of the most valuable interventions in obstetrics only work if they happen before conception, not after.
Ideally, come three months before you start trying. That gives time for supplementation to take effect, for medication to be reviewed and adjusted, for any deficiency to be corrected, and for a chronic condition to be brought under good control.
Who particularly benefits from a pre-conception consultation?
Every woman planning a pregnancy benefits. Some benefit a great deal:
- Women with diabetes — glucose control around conception directly affects the risk of congenital malformation, and this is one of the clearest examples of an intervention that must happen before pregnancy to work.
- Women with high blood pressure, thyroid disease, epilepsy, autoimmune conditions, cardiac or kidney disease, where medication frequently needs review for pregnancy safety.
- Women taking regular medication of any kind — some drugs are unsafe in pregnancy and need switching in advance rather than stopped abruptly on a positive test.
- Women with a previous pregnancy complication — pre-eclampsia, preterm birth, growth restriction, stillbirth, recurrent miscarriage or a previous caesarean.
- Women aged 35 and above, or with a family history of genetic conditions.
- Couples with a family history of thalassaemia or sickle cell disease, which is an important consideration in parts of India and where carrier testing before pregnancy genuinely changes options.
- Women who are significantly over or under weight, where improvement before conception affects outcomes measurably.
Folic acid: start before you conceive
Folic acid supplementation reduces the risk of neural tube defects such as spina bifida. The neural tube closes by around 28 days after conception — often before a missed period. Starting folic acid after a positive pregnancy test is therefore too late to achieve the main benefit.
Standard advice is to begin at least one month, and preferably three months, before conception and to continue through the first trimester. A higher dose is recommended for women at increased risk — a previous baby with a neural tube defect, diabetes, epilepsy on certain medications, or a significantly raised body mass index. Your obstetrician will advise the dose appropriate to you.
Which tests are worth doing?
The exact panel is individual, but a pre-conception assessment typically considers:
Blood group and antibodies
Including Rhesus status, which matters for pregnancy management and for anti-D prophylaxis.
Full blood count
Anaemia is common and is far better corrected before pregnancy than during it, when iron demand rises sharply.
Haemoglobin studies
Screening for thalassaemia and haemoglobinopathy carrier status where indicated by ethnicity or family history — and testing the partner if the woman is a carrier.
Thyroid function
Untreated thyroid disease affects both fertility and fetal development, and requirements change in pregnancy.
Glucose or HbA1c
To detect undiagnosed diabetes and to establish control in known diabetes before conception.
Rubella immunity
If not immune, vaccination before pregnancy — the vaccine is not given during pregnancy and conception should be deferred for a period afterwards.
Infection screening
Hepatitis B, hepatitis C, HIV and syphilis, all of which have management implications that begin before or early in pregnancy.
Vitamin D
Deficiency is very common in India and worth identifying rather than assuming.
Cervical screening
A good moment to ensure your smear is up to date, since it is more straightforward before pregnancy than during it.
A pelvic ultrasound may be arranged where there is a history of fibroids, ovarian cysts, PCOS or previous pelvic surgery.
Optimising health before conception
Weight
Both a high and a low body mass index affect fertility and pregnancy outcomes — a raised BMI increases the risk of gestational diabetes, hypertensive disease, difficulties in labour and caesarean delivery. Losing weight before pregnancy is considerably more effective and safer than attempting it during pregnancy, when weight loss is not the goal.
Smoking, alcohol and tobacco
Stop before conceiving. Smoking is associated with reduced fertility, miscarriage, growth restriction, preterm birth and stillbirth. No safe level of alcohol in pregnancy has been established, so the sensible course is to stop while trying. Smokeless tobacco carries its own risks and is often not mentioned unless asked about directly — it is worth disclosing.
Existing medication
Bring every medicine you take, including over-the-counter drugs, supplements and Ayurvedic or herbal preparations, to the appointment. Some are unsafe in pregnancy and need substituting in advance. Equally important: do not stop a prescribed medication on your own when you discover you are pregnant. Uncontrolled epilepsy, thyroid disease or hypertension can pose a greater risk to a pregnancy than the medication treating them. That is a decision to make with your doctor, in advance.
Vaccination
Rubella immunity should be checked and vaccination given before pregnancy if needed. Other vaccinations may be advised depending on your history.
Dental and general health
Gum disease has been associated with preterm birth, and dental treatment is simpler before pregnancy. It is a small thing that is easy to arrange in advance and awkward to arrange later.
How long should it take to conceive?
Most couples having regular unprotected intercourse conceive within a year. General guidance is to seek assessment after twelve months of trying, or after six months if the woman is 35 or older — and sooner still if there is a known reason to expect difficulty, such as irregular periods, endometriosis, previous pelvic surgery or infection, or a known male factor.
There is no advantage in waiting the full period if something already suggests a problem. Investigation is straightforward, and time is the variable that matters most in fertility.
Bring your partner. A male factor contributes in a substantial proportion of couples with difficulty conceiving, and a semen analysis is a simple, inexpensive early test. Pre-conception planning is a conversation for two people, and framing it as the woman's appointment alone tends to delay half the assessment.
Frequently asked questions
When should I have a pre-pregnancy check-up?
Ideally about three months before you start trying to conceive. That allows time for folic acid supplementation to take effect, for any medication to be reviewed and safely changed, for deficiencies such as anaemia or low vitamin D to be corrected, and for a chronic condition such as diabetes or thyroid disease to be brought under good control. Because the baby's organs form in the first eight weeks — often before a woman knows she is pregnant — several of the most valuable interventions only work if they happen beforehand.
When should I start taking folic acid?
At least one month, and preferably three months, before conception, continuing through the first trimester. The neural tube closes by around 28 days after conception, frequently before a missed period, so starting after a positive pregnancy test is too late for the main benefit. A higher dose is recommended for women at increased risk — a previous baby with a neural tube defect, diabetes, epilepsy on certain medications, or a significantly raised body mass index. Ask your obstetrician which dose applies to you.
Which tests are done before pregnancy?
Typically blood group and Rhesus status, a full blood count, thyroid function, glucose or HbA1c, rubella immunity, and screening for hepatitis B, hepatitis C, HIV and syphilis. Vitamin D is worth checking given how common deficiency is in India. Where ethnicity or family history indicates, haemoglobin studies for thalassaemia and haemoglobinopathy carrier status are important — and the partner should be tested if the woman is a carrier. Cervical screening is easier to bring up to date before pregnancy than during it.
Should I stop my regular medication when I want to get pregnant?
Not on your own. Some medicines are unsafe in pregnancy and need substituting in advance, but stopping a prescribed medication abruptly can be more dangerous than continuing it — uncontrolled epilepsy, thyroid disease or hypertension can pose a greater risk to a pregnancy than the drugs treating them. Bring everything you take, including over-the-counter medicines, supplements and Ayurvedic or herbal preparations, to your pre-conception appointment and decide together, before you conceive.
How long should we try before seeking help?
General guidance is to seek assessment after twelve months of regular unprotected intercourse, or after six months if the woman is 35 or older. Come sooner if there is already a reason to expect difficulty — irregular or absent periods, known endometriosis or PCOS, previous pelvic surgery or infection, or a known male factor. There is no advantage in waiting out the full period when something already points to a problem, and in fertility, time is the variable that matters most.
Does my partner need to be involved?
Yes. A male factor contributes in a substantial proportion of couples who have difficulty conceiving, and semen analysis is a simple, inexpensive early test. Lifestyle matters on both sides — smoking, alcohol, weight and certain medications all affect sperm quality. Treating pre-conception planning as the woman's appointment alone tends to delay half of the assessment by several months.
Related reading
Written & medically reviewed by Dr. Vaishali Joshi, FRCOG CCT MD DNB DGO FCPS — Senior Consultant Obstetrician & Gynaecologist, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
Last reviewed . This article is general information and is not a substitute for individual medical advice. Please discuss your own circumstances at consultation.