Pre-pregnancy counselling is an appointment you have before you conceive. It looks at your health and checks for anything that could affect your pregnancy, so any issues can be managed early. This is helpful for both you and your baby. It covers your physical and mental health and gives you a chance to improve your wellbeing before you become pregnant. It is also a good time to review any medication you take.

Anyone planning to have a baby can have pre-pregnancy counselling. It is a good idea to have it before you start trying, so you feel informed and prepared.

Even if this is not your first pregnancy, you may still find it helpful, especially if you:

• have a child with a genetic disorder
• are over 35
• live with a mental health condition
• have had problems in a previous pregnancy, such as miscarriage, gestational diabetes, preterm birth or a birth defect
• have a medical condition such as diabetes, high blood pressure, a kidney, heart or thyroid condition, or epilepsy

You can raise anything that is worrying you about pregnancy, such as:

• any hereditary conditions you know of in your family
• your diet
• starting prenatal vitamins

Dr Mahadik will also talk with you about your medical history, your weight, diet and exercise, your age, your lifestyle, and any pre-pregnancy health checks you may need.

To understand your chances of conceiving and whether any further tests are needed, she will ask about your reproductive history, including:

• your menstrual cycle
• any contraception you have used
• any history of sexually transmitted infections (STIs) or vaginal infections
• your previous Cervical Screening Test (CST, previously called a Pap smear) results
• starting your previous pregnancies, including any miscarriage, gestational diabetes, preterm birth or birth defect

Understanding your health history helps show what steps, if any, can lower risks during your pregnancy.

If you have any health problems, physical or mental, it helps to tell Dr Mahadik about them. Together you can make a plan to manage them while you plan your pregnancy. This gives you a good chance to conceive, carry to term and have a healthy baby. It also helps to mention any past hospital stays, surgery and all the medicines you take, including prescription medicines, over-the-counter medicines and herbal supplements. Some medicines may need a lower dose or a change before pregnancy, and a plan can be made that keeps you well and supports a healthy pregnancy. Please do not stop any medication without medical advice.

If you have a thyroid condition, it is important to mention it early, as your thyroid plays a role in a healthy pregnancy and your care may need to be reviewed before you conceive. (See "Weight, diet and supplements" below for advice on iodine if you have a thyroid condition.)

If you have diabetes, take anti-epileptic medicine, or have a family history of neural tube defects, it is important to discuss this, as these can raise the risk of certain problems. In some of these situations a higher dose of folic acid is recommended, so this is worth planning early with Dr Mahadik or your GP. Your mental health may also be reviewed to support the best possible pregnancy. If you have a serious medical condition, you may need a team of specialists to support your pre-pregnancy planning.

If you have had a miscarriage before, mention this too — it can be reviewed as part of planning your next pregnancy. You can read more on the miscarriage page.

Please also mention any family history of genetic (hereditary) conditions, any multiple births (twins, triplets and so on) in your family, or a child you already have with a genetic disorder. Dr Mahadik may recommend genetic counselling.

Being a healthy weight makes it easier to conceive and supports better outcomes for you and your baby. If you are underweight, you may be asked to gain some weight healthily before you conceive, to lower the chance of a baby with a low birth weight. If you are overweight, losing some weight can lower the chance of complications during pregnancy.

Whatever your weight, good eating habits matter for all women, and especially during pregnancy. It helps to improve your diet before you conceive and to keep it up throughout your pregnancy. Your diet should be well balanced, including fibre, fruits and vegetables, calcium-rich foods and proteins. It also helps to cut down on caffeine from coffee, soft drink and chocolate. You can find further information on the Pregnancy, Birth and Baby website (healthy diet during pregnancy).

A daily folic acid supplement of 400 micrograms is recommended for all women planning a pregnancy. Start it at least one month before you conceive — ideally around three months before — and keep taking it for the first three months of pregnancy. Folic acid lowers the chance of neural tube defects, such as spina bifida, which develop very early, often before you know you are pregnant, so starting after a positive test can be too late. If you have diabetes, take anti-epileptic medicine, or have had a pregnancy affected by a neural tube defect, a higher dose may be recommended — ask Dr Mahadik or your GP what is right for you.

A daily iodine supplement of 150 micrograms is recommended for all women who are planning a pregnancy, pregnant or breastfeeding. Iodine supports the development of your baby's brain and nervous system. If you have a thyroid condition, speak with Dr Mahadik or your GP before taking an iodine supplement.

Iron needs increase during pregnancy. Some women are more likely to need an iron supplement, such as women expecting more than one baby, women who are vegetarian or vegan, or women who have low iron. A blood test can check your iron levels, so Dr Mahadik or your GP can advise whether a supplement is right for you.

Vitamin D supports healthy bones for you and your baby. A supplement may be recommended, especially if a blood test shows your vitamin D level is low. Dr Mahadik or your GP can advise whether you need one.

If you are over 35, it can take longer to conceive. Age can also raise the chance of some pregnancy complications, including miscarriage, gestational diabetes, pre-eclampsia and preterm birth, to name a few. There is also an increased association with caesarean section, bleeding after birth (postpartum haemorrhage) and admission of the baby to the nursery. Age can raise the chance of some conditions in the baby too, such as chromosomal differences. Dr Mahadik will talk through these risks with you and how they can be managed.

Some lifestyle factors affect both conceiving and having a healthy pregnancy. It is important not to smoke, drink alcohol or use illicit drugs during pregnancy. These can seriously affect a developing baby, including birth defects, preterm birth, low birth weight and problems with the placenta, which affect both you and your baby.

It is best to stop smoking, drinking and using drugs before you conceive. Health professionals can help you stop.

Some hazards at home or at work can also affect conceiving and pregnancy. It helps to avoid exposure to lead, toxic solvents and radiation, and to avoid handling cat faeces.

Staying healthy while you are trying to conceive and during pregnancy matters, because some infections can affect an unborn baby.

• Have the rubella (German measles) vaccination, or a booster if a blood test shows your immunity is low. Do not conceive within 28 days of this vaccination.
• Have the varicella (chickenpox) vaccination if you are not immune. Do not conceive within 28 days of this vaccination.

A blood test can check your immunity, because even if you have been vaccinated before, you may not be fully immune. Infections during pregnancy can seriously affect you and your baby, so your vaccination history and immunity are checked. Vaccinations to consider include measles, mumps, rubella, varicella (chickenpox), diphtheria, tetanus and pertussis (whooping cough). An influenza vaccine is also recommended, and can be given at any stage of pregnancy. Dr Mahadik will advise you on the schedule to follow.

Before you conceive, you may be sent for some tests. Which ones depend on what comes up in your pre-pregnancy consultation. They may include:

• a physical check of your abdomen, breasts, heart, thyroid and lungs
• a pelvic examination and a Cervical Screening Test (CST)
• blood tests to check for rubella immunity, hepatitis, HIV and syphilis
• genetic counselling

Your GP will also do a blood test to check your Rhesus (Rh) factor. If you are Rh negative and your partner or sperm donor is Rh positive, you will need medical attention, because your immune system could otherwise make antibodies that act against your baby's blood. An injection can prevent these antibodies from forming.

If you have a family history of genetic disorders, a previous child with a genetic disorder, or you are over 35, genetic counselling can help you understand the chance of having a child with a genetic condition or intellectual disability.

Below are some genetic and chromosomal conditions for which women may seek genetic counselling:

• Down syndrome
• cystic fibrosis
• haemophilia
• thalassaemia
• Tay-Sachs disease