Thinking About Getting Pregnant? A Preconception Checklist
The months before you start trying are a chance to set yourself up well. Here is a practical checklist: folic acid, genotype and blood group, vaccines, long-term conditions, medicines, lifestyle, and your partner's health too.
TL;DR: Start 400 micrograms of folic acid a day, ideally three months before you try, and ask about the higher 5mg dose if you have diabetes, sickle cell disease, thalassaemia or take epilepsy or HIV medicines. Know your genotype and your partner's, and your blood group. Check your rubella protection, get any long-term condition well controlled, and review every medicine with a doctor before stopping anything. Stop smoking and alcohol, get an STI check if there is any chance you need one, and bring your partner along: his health counts too.
Many of us grow up hearing about pregnancy only once it has happened: the cravings, the antenatal visits, the naming ceremony. Far less is said about the months before. Yet the early weeks of pregnancy, when the baby's brain, spine and heart are forming, often pass before you even know you are pregnant. What you do beforehand matters. Think of this checklist as a gentle plan you can work through over a few months, ideally with a doctor or nurse who knows you. It is not a test you have to pass before you are allowed to try.
1. Start folic acid now
Folic acid helps protect your baby against neural tube defects such as spina bifida. The NHS recommends 400 micrograms every day, ideally starting three months before you try, and continuing for the first 12 weeks of pregnancy. It is hard to get enough from food alone, even with plenty of ugu and beans, so a supplement is the reliable route.
Some people need a higher dose of 5mg, which a doctor prescribes. According to the NHS, that includes you if you have diabetes, a blood condition such as sickle cell anaemia or thalassaemia, take medicine for epilepsy or HIV, or if you or your partner has a personal or family history of neural tube defects. While you are at it, the NHS also advises 10 micrograms of vitamin D daily in the darker months, and suggests considering it all year round if you have black or brown skin, as this affects how much vitamin D your skin makes. Our pregnancy nutrition guide covers food in more detail.
2. Know your genotype, and your partner's
In Nigeria and across much of West Africa, "what is your genotype?" is a familiar question before marriage, and for good reason. A study of premarital couples in south-east Nigeria found that about one in four carried sickle cell trait (AS). If both partners carry the trait, each pregnancy has a one in four chance of a baby with sickle cell disease (SS).
Knowing early gives you time to understand your options and talk to a counsellor, rather than finding out in the middle of a pregnancy. In the UK, the NHS offers screening for sickle cell and thalassaemia in pregnancy and notes that carriers are more likely to have family roots in Africa, the Caribbean and other regions. If you are a carrier, your partner is offered a test too. If you live with sickle cell disease yourself, read our guide to sickle cell, periods and pregnancy and involve your haematology team before you try.
3. Check your blood group
Your blood group includes your rhesus (D) status. If you are D negative and your baby is D positive, your body can make antibodies that affect the baby's blood, a condition called haemolytic disease of the fetus and newborn. It is preventable: if there is a risk, you are usually offered injections in pregnancy to stop antibodies forming. Knowing your blood group in advance means one less surprise at your booking appointment.
4. Get your vaccines up to date
Rubella (German measles) is usually mild, but catching it in early pregnancy can cause miscarriage or serious problems with a baby's sight, hearing, heart or brain. The MMR vaccine protects against it, but it is not given during pregnancy, so the time to check is now. If you are not sure whether you had it as a child, ask your clinic about your records or a blood test for immunity. It is also a good moment to make sure your cervical screening is up to date.
5. Get long-term conditions under control
If you live with a long-term condition, planning ahead is one of the most protective things you can do. The NHS advises speaking to a GP before trying if you or your partner has a condition such as epilepsy, diabetes, sickle cell disease or HIV.
- Diabetes. NICE advises aiming for an HbA1c below 48 mmol/mol before pregnancy if it is safe to do so, taking 5mg folic acid, and using contraception until your blood sugar is well controlled. Any improvement towards that target is likely to lower the risk to the baby.
- High blood pressure. Some common blood pressure medicines, ACE inhibitors and ARBs, carry an increased risk of birth defects in pregnancy. NICE advises discussing alternatives with your doctor while you are planning.
- Thyroid. If you take levothyroxine for an underactive thyroid, tell your doctor you are planning a pregnancy. The NHS says your dose will likely need to change once you are pregnant. More in our thyroid health guide.
6. Review every medicine, including herbal ones
Bring a full list to your doctor or pharmacist: prescriptions, over-the-counter tablets, supplements and herbal remedies, including agbo, teas or mixtures from home. Some are fine in pregnancy and some are not. The key rule from the NHS: do not stop a prescribed medicine until you have talked it through with your GP or specialist, who can help you find the safest treatment while you try.
7. Alcohol, smoking and weight
The NHS advises not drinking alcohol when you are trying to get pregnant, and getting support to stop smoking. NICE notes that smoking is likely to reduce fertility, and that even passive smoking may affect your chances.
Weight can play a part in both directions. NICE says women with a BMI of 30 or over are likely to take longer to conceive, and that for women with a BMI under 18.5 whose periods are irregular or absent, gaining weight is likely to help. This is about health, not appearance, and small changes count. A doctor can help you set a realistic goal.
8. Get an STI check
Some sexually transmitted infections, chlamydia in particular, often cause no symptoms. Untreated STIs can lead to pelvic inflammatory disease, which can damage and scar the fallopian tubes. The NHS recommends getting tested before you try if you think you or your partner might have one. It is a quick, routine test. Our STI guide explains the common ones.
Does my partner need to prepare too?
Yes. Sperm take around three months to develop, which is why NICE recommends repeating an abnormal semen test about three months later. So changes he makes now show up in the sperm that may make your baby. NICE links heavy drinking, smoking and a BMI of 30 or over with poorer semen quality or reduced fertility. He should also know his genotype and get an STI check. We go deeper in male fertility: why it is half the conversation.
How long should we try before seeing a doctor?
NICE says over 80% of couples conceive within a year if the woman is under 40 and they have regular sex without contraception. The NHS advises seeing a GP after a year of trying, or sooner if you are 36 or over or already know you may have fertility problems. See when to see a fertility specialist for the details, and your fertile window for how timing works.
Where Asele fits
Starting to track your cycle now, before you try, gives you months of useful history: cycle length, symptoms, anything unusual. Asele lets you log it all in one place, and Amara can answer questions in Yoruba, Hausa, Igbo, Swahili, French or English as you work through this list. When you book that preconception appointment, the Health Brief puts your history into a short summary to show your doctor. You can find us at Asele.
This post is education, not medical advice. Please see a doctor, nurse or midwife for advice that fits your own health and history.
References
- NHS. Pregnancy vitamins and supplements. nhs.uk
- NHS. Trying to get pregnant. nhs.uk
- Nnaji GA et al. Prevalence and pattern of sickle cell disease in premarital couples in Southeastern Nigeria. Nigerian Journal of Clinical Practice, 2013. ncbi.nlm.nih.gov
- NHS. Screening for sickle cell and thalassaemia. nhs.uk
- NHS. Haemolytic disease of the fetus and newborn (rhesus disease). nhs.uk
- NHS. Rubella. nhs.uk
- NHS. MMR vaccine. nhs.uk
- NICE. Diabetes in pregnancy: management from preconception to the postnatal period (NG3). nice.org.uk
- NICE. Hypertension in pregnancy: diagnosis and management (NG133). nice.org.uk
- NHS. Underactive thyroid: treatment. nhs.uk
- NICE. Fertility problems: assessment and treatment (NG257), 2026. Advice about factors that can affect fertility; Investigation of fertility problems; Initial advice
- NHS. Causes of infertility. nhs.uk
- NHS. Infertility. nhs.uk
- NHS. Chlamydia. nhs.uk
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