Preconception Care: Getting Ready Before You Try

A lot of what shapes a pregnancy is settled before it begins. Preconception care means getting a few things in order in the months before you start trying — and most of it is simple.

Start folic acid before you conceive

This is the single most valuable thing you can do, and timing matters more than most people realise. Folic acid protects your baby's developing brain and spine, and that development happens in the earliest weeks — often before you know you are pregnant. Starting it after a positive test is already late.

Begin about three months before you start trying, and continue through the first trimester.

What dose?

• The international guideline dose is 400 micrograms daily.
• The tablets commonly available in Sri Lanka are 1 mg. This is perfectly appropriate — take one daily.
• A higher dose of 5 mg daily is used for women at higher risk — particularly those with obesity or diabetes, and also women with epilepsy on certain medicines, a previous pregnancy affected by a neural tube defect, or certain inherited conditions.

Ask your doctor which applies to you rather than assuming the standard dose is right.

Think about timing and your age

Fertility and pregnancy outcomes are both influenced by age. Women in their twenties and early thirties generally find it easiest to conceive and have the fewest complications. This is not a reason to panic, and many women have healthy pregnancies later — but if the timing is within your control, it is worth weighing.

If you are over 35 and planning a pregnancy, see a doctor early rather than waiting a year to see what happens.

Get to a healthy weight

Both being significantly overweight and being underweight can interfere with ovulation and make conception harder. A healthy weight before pregnancy also lowers the risk of gestational diabetes, high blood pressure and pre-eclampsia.

Aim for steady, sustainable change before conception. Dieting during pregnancy is not recommended, so this is the window for it.

Check your vaccinations

Some vaccines are best given before pregnancy rather than during it. Rubella immunity matters most, because rubella infection in early pregnancy can seriously affect a baby. Tetanus should be up to date, and influenza and routine COVID-19 vaccination can be discussed with your doctor along with anything else relevant to you.

Sort out any existing medical conditions

If you have diabetes, high blood pressure, thyroid disease, epilepsy or heart disease, the time to get it well controlled is before pregnancy. Some medicines need switching to safer alternatives, and some conditions need to be stable before conceiving for the best outcome.

Do not stop any regular medicine on your own. Talk to your doctor and let them make the changes safely.

Screening for infections such as HIV and syphilis is part of preconception assessment, and in Sri Lanka screening for congenital and rheumatic heart disease is also recommended.

Understand your fertile window

Conception is most likely in the few days before and including ovulation. Knowing roughly when you ovulate helps you time things sensibly — though for most couples, having sex every two to three days across the cycle works just as well as trying to pinpoint a single day.

Our fertile period calculator gives you an estimate based on your cycle. See also our guide to the menstrual cycle and fertility.

Practical steps in Sri Lanka

• Register in the eligible couple register with your local public health midwife, which gives you access to preconception services including examination, screening and counselling.
• Plan when to stop contraception — the timing differs between methods, and after the contraceptive injection in particular it can take several months for fertility to return.
• Stop smoking and alcohol before you start trying, not after you find out.
• Consider genetic counselling if there is a family history of an inherited condition.

When to seek help

See a doctor if you have been trying for a year without success — or six months if you are over 35. Come sooner if you have irregular or absent periods, known gynaecological problems, or a history that concerns you.

The bottom line

Start folic acid three months ahead at the right dose for you, get to a healthy weight, check your vaccinations, and get any existing condition under control. Register with your public health midwife, and see a doctor early if you are over 35 or have a medical condition. For more, see our guide to preconception care.