What tests to do before pregnancy
A sensible list fits on one page and costs less than people expect. The point is not to test everything, but to find what can be fixed in advance: anaemia, an untreated thyroid, no immunity to rubella.
When to start
About three months before you plan to conceive. Not because the tests take that long, but because that is how long it takes to fix what they find: topping up iron, settling the thyroid, being vaccinated against rubella (after which you wait a month), switching a medicine for one that is safe in pregnancy.
Folic acid, by contrast, starts as soon as the intention does: the neural tube closes on day 28 after conception — before most women know they are pregnant at all.
Blood and urine
| Test | Why |
|---|---|
| Full blood count | Anaemia before pregnancy gets worse during it; it is easier to correct now |
| Blood group, Rh and antibodies | Rh incompatibility can be planned for if it is known in advance |
| Ferritin | Iron stores can be empty with a normal blood count |
| Fasting glucose | With excess weight, polycystic ovary syndrome or diabetes in the family, add a glucose tolerance test |
| TSH | An underactive thyroid is common, silent, and raises the risk of miscarriage |
| Vitamin D | At this latitude deficiency is the rule, not the exception |
| Urine dipstick and culture | A symptomless urinary infection is treated before pregnancy, not during it |
Infections
This part of the list has one purpose: to find out what you are immune to, and what needs treating before you conceive.
- Rubella IgG. No immunity means vaccination, after which you wait a month before trying. The vaccine cannot be given during pregnancy.
- Toxoplasma IgG and IgM. A negative result is not a disease. It only means that in pregnancy the usual care with raw meat, soil and cat litter applies to you.
- HIV, HBsAg, HCV, syphilis. All four can either be treated or the baby protected, if they are known early.
- Chlamydia. Symptomless, damages the tubes, and remains one of the commoner causes of infertility and ectopic pregnancy.
- Chickenpox — if you have neither had it nor been vaccinated.
At the gynecologist
A pre-pregnancy visit means an examination, cervical screening and a transvaginal scan. The scan shows fibroids, polyps, cysts, uterine anomalies and the state of the ovaries — everything that is better dealt with before pregnancy than during it.
Cervical screening follows the usual schedule; if the last one was more than three years ago, it is done now. An abnormal result needs sorting out before pregnancy, when the options for investigation and treatment are wider than they will be later.
This is also the moment to review medicines. Some drugs for epilepsy, blood pressure, acne or psoriasis are contraindicated in pregnancy but have safe alternatives. They are swapped before, not after.
Folic acid and supplements
Folic acid — 0.4 mg a day, for at least 12 weeks before conception and through the first trimester. It reduces the risk of neural tube defects. After a baby with such a defect, or with certain conditions, the dose is set by a doctor and is markedly higher.
Iodine — 150–200 µg a day, unless the thyroid says otherwise.
Vitamin D — the dose follows the test result, not the season.
Iron only if the results call for it. Taking it "just in case" is not harmless.
The partner
Half the causes of infertility are male, and a semen analysis is cheaper and faster than most of what a woman goes through. It is worth doing straight away if you have been trying for more than six months.
Beyond that: testing for sexually transmitted infections, cutting down on alcohol, stopping smoking. Sperm take about three months to mature, so changes are worth making that far ahead.
When not to put the visit off
If you have been trying for a year and you are under 35, it is time to be investigated. Over 35 that becomes six months, and over 40 it is worth coming straight away.
At any age an earlier visit makes sense with irregular cycles, after two or more miscarriages, after an ectopic pregnancy, after pelvic surgery, and with diagnosed endometriosis or polycystic ovary syndrome.
Short answers
What blood tests should be done before pregnancy?
A full blood count, blood group with Rh and antibodies, ferritin, fasting glucose, TSH, vitamin D, and for infections rubella IgG, toxoplasma IgG and IgM, HIV, HBsAg, HCV and syphilis.
When should I start folic acid?
At least 12 weeks before you plan to conceive, 0.4 mg a day, continuing through the first trimester.
How much do pre-pregnancy tests cost?
The scope and the cost depend on what you have already had done. Some tests are ordered by a family doctor under NFZ; the rest are private. The list is drawn up at the appointment so that nothing current is repeated.
Is an ultrasound needed before pregnancy?
It is worth having. A transvaginal scan shows fibroids, polyps, cysts and uterine anomalies — things that are easier to deal with before pregnancy than during it.
This text describes the general picture and does not replace a consultation. Timings and indications differ from woman to woman and are decided at the appointment, from your history and test results.