# Preconception care: health before pregnancy > Preconception care: folic acid, weight, smoking, alcohol, caffeine, rubella immunity, long-term conditions and medicines to review before trying for a baby. Source: https://www.ghinashami.com/en/interests/preconception-health/ Updated: 2026-10-13 Step 1 of 4 · Tests The months before a pregnancy are a good time for both partners to look after their health. Public-health guidance focuses on a short list of steps with evidence behind them: folic acid, a healthy weight, no smoking or alcohol, up-to-date vaccinations, and a review of long-term conditions and medicines. - 5 min read - Reviewed 13 October 2026 - 6 references ## Why the months before pregnancy matter The World Health Organization describes preconception care as health care for women and couples before conception, aimed at improving their health and reducing the factors that lead to poor health in mothers and babies. Some steps only work if they start early: folic acid helps prevent problems of the baby's brain and spine that develop in the very early weeks of pregnancy, often before a woman knows she is pregnant. ## Folic acid and vitamins The NHS advises taking 400 micrograms of folic acid every day while trying to conceive, ideally from three months before, and until the 12th week of pregnancy. It lowers the chance of a neural tube defect such as spina bifida. A higher dose of 5 milligrams, on prescription, is advised for some people, including those with diabetes, sickle cell anaemia or thalassaemia, those taking medicine for epilepsy or HIV, and couples where either partner or a relative has a neural tube defect, or where a previous pregnancy was affected. Vitamin D is also advised. Cod liver oil and supplements containing vitamin A (retinol) should not be taken in pregnancy. ## Weight, smoking, alcohol and caffeine - **Weight.** NICE notes that women with a body mass index (BMI) of 30 or more are likely to take longer to conceive, and that losing weight is likely to improve the chance of conception when ovulation is not happening; for women with a BMI under 18.5 and irregular or absent periods, gaining weight is likely to improve it. Men with a BMI of 30 or more have a higher risk of reduced fertility. Being overweight in pregnancy raises the risk of complications such as high blood pressure, pre-eclampsia and gestational diabetes. A balanced diet and regular physical activity help you reach and keep a healthy weight. - **Smoking.** Smoking is likely to reduce a woman's fertility, passive smoking is likely to affect the chance of conceiving, and smoking in men is linked with reduced semen quality. NICE recommends support to stop. - **Alcohol.** The NHS advises not drinking alcohol while trying to get pregnant. NICE advises women that avoiding alcohol altogether carries the lowest risk to a developing baby, and notes that heavy drinking harms semen quality. - **Caffeine.** NICE finds no consistent evidence linking tea, coffee, energy drinks or colas with fertility problems. Advice on caffeine during pregnancy itself is a separate matter that your doctor or midwife can explain. - **Drugs.** The NHS advises not using illegal drugs, and NICE lists anabolic steroids and cannabis among the substances that can affect fertility or pregnancy. ## Vaccinations and infections Rubella (German measles) caught early in pregnancy can cause miscarriage, stillbirth or congenital rubella syndrome, which affects the baby's hearing, eyes and heart, according to the WHO. The NHS advises having the MMR vaccine before trying for a baby if you have not already had it. NICE advises testing rubella immunity when vaccination history is uncertain, vaccinating those who are not immune, and avoiding pregnancy for at least one month after the vaccine. The NHS also advises checking that cervical screening is up to date, and testing for sexually transmitted infections if either partner may have one. ## Long-term conditions and medicines If either partner lives with a condition such as diabetes, epilepsy, sickle cell disease or HIV, or takes prescribed or over-the-counter medicines or herbal remedies, the NHS advises talking to a doctor before trying, so that treatment can be planned for pregnancy. A prescribed medicine should not be stopped without advice. NICE advises asking about medicines and substances that can affect fertility or pregnancy, such as GLP-1 medicines used for diabetes and weight loss, testosterone, finasteride, anti-inflammatory painkillers, anabolic steroids and cannabis. If IVF is planned, the [preparing for IVF](https://www.ghinashami.com/en/guide/preparing-for-ivf/) guide covers the months before treatment. ## Questions worth asking your doctor - Do I need the standard dose of folic acid, or the higher prescription dose? - Am I immune to rubella, and are my other vaccinations up to date? - Do any of my medicines, supplements or herbal remedies need reviewing before pregnancy? - Is my long-term condition well controlled for pregnancy? - Is my cervical screening up to date? ## Risks and limits Preconception care supports the health of parents and baby, but it is not a treatment for infertility, and it does not replace an assessment of both partners when a pregnancy is taking longer than expected; see [fertility tests for couples](https://www.ghinashami.com/en/interests/fertility-tests/). NICE notes that the effectiveness of complementary therapies for fertility problems has not been properly evaluated, and it advises against supplements or antioxidants to improve sperm DNA. When age is a factor in timing, preparation can run alongside treatment. ## Common questions **When should we start preparing?** Ideally about three months before trying. The NHS advises starting folic acid three months before conception, and sperm take about three months to form, so changes in a man's health take that long to show in a semen analysis. If age is a factor in timing, preparation can run alongside treatment. **Is preconception care an alternative to fertility treatment?** No. It improves general health before pregnancy but does not treat the causes of infertility. NICE advises an assessment of both partners after a year of trying, or sooner if the woman is 36 or older or there is a known cause. **Does the male partner need to prepare too?** Yes. NICE links smoking, heavy drinking, a BMI of 30 or more, and some medicines and drugs, such as testosterone and anabolic steroids, with reduced male fertility. Stopping smoking also protects the partner from passive smoke. **Should I stop my regular medicines before trying?** Not without advice. The NHS advises not stopping a prescribed medicine until you have talked to your doctor, who can review the options while you are trying to conceive. **Evidence basis:** This page is public-health information based on guidance from the NHS, NICE, the WHO and the CDC and the studies they cite; where the evidence is limited, the page says so. ## References 1. Trying to get pregnant, NHS (2026) — [nhs.uk](https://www.nhs.uk/pregnancy/trying-for-a-baby/trying-to-get-pregnant/) 2. Pregnancy vitamins and supplements, NHS (2026) — [nhs.uk](https://www.nhs.uk/pregnancy/keeping-well/pregnancy-vitamins-and-supplements/) 3. Fertility problems: assessment and treatment, National Institute for Health and Care Excellence (NICE), guideline NG257 (2026) — [nice.org.uk](https://www.nice.org.uk/guidance/ng257) 4. Rubella, World Health Organization (fact sheet) (2026) — [who.int](https://www.who.int/news-room/fact-sheets/detail/rubella) 5. Preconception care: Maximizing the gains for maternal and child health - Policy brief, World Health Organization (2013) — [who.int](https://www.who.int/publications/i/item/WHO-FWC-MCA-13.02) 6. About Folic Acid, Centers for Disease Control and Prevention (CDC) (2026) — [cdc.gov](https://www.cdc.gov/folic-acid/about/index.html) Written and reviewed by [Dr. Ghina Shami](https://www.ghinashami.com/en/about/), Consultant, Reproductive Medicine and Infertility · 13 October 2026 · [How these pages are prepared](https://www.ghinashami.com/en/legal/#accuracy)