Why now

The neural tube closes about 6 weeks after the last period and the major organs form at 5–10 weeks. Only 60% of women have had an antenatal visit by 10 weeks (AIHW, 2023 data). Preconception care happens in general practice.

Ask one question at routine visits

“Would you like to become pregnant in the next year?”

Yes

Book a long consult and invite the partner. Start folic acid and iodine now.

Unsure

Start folic acid today. Prescribe as if pregnancy is possible.

Not now

Record it. If pregnancy isn’t wanted yet, discuss effective contraception. Keep prescribing pregnancy-aware; ask again at the next review.

Good moments to ask: repeat scripts · chronic disease reviews · cervical screening · health checks · the 6-week postnatal check · travel visits

Ask · Check · Advise

The preconception checklist

Ask

Both partners where relevant

  • Pregnancy intention, age and time trying
  • Medical, obstetric and family history (three generations; consanguinity)
  • All medicines, including over-the-counter, complementary and online products
  • Smoking, vaping, alcohol, cannabis and other drugs
  • Mood: Whooley questions or PHQ-2, plus GAD-2
  • Safety at home: ask privately, never with the partner present (1800RESPECT)

Check

 

  • BMI and blood pressure
  • Rubella IgG; varicella IgG if history uncertain; hepatitis B if at risk
  • FBC and ferritin (iron deficiency = ferritin under 30 µg/L)
  • HbA1c if BMI over 30, previous gestational diabetes or other risk
  • Cervical screening if due
  • STIs if at risk, and partners: syphilis, HIV, hepatitis B and C, chlamydia, gonorrhoea
  • Carrier screening: offer to everyone (MBS 73451)
  • CMV IgG if young children at home or at work

Advise

 

  • Folic acid 0.4–0.8 mg daily, from at least 1 month before conception to 12 weeks; 5 mg if indicated
  • Iodine 150 micrograms daily (check first if she has thyroid disease)
  • One prenatal product: no stacking, no herbal fertility blends
  • Catch-up vaccines, then wait 28 days after MMR or varicella vaccine before trying
  • Switch teratogenic medicines before trying; stop GLP-1 medicines about 2 months before (tirzepatide 4 weeks)
  • No alcohol, smoking, vaping or cannabis
  • Weight: a 5–10% loss helps; 150 minutes of activity a week; dental check
  • CMV hygiene if she is around young children

Quick reference

Download the PDF (2 pages, A4)
Refer or discuss

When to refer or call

  • Refer to me for a pre-pregnancy plan: previous preterm birth or cervical surgery; pre-eclampsia, growth restriction, stillbirth or recurrent miscarriage; previous caesarean with questions about timing; any chronic condition that needs an obstetric plan.
  • Specialist input before trying: pre-existing diabetes, hypertension, epilepsy (especially on valproate), thyroid, cardiac, renal or autoimmune disease, serious mental illness.
  • Genetic counselling: an increased-chance carrier result.
  • Urgent, maternal-fetal medicine: CMV seroconversion in early pregnancy.
  • Fertility assessment: after 12 months of trying if under 35; after 6 months if 35 or over; sooner with irregular cycles or a known cause in either partner.

Sources: RANZCOG C-Obs 3a (2024), C-Obs 63 (2024), C-Obs 64 (2023), GLP-1 guidance (2026); RACGP Red Book (2024); Australian Immunisation Handbook; NHMRC iodine (2010) and alcohol (2020); ADIPS (2020); COPE (2023); CDNA syphilis testing schedule; TGA valproate advice (2025); AIHW Australia’s mothers and babies (2023 data). Landmark studies: MRC Vitamin Study (Lancet 1991); ORIP (NEJM 2019); Mackenzie’s Mission (NEJM 2024); Maya (JAMA 2025); Ahlqvist (JAMA 2024).

Version 1.0, October 2026. Review: October 2027.

For health professionals. General guidance only; it does not replace clinical judgement.