Planning a pregnancy: where to start

Mikhail Derebenchenko — GP, obstetrician-gynecologist

Folic acid — start early

Folic acid reduces the risk of neural tube defects. The crucial detail: the neural tube closes in the earliest weeks, often before a woman knows she is pregnant. Supplementation therefore starts not after a positive test but at least one to three months before conception. The standard preventive dose is 400 mcg daily; in specific situations, and after a previous affected pregnancy, the dose is higher and set by your doctor.

What to check before conceiving

• Immunity to rubella and varicella. Rubella in pregnancy is dangerous to the fetus, and live vaccines cannot be given during pregnancy — so vaccination has to happen beforehand, with an interval before conceiving;
• Thyroid function — untreated hypothyroidism affects both conception and fetal development;
• Ferritin and full blood count — entering pregnancy iron-deficient means leaving it more so;
• Vitamin D — deficiency is common in the UAE;
• Glucose and HbA1c, particularly with excess weight or a family history of diabetes;
• Gynecological examination and cervical screening if it is due — options are limited during pregnancy;
• Infection screening as indicated, including the TORCH panel.

What to discuss beyond tests

Chronic conditions and medication — some need switching before conception rather than after. Stopping smoking and alcohol, for both partners. Weight: both excess and insufficient weight reduce the chance of conceiving and raise the risk of complications. Vaccinations, including influenza. Working conditions and exposure to hazards.

The partner

Half of all difficulties conceiving involve a male factor, and assessing it is simpler and cheaper than the female work-up. It starts with a semen analysis; where it is abnormal, a urologist-andrologist becomes involved. Investigating only the woman is a common and time-consuming mistake.

When to seek help

The accepted marker: if pregnancy has not occurred after 12 months of regular unprotected intercourse, assessment is indicated. Over the age of 35 that interval shortens to 6 months, and with known problems — irregular cycles, previous pelvic surgery, endometriosis — it is worth coming straight away rather than waiting.

Where to be seen

At GMS an obstetrician-gynecologist consultation is AED 600 and a specialist consultation AED 750; pelvic ultrasound AED 800–1,000, anti-Müllerian hormone AED 400, female fertility panel AED 290, female hormone profile AED 1,100, TORCH panel AED 500 and ovulation monitoring AED 500. All in one clinic, in English and Russian.

References

• ACOG. Good Health Before Pregnancy: Prepregnancy Care
• CDC. Folic Acid Recommendations

FAQ

When should I start folic acid?

At least one to three months before conception, not after a positive test. The standard preventive dose is 400 mcg daily; in specific situations, and after a previous affected pregnancy, the dose is higher and set by your doctor.

Why check rubella immunity before pregnancy?

Rubella in pregnancy is dangerous to the fetus, and live vaccines cannot be given during pregnancy. So vaccination has to happen beforehand, with an interval before conceiving.

When should we seek help if pregnancy doesn’t happen?

If it has not occurred after 12 months of regular unprotected intercourse, or after 6 months if you are over 35. With irregular cycles, previous pelvic surgery or endometriosis it is worth coming straight away.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

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