Executive summary
- Preconception care is risk reduction before conception, not just “take folic acid”. It includes medication review, lifestyle counselling, chronic disease optimisation, and identifying who needs specialist input before trying to conceive.
- Folic acid: advise 400 micrograms daily from preconception until the end of week 12 of pregnancy for most people planning pregnancy.
- Use 5 mg daily if there is increased risk of neural tube defect or congenital malformation, including previous affected pregnancy, relevant family history, diabetes, certain haematological conditions, or medicines that interfere with folate metabolism.
What a good GP preconception review should cover
- Medication review: identify medicines that may need stopping, switching, dose adjustment, or specialist advice before conception.
- Lifestyle: smoking cessation, alcohol avoidance, recreational drug advice, healthy weight discussion, and practical support rather than vague generic advice.
- Vaccination and infection risk: check whether there are obvious immunisation gaps or exposure issues that should be addressed before pregnancy where appropriate.
- Chronic disease control: diabetes, hypertension, thyroid disease, epilepsy, mental health disorders, and other long-term conditions often need disease-specific planning before conception rather than after it.
Who needs specialist planning before conception
- Refer or seek specialist advice early when pregnancy would be materially affected by chronic medical disease, complex medicines, prior adverse obstetric history, or high teratogenic risk.
- Do not wait until pregnancy is confirmed for women with diabetes, complex hypertension, significant mental health treatment, epilepsy, or other conditions where drug changes need planning.
- The goal is safer conception, not just early antenatal booking.
Frequently asked questions
What is the standard folic acid dose?
For most people planning pregnancy, NICE advises 400 micrograms daily from preconception until the end of the first 12 weeks of pregnancy.
Who should receive 5 mg folic acid instead?
People at increased risk of neural tube defect or congenital malformation, including those with diabetes, previous affected pregnancy, relevant family history, certain haematological conditions, or medicines that interfere with folate metabolism.
Why is a medication review so important before conception?
Because some medicines are unsafe or suboptimal in pregnancy and need planned substitution rather than a rushed change after a positive pregnancy test.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.