Something different from the usual. Before Greenher, I spent my PhD and the years after it researching women's health before, during and after pregnancy.
What we found was about how little the system tells women before something goes wrong. If you have ever left an appointment feeling unheard, you will recognise it.
The months and years before count
Preconception care is the health care you get before you conceive. But the health you bring to a pregnancy is built long before any appointment, and it applies before a first baby as much as between babies.
There is no neat window on it. There are the years, and then a shorter stretch of deliberate preparation.
The years are general stuff. Weight, activity, blood pressure, how any chronic condition is tracking, smoking, alcohol, mental health. In some ways, none of it is preparation for anything in particular. It is just your health, and you arrive at conception with whatever it is. We all let these things slide, but pregnancy is one of the most motivating life stages there is for changing behaviours. If that drives you, use it.
The months are the specific bits. A medication review, because some are not safe in pregnancy and swapping takes time. Immunisation status. Carrier screening, which is now recommended for everyone planning a pregnancy rather than only those with a family history, and is Medicare funded. Getting thyroid or blood pressure properly optimised rather than roughly controlled. Supplementation. Iron stores, because starting depleted makes everything afterwards harder.
Most of those take time. That is the reason preparation matters.
What we found
I went looking at what preconception actually looks like for Australian women.
Before pregnancy, uptake was low. That part was expected. What I did not expect was that it was low among women who were highly educated and comfortably off, with GPs, time and the means to ask.
So it was not an access problem. Almost nobody knew it was a thing to ask for. It tended to come up after something had gone wrong or time to conceive dragged on, rather than before.
And when women did raise it themselves, the response from a GP was not always a proactive one. I found that myself, as an otherwise healthy woman.
Once they conceived, that changed. Women engaged with their GP, went to their appointments, did the things. The system picks you up at a positive test.
But it does not answer everything, and it is not there at 11pm. So the questions in between went online. Apps, forums, social media, often answered by people with no qualifications at all.
That continued after the baby arrived, and it was worse there. "Is this normal", asked again and again, on a forum of strangers, at the point when women are most isolated and least likely to have someone to ask.
It is not only about women
My research focused on women, but preconception health applies to both partners. Sperm take around two to three months to develop, so a partner's smoking, drinking, weight and general health in the months beforehand counts as well.
The appointment below is one either of you can book, and it goes better if you both turn up.
What has changed since
Some of this has improved. Carrier screening is funded now, and preconception is discussed in places it was not years ago. There is also more access to qualified people online, though it comes at a price, and it still requires a woman or a couple to go looking in the first place.
Which is the part that has not shifted. Almost all of it still depends on knowing there is something to ask about.
If you know someone
If you know someone who is thinking about a baby, or might be in a year or two, tell them the months before matter. That is it.
If they want somewhere to start, it is a GP appointment where they say they are thinking about trying. Not pregnant, thinking about it. That is a different conversation and most couples do not know they can have it.
A daughter, a son, a niece, a friend, someone close at work. It costs you a sentence, and it is the sentence almost nobody says, unless they have been on one of the more challenging journeys.
The nutrition side
Less dramatic than the internet suggests.
Folate has the firmest deadline. The neural tube closes about two weeks after a missed period, which is why the advice is to start at least a month before you conceive rather than when you find out. It is also why bread flour here has been fortified with folic acid since 2009.
Iodine, from seafood, dairy, eggs and iodised salt. Requirements rise in pregnancy and breastfeeding.
Iron, because stores take months to build and you generally cannot do it quickly. If you want to know where yours sit, ask for your ferritin number.
Then the part nobody writes articles about. Eating enough, eating a reasonable range of things, and having a body that is generally in decent working order. That is most of it, and it is much the same advice I would give anyone.
The takeaway: Preconception health is built over years and prepared over months, and it applies to both partners. Uptake was low even among well resourced women, because almost nobody knew to ask. The system picks women up at a positive test, and the gaps either side get filled by forums. If you know someone thinking about a family, tell them the months before count, and that a GP appointment for thinking about trying is a real thing.
The science behind this post:
- Brammall B. Published research available on ResearchGate: https://www.researchgate.net/profile/Bonnie-Brammall
- World Health Organization (2013). Preconception care: maximizing the gains for maternal and child health. who.int
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Reproductive carrier screening. Recommended to be offered to all couples planning a pregnancy or in early pregnancy; Medicare funded since November 2023. ranzcog.edu.au
- National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand: Folate, Iodine and Iron. nrv.gov.au
- Food Standards Australia New Zealand. Mandatory fortification of bread making flour with folic acid and iodised salt, in place since 2009. foodstandards.gov.au