How to Create a Medication Plan Before Conception for Safety

Planning for pregnancy isn’t just about getting pregnant-it’s about making sure your body is ready to support a healthy baby from day one. And that starts with your medication plan. Many people assume that if they’re not actively trying to conceive, they don’t need to worry about what they’re taking. But here’s the reality: by the time you miss your period, you’re already four weeks into pregnancy. And in those first four weeks, your baby’s heart, brain, spine, and limbs are forming. If you’re on a medication that’s risky during early pregnancy, you might already be exposing your future child to danger-before you even know you’re pregnant.

Why Timing Matters More Than You Think

Most birth defects happen between weeks 3 and 8 of pregnancy. That’s before most women take a pregnancy test. The American College of Obstetricians and Gynecologists (ACOG) estimates that nearly half of all pregnancies in the U.S. are unintended. That means thousands of women are unknowingly exposed to medications that could harm fetal development. Drugs like valproic acid (used for seizures), lithium (for bipolar disorder), and isotretinoin (for acne) are known to cause serious birth defects. Valproic acid alone increases the risk of major congenital malformations to over 10%. That’s 10 times higher than the baseline risk.

Waiting until you’re pregnant to stop or switch medications isn’t just risky-it’s often too late. Some drugs need weeks or months to fully clear your system. Methotrexate, for example, can stay in your body long enough to affect a pregnancy even after you stop taking it. That’s why experts recommend starting your medication review at least 3 to 6 months before you start trying to conceive.

What Medications Should You Review?

It’s not just about prescription drugs. Your preconception medication plan should include:

• Prescription medications (for chronic conditions like epilepsy, diabetes, depression, or autoimmune diseases)
• Over-the-counter drugs (like ibuprofen, decongestants, or herbal supplements)
• Vitamins and supplements (including high-dose folic acid)
• Recreational substances (alcohol, nicotine, marijuana)

Some of the most common culprits you might not realize are risky:

• Valproic acid and carbamazepine (for seizures): linked to neural tube defects and facial malformations
• Lithium (for bipolar disorder): increases risk of Ebstein’s anomaly, a heart defect
• ACE inhibitors (for high blood pressure): can cause kidney damage in the fetus
• Warfarin (blood thinner): causes fetal warfarin syndrome with skull and limb deformities
• Methotrexate (for rheumatoid arthritis or psoriasis): a known teratogen that requires 3 months of washout
• Isotretinoin (for acne): causes severe birth defects-even one dose can be dangerous

The good news? Most of these can be safely replaced. For example, women with epilepsy can often switch from valproic acid to lamotrigine, which has a much lower risk profile. Women with high blood pressure can switch from ACE inhibitors to methyldopa or labetalol. The key is planning ahead.

Folic Acid: The One Supplement That Changes Everything

Folic acid isn’t just a nice-to-have-it’s non-negotiable. The World Health Organization (WHO) recommends 400 micrograms (mcg) daily for all women of childbearing age. Why? Because neural tube defects (like spina bifida) are among the most common and preventable birth defects. Folic acid reduces that risk by up to 70%.

But not everyone needs the same dose. If you have a history of neural tube defects, diabetes, obesity, or are on seizure medications like valproic acid, you need a higher dose: 4 to 5 milligrams (mg) daily. That’s 10 times the standard amount. Don’t assume your regular multivitamin has enough. You’ll need a separate prenatal vitamin or prescription-strength folic acid. Start taking it at least 3 months before conception. Waiting until you’re pregnant means you’ve already missed the critical window.

Managing Chronic Conditions Before Pregnancy

If you have a chronic illness, your preconception plan isn’t optional-it’s essential. Here’s how to handle some common conditions:

Diabetes

High blood sugar in early pregnancy increases the risk of miscarriage, heart defects, and stillbirth. The goal? Get your A1C below 6.5% before you conceive. That often means adjusting your insulin regimen, diet, and activity level. Metformin is generally safe during pregnancy, but some oral diabetes drugs aren’t. Talk to your endocrinologist.

Thyroid Disorders

Hypothyroidism during early pregnancy raises miscarriage risk by 60%. Your TSH (thyroid-stimulating hormone) should be under 2.5 mIU/L before conception. Once pregnant, your levothyroxine dose usually needs to increase by 30% within weeks. Waiting until you’re pregnant to adjust your dose is too late.

Autoimmune Diseases (Lupus, Rheumatoid Arthritis)

Drugs like methotrexate and cyclophosphamide must be stopped months before conception. But you don’t have to go untreated. Sulfasalazine and hydroxychloroquine are safer alternatives. Work with a rheumatologist to find a plan that keeps your disease in check without risking the baby.

Mental Health (Depression, Anxiety)

Untreated depression during pregnancy can lead to preterm birth and low birth weight. But not all antidepressants are equal. SSRIs like sertraline and citalopram are generally considered low-risk. Paroxetine, however, has been linked to heart defects and should be avoided. Never stop your medication abruptly-work with your psychiatrist to make a safe switch.

What About Birth Control?

If you’re on hormonal birth control and planning to conceive, you don’t need to wait a cycle before trying. That’s an old myth. But if you’re on certain seizure medications (like carbamazepine), your birth control might not work well. Enzyme-inducing drugs can break down hormones too fast, making pills, patches, or rings ineffective. In those cases, you need a backup method-like an IUD or implant-until you’re ready to conceive.

Getting Your Plan in Place

Here’s how to build your preconception medication plan:

1. Make an appointment with your OB/GYN or primary care provider at least 6 months before you plan to conceive.
2. Bring a full list of everything you take-prescriptions, OTC meds, supplements, herbs, and even recreational substances.
3. Ask for a medication review using the latest teratogen databases. Many clinics now use digital tools like Luma Health’s Preconception Navigator, which cross-checks 1,200+ drugs against safety data.
4. Get specialist input if you have chronic conditions. A neurologist, endocrinologist, or rheumatologist may need to adjust your treatment.
5. Start folic acid at the right dose-400 mcg for most, 4-5 mg if you’re high-risk.
6. Track your progress with a simple log: what you stopped, what you started, and when.

Don’t wait for your next annual checkup. If you’re thinking about pregnancy-even vaguely-start this conversation now. The earlier you act, the safer your future baby will be.

What If You’re Already Pregnant?

If you’re already pregnant and haven’t reviewed your meds, don’t panic-but don’t delay either. Contact your provider immediately. Many medications can still be adjusted safely in early pregnancy. And if you’re on a high-risk drug, your doctor can monitor your baby more closely with ultrasounds and specialized testing.

But prevention is always better than correction. That’s why preconception planning isn’t just smart-it’s the standard of care.

What’s Next?

If you’re thinking about pregnancy, your next step is simple: make a list of every medication, supplement, and substance you take. Then call your doctor. Don’t wait for a pregnancy test. Don’t wait for a missed period. Start this conversation now. With the right plan, you can protect your health and give your future child the safest possible start.