Most couples start trying to conceive without ever seeing a doctor first. That's understandable — but a pre-conception visit is arguably the most cost-effective health investment you can make. It takes one appointment to identify issues that, if left unaddressed, could complicate your pregnancy or take months off your conception timeline.
Here's what a thorough pre-conception screen should cover, aligned with current ACOG (American College of Obstetrics and Gynaecology) and MOH Singapore guidelines.
Screens for anaemia — particularly iron-deficiency anaemia — which is prevalent in women of reproductive age and associated with adverse pregnancy outcomes including preterm birth and low birth weight if uncorrected.
If you're Rh-negative and your partner is Rh-positive, your body may develop antibodies that attack a Rh-positive baby in subsequent pregnancies. Knowing this early allows prophylactic anti-D immunoglobulin administration to be planned.
Rubella (German measles) infection in the first trimester carries a >80% risk of congenital rubella syndrome — causing cataracts, deafness, and cardiac defects. Most women in Singapore are immune via childhood MMR vaccination, but serology confirms this. If non-immune, the MMR vaccine should be given and pregnancy delayed by at least one month.
Subclinical hypothyroidism affects 2–3% of women of reproductive age and is associated with reduced fertility, miscarriage, and impaired fetal neurodevelopment. The American Thyroid Association recommends selective screening in women with risk factors (family history, prior pregnancy loss, autoimmune conditions). Pre-conception TSH should ideally be ≤2.5 mIU/L.
Singapore has a hepatitis B carrier rate of approximately 3–4%. If you are HBsAg-positive, vertical transmission to the newborn can be prevented with timely neonatal immunoprophylaxis — but this needs to be planned in advance.
Undiagnosed type 2 diabetes significantly increases the risk of neural tube defects, macrosomia, and stillbirth. Pre-conception glycaemic optimisation is critical — the risk of major congenital anomalies rises proportionally with first-trimester HbA1c levels.
💡 Cervical Screening: If you are due for a Pap smear / HPV cervical screen (recommended every 5 years from age 25 in Singapore), do it before conception. Managing any abnormalities is far simpler pre-pregnancy.
Expanded carrier screening can identify whether you or your partner carry recessive genetic conditions — thalassaemia, cystic fibrosis, spinal muscular atrophy — that could affect your child. In Singapore, thalassaemia carrier screening is particularly relevant given its prevalence across Chinese, Malay, and Indian ethnic groups.
If you have a pre-existing condition (hypertension, epilepsy, autoimmune disease), a pre-conception review with your specialist is essential. Several medications commonly used in these conditions (e.g., valproate, ACE inhibitors, methotrexate) are teratogenic and require substitution before conception.
Untreated chlamydia is the leading preventable cause of tubal infertility. A brief STI screen — chlamydia, gonorrhoea, syphilis, HIV — is standard preconception practice in most guidelines.
A single pre-conception consultation covers most of the above. In Singapore, this can be done at your GP, polyclinic, or a women's health clinic. The cost is modest. The information is invaluable.
Think of it as a systems check before a long journey — most things will be fine, but the few that aren't are far better caught now than mid-pregnancy.
References
ACOG Committee Opinion No. 762: Prepregnancy Counseling (2019, reaffirmed 2023)
American Thyroid Association Guidelines for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum (2017, updated guidance 2023)
Ministry of Health Singapore — Health Promotion Board Antenatal Care Guidelines
USPSTF Recommendations on Preconception and Prenatal Care (2024)