Planning a pregnancy: preconception care in Spain

Key rules

• Folic acid: Start it at least one month before you try to conceive.
• Rubella vaccine: If you need the MMR vaccine, avoid pregnancy for one month afterwards.
• Iodine: Skip iodine if you have thyroid disease unless your doctor says otherwise.
• Where to go: Book through your health centre; not every centre has a dedicated preconception service.

Start with an appointment at your health centre

Book a preconception appointment at your health centre. In many centres the matrona sees you. In others it is your médico de familia, and sometimes gynaecology. You need a health card for the public system. You book the same way as any other appointment.

Not every centre runs a dedicated preconception service, and availability varies by region. If yours does not, ask your family doctor to cover the same ground. The visit usually reviews your history, vaccinations, lifestyle, current medicines and supplements.

Supplements to start before you conceive

Folic acid is the one not to leave late. Start it at least one month before you try to conceive and keep taking it through the first 12 weeks. The usual dose is 0.4 mg daily.

A higher dose of 4–5 mg daily is for women at high risk. Examples are a previous baby with a neural-tube defect, diabetes, or taking some antiepileptic medicines. Tell the doctor or matrona about any of these. They set the dose for you.

Iodine, about 200 µg daily, is recommended before and during pregnancy and while breastfeeding. Do not take it if you have thyroid disease. Check with your doctor first.

Tests to ask for

Ask for blood tests that show whether you are immune to rubella and varicella. Also ask about syphilis, HIV, hepatitis B and toxoplasma tests, and a blood count. Check that your cervical screening is up to date.

If you are not immune to rubella, you can have the MMR vaccine. Then avoid getting pregnant for one month afterwards. This is why the tests come first, before you stop contraception.

Where to go next

The checklist, timeline and warnings below turn this into steps. Your doctor or matrona may adjust doses and tests to your own health.

Timeline and deadlines

• Start folic acid: at least 1 month before trying to conceive

• Keep taking folic acid: through the first 12 weeks of pregnancy

• Wait before trying to conceive after an MMR vaccine: 1 month after the vaccine

Checklist

• Book a preconception appointment at your health centre with the matrona (midwife) or your family doctor (médico de familia).

• Start folic acid at least 1 month before you try to conceive.

• Ask whether you need the higher folic acid dose of 4–5 mg daily.

• Start iodine, about 200 µg daily, unless you have thyroid disease.

• Ask for a blood test for rubella and varicella immunity.

What to watch out for

• Starting folic acid too late: Folic acid works best when taken before conception, so starting after a positive test misses the early weeks. Start at least 1 month before you try to conceive and continue through the first 12 weeks.

• Pregnancy too soon after the MMR vaccine: If you are not immune to rubella, you need the MMR vaccine, and pregnancy in the following month should be avoided. Use contraception for 1 month after the vaccine, then start trying.

• Taking iodine with thyroid disease: Iodine is not suitable for everyone, especially if you have thyroid disease. Tell your doctor or midwife about any thyroid condition before you start.

Frequently asked questions

Do I need a higher folic acid dose before pregnancy?

Yes, a higher folic acid dose of 4–5 mg daily is advised if you are at high risk, for example after a previous neural-tube defect, with diabetes or on some antiepileptic medicines. The usual dose is 0.4 mg daily. Your doctor or midwife sets the dose that fits you.

Should I take iodine when planning a pregnancy?

Yes, about 200 µg of iodine daily is recommended before and during pregnancy and breastfeeding, unless you have thyroid disease. If you have a thyroid condition, ask your doctor before taking it.

How long should I wait to get pregnant after a rubella vaccine?

You should avoid pregnancy for one month after the MMR vaccine. The vaccine is given only if a blood test shows you are not immune to rubella.