Preconception Medication Safety Checker
Check Your Medications
This tool helps identify medications that may pose risks during early pregnancy and provides guidance for safe alternatives. Note: This is not a substitute for medical advice. Always consult your healthcare provider.
Results
Select a medication and click 'Check Safety' to see information about risks and alternatives.
Half of all pregnancies in the U.S. are unplanned. That means for many women, the first weeks of pregnancy - when the baby’s heart, brain, and spine are forming - happen before they even know they’re pregnant. And if they’re taking certain medications during that time, the risks to the baby can be serious. This isn’t about scaring people. It’s about giving them time to make safe, smart changes before conception.
Why Timing Matters More Than You Think
Most people think prenatal care starts when you find out you’re pregnant. But the real window for protecting your future baby opens months before that. The first eight weeks after conception are when the embryo builds its major organs. By the time a pregnancy test turns positive, that process is already well underway. If you’re on a medication that can interfere with this, waiting until you’re pregnant to switch is too late. That’s where preconception medication counseling comes in. It’s not just for women trying to get pregnant. It’s for anyone who could get pregnant - whether they’re planning it or not. The CDC estimates that 51% of U.S. pregnancies are unintended. If you’re on chronic medication and you’re sexually active without reliable contraception, you’re already in the risk zone.Medications That Can Harm Early Development
Not all drugs are dangerous, but some carry known, serious risks during early pregnancy. These aren’t rare outliers - they’re common prescriptions. Here are the big ones:- Valproic acid (used for epilepsy and bipolar disorder): Raises the risk of neural tube defects like spina bifida from 0.1% to over 10%. That’s more than 100 times higher.
- ACE inhibitors (like lisinopril or enalapril for high blood pressure): Can cause kidney damage, low amniotic fluid, and even fetal death if taken after the first trimester.
- Warfarin (a blood thinner): Can lead to fetal warfarin syndrome - facial deformities, bone problems, and developmental delays.
- Isotretinoin (Accutane for acne): One of the most dangerous. Up to 35% of babies exposed in early pregnancy develop major birth defects.
- Methotrexate (for rheumatoid arthritis or psoriasis): Causes high rates of miscarriage and severe birth defects.
- Dolutegravir (an HIV drug): Early data showed a small but real increase in neural tube defects - enough to require careful discussion before conception.
What Safe Alternatives Look Like
The good news? For almost every high-risk drug, there’s a safer option - if you plan ahead.- For epilepsy: Switch from valproic acid to lamotrigine. Lamotrigine has a major malformation rate of just 2.7%, close to the general population’s 2-3%. Experts recommend starting this switch 3 to 6 months before trying to conceive to allow your body to adjust.
- For high blood pressure: Swap ACE inhibitors for methyldopa or labetalol. Both have been used safely in pregnancy for decades. No major birth defects linked. Start the switch at least one full menstrual cycle before conception.
- For autoimmune diseases: Stop methotrexate at least 3 months before trying to conceive. Folic acid supplementation (5 mg daily) is recommended during this transition to support healthy cell development.
- For acne: Stop isotretinoin completely. Wait at least one month after your last dose - but many doctors recommend three months to be extra safe, since the drug stays in fat tissue.
- For HIV: Work with your infectious disease specialist to switch from dolutegravir to a safer regimen like dolutegravir + raltegravir, or switch to a different class entirely. The goal is viral suppression without added fetal risk.
How Counseling Actually Works
Preconception counseling isn’t a one-time chat. It’s a process. First, your provider asks: “Would you like to become pregnant in the next year?” That’s the “One Key Question” framework. It’s simple, non-judgmental, and works whether you’re actively trying or not. Then, they review every medication you take - prescriptions, over-the-counter drugs, supplements, even herbal remedies. Many people don’t realize that common painkillers like ibuprofen can be risky in early pregnancy, or that some vitamins (like high-dose vitamin A) can be teratogenic. They check each drug against the FDA’s Pregnancy and Lactation Labeling Rule (PLLR), which replaced the old A-X categories with plain-language summaries of risks. Tools like MotherToBaby and TERIS give providers real-time data on what’s safe and what’s not. Finally, they create a transition plan. For drugs like methotrexate, that means stopping three months early. For others, it’s switching to a new pill and monitoring your condition for a few weeks to make sure it stays under control. All of this gets documented using the ICD-10 code Z31.69. That’s not just paperwork - it’s how health systems track whether this care is actually happening.Why So Few People Get This Care
Despite the evidence, most people never hear about it. A 2022 survey found only 23.7% of reproductive-aged women received any preconception care. Primary care doctors - who see these patients most often - don’t always feel trained or responsible for it. One study showed only 41% of PCPs routinely check for teratogenic meds. Patients don’t always speak up either. Many assume their doctor already knows what they’re on. Others are afraid to change meds they’ve been taking for years. One Reddit user wrote: “My neurologist said, ‘I don’t do pregnancy stuff - go see an OB.’ But my OB said, ‘I need you to get your meds adjusted before I can help you.’” That kind of blame game leaves people stuck. And it’s worse in rural areas. Only 12% of rural clinics offer preconception counseling, compared to 33% in cities. Access to specialists - neurologists, rheumatologists, endocrinologists - is limited. If your only doctor is your local clinic, you might never get the full picture.
What Works When It’s Done Right
When care is coordinated, outcomes improve dramatically. A 2021 JAMA study of over 12,000 women found that those who got preconception counseling had 37% fewer major birth defects. Neural tube defects dropped by 42%. Heart defects dropped by 33%. One woman on BabyCenter shared her story: “My MFM specialist made me a 6-month plan. We lowered my valproic acid, slowly added lamotrigine, checked my levels weekly, and I started 5mg of folic acid. I got pregnant on schedule. My son is healthy. No regrets.” Electronic health records with built-in alerts can cut high-risk exposures by 29%. But only 35% of U.S. clinics have them. That’s a huge missed opportunity.What You Can Do Now
You don’t need to wait for your doctor to bring it up. Here’s what to do:- Make a list of every medication, supplement, and herbal product you take - even the ones you only use sometimes.
- Ask your provider: “Could any of these affect a future pregnancy?” Don’t be shy. This is a normal question.
- Ask for a referral if you’re on a high-risk drug. You may need to see an OB-GYN, maternal-fetal medicine specialist, or your specialist (neurologist, rheumatologist, etc.) to coordinate a safe switch.
- Start folic acid - 0.4 mg daily, or 5 mg if you’re on epilepsy meds. It reduces neural tube defects by up to 70%.
- Use reliable contraception if you’re not ready to conceive - especially if you’re on a high-risk drug. Don’t assume you’re safe just because you’re not trying.
The Bigger Picture
This isn’t just about avoiding birth defects. It’s about giving women control. Too often, pregnancy is treated like an emergency - something that happens to you. But preconception counseling turns it into a choice. You get to plan. You get to prepare. You get to protect your future child without giving up your own health. New tools are coming. AI-powered risk calculators are being tested. Pharmacogenomics might soon tell us how your body metabolizes drugs before you even get pregnant. The FDA is pushing for faster data collection on medication safety. And in 2024, Congress introduced the PRECONCEPTION Act to make this care a covered benefit. But right now, the most powerful tool is a simple conversation. One question. One review. One plan. That’s all it takes to change the outcome of a pregnancy - before it even begins.Do I need preconception counseling if I’m not trying to get pregnant?
Yes. Since about half of all pregnancies are unplanned, any reproductive-aged person taking medication should get this counseling. You don’t need to be trying to conceive for it to matter. The goal is to be prepared - whether you plan to get pregnant next month or five years from now.
Can I just stop my medication if I think it’s risky?
No. Stopping medication suddenly can be dangerous. For example, stopping seizure meds can cause life-threatening seizures. Stopping blood pressure or antidepressant meds can lead to complications like preeclampsia or severe depression. Always work with your doctor to switch safely - and give yourself enough time. Some drugs need 3 months or more to clear your system.
Are all supplements safe during pregnancy?
No. While folic acid is essential, some supplements can be harmful. High-dose vitamin A (over 10,000 IU) can cause birth defects. Herbal products like black cohosh, dong quai, and goldenseal have been linked to miscarriage or fetal harm. Always tell your provider about every supplement you take - even if you think it’s “natural.”
What if my doctor says they don’t handle this?
Your primary care doctor, pharmacist, or specialist should still be able to help you get started. If they say it’s not their job, ask for a referral to a maternal-fetal medicine specialist or a preconception clinic. You can also contact MotherToBaby (1-866-626-6847) for free, expert advice. You have the right to safe care - no matter who you see.
Is this covered by insurance?
Yes, under the 2022 CMS mandate, Medicaid must cover preconception counseling. Most private insurers also cover it under preventive care benefits. Ask your provider to bill using ICD-10 code Z31.69 and CPT codes 99202-99215. If they say it’s not covered, call your insurance company - it’s a common misunderstanding.