In my last post, Why It's Important to Eat Healthy Before You Get Pregnant: And Other Preconception Lifestyle Changes, I discussed why it is important to make nutrition and other lifestyle changes before you get pregnant. In this post I will talk about what kinds of changes you can make to support your fertility, future pregnancy, and your baby.
There are so many areas of opportunity during preconception and while trying to conceive. So, look for future posts where I go into more depth on some of these topics. Or if you are looking for more support now, check out my services, from meal planning to nutritional counseling.
Just a quick note, I use both the terms preconception and trying to conceive in this post. While these terms can be synonymous, they can also be different. Preconception is the window before conception. You may or may not be trying to conceive during this time. Some women may need to make certain changes before trying to conceive. For example, if you are taking a medication that is not safe during pregnancy you may need time to clear it from your system. Or you may need to get a health condition under control before starting to try to get pregnant. These tips are relevant for both preconception and while trying to conceive.
1. Eat Like You Are Already Pregnant
Women are usually several weeks into pregnancy before they know they are pregnant. So, you want to be cautious with anything that could be harmful to a developing baby, because you will likely be pregnant before you know it. Secondly, many of the things that are bad for you and the baby during pregnancy are also not great for fertility/trying to conceive. Alcohol is very inflammatory, so can decrease your odds of getting pregnant. Additionally, it interferes with absorption of some of the B vitamins, including folate. Similarly, there have been some small studies linking high preconception caffeine intake to lower fertility and increased miscarriage rates (this is the case for both the mom and dad).
Do you have to be perfect during this time? The answer is no. I was trying to conceive for three years. I assure you there were days that I had an extra cup of coffee, especially once I realized we were in it for the long haul. Likewise, some of you might choose to have a glass of wine during your period when you know that you are not pregnant.
I think a helpful tool in making these changes is to reframe how you think about this time. Rather than a time of sacrifice it is a time to nurture your body and soul.
2. Eat a Wide Variety of Whole Foods
Eat Plenty of Vegetables and Fruit
Eat the rainbow - when eating your fruits and vegetables eat all the colors of the rainbow. Below I will talk about some of the nutrients that are especially important during preconception and while trying to conceive. However, I can’t stress enough that all nutrients are important. Eating a wide variety of foods helps to ensure you are getting a wide variety of nutrients.
Eat Plenty of…
Iron Rich Foods – Oxygenated blood is essential for life, but during preconception and pregnancy it is particularly important. It is important for ovulation. Oxygenated blood flow to the uterus is important to developing a healthy uterine lining so implantation can occur and to support your developing baby. Iron rich foods include well sourced red meat, poultry, seafood, organ meats, and bone marrow. The grain teff is also a good source of iron. While leafy greens are a rich source of non-heme iron they do not contain heme iron. Heme iron is more easily absorbed than non-heme iron. Meat is the only source of heme-iron.
Zinc- Zinc is important in regulating egg development. It is also important once you get pregnant because it plays a role in embryo development and DNA regulation. It is also important in placenta development. Meat, seafood, and milk contain higher levels of zinc. Zinc is also important for men’s fertility and can affect the quality of the embryo once conception happens. This is because zinc supports testosterone production and sperm quantity and quality.
Choline- Choline is important for normal neural tube (spine and brain) development. Most people do not get adequate amounts and most prenatal vitamins contain little to no choline. So, this is definitely one to focus on getting from your food. Egg yolk, liver, meat, lima beans, and greens have choline.
Omega 3’s – Eat 2-3 servings per week of salmon, sardines, mussels, rainbow trout, and Atlantic mackerel. These fish are high in omega 3’s but lower in mercury. Check out the Earth Working Group’s (EWG) Seafood Calculator.
Probiotics and Fermented Foods - Have you heard of the microbiome? It has been a hot topic in the health world for the last several years. With good reason. It turns out the microbiome, the community of bacteria, fungi, and viruses that make up the ecosystem of the gut, vagina and skin play a huge role in our health. It is especially important during pregnancy and lactation because moms pass their microbiome to their babies at birth via vaginal delivery and they also transfer it via breast milk and skin contact while nursing. While we can change our microbiome throughout our lives, it becomes more difficult and harder to restore, so it is particularly important to establish a solid microbiome during infancy and the toddler years.
Therefore, the health of mom’s microbiome is especially important to her baby. It can take a long time to help our microbiomes recover from the various assaults of modern life (pesticides, antibiotics, other medications, and a lack of fermented foods). Therefore, eating fermented foods like sauerkraut, pickles, and yogurt and taking probiotics during preconception and while trying to conceive gives you time to increase the diversity of your microbiome.
3. Take a Quality Prenatal
I am a big advocate of getting nutrients through food and supplementing with caution. Pregnancy is one of those times that supplementation is important. The reason is that even when we are eating a diverse whole food diet, we can still come up short on some nutrients for a variety of reasons. The soils our food is grown in are often not as rich in nutrients as they used to be due to modern growing practices. Shipping foods across the world and country allows them to sit a long time, which reduces the amount of the various nutrients. Plus, our own health can impact our ability to extract all the nutrients from our food. That does not even consider the challenges of pregnancy. Food aversions and restrictions limit the variety of a pregnant woman’s diet.
This does not mean we shouldn’t eat as diverse of a diet as possible. Because we should. The nutrients from whole foods are always more easily absorbed and utilized by the body. But taking a good quality prenatal acts to supplement the diet, a kind of insurance policy, to make sure you are getting all the nutrients you need. Taking a prenatal during preconception and while trying to conceive gives you time to make sure you have built up all your stores of the various nutrients and makes sure you have the nutrients you need when you get pregnant. Remember, as discussed in my post Why It's Important to Eat Healthy Before You Get Pregnant: And Other Preconception Lifestyle Changes, your baby is developing important systems in the early days of pregnancy, usually before you know you are pregnant. Developing those organ systems requires adequate stores of nutrients.
To ensure that a prenatal is quality make sure that it is third party tested to ensure it contains the nutrients listed in the amounts described and to ensure it does not have contaminants.
4. Get Plenty of Exercise
Like most things in life moderation is the key to exercise during preconception and when trying to conceive. Exercise improves fertility and just as importantly it prepares you for the hard work of pregnancy and childbirth. However, too much exercise can interfere with your menstrual cycle and even halt ovulation. As a general guide 30 minutes a day of moderate exercise is a good goal.
5. Get 7-8 Hours of Quality Sleep
In recent years we have become increasingly aware of how important sleep is to health and longevity. It is during sleep that the body repairs itself. Sleep is restorative. If we are not getting enough quality sleep it is a huge stress on our bodies. It can most definitely interfere with hormone regulation and decrease fertility. Make sure you are getting at least 7 hours of good quality sleep each night. Ideally you are going to bed and waking up around the same time each day; try to stay within the same hour. A great book about sleep in general is Matthew Walker’s Why We Sleep: Unlocking the Power of Sleep and Dreams.
He has a Ted Talk that is great too and the beginning specifically touches on sleep and reproductive health. He also talks about it in terms of children and learning. Important info for parents:
6. Reduce and Manage Stress
A large part of our nervous system is under automatic control (autonomic nervous system). Meaning we do not have conscious control over it. This automatic part of our nervous system is the part of our nervous system that controls our heart rate, blood pressure, gastrointestinal signals, and a host of other important bodily functions.
There are two aspects to this automatic part of our nervous system, one is the sympathetic nervous system, and the other is the parasympathetic nervous system. The sympathetic nervous system takes over when we encounter stress in its various forms and controls “fight or flight” responses. The parasympathetic nervous system is active the rest of the time and it deals with “rest and digest” activities, or as one of my teachers used to say, “breed or feed”. Can you guess which system we want to be in most of the time?
It is not possible to have both active at the same time. We evolved in a world where we would encounter a threat like a lion or bear and either fight or flee. So, the fight or flight response gears up the body systems that will enable us to fight or flee. Cortisol floods are system, our hearts start beating hard and fast, our vision focuses, we lose some fine motor control in favor of being able to run and fight. These are great responses when we are under threat, but in the modern world our bodies do not distinguish between life threatening stress and our daily stresses, such as aggressive driving. So, most of us are stressed most of the time. When it used to be the opposite. Most of the time we were in the rest and digest mode, we’d encounter a threat and then we would fight or flight and make use of the cortisol dump. Now we are in the fight or flight most of the time and we are not using our bodies in response to threats. So, the various hormones that are flooding our system are not being used and are instead causing damage and telling our bodies now is not the time to reproduce.
So, what do we do about it? Most of us can’t just eliminate the things that cause us stress. Traffic, in-laws, work, etc. The good news is there are ways to manage the existing stress. Exercise is one of the most beneficial because then we are utilizing and burning up the cortisol and other chemicals that the sympathetic nervous system dumps and that allows us to reset among other advantages. We can also incorporate mindfulness into our lives. That looks different for everyone. For some people this is meditation and for others it may be gardening. Pretty much anything that allows you to enter the rest and digest phase. The first step is learning to recognize when you are in fight or flight versus rest and digest. Once you learn to recognize that you can start to identify which things you can do to more frequently flip the switch to "rest and digest". You can also learn to look at your stressors differently, as sometimes reframing things can prevent triggering the fight or flight response.
7. Schedule a Preconception Appointment with Your OB
During this appointment you can get checked out to see if there is anything you need to address before you get pregant. You should also discuss any exisitng health conditions that you may need to manage before and during pregnancy and discuss any other pregancy related questions you may have. Additionally, it is a chance to make sure your OB is the one you want to go through your pregnancy journey with. You probably dont' have a birth plan yet, but you may have some ideas of what you want your pregnancy and birth to look like, so ask questiosn to help you figure out if their views align with yours. Ask how they handle different scenarios during pregnancy. For example, if you are considered of advanced maternal age, will they want to see you more often, if so how often. For example, during my pregnancy I had to come in twice a week during the last trimester due to advanced maternal age and gestational diabetes. I've talked to other friends who were older and their OB's had them come in less frequently. Personally, it made me feel better to have someone give me the thumbs up each week, but you may prefer something different. So this is a great time to ask questions about what your care will look like.
Citation and Additional Resources
Baldassarre ME, Di Mauro A, Mastromarino P, et al. Administration of a Multi-Strain Probiotic Product to Women in the Perinatal Period Differentially Affects the Breast Milk Cytokine Profile and May Have Beneficial Effects on Neonatal Gastrointestinal Functional Symptoms. A Randomized Clinical Trial. Nutrients. 2016;8(11):677. Published 2016 Oct 27. doi:10.3390/nu8110677
Bisgaard H, Stokholm J, Chawes BL, et al. Fish Oil-Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring. The New England Journal of Medicine. 2016 Dec;375(26):2530-2539. DOI: 10.1056/nejmoa1503734.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics and Gynecology. 2007 Nov;110(5):1050-1058. DOI: 10.1097/01.aog.0000287293.25465.e1.
Kar S, Wong M, Rogozinska E, Thangaratinam S. Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies. Eur J Obstet Gynecol Reprod Biol. 2016 Mar;198:40-46. doi: 10.1016/j.ejogrb.2015.11.033. Epub 2015 Nov 30. PMID: 26773247.
Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018 May 5;391(10132):1830-1841. doi: 10.1016/S0140-6736(18)30311-8. Epub 2018 Apr 16. Erratum in: Lancet. 2018 May 5;391(10132):1774. PMID: 29673873; PMCID: PMC6075697.
Tian X, Anthony K, Neuberger T, Diaz FJ. Preconception zinc deficiency disrupts postimplantation fetal and placental development in mice. Biol Reprod. 2014;90(4):83. Published 2014 Apr 25. doi:10.1095/biolreprod.113.113910