‘Trimester Zero’ is one of the newest terms being bandied around in the ‘trying to conceive’ circles (that’s TTC for those in the know on the internet). We chatted to experts and doctors about what really matters when it comes to preconception care – and what doesn’t – plus, why it’s something that both partners need to consider.
Earlier this year New York’s The Cut ran a story about pregnancy, using a term that soon went viral.
If you’re someone who is thinking about having a baby at some stage, you’ve likely heard those two words by now:
‘Trimester Zero’
“Technically, pregnancy starts about two weeks before conception,” began the article. “But in certain corners of Instagram and TikTok, women are convinced it really starts much earlier. Now, in addition to the 40 weeks your body is actively growing a foetus, you also have to worry about ‘trimester zero’ – the months before you even start trying to conceive.”
The article was – as you can gather by that intro – pretty critical of Trimester Zero with large chunks of it listing some of the far-fetched things influencers are doing and recommending to their anxious followers (Detoxes! Avoiding any iced beverages! Wearing blue-light blocking glasses!) in the months – or even years – leading up to trying to conceive a baby.
The Cut’s take was that the Trimester Zero movement is yet another thing heaping anxiety onto women that, for the most part, is simply unwarranted fearmongering.
Sure, there are some wise things to look at doing when you’re trying for a baby – but is there a push to take it too far, particularly with the rising number of health influencers who have zero credentials yet are whisking us all up into an anxious state?
If you’re in that ‘trying to conceive’ zone yourself right now, the messages out there may very well be confusing – or even distressing at times. Right at a time when stress can really exacerbate the whole situation and make conceiving a baby more tricky. Cool cool cool.
Dr Libby is one of Australasia’s most trusted doctors when it comes to women’s health in particular, so she was my first stop in getting to the bottom of Trimester Zero and cutting through some of this noise – and stress. We set about finding where the truth really does sit. How much do you really have to consider during preconception?
Here, I’ve spoken to the experts to get some real answers about what really does matter – and what doesn’t during preconception.
And a little note here to start off with: This can be a tricky conversation. The whole experience of deciding whether or not to have children, working out whether you should try for a baby, trying to conceive, perhaps discovering you’re pregnant and it coming as a huge surprise (you’re not alone! In NZ around 40% of pregnancies are unplanned!), being pregnant, having a miscarriage… there can be a lot of stress, anxiety and heartbreak involved.
This story is not intended to cause any stress – if anything, the hope is to alleviate some of that anxiety by arming ourselves with factual information. It’s important to note that while doctors agree preconception care is important – it’s only one piece of the whole big puzzle of having a baby. So if you’re reading this, and you’re already pregnant – or maybe you have a little baby in your arms – and worrying about what you have or haven’t done, do not stress. This is just one piece of the big old puzzle. Or, maybe you’ve had a miscarriage and trimester zero feels like a blame game – we hear you, and again want to reiterate that you did not cause the miscarriage. Please click here for more support and info around miscarriages. We’re sending love.
So What Exactly is Trimester Zero / Preconception Care?
Okay, let’s cut to the chase with Dr Libby. She says preconception care is important as it can be beneficial in increasing your likelihood of getting pregnant in the first place, as well as going on to have a healthy pregnancy and baby.
But, it’s also not something to stress about.
“Don’t ignore it, but don’t stress about it,” she says.
“Preconception care might have a new name, but it’s not a new concept,” says Dr Libby. “Francesca Naish wrote a book called The Natural Way to Better Babies in 1996 and some of my friends were doing preconception care in the early 2000s. Before that, a research group was established in the UK and they continued their work in this area for 50 years.”
As Dr Libby explains, preconception care is an important piece of the puzzle of having a baby – but it doesn’t have to be an overwhelming part of it.
“Reproductive health is closely related to general health so doing what you can to foster good overall health is a great place to start,” she says.
“There are also some unique functions of reproductive health that benefit from some additional focus – such as menstrual cycle health, stress hormone output and specific nutrient sufficiencies – so looking at these additional factors can help improve your chances of conceiving.”
And beyond conception itself, there can be additional benefits to doing some work on your improving your overall health.
“Preconception care is not only about conception – it’s about having a healthy baby,” says Dr Libby. “Plus, pregnancy places enormous nutritional demands on the mother’s body, and her nutrient status in the months leading up to it can have a meaningful influence, not only on her baby’s future health, but on how she feels throughout pregnancy and into the postpartum period. Too many women enter motherhood already depleted of key nutrients, iron in particular. When those foundations are stronger beforehand, the transition into pregnancy and the early months of motherhood can be navigated with far greater energy and resilience – and that is so worth the effort.”
Why is Preconception Care Important? How Can it Have an Impact?
Yes, as The Cut said in that opening paragraph, pregnancy technically starts about two weeks before conception. But there is an opportunity before that to have a positive impact – because the story of the egg and sperm that create that embryo does begin a lot earlier.
For the egg, although, yes, we women are born with all our eggs, the process of an egg maturing begins three to four months before it’s released by our ovaries in the hopes it might travel down our fallopian tubes to be fertilised.
Sperm has a shorter story of 70-90 days (That’s right – preconception care is very much about the biological father as well!).
It’s during that three to four months – or 70-90 days for men – that we can make a difference.
“The health of your eggs today is a reflection of your health three to four months ago,” says Dr Libby. “Folliculogenesis – the maturation process of ovarian follicles – takes three to four months.
“This means we ideally want to have a minimum of four months of intentional preconception care to give the body time to replenish key nutrients, stabilise blood glucose, support consistent ovulation and healthy hormone production, as well as address factors such as iron status, thyroid health and stress physiology that can influence fertility and having a healthy baby.”
Dr Libby says the best course of action differs from person to person, so the best thing to do is to book a consult with your GP if you’re considering having a baby.
“A conversation with your GP and/or an experienced nutritionist or naturopath, along with preconception blood tests, is best had as early as possible to assess key markers that may need time to be addressed,” she says.
“Rather than waiting until you are trying to conceive, thinking about preconception health many months or a year in advance allows both partners to create the best possible environment for conception and for the early stages of a baby’s development.”
So What Kind of Things Are We Talking About Here?
For a start, no, it’s best not to listen to the influencers. In order to get pregnant and have a healthy pregnancy, you don’t need to wear blue-light blocking glasses, do an expensive juice cleanse, throw out your nail polish (this is something MAHA influencer Alex Clark has recommended to her followers), meditate for an hour each day, eat a strict diet of no gluten/dairy/sugar/grains/saturated fats/iced drinks and work out every day, but somehow not overexert yourself in the process.
Capsule reader Kate says it took her three years to conceive – but she believes it would have actually happened a lot sooner if she’d just got out of her own way. “I was hyper-fixated on getting myself in perfect health before we started trying for a baby,” she says. “I got lost down every internet forum. I joined a gym and was working out every day. It wasn’t until I went to see a specialist who told me I was underweight – and despite everything good I thought I was doing, I had a lot of inflammation markers. I dropped it down to working out two or three times a week, put on some weight and relaxed everything I was doing – we got pregnant a few months later.”
Preconception care isn’t about extremes – it’s about being considered.
Dr Greg Phillipson, a gynaecologist and fertility specialist working out of his hometown of Christchurch says it’s important to discuss preconception health with your GP to check in on any pre-existing medical concerns, check your vaccinations are up to date, run blood tests, run STI checks, and to discuss supplements.
Some of those checks might sound a bit out of leftfield, but they’re in there for good reasons. Some sexually transmitted infections, for example, have few or no symptoms whatsoever – but, can have devastating consequences during pregnancy, causing miscarriage or serious harm to growing babies (particularly HIV and syphilis). Same goes for things like measles, mumps or rubella, which if you catch while pregnant can cause complications for your growing baby.
Your doctor will also be able to prescribe the right supplements for you – many of which are government subsidised.
“Women should take a daily folic acid supplement of at least 400 micrograms before conception and during the first three months of pregnancy,” he says. “This can reduce the risk of a child with neural tube defects such as spina bifida. Also, 150mcg of Iodine daily is advised, as deficiency can alter the development of the nervous system. Folic acid and Iodine are available over the counter and combined with several commercial multivitamin preparations.”
It’s important to head to your doctor though to discuss exactly what’s right for you, because these amounts can differ from person to person, he says – particularly if you have a health condition like diabetes, epilepsy or a BMI of more than 30.
And yes, as Dr Libby said, much of it is closely related to general health – so, your doctor may also talk to you about your stress levels, exercising and maintain a healthy body weight (Dr Greg Phillipson says it’s important during preconception as being overweight or underweight can affect fertility and increase the risk of miscarriage). They may talk about your mental health also, and check in that you’re safe at home with your partner.
A biggie he says though, is avoiding harmful substances during that window of preconception.
“Smoking, alcohol consumption, and recreational drug use can all affect fertility and increase the risk of pregnancy complications,” he says. “It is important to avoid these substances before and during pregnancy.”
Your doctor will also be able to chat to you about any pre-existing conditions you may have. Conditions such as diabetes, hypertension, and thyroid disorders can increase the risk of pregnancy complications.
For me, personally, my doctor lead the charge on this one when I was in my very late thirties, by asking if I wanted to have children one day. He reminded me that my thyroid health would need some work if I wanted to have a baby, so it might be a good idea to get working on it!
I have an autoimmune illness that affects my thyroid – Hashimoto’s Thyroiditis – which can make for slightly scary reading if you’re wanting a baby. If you have a thyroid imbalance that goes untreated it can make getting pregnant difficult, as well as increase your risk of miscarriage, preterm birth, preeclampsia and development issues (none of which you want to be reading about while pregnant!).
It took five months to get my levels to what the thought would be absolutely ideal for getting pregnant, so I was glad we had that conversation early. And my story finished with the good ending – a healthy baby boy who I had at 40!
If you have an existing medical condition, it may be something you’ve already been thinking about and giving consideration to when it comes to pregnancy. Your GP – or specialist – will be able to help you come up with a plan that’s right for you.
The Other Half of the Story
As we mentioned earlier, preconception care isn’t just for women. “Oh, absolutely not,” says Dr Libby. “The health of a man’s sperm is 50% of the preconception picture! Male factors contribute to around half of infertility cases, yet preconception conversations are still often focused almost entirely on women.”
Dr Libby says there’s a few factors at play when it comes to sperm, fertility and a healthy pregnancy.
“Sperm are not simply carriers of DNA; they also deliver epigenetic information – signals that influence how genes are expressed in the developing embryo,” she says. “Research shows that a father’s diet, stress levels, body composition and environmental exposures can alter these epigenetic patterns in sperm and influence early embryo development and even aspects of a child’s long-term health.”
She says that ideally, men should approach preconception in much the same way women are encouraged to. That means “prioritising their overall health for a minimum of three months before trying to conceive,” she says.
“Spermatogenesis is 70 – 90 days, briefer than folliculogenesis, so the health of his sperm today is a reflection of his health around three months ago. It can be helpful to think of this as three tiny months out of his very long life that will significantly contribute to his baby’s future health.”
The Anxiety Factor
Okay, if you were hoping to read this and find that Trimester Zero is all a bunch of baloney and not something to even think about, I’m sorry.
But again, this information is meant to be powerful, not stressful. It’s about making sensible, considered changes – but it shouldn’t be something you hyper-focus on and tie yourself up in knots worrying about.
“It’s a privilege to have access to research that shows us some of what’s needed to increase the chances of having a healthy baby,” says Dr Libby. “Don’t ignore it and also don’t stress about it. Receive the information with gratitude and simply do your best.”
Nutritionist and Health Coach Renee Brown says it’s all about just feeling good – and it can be a beautiful time, nourishing yourself before you have someone else to pour your energy into!
“I don’t think it needs to be looked at like another stressful thing to add to the list,” she says. ‘but more a beautiful focus to nourishing your body and feeling your best. As a Nutritionist, I can’t recommend it enough – investing in your health and vitality before trying for a baby is one of the best things you can do for yourself.”
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