Optimizing Preconception Health for Women

Feb 1

Our society is not as focused on reproductive health as it should be - and it shows. Our collective fertility rates are declining, and children’s developmental health issues are rising. Taking a proactive approach to health in the preconception period is essential because a healthy baby and pregnancy begin well before a woman conceives. Improving your health is one of the most important things you can do to prepare for pregnancy.

Fertility Rates are Declining

A study in North America, Europe, Australia and New Zealand found that sperm count declined by 50-60% between 1973 and 2011 over about 40 years. 1 If this trend continues, most men will have little to no capacity to reproduce by 2060.

See Optimizing Preconception Health For Men

Measuring if women’s fertility has dropped alongside sperm count is a little more challenging because we need to consider social factors like intentional delays in family planning and the desire to have fewer children overall. However, considering these trends, we still see evidence that women increasingly have challenges conceiving and carrying healthy pregnancies to term. 3

Rates of Chronic Health Conditions Among Children are Increasing

Chronic health conditions among children have risen over the past 50 years, particularly asthma, obesity, mental health conditions and neurodevelopmental disorders. 2 The prevalence of allergies is also increasing. 10 Many of these health issues can be linked to events that occur before the baby is even born.

The Case for Optimizing Health in the Preconception Period

Women of reproductive age are often unaware of what they should do to prepare for pregnancy. This is a missed opportunity to prepare her body to undergo what is likely one of the most demanding projects it will ever take on. Mindful preparation will increase the likelihood of a healthy mother, pregnancy, and baby.

The emerging science of epigenetics emphasizes the importance of a mother’s health even before conception, with impacts not only for her own children, but her grandchildren as well. The CDC defines epigenetics as follows:

“Epigenetics is the study of how your behaviours and environment can cause changes that affect the way your genes work. Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence.” 15

Dr Kara Fitzgerald, who is engaged in clinical research on the DNA Methylome says that it is thought that up to 30% of the epigenome is passed from parent to child in utero. 16 This provides mothers with an opportunity to gift their child an epigenome that has been shaped by healthy lifestyle choices. Unfortunately, she can also pass on an epigenome that is influenced by an unhealthy environment or behaviours - some factors more easily controlled than others.

How to Prepare in the Preconception Period

There are several ways a woman can tailor her lifestyle to optimize her own health, pregnancy, and the health of her future children.

Pay Attention to Your Period

Your menstrual cycle is one of the clearest ways your body uses to communicate with you about your health. Unfortunately, for many women, that communication line has been cut off with the use of birth control pills, IUDs, implants, and other forms of birth control that work by disrupting your hormones and menstrual cycle.

Many women take birth control to help tame their symptoms, which, depending on their severity, can significantly negatively affect their quality of life. However, intense menstrual cramps, heavy bleeding, and acne is your body’s way of waving a red flag telling you something needs to change. Addressing the root cause, and not masking the issues with synthetic hormones is the best approach.

Emphasize Nutrition

You quite literally are what you eat. Most people don’t like the sound of building their bodies with highly processed foods, harmful additives, and pesticides - much less a baby. Nutrition of the mother doesn’t just matter in pregnancy, but before conception as well.

Folate

Folate, for example - found in foods like leafy greens and beans, is crucial in the first few weeks of pregnancy. It is one of the cornerstones of prenatal vitamins because it is important to prevent major birth defects in the baby’s brain and spine. 4 The problem is that many women won’t realize they are pregnant in time to add folate that may be missing from their normal diet.

Calcium

Used by your body to create your baby’s bones and teeth, your body will pull calcium from your own stores if you are not getting enough from your diet. If your calcium stores are low to start or are not replenished after having a baby, this can lead to osteoporosis in the future. 4

Iron

Iron is used to make red blood cells, which your body needs more of when you are pregnant. If a mother has low levels of iron during pregnancy, it can affect her baby's growth and may increase the risk of premature labour. 6

These are just a few crucial nutrients your body needs during pregnancy (and life). Many nutrients can be stored to varying degrees within the body over time and depleted when you are making another human. You should ideally make sure that these reserves are well stocked before conception. With this in mind, I’ve decided to keep a close eye on my nutrition through regular blood work.

Track Your Bloodwork

One of the tools that I am using to track my bloodwork is InsideTracker. For each blood marker, it tells me whether I am optimized, need work, or if I am at risk. It also gives me tailored recommendations to optimize my blood markers that require attention.

This is a great tool for me because I don't have access to a family doctor right now, and even if I did, they barely have enough time to consult with me on how to improve my blood work. InsideTracker also shows optimal zones, while many tests will only flag results when they enter the “At Risk” range. Since I want to focus on preventing problems before they appear, knowing these optimal zones is important to me.

This product is recommended by a couple of scientists I follow, Andrew Huberman (Stanford) and David St-Clair (Harvard). I had wanted to try it for a few years, and I finally pulled the trigger a few months ago. I’m glad I did - because I have several blood markers that need work (HDL, Vitamin D, and B12, for example).

See my Blood Tracking Results here.

Whichever way you do it, I highly encourage you to seek out regular blood work and ensure you are correcting any areas that need improvement.

Track your Food Intake

I like to track my food intake on Chronometer, so I can see if I am hitting my key nutrient targets every day with my diet. Chronometer is an excellent (free!) app with a huge food database and corresponding micro and macronutrients. You can also pay for an upgraded version that will suggest foods to hit your nutrient targets and generate weekly reports so you can track your progress.

Ditch the Harmful Chemicals

Reducing the load of harmful chemicals that you are exposed to is crucial for the health of both you and your baby. One study found an average of 200 industrial chemicals and pollutants in babies' umbilical cord blood - including pesticides, consumer product ingredients, and wastes from burning coal, gasoline, and garbage. 7 Exposure to most of these chemicals is linked to cancer, birth defects and abnormal development, and the majority are toxic to the brain and nervous system.

There was a time when the placenta was thought to protect the baby from these sorts of environmental factors. However, as this study demonstrates, the chemical soup we live in does indeed impact the developing fetus.

These chemicals are so prevalent now that it would be impossible to avoid them completely, but we can reduce the body’s burden by avoiding them as much as we can in consumer products. Identifying and avoiding these dangerous ingredients is a skill I have honed for years, so I will share some time-saving tips with you.

First - assume everything is tainted. Consider a product guilty until you prove it innocent after carefully analyzing its ingredients.

Shampoos, soaps, cleaning supplies, perfumes, laundry detergent - most of the conventional brands have terrible ingredients. To find non-offensive products you can leverage a (free!) app called EWG Healthy Living App. With a quick scan of a barcode, EWG provides an analysis and safety score of thousands of products.

Also - avoid anything that has “fragrance” listed on the ingredients -avoid it like the plague. Since fragrances are considered trade secrets, “fragrance” in an ingredient list can hide unsafe things like endocrine-disrupting phthalates. 7

Prioritize Organic Foods

Organic foods are cleaner and exposed to far fewer synthetic fertilizers and pesticides. They may also have better nutritional profiles as they are more likely to be grown in healthier soil. Soil degradation is a major issue of increasing urgency, as many foods are becoming less nutritionally dense over time due to depleted nutrients in the soil.

You should prioritize eating organic as much as you can. I know that for many people, there are barriers to accessing organic foods - whether those barriers are financial or location-dependent.

There are ways to reduce cost of cleaner foods by tailoring your shopping list according to the “clean 15” and “dirty dozen''. These lists track which conventionally grown foods are the cleanest versus the most contaminated. You may choose to opt for conventional produce from the “clean 15” list, but invest in organic food whenever you eat foods listed in the “dirty dozen”.

If you can grow your own food at home or in a community garden plot, this can also help you control the inputs and environment in which your food grows, and can lower costs. If you are knowledgeable and able, foraging wild foods from a clean environment is also a good option.

I have prioritized eating primarily organic whole foods for a few years now. However, I acknowledge that this may double my grocery bill compared to if I bought the same ingredients conventionally grown. The way I think about it - health is a form of wealth (and my diabetic and mostly chair-bound grandmother heartily agrees with this statement).

I have a lot of diseases in my family history that I would like to avoid, so if this helps me get there, I consider it a worthwhile investment - not only for myself but my future children (and grandchildren).

Exercise

Exercise is critical to overall wellness, and the ripple effects of a woman's health during the preconception period can affect future generations. As such, a woman’s physical health and strength deserve attention during the preconception period.

Many people will train for a big race with diligent dieting and carefully tailored exercise regimes. Pregnancy is also a physically demanding project - like running a continuous marathon.

“Pregnancy is the most energetically intensive activity the body can maintain for nine months,” says Duke University Professor Herman Pontzer, who co-authored a study examining the human limits of endurance. 9

When preparing to carry a healthy pregnancy, women should focus on the strength of their heart, core, pelvic floor, and muscles that support functional movement. She should also make sure that she is maintaining a healthy weight.

Weight Management

Exercise is an important tool for weight management. Maternal obesity has been associated with an increased risk of preterm birth, neurodevelopmental problems, and ADHD-related symptoms. 11 Making sure that the mother is at a healthy weight will contribute to the physical and mental health of her baby both while in the womb and for the rest of their life.

Heart

During pregnancy, a woman’s heart will pump 40-45% more blood 8, so making sure that your heart is in good shape in the years and months leading up to pregnancy is a fantastic idea. This can be accomplished through regular cardiovascular exercise. The general recommendation for overall health is 150 minutes of aerobic exercise per week. 5

Core

Having a strong core before conception is important, as it will help you have a more comfortable pregnancy, allowing you to carry the extra 25 to 35 pounds more easily, while reducing back pain. 14

Pelvic Floor

Your pelvic floor is the group of muscles and tissues that support the bladder, bowel and uterus. The pelvic floor stretches during birth to accommodate the baby’s exit from the body. 13 Pregnancy and childbirth can often cause complications such as urinary incontinence and pelvic organ prolapse, so it is important to make sure your pelvic floor is healthy in advance.

After pregnancy, the pelvic floor may need some support to regain its full function. If your mom has ever told you that she has not been able to sneeze without peeing herself a little since she birthed your big head, you have already heard of the effects of the weakened pelvic floor and urinary incontinence.

Another complication related to the pelvic floor is called pelvic organ prolapse (POP). This is a condition that affects half of women that routinely go to the gynecologist. POP is a condition often caused by pregnancy and childbirth - with varying severity - where one or more organs will move from their normal position and bulge into the vagina. 12

A 2021 study which summarizes the research in this area acknowledges that there is still much to discover on this topic but suggests that women perform Pelvic Floor Muscle Training (PFMT) in prepartum and postpartum periods. 12 There are now physiotherapists who specialize in this area of practice who would be able to guide you on how to best implement PFMT.

Functional Strength

After giving birth, a woman will likely find herself lifting many new things - a baby, a car seat, a stroller. Making sure that she incorporates functional strength training into her routine will ensure that she can face the world with overall improved strength and stability in the present and future when she has a child to care for.

Takeaways

Decreasing fertility rates and increasing childhood development issues are a warning call for future parents-to-be. One of the best gifts we can give our future children is the gift of health - and these are some actions that we can take to prepare our bodies to provide them with the best chance at producing a healthy child:

Observe the nuances of your menstrual cycle. Consider symptoms like hormonal acne, intense cramping and irregular periods to be a message from your body that it needs support to return to a healthy balance.
Focus on nutrition. To make a healthy baby and ensure that you are not depleted during or after pregnancy, your body needs support with beneficial nutrients to ensure it has adequate reserves. You can assess your current state and track your progress by getting bloodwork done and tracking your nutrient intake with tools like Chronometer and InsideTracker.
Cut unhealthy chemicals from your life. Your baby will be exposed to the same chemicals you are exposed to. Ridding your environment of them now will give your body some time to detox them out of your system and hopefully reduce your future baby’s chemical load as well.
Prioritize Organic Foods. You want to ensure you are feeding yourself with the cleanest and most nutritious food available. This will reduce the toxic load on your body and, in turn, hopefully, reduce the toxic load on your future baby.
Train Your Body. Pregnancy is the most energetically intense endurance project a human can take on. Make sure you focus on maintaining a healthy weight, heart, core and pelvic floor, and challenge your body to develop functional strength.

Note: The purpose of this article is not to blame parents for the outcome of a pregnancy - there are many factors that cannot be controlled, restricted resources, and limited knowledge, especially with science that is ever-evolving. Instead, the purpose of this article is to empower parents-to-be with information to help guide them to make the best choices that they can.

Disclaimer:

The information on Better Health Project is intended for educative and informational purposes only and is not intended to serve as professional or medical advice. The content of this site is not written by a medical professional. Always seek the advice of a trusted and qualified healthcare professional before making health changes.

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Amanda Scott