Trimester Zero: Strategies for Your Best Preconception Health
In May, The Lancet published three papers showing scientific evidence of the vital importance of preconception care. These are the months and weeks before you decide to conceive, or what I like to call Trimester Zero. The papers show that both the health of men and women before they conceive can profoundly influence a pregnancy?—?this includes being overweight or underweight. There is also a direct connection between your health and its impact on your growing baby, including birth weight, brain development and the long-term risks of a child developing cardiovascular, metabolic, immune and neurological problems.
It’s always a good idea to meet with a dietitian and nutritionist in order to optimize what you’re eating and know how to prepare food for pregnancy at least three months before you start trying
It’s studies like these that led Judy Simon to start Mind Body Nutrition, a program that helps families take positive steps towards preconception health. In this interview, she offers advice on the type of people her program can help and the best nutrition strategies to support your fertility whether you’re thinking about getting pregnant in the future or going through IVF now.
EW: How did you get interested in nutrition for fertility?
Fifteen years ago I taught a class to busy career women. I asked them what they thought their barriers were to healthy eating were? They all said: “ We’re on the run and we don’t have enough time to go to the store and to cook.” I saw that they were spending so much time trying to get pregnant and succeed at work. I realized I could help them with practical tips on how they and their partners could eat more healthy to improve their chances of pregnancy. For example, studies show that men who eat a healthy diet made of up of fruits and vegetables can improve the quality of their semen.
EW: What types of challenges do women come to you with?
Over 70% of the women I’ve tracked have gone on to conceive and start a family, and these are not easy women to get pregnant
Women with Polycystic Ovarian Syndrome: PCOS is a common endocrine disorder that occurs in approximately 10% of reproductive-age women. The condition causes irregular ovulation and periods, and is the number one reason a woman goes to a fertility clinic. There has now been a lot researchshowing that nutrition changes can help PCOS. Many women in their 30s with PCOS have been on the pill since they were teenagers. When they come off it, they experience weight gain, acne, hair loss and have trouble getting pregnant. I feel very strongly that when a woman is diagnosed with PCOS, no matter her age, she needs to know what impact it can have on her future fertility. I also like to help younger women with this diagnosis by talking to them about fertility because they’re not always having this conversation with their primary care doctors.
Women Going Through Egg Freezing: Some women work with me because they are overweight and it’s impacting their ovulation, or they’re just not optimally healthy. They’ve been told by their doctors that if they’re going to spend all this time, money and energy on this process, then they should make sure that they’re really healthy. Some women have challenges because they have a diminished ovarian reserve, or they have a hypothalamic amenorrhea, which means they have a lack of available energy, and they’re not producing the amount of eggs they want.
Women Preparing for Pregnancy: Maybe it’s as a simple as feeling like they’ve gained some weight and they really want to be healthy before they get pregnant. It’s always a good idea to meet with a dietitian and nutritionist in order to optimize what you’re eating and know how to prepare food for pregnancy at least three months before you start trying.
Women Facing Obesity: Many women need to loose a significant amount of weight in order to get pregnant naturally or through IVF. Many have already had a failed IVF cycle. If you have a BMI over 40, it’s generally harder to get pregnant both naturally and through IVF because it makes an egg retrieval and anesthesia more challenging.
Women with Hypothalamic Amenorrhea: These are women who tend to be very thin, although their BMI might be considered in the normal range like 22. But they’ve been running two or three marathons a year. And because of the toll on their body, they lack available energy. When they’re doctor does an ultrasound, their ovaries and uterus often look like those of a prepubescent girl. It’s a challenge because basically these women just have to eat more, and it’s often a struggle because they have concerns about their body size. I’ll often refer them to a therapist to help with the emotional side.
Women with eating disorders?-?anorexia or binge eating: These disorders can can affect ovulation too. A July 2017 study published in The International Journal of Eating Disorders found that women with eating disorders experience a reduction and delay in reproduction, and therefore concluded that fertility screening is critical.
EW: What lead to start your Food for Fertility Program and how does the program work?
I noticed that women with these challenges were feeling very isolated and didn’t have too many places to turn. They wanted a safe space to deal with these issues and process their goals. So I decided to develop a program with Dr. Angela Thyer of Seattle Reproductive Medicine. Patients work with me for 2 hours a week for six weeks within a small group of other women. They write down their goals. I teach them about nutrition. We cook together and do meal planning. I introduce them to easy ways to use lentils, beans and quinoa. Then we take a walk and do yoga or a trainer comes in and teaches them to use fitness bands. It’s not that hard to plan meals and eat more fruits and vegetables, but the program helps them figure out what works for them and gives them more confidence. I try to make the changes fun and pleasant.
Over 70% of the women I’ve tracked have gone on to conceive and start a family, and these are not easy women to get pregnant. A lot of the women having been waiting to do fertility treatments, and then spontaneously conceive after the class even if they don’t lose all their weight. It’s just a matter of being healthier.
EW: What are the important lifestyle and diet changes you recommend for a woman trying to get pregnant?
The simple approach is to eat real food, fruits and vegetables, and stay away from unhealthy fats. A 2018 study published in Human Reproduction found that a Mediterranean diet improve rates for pregnancy for women going through IVF. Many of the women I see with metabolic challenges like PCOS or pre-diabetes try to stay on an anti-inflammatory diet. If they swap white rice and white flour with quinoa and vegetables, we see a huge change in their labs?—?they’re blood sugars improved and they’re lipids improved. When there are more antioxidants in their diet, that helps all the little biochemical processes that go on in fertility.
EW: Do you believe that there’s a personalized approach to a person’s nutrition choices for fertility?
It’s not one size fits all. People are told many things to do and not to do that it can become overwhelming. I sometimes see women come in who are poorly nourished because they’ve been restricting too much, and I tell that they don’t have to go on a Paleo diet to get pregnant. They don’t have to be on a no-carb keto diet, and they may be doing themselves more harm than good if they’re missing some of the nutrients they need.