A series on trying to stay well without overthinking absolutely everything.
Photo-Illustration: The Cut; Photos: Getty
Technically, pregnancy starts about two weeks before conception. 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 fetus, you also have to worry about “trimester zero” — the months before you even start trying to conceive. In this world, the ideal woman can’t get enough organ meat and takes double the daily recommendation of choline to boost her future baby’s IQ. She orders her own ferritin tests online so she can see if her iron levels are holding strong at 70 ng/mL or dipping below 50 ng/mL. She has no need for an alarm clock or caffeine, since she wears blue-light blockers after dark and wakes naturally with the sunrise. The air she breathes is filtered and unpolluted by artificial fragrance. Her kitchen is free of plastic and bleach. Physically, she’s the strongest she’s ever been, because she knows that for the next nine months, her body will be running the equivalent of a marathon every day.
Pregnant women have long been subject to endless rules on how to treat their bodies. But increasingly, it feels like the goal post has been moved back. On her podcast, Culture Apothecary, MAHA influencer Alex Clark recommends women thinking about getting pregnant soon stop wearing nail polish, while holistic nutritionists say it’s important to avoid drinking iced beverages. Influencers are chronicling their meditation journeys to lower cortisol six months before trying to conceive, while others are ordering direct-to-consumer micronutrient labs and embarking on 60-day pregnancy-prep detoxes. While the recommendations are all over the map, the message is clear: What you’re doing now could be putting your future child at a disadvantage — even if you’re not pregnant yet.
I heard from a woman who eats liver every week (it tastes gross, but she read that it’s full of B vitamins) and another who got a stool analysis done to assess her gut health. A dietitian who specializes in fertility says women are coming to her for advice on how to optimize their microbiome before passing it on to their babies. One mother told me she became fixated on her blood sugar and worried that spikes would increase her risk of miscarriage. She started using a glucometer and stopped drinking orange juice and eating bananas.
Many of those I spoke to mentioned reading Lily Nichols’s Real Food For Fertility, which emphasizes that, even before you’re pregnant, your diet lays “the essential groundwork for your baby’s development.” That’s just one of a raft of recent books full of advice for women thinking about trying to get pregnant. In her forthcoming book, The Fertility Formula, the reproductive endocrinologist Natalie Crawford suggests women lower their exposure to toxins by avoiding travel during rush hour. Ann Shippy’s The Preconception Revolution tells women not to touch receipts or use hair dye. For the toxins that cannot be avoided, she suggests you start taking her line of detox supplements, which she says can help remove heavy metals from your system before you pass them on to your baby via breastmilk.
It’s true that many couples struggle to get pregnant, and doctors like Crawford argue that the standard medical advice — start trying and see what happens — is failing women. Yet some claims about the importance of trimester zero strain credulity. According to Alexandra Radway, who coaches women on how to prepare their bodies for conception, the women who follow her protocol have pregnancies unburdened by the inconveniences of morning sickness, fatigue, or back pain. Shippy, a functional medicine practitioner, tells me that women have been misled to believe that their fertility declines after age 35. With the right supplements and a “super-clean diet” (i.e., no gluten or dairy), she claims women can easily get pregnant well into their 40s and feel great, “because their bodies are so ready.” For women who are truly healthy, IVF is “very rarely” necessary, she says. Listening to them talk, it’s easy to come away thinking that if you struggle to get pregnant or have a difficult pregnancy, it’s your fault.
Of course, your health before conception matters. But the doctors I spoke to said the things that actually make a difference are far more basic. You should take a prenatal with folic acid and avoid smoking and drug use. You should also make sure any chronic conditions, like high blood pressure or diabetes, are under control, and get up to date with vaccines and STI testing. Most of these are things doctors would recommend to everyone, not just women planning to get pregnant.
And even if you go out of your way to micromanage your nutrients and rid your home of toxins, there’s still no guarantee you’ll get pregnant. No matter what fancy prenatal brands try to tell you, there’s no magical solution that will stop your eggs and ovaries from aging, says Katherine VanHise, an OB/GYN and reproductive endocrinologist at HRC Fertility Beverly Hills. And sure, some women have no problem getting pregnant in their mid-40s — but that probably has more to do with genetics than with their diet.
For many women, pregnancy is an exercise in learning to accept what we cannot control. Growing a baby inside your body requires a certain level of blind faith. Of course it’s comforting, and human, to fixate on the choices we do have. It’s also hard to ignore that the rulebook for how to have a healthy pregnancy is expanding at the same time that access to maternal health care is being decimated. The Trump administration has gutted the CDC’s Division of Reproductive Health, stopped collecting crucial data on pregnancy, and slashed funding for Medicaid, which many women rely on for prenatal care, while simultaneously urging pregnant women to “tough it out” and avoid Tylenol against the advice of leading medical associations. Dr. Oz recently applauded the fact that, facing a severe shortage of OB/GYNs, Alabama is now using robots to perform ultrasounds on pregnant women.
As prenatal care becomes a luxury, maternal and infant health is increasingly presented as a matter of personal responsibility, with choices as basic as what to have for breakfast framed as high stakes. The noise only gets louder once you’re actually pregnant. According to Jessie Inchauspé, a.k.a. the Glucose Goddess, pregnant women should think twice before eating that bagel. Her new book, Nine Months That Count Forever, warns that overdoing it on sugar and refined grains can put your baby at risk for all sorts of health complications, including diabetes, obesity, ADHD, and autism. (OBs say that while prenatal nutrition is important, your baby’s future health is impacted by far more than the number of cookies you eat while pregnant.)
Nervous about her chances of getting pregnant at 37, one mother told me she went on an “insane, anxiety-fueled health kick” before trying to conceive. She did acupuncture, stopped wearing perfume, swapped out her scented soap, and ate as many goji berries as she could stand. While ovulating, she took Mucinex to thin her cervical mucus. “I stopped working out with a trainer, because I’d read that if you worked out too hard, the egg wouldn’t implant.” She got pregnant after a few months of trying. Yet despite eating “the cleanest I’d ever eaten,” she was diagnosed with gestational diabetes. She knew it was most likely genetic; diabetes runs in her family. Still, she felt guilty and worried her baby was going to have blood-sugar issues.
“It just feels like there’s this responsibility on mothers that starts even before you’re pregnant, like, if you don’t do all these things perfectly, then you’re being irresponsible with your future child.” Now, when she takes her 2-month-old to the pediatrician and fills out the postpartum-depression assessment, she always pauses on the question: “Have you blamed yourself unnecessarily?” “I think that’s really hard to answer as a mother, when all the messaging is, ‘You need to do this and this,’” she told me on a phone call while she pumped. These days, her feeds are full of advice on everything she should eat while breastfeeding to ensure her baby is getting all the optimal nutrients. “It feels like it never ends.”