The preimplantation embryo starts as a single cell, the zygote. The first cell divisions do not lead to volume expansion, but rather to an increasing number of small cells. At the morula stage the first two cell lineages differentiate into the trophoblast and the inner cells mass/embryoblast. During development of the preimplantation embryo, apoptosis occurs only after the onset of the embryonic genome. It has become clear that the development of a healthy child requires not only very high rates of proliferation and differentiation, but also apoptosis, which is a crucial mechanism for morphogenesis and the development of the inner organs. Furthermore, the generation of specific cell types, such as lens cells, erythrocytes, and thrombocytes, depends on the apoptosis pathways. This is also true later in gestation, when the trophoblasts form the placenta and provide the epithelial cover of the villous trees of the placenta. This layer is in direct contact with maternal blood and, as do all epithelia, displays a continuous turnover of cells. Thus, apoptosis is a normal constituent of survival in this layer as well, and changes in the regulation and rate of apoptosis have deleterious effects on the trophoblast and consequently the developing embryo or fetus. Here we present a very brief overview of the importance of apoptosis for the development of the preimplantation embryo and the maintenance of placental trophoblasts. Furthermore, we highlight what happens when regulation of proliferation or apoptosis fails in these systems, and attempt to show that apoptosis is only the consequence of poor embryo or trophoblast development—not its cause. Birth Defects Research (Part C) 75:249–261, 2005. © 2006 Wiley‐Liss, Inc.