I have been spending off hours on PubMed, trying to discover the rational basis for the host of rules pregnant women are adjured to obey:
--Don't eat unpasteurized cheese (Brie, Gorgonzola, feta, chevre...all the good stuff)
--Don't eat deli meats unless they've been heated to steaming
--Don't even think about licking the bowl clean of cookie batter
--Sushi? Do you want the baby to die, or what?
--Lying on your back past the fourth month is going to give the critter brain damage
--A sip of wine? Why not just smoke crack and be done with it?
I'm not talking "old wives' tales your grandmother produces." These things are specifically listed as fetal death-traps in publications ranging from the leaflets I was handed at the ob-gyn to "What to Expect When You're Expecting," probably the single most popular pregnancy book available.
But here's the funny thing. When you look for actual studies about these things on PubMed, you keep thinking that you've entered the wrong search terms, because so little comes up.
For example, many a pregnancy site will tell you that sleeping on your back when preggers will cause pressure on the vena cava, decreasing blood return to the heart and causing all kinds of mayhem to The Little One. What does "pregnancy sleep supine" get you in PubMed? A lot of articles on SIDS, and this saying that blood oxygen drops in pregnant women sleeping on their backs. The same group also says that these lower oxygen levels don't cause any more apnea or less REM sleep, leaving one to wonder exactly what the problem is.
A couple of physicians have gotten so bemused by the onslaught of patients asking them about sleep position that they wrote this piece, opining that back sleeping would only be a problem in a small minority of women, and even for them it was unlikely to cause fetal harm.
Ms. Williams, a tart-tongued Brit (aren't they all?) with a strong sense that the world is deranged, makes the argument that a lot of these rules are based on astonishingly modest evidence, and in fact sometimes directly contradicted by other bits of evidence. She's particularly lit up about listeria, the reason so many foods (unpasteurized cheese, deli meats, and sushi) are verboten, and relays this from a professor of fetal medicine:
Jauniaux cites an interesting difference between Google hit rates and those on PubMed, a collected source of peer-reviewed papers in medical journals. "Listeria and pregnancy - Google, 190,000 hits; PubMed, 107 hits. Cheese and listeria - Google, 194,000 hits; PubMed, 169 hits. Sushi and pregnancy - Google, 628,000 hits; PubMed, 0 hits. Raw fish and listeria: Google, 123,000 hits; PubMed, 49 hits. You can see immediately," Jauniaux concludes, "the disproportion between the epidemiological evidence and the general public hysteria about the disease."
Americans in particular are obsessed with the "right" foods, despite our national inability to figure out what those are, and I think this is one reason that pregnant women here readily accept restrictions on their diet: we've been trained since birth that food is dangerous, and eating the wrong thing will surely give you cancer/make you fat/blemish your skin/diminish your virtue. The idea that pregnant women have to be even more careful follows naturally. Meanwhile, if you told a French lady to avoid Brie, or a Japanese one to shun sushi, you might trigger premature labor due to hysterical laughter.
Of course, it's one thing to say that a lot of these prescriptives are junk, and another thing to be comfortable flouting them. I made my decision to ignore these rules after an internal conversation along the lines of:
Self: "If you miscarry or the critter has some serious problems, are you going to spend days berating yourself for the salmon sashimi?"
Self: "Uh, no."
Self: "Okay then, carry on."
Obviously if your pregnant self responds differently, then it seems reasonable to stick with the guidelines.
But my sushi-eating, feta-nomming, back-sleeping, wine-sipping ass is pretty happy here at the half-way mark.
ps) Don't tell Dr Hyde that the toxoplasmosis bit is farfetched too, as I have no intention of terminating this vacation from cat litter duties. There's skepticism, and then there's stupidity.
30 comments:
I slept on my back till about 7 months into the pregnancy, then I started getting dizzy. After that sleeping on the right side was the most comfortable for some reason.
Hopefully this is a debate you won't have to have, but just for fun, try finding any evidence on pubmed that bedrest is an effective preventative measure for pre-eclampsia (or various other conditions). Heck, I'd have settled for evidence that it was at least a benign intervention.
I have been spending off hours on PubMed, googling such stuff. However, re toxo, you can also find "support" for other, habits ;-)
I've never heard about this back-sleeping thing, but have heard the rest. I think the problem is, even though there's little more than a minuscule chance these things will affect the baby, pregnant women don't want to take that chance (like you said at the end of your post). I really wish there were better resources out there for women so they don't have to make themselves crazy over eating a bite of brie!
THANK YOU for this post. Yes yes yes. This topic is just as bad as the "evidence" touted to be behind most of the obesity hysteria. What is with this obsession with good foods/bad foods and assigning unnecessary restrictions all the time??
I stopped sleeping on my back at about 7 months when I was pregnant not because of the vena cava thing (though we knew about it even way back when) but because it made my back hurt like hell. As you grow, you're going to get more and more uncomfortable and have a harder and harder time sleeping: my recommendation is to sleep in the most comfortable position for you.
As for the food avoidance thing...none of us knew any of that stuff when 15+ years ago, and most of us ended up with perfectly healthy kids. Unless you have a history of miscarriage, I say eat whatever you want to eat.
Yeah, I don't sleep on my back much just because...I'm usually a side sleeper anyhow. But last month there were a couple of nights where I just couldn't get comfortable on my side and got anxious about sleeping on my back--and decided to look into it. Uh, yeah, not much evidence. So now I just sleep however the heck I can manage to sleep (those aching hips are awesome....)
Anon, I read one doctor who said bed rest was basically a good idea because it made everyone feel like they were doing something. Jeebus. I like Fia's solution much better :) (although you'll note that since chocolate contains caffeine, pregnant women are also warned not to eat to much of it at a sitting. Like hell.)
I agree on the hysteria about every little thing during pregnancy, but the Google hits:Pubmed hits argument is flawed because it's apples to oranges. Do a google and pubmed search on "smoking lung cancer", and you come up with similar ratios. The real argument is the small absolute number of studies on these topics. Also, it's a matter of how much is too much - especially with alcohol, which has clear effects, IF you drink heavily - so Drs and other advice-givers err on the side of safe than sorry because no one wants to take responsibility of defining a 'safe' level.
I had to sign a form that said I would not drink or smoke while pregnant, as long as I was in MO. It is apparently against the law here. But, I can skip over to Kansas for a drink.
It is so patronizing to be told that because I'm pregnant, I can no longer make decisions for myself. I did not lose my mind when I got pregnant for goodness sake.
Yikes Dr. J&Mrs. H., Yikes.
Those first two :
'--Don't eat unpasteurized cheese (Brie, Gorgonzola, feta, chevre...all the good stuff)
--Don't eat deli meats unless they've been heated to steaming'
As you know have to do with contamination of unpasteurized foods and deli meats (contaminated AFTER processing in the case of deli meats- because plants are not very clean and this stuff lives everywhere) by listeria monocytogenes. As a microbiologist, I take these seriously but everyone else gets to make their own choice. And Zoe Williams' midwife was completely correct when she said most people who contract listeria don't know that they have it...this speaks to who who actually gets diagnosed, and who doesn't. I would kindly suggest that pubmed (or the guardian) isn't the first place I would be looking for information on this. I would start with a basic medical textbook, and for more information see the CDC's bad bug book section on Listeria:
http://www.foodsafety.gov/~mow/chap6.html
and here:
http://www.cdc.gov/nczved/dfbmd/disease_listing/listeriosis_gi.html
But speaking of cheese made from unpasteurized milk- there are two other seriously bad actors (microbially speaking) that pasteurization is meant to eliminate (or reduce)- these are Mycobacteria and Brucella (not to mention stuff like Coxiella burneti- which causes Q fever), and I wouldn't want to tangle with any of them. While we have intensive control efforts here in the US to control these bugs- that's not true everywhere- (let's just take Mexico for example where you can get Brucella melitensis from eating cheese made from unpasteurized goat milk), ...
as for #3 there- I presume this has to do with the simple fact that eggs can be contaminated with Salmonella enteritidis while in the oviduct (transovarian transmission, i.e. not the shell that is contaminated but also the inside of the egg itself)- we KNOW that children under the age of 5 years get the highest number of cases of salmonellosis in the USA, and that they can become septicemic from this organism- this can be seriously bad news for your kid. As for pregnant women, I don't know if you were serious about this as a recommendation for pregnant women- but I've never heard it myself. Then again, I'm not a OB.
As for the toxo story- pregnant women have a problem only if their first exposure is during the pregnancy. Zoe Williams doesn't really know what she is talking about here either- when she quotes someone ?"The cat will only give it to you when it has infected itself. It doesn't live in the cat."? ... which is BS, to put it kindly- cats are the definitive host for toxo (http://www.stanford.edu/class/humbio103/ParaSites2006/Toxoplasmosis/lifecycle.html, for the lifecycle). ... but she is correct to say that most human cases come from other sources (infected undercooked meats, and the dirt, frankly).
With the back-sleeping, I can't help ya.
Wow, now I actually have real work to do.
Husband and I have small arguments about this at least once a day. I know the risks, I understand the microbiology and pathology associated with listeria and toxoplasmosis, but sometimes, you just really want a piece of prosciutto. Everything in moderation I say, without indulging. I'm a side sleeper anyway, so I'm just going to try to be comfortable whatever way that is. Also though, for what it's worth, my pregnant French sister in law also was told to avoid unpasturized soft rind cheeses (listeriosis is taken pretty seriously in France)... so it's not exclusively and American thing.
I did stay away from sushi when I was prego, only because there are many places that do not sell sashimi grade sushi. Its the fish as not been properly snap frozen, you can get a lot of bad bacteria. For me, I would rather be safe than sorry...
While I understand that some of these threats are real, I also understand that women have been successfully growing and birthing babies for millions of years without the benefit of scientific literature.
I would think that although pregnancy deserves caution, it certainly should not provoke hysteria.
Neurowoman, I'm not saying that more hits on Google than pubmed is a problem--I'm saying that ZERO hits on pubmed (e.g. for preg + sushi) suggests that the literature is, er, sparse. And frankly, 107 papers on "listeria and pregnancy"? There are easily ten times that many papers on the role of calcium in vesicular release, and I sure wouldn't say we understand THAT.
Anon in MO, that's just horrifying. This is the authoritarian stance that I find so obnoxious towards pregnant women--you notice that no one makes, say, men with heart disease sign a similar form.
Doubledoc, the first listeria page listed the following possible sources of listeria:
raw milk, supposedly pasteurized fluid milk, cheeses (particularly soft-ripened varieties), ice cream, raw vegetables, fermented raw-meat sausages, raw and cooked poultry, raw meats (all types), and raw and smoked fish.
So....did you also make sure to eliminate ice cream, raw vegetables, and cooked poultry from your diet while pregnant? Do you think all women should be told to? It beggars belief.
I happen to think we should clean up our food production system, rather than lecture pregnant women about what they can and can't eat.
I know Williams was wrong on toxo, but the thing is--none of the damn preg books say, "If you've owned a cat for N years, you probably already have toxo if you're going to get it, so don't worry about it." They just say, "AAAGGH toxoplasmosis! Stay away from kitty litter!"
My objection is the lack of accurate, sensible, non-hysterical advice. I think it's absurd to say that since binge drinking is bad, women should feel guilty about having even a few sips of beer at dinner. The fact is, we just don't know whether that matters. But instead of saying that, OBs etc recommend cutting it entirely out--a very paternalistic, "patients can't be trusted to follow instructions" attitude. It stinks.
hm, DJ&MH - I think you hit the headon the nail in the last exchange of words... ;) If you think you will beat yourself up over something happening after you have eaten sushi then do not eat it.
Then again, I think this all is something to tell parents that "if" (god forbid) something goes wrong with the pregnancy it is because some of these "rules/guidelines" were broken [by the woman]. THat is imho bull since there will always be things that happen. And it doesn't have to be anyone;s fault. It is also our society today / we like to think we are in control of everything. These food and other rules are part of it.
That said, as a microbiologist, I think I would refrain from eating sushi from most places here in the South. My own, maybe. And the brie/feta cheese... here in the States most of them are made from pasteruized milk. And wine, hm... I am so Swedish at times. I would probably refrain from wine, then again I would gulp down 3 cups of coffee since the rules back home is ok with coffee as long as you stay farfaraway from alcohol. (all in moderation maybe?)
I am so happy all seems good though :)
Chall--yes, I think picking whatever course seems sensible to you is the key. I still eat sushi because it's very high-quality here; but I don't eat it from the corner deli, just from one high-end small restaurant that Dr Hyde and I have gone to once every few months for several years. I think I know what I'm getting.
And I cut out caffeine almost entirely just because I'm not a big caffeine person anyhow (just switched my morning tea to decaf tea). It was easy for me to do that, and I don't miss the caffeine--whereas I would be very sad not to have a sip or two of beer with Indian food! If I were more into coffee, and less into booze, I'd probably have decided differently.
Basically I think that if you are at the stage where you deeply and constantly resent the pregnancy for not letting you drink coffee, or whatever, you're probably just making the fetus unhappier than if you just drank some....
Good Luck! I was told not to sleep on my back first preganancy, told it was totally okay second pregnancy (by two physicians, two different states). I got much better sleep the second pregnancy!
I also adopted the "would I hate myself because of this if there is something wrong with my baby" approach for all baby health related questions. Which left me with no wine, but tons of caffeine (I needed it to keep up with firstborn, age 3 years).
Also did not tell hubby about the toxo - the break from cat poo is well deserved.
Hang in there!
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