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.


