Thursday, May 18, 2006

No fun for you!

[This will be mildly incoherent because I am still suffering from work-fried brain.]

When I saw the Post's Tuesday Health section and saw the "pre-pregnant" article, I freaked out--generally, for the reasons others were freaking out. (Please read Bitch Ph.D.'s initial post and comments, as well as the follow-up.) Once I stopped freaking out, I started thinking more about the advice that doctors (and laypeople) give pregnant women, at least in the United States. Especially since a good chunk of the people who find their way to my blog (when they aren't trying to figure out whether a certain actress is preggers) are searching for pregnancy and non-alcoholic beer.

Don’t smoke.
Don't eat soft cheese (no brie, not even that great queso blanco at my favorite Tex-Mex places).
Don't eat sushi.
Don't drink caffeine.
Don't drink alcohol.
Don't eat tuna.
Don't take certain medications (including Accutane).

Some doctors will allow a little leeway on some of these. For example, my current OB told me I should limit my caffeine intake to one drink (i.e., 12 oz.) a day, which seems reasonable enough to me. I've read about other doctors who say even 2 or 3 cups of coffee a day during pregnancy is fine. My doc also told me that, while I should avoid alcohol, it wouldn't be horrible if I wanted to have a glass of wine or champagne for a special occasion (I think beer at a sunny ballgame is a special occasion, but tomato/tomahto). I've also read that, if you are going to have alcohol, you should drink it slowly, and on a full stomach.

I am just so interested in the flat-out prohibitions, though, given how recent they are. And how American-centric they are. Do we honestly think that European women completely give up wine while they are pregnant? (I've talked to Western Europeans--the answer is "no.") Do I think that Japanese women stop eating sushi? Well, I actually don't know the answer to that, but I'd love to. And as to the newness of these prohibitions: women of my mother's generation and older drank and smoke with more frequency during pregnancy than women of my generation do. I've (unscientifically) polled my friends, and most of them had mothers who drank and/or smoked at some point during pregnancy--if not through the whole thing--and they without exception turned out healthy, strong and smart. So how do I reconcile that with what many doctors (and people who stick their noses into my business) say about what I can and cannot do while I am pregnant? I'm not saying I’m going to start drinking a vodka tonic with lunch every day while handling raw chicken, but I just find it interesting.


Blogger susan said...

I've often wondered whether Japanese doctors say not to eat sushi. As I've never been pregnant, I've not personally contended with these factors, but I have been amused at the way my (generally rational, generally well-educated) friends who've been pregnant have also gotten a lot of advice like "don't use hair dye; we don't know if it affects pregnancy, but just in case..." or "don't stand in front of the microwave, just in case..." Some of it seems so irrational.

8:56 PM, May 18, 2006  
Blogger Lex said...

One thing I was vaguely aware of before but really had driven home to me while Ann was pregnant with Victoria is how frequently perfect strangers will feel the need to give medical advice to pregnant women they run into on the street or at the grocery store or whatnot. It's incredibly patronizing. I recall wondering at the patience with which Ann dealt with these folks.

9:11 PM, May 18, 2006  
Blogger Lawmummy said...

When I was pregnant with my first daughter, I fell down and passed out. I had to go to the perinatal ICU and I was sooo stressed out that something terrible had happened to the baby. The attending nurse, after pumping me full of IVs, told me to go home, put my feet up and have a nice glass of red wine. She said it would be good for my heart and for my nerves.

The reality is, doctors say what they say because (1) Americans can't seem do anything in moderation and (2) our medical professionals are terrified of giving advice that might backfire (see #1) and result in a lawsuit. I truly believe this. I think doctors say "no drinking, no sushi" and so on because if they say "just a little" patients will take it as an unequivocal "yes" and then sue if anything goes wrong.

9:22 PM, May 18, 2006  
Blogger Angry Pregnant Lawyer said...

Susan: glad I'm not the only one who wondered about the sushi thing.

Lex: Ann is a better woman than I. Not one person gave me any assvice while I was pregnant, but if they had, I would've gone nuclear, I'm sure.

Lawmummy: You are so right about the moderation thing. A friend of mine was talking to her OB, who was a very cool, very honest woman. The OB basically said that if you tell people they can drink 2-3 cups of coffee while they're pregnant, they'll drink 6. So you tell them they can have just one in the hopes that they'll stop at 3. But I wonder how much of that is just because people don't trust their doctors to be honest with them. Which is the cause and which is the effect? Do doctors hedge their advice because people won't take it? Or do people ignore their doctors' restrictions because patients assume doctors are talking worst-case scenario/minute possibilities?

9:37 PM, May 18, 2006  
Anonymous Kristen said...

I was pregnant at the same time as my best friend. She lived in Paris. I lived in Wisconsin. I avoided everything in the world. No alcohol, no soft cheese, no hair dye, no caffiene, no nothing. She had a glass of wine with dinner every night as she enjoyed her brie and baguette.

She gave birth to a relaxed, happy baby. I gave birth to the most colicky baby in the history of babies. (adorable, delightful, but colicky.)

Coincidence? I think not.

Luckily, I had my babies before they added the "no peanut butter" in there. I lived on peanut butter when I was pregnant - 3 meals a day included peanut butter. But now, one of my recently pregnant friends has informed me that they are telling her not to eat peanut butter, due to the allergy issues.

I would not have survived....

10:03 PM, May 18, 2006  
Blogger Angry Pregnant Lawyer said...

Oh, don't get me started on the peanut butter thing. I mean, if there's a history of allergies, you want to be on the safe side. I definitely understand that. (And I'm not one of those crazy people who insists that peanut allergies are made up--I know kids who are really allergic.)

But there is no history of any peanut (or food) allergies in my or NSAH's family, so I ate PB all the time. While pregnant, while breastfeeding, what have you. Love me the PB. Won't give that up unless they tell me it causes cancer.

10:11 PM, May 18, 2006  
Blogger Piece of Work said...

The thing about this argument that bugs me--its the same argument my mother in law uses when she says "well, we didn't even use carseats, and my boys survived!" While that is true, it is also true the childhood mortality rates have gone WAY down in the last twenty years or so, mostly because of the things scientists have learned (carseats save lives. smoking while pregnant can cause birth defects. Outlet covers can prevent burns) THing is--you are right-- not everyone who drinks wine every night while pregnant will give birth to a baby with fetal alcohol syndrome. But the fact is, the more alcohol you drink, the more likely that is to happen. So I don't necessarily think it's bad advice (and I don't think that's what you're saying, either). I just think people are so HYPER these days, that doctors or scientists or the media says "drinking alcohol while pregnant can cause birth defects" and suddenly anyone who has a sip of Coors is a murderess.

I totally agree with your main point but I think the reason there are so many STRICT rules is that Americans sensationalize everything. I don't think the doctors are doing us a disservice by pointing out the potential dangers, I think we just take the warnings way too seriously.

10:27 PM, May 18, 2006  
Blogger Quinn said...

Wait, Peanut Butter??? Thank goodness I've already done my pregnancies (knock on wood). B/c without my peanut butter crackers, I would have wasted away to nothingness during the first trimester.

Grocery stores seem to be the gathering place of ass-vice instigators. Best part of my most recent pregnancy: early morning chat sessions with my officemate, who at the tender age of 23 had NO idea what all pregnancy stuff was about. Started out with "you still drink soda. Is that ok?" to "so can you still have sex? Is it good? What positions do you use?" I liked being the "expert" for once.

10:30 PM, May 18, 2006  
Blogger kenju said...

Back in the dark ages, when I was having babies, I smoked 1-2 packs per day and drank regular coffee like I do decaf now - 10-12 cups per day. As you know, it didn't stunt their growth (or their brainpower). Their birthweights were smaller (6lbs. 4 oz to 6 lbs. 14 oz.) but they were all healthy. I didn't drink alcohol back then, but once I had a glass of champagne at an anniversary celebration, and the baby jumped around in my womb like it was a Mexican jumping bean, so it was obvious that the alcohol affected her. During breast-feeding, the doc had me drink 1-2 beers per day in order to increase my flow of milk. Go figure!

Why do they say to avoid soft cheese? I've never heard that before.

11:47 PM, May 18, 2006  
Anonymous Anonymous said...

I'm not saying I’m going to start drinking a vodka tonic with lunch every day while handling raw chicken...

What you do at lunch is your own business, but everyone knows that mojitos are the drink of choice while handling raw chicken. Vodka tonics are for trichinosis-riddled raw pork.

4:22 AM, May 19, 2006  
Anonymous nutso-ranter said...

Ahhh, how timely.

I can explain the soft-cheese thing: (Or at least, I can pass on all the mis-information I know!). It comes from fear of an organism called listeria, which can cause listeriosis (not usually a big deal to healthy adults, but can be deadly to unborn babies). Believe it or not, "deli meat and hot dogs" are also on many lists for the same reason.

I researched this as best I could, after seeing conflicting info on the "soft cheese" thing. I've heard two things... 1st, the "soft cheese" ban originally was aimed at un-pasteurized European cheese (brie, feta, etc.) because they were more likely to have listeria (as they were unpasteurized). Some doctors have told me that as long as you are eating cheese made from pasteurized milk (and many domestic Bries/fetas are) you're fine.

The other explanation I heard was that these cheeses, even when they're pasteurized, are still more likely to pick up and hold listeria because of the way they're made, so you should avoid them anyway.

Listeria outbreaks in this country are very very rare.

So, with all this conflicting advice? I think pasteurized soft cheeses are probably fine. But what do I do? Well, I avoid Brie (which is painful, because I love it), but I eat feta as long as its pasteurized. I know that makes no sense, but oh well. Perhaps because its easier for me to avoid brie... its generally a cheese I eat with crackers for a snack, and I can always have another type. Feta, on the other hand... is in too many great lunch/dinner options,... and especially if you're trying to avoid deli-meat, what the heck are you supposed to eat for lunch?

(P.S., the other thing I heard about listeria, is that it is very sensitive to heat... so if you're cooking/heating any of this stuff, you're probably fine.)

So. That's what I've heard from a variety of sources.

7:59 AM, May 19, 2006  
Blogger DevilMacDawg said...

When I became pregnant, I had a very long talk with my father in law. Dr. Mac was one of the foremost perinatologists in the country. I felt that he knew whereof he spoke.

On the smoking - he said that smoking was really bad for the baby because it impeded the flow of oxygen. He told me not to smoke and to try and avoid smokers.
That is the ONLY prohibition he made.
Dr. Mac said, very honestly, that American health and cleanliness standards with regard to seafood was what led him to caution against eating raw/undercooked seafood in his practice. He said that the Japanese, for example, just had higher standards for such things.
He thought the prohibition against alcohol was ridiculous. He was Irish (born and bred), so that makes sense. I will say that I avoided alcohol while pregnant, but because it made me ill.
He said that avoiding things and stressing over them did more harm to the fetus than did rational indulgence.
And he said the single best snack I could prepare for myself was an apple topped with peanut butter, or a peanut butter and banana sandwich.
I miss him some days. :-)

8:43 AM, May 19, 2006  
Blogger Mykal said...

On the listeria thing I read about a study that found that even though listeria is very uncommon in the general population when pregnant your risk of getting listeria got up about 20-30%. So the advice on avoiding potential listeria things in pregancy seems valid.

8:57 AM, May 19, 2006  
Blogger Rev Dr Mom said...

I'm going to put on my devlopmental psychologist hat here for a minute and say that it does seem like some of these prohibitions are going to the extreme BUT we do know alot more about teratology (effects of substances that can cross the placenta) than we did 20-40 years ago. The worrisome thing to me is that with many substances, alcohol being the best example, there isn't a good dose-response curve; in other words it has proven very difficult to establish exactly how much alcohol it takes to cause damage. Animal models (one of which I worked on as a student) indicate taht small amounts of alcohol at critical points in development can cause subtle learning problems. So the prohibition against alcohol I think is sound. It's also true that the time in prenatal development one is exposed to a substance is critical. That's why the first few weeks are so important--all the organ systems are developing and are most susceptible. If you look at a developmental text you will see charts for the gestational days different systems are most susceptible.

I wonder about all the allergy stuff, and here my psych training is of no help. But anecdotally there are so many more kids today with nut allergies (as just one example) that it makes me wonder if too much avoidance makes kids MORE sensitive. As someone else said, if there's a family history, then it makes sense to be careful. But otherwise, I just don't know.

The other downside of all this is, I think, the horrible guilt that mothers can feel if there is a problem. "If I hadn't done...." whatever, but that's often not realistic.

10:05 AM, May 19, 2006  
Anonymous Genevieve said...

Smoking, I put in a different category for these other things. I've seen the information on what smoking can do in terms of starving a fetus for oxygen. (And yes, my mother smoked quite a lot when she was pregnant, which the doctor told her was just fine: I was born quite small, and am shorter than my mother and grandmother, and have numerous allergies and asthma that weren't present in my family history.) So I agree with piece of work that some prohibitions are because of more things the doctors have learned.

But in general, APL, I definitely see your point. Caffeine, for example, seems like one of the things people go overboard on prohibiting, particularly since you see how different doctors give you different rules on those. And I'm very glad that deli meats and peanut butter weren't on the prohibited list when I was pregnant. (I did eat a lot of California rolls, figuring that "sushi" meant uncooked in this case.)

I do wonder what France's rate of listeria in soft cheeses is - perhaps theirs is safer than ours? Made in better conditions? Which seems to be true of Japanese sushi, as Devilmacdawg's FIL pointed out. Anyway, since listeria has a specific risk for miscarriage, even though it was a small likelihood, I ended up avoiding soft cheeses. But I don't know what I would've eaten if I'd had to avoid deli meats - actually, I guess I would've heated up turkey sandwiches in the microwave most days, since heat kills listeria.

11:57 AM, May 19, 2006  
Blogger LawMommy said...

I lived in Japan from 1995-1996. I can say that I personally saw any number of pregnant women eating sushi. Perhaps that has changed in ten years, though.

2:13 PM, May 19, 2006  
Blogger ccw said...

I am always amazed by the things women will give up when pregnant. I had one friend who didn't eat ice cream because her doctor said the cold was bad for the baby. Another would not chew gum, but guzzled Red Bull.

I ate peanut butter throughout my 3 pregnancies and while bf the first two, but the pediatrician told me not to eat peanuts while breastfeeding Nonami.

My mom smoked the entire time she was pregnant with me. Yes, I turned out fine and was healthy at birth, but I spent a lot of time sick as a very young child.

2:59 PM, May 19, 2006  
Blogger liz said...

I ditto what Genevieve said about smoking. My mom smoked when she was pregnant with me and I am quite a bit shorter than the rest of the family (we're all short though) and have allergies and asthma (no history in the rest of the family) and got Whooping Cough, even though I'd been vaccinated.

But her doctor at the time said that smoking while pregnant was fine.

6:09 PM, May 19, 2006  
Blogger jo(e) said...

The point that Rev Dr Mom made is really important. Our regulatory system in this country is based on the idea that "the dose makes the poision." That is, we assume that toxins won't hurt us as long as we have ingest them in moderation. So we have this cultural idea that we can eat anything as long as we don't overdo.

But studies in fetal toxicology show that it isn't the amount of the toxin .... but the timing. Especially those early weeks.

And as long as we are giving anecdotal evidence ... my grandmother smoked and drank when she was pregnant because it was the 1930s and no one knew better. All her babies were born premature, very low birthweight, and one was so tiny that she did not survive. At the time, doctors told her that the reason her babies were so tiny is because she was so active -- always swimming, hiking, stuff like that. More up-to-date science would suggest that the cigarettes and alcohol were the big factors, not all the exercise she got.

8:42 PM, May 21, 2006  
Anonymous _g said...

Ethanol is cytotoxic - it kills cells. The fetal brain is developing rapidly in the last trimester of pregnancy. Unlike teratogens which are most hazardous in early pregnancy, alcohol is more hazardous in late pregnancy. The cell damage is dependant on the concentration of alcohol so one episode of heavy drinking could be a problem.

Smoking is associated with bladder cancer. Think about it. The toxins from smoke circulate through the blood and end up excreted in urine. God only knows what the toxins do to a fetus, but we know that maternal smoking is associated with infant asthma.

As for raw fish - it's better in Hawaii.

10:05 AM, May 23, 2006  
Blogger Angry Pregnant Lawyer said...

OK, I didn't think I needed to say this, but apparently I do:

I am not, NOT, advocating smoking during pregnancy. I don't advocate smoking even when a person isn't pregnant. I just find it interesting what doctors will prohibit now, compared with the old advice.

And g, your explanation of why alcohol is more dangerous later in a pregnancy is very intriguing, because I've heard the opposite (i.e., it's less dangerous to have a drink here and there in the second and third trimester, once the baby is more developed).

10:25 AM, May 23, 2006  
Anonymous _g said...

The fetal brain undergoes a growth spurt at the 6th month of pregnancy which continues until the baby is 3 yrs old.

Most drugs are most dangerous in early pregnancy when teratogenic effects happen. Drugs and chemicals that affect the brain, including anaesthtics, are dangerous during the last 3 months of pregnancy. That's why good OBGyn's are very careful about how they prescribe anaesthetics in pregnancy. Good OB's minimize fetal exposure.

5:00 PM, May 23, 2006  

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