What you eat mat­ters, and other myths about preg­nancy.

Preg­nancy has never been safer — a good rea­son for par­ents and chil­dren ev­ery­where to cel­e­brate on Mother’s Day. Iron­i­cally, as ma­jor risks have re­ceded into the past, mi­nor risks have taken cen­ter stage. Preg­nancy of­ten feels like a mine­field: Watch what

The Washington Post Sunday - - OUTLOOK - By Amy Tu­teur out­look@wash­post.com Amy Tu­teur is an ob­ste­tri­cian-gyne­col­o­gist and for­mer clin­i­cal in­struc­tor at Har­vard Med­i­cal School and the au­thor of “Push Back: Guilt in the Age of Nat­u­ral Parenting.”

MYTH NO. 1 Pre­na­tal vi­ta­mins are nec­es­sary for healthy preg­nan­cies.

What to Ex­pect, the web­site af­fil­i­ated with the fa­mous preg­nancy ad­vice book, ex­plains pre­na­tal vi­ta­mins as “an in­surance pol­icy, of­fer­ing you the se­cu­rity of know­ing that your body is stock­ing up on the most es­sen­tial baby­mak­ing vi­ta­mins it needs to con­ceive and nour­ish your baby-to-be through a healthy preg­nancy.” BabyCen­ter, a pop­u­lar parenting web­site, an­swers the ques­tion “Are pre­na­tal vi­ta­mins re­ally nec­es­sary?” with a solid “Yes.”

Where did we get the idea that big, ex­pen­sive mul­ti­vi­ta­mins are nec­es­sary for a healthy preg­nancy? As with so many as­pects of nutri­tion in preg­nancy, re­searchers stud­ied women from de­vel­op­ing coun­tries, of­ten women who were se­verely nu­tri­tion­ally de­prived. Not sur­pris­ingly, for women who are chron­i­cally mal­nour­ished and lack­ing es­sen­tial vi­ta­mins and nu­tri­ents, pre­na­tal sup­ple­ments can make a dif­fer­ence. Yet that does not mean they’re nec­es­sary for women who al­ready eat all the vi­ta­mins and min­er­als they need.

For women who aren’t mal­nour­ished, nearly ev­ery vi­ta­min and min­eral con­tained in those bulky pills (with the ex­cep­tion of fo­late and iron) ap­pears to have no im­pact on preg­nancy out­comes. Since fo­late and iron are each avail­able on their own, there’s no need to take a huge, of­ten nau­se­at­ing pre­na­tal vi­ta­min, which does lit­tle more than give women ex­pen­sive urine.

MYTH NO. 2 Preg­nant women must mon­i­tor their di­ets care­fully.

An Amazon search for books on the proper preg­nancy diet turns up page af­ter page with ti­tles like “What to Eat When You’re Preg­nant: A Week-by-Week Guide to Sup­port Your Health and Your Baby’s De­vel­op­ment” and “Eat­ing for Preg­nancy: The Es­sen­tial Nutri­tion Guide and Cook­book for To­day’s Moth­ers-to-Be.”

De­spite alarm­ing ar­ti­cles warn­ing against foods from cof­fee to chicken wings, elab­o­rate dietary rules aren’t nec­es­sary. Myr­iad stud­ies show that nu­tri­tional changes can help women who are mal­nour­ished, but eat­ing spe­cific foods in spe­cific quan­ti­ties ap­pears to have no ef­fect on preg­nancy out­comes in in­dus­tri­al­ized coun­tries. There’s no ev­i­dence that fad di­ets, re­stric­tive di­ets or the Brewer diet, in which al­ter­na­tive-health prac­ti­tion­ers ad­vise a com­pli­cated reg­i­men of 14 dif­fer­ent cat­e­gories of food daily, have any im­pact on the health of the baby or the in­ci­dence of com­pli­ca­tions.

The most im­por­tant guid­ance for preg­nant women in the United States in­volves foods that can trans­mit ill­nesses; that’s why women should avoid un­der­cooked meats and raw dairy prod­ucts. But there is no ev­i­dence that small amounts of caf­feine af­fect un­born ba­bies. Stud­ies on al­co­hol are more am­bigu­ous. Although it is quite clear that large amounts of al­co­hol can cause fe­tal al­co­hol syn­drome, the limit of safe con­sump­tion is un­known. There are some doc­tors who in­sist that if we don’t know the ex­act limit, women should avoid any al­co­hol. But most be­lieve that an oc­ca­sional glass of wine or beer will not cause any prob­lems.

MYTH NO. 3 Bed rest can pre­vent mis­car­riage.

Ac­cord­ing to Nat­u­ral Fer­til­ity Info, one of the old­est al­ter­na­tive-medicine ad­vice sites about preg­nancy, “Bed rest and re­moval of stress fac­tors is the most im­por­tant first step to take” to pre­vent mis­car­riage. And the Univer­sity of Mary­land Med­i­cal Cen­ter points out that “your physi­cian may also pre­scribe bed rest” in hopes of pre­serv­ing a preg­nancy.

Mis­car­riage is not a rare ex­pe­ri­ence: Up to 20 per­cent of preg­nan­cies will nat­u­rally end that way. The most com­mon cause is a se­ri­ous ge­netic ab­nor­mal­ity. In some cases, the fer­til­ized egg di­vides and grows for a pe­riod of time but even­tu­ally dies. In many cases, no fe­tus de­vel­ops, only pla­cen­tal tis­sue. So noth­ing can pre­vent most mis­car­riages: Those preg­nan­cies are doomed from the mo­ment of con­cep­tion.

More broadly, stud­ies have found that bed rest does not change a woman’s chances of hav­ing a mis­car­riage. So why did doc­tors start rec­om­mend­ing bed rest to re­duce mis­car­riages? It’s not be­cause there was ever high-qual­ity sci­en­tific ev­i­dence to sup­port it. At most, it seemed like a harm­less rec­om­men­da­tion — a way for women to feel that they were do­ing some­thing to pre­serve the preg­nancy, though ben­e­fits in the first trimester are usu­ally lim­ited to peace of mind.

MYTH NO. 4 Preg­nant women should not have X-rays.

Fit Preg­nancy, a pop­u­lar health web­site, prom­ises to teach women “how to pro­tect your baby from the un­seen dan­gers of X-rays,” while Bri­tain’s Na­tional Health Ser­vice warns that “if pos­si­ble, you should avoid hav­ing an Xray while you’re preg­nant.” Health ad­vice fo­rums are awash with moth­ers anx­iously wondering if it’s safe to go in for an X-ray.

Like any med­i­cal pro­ce­dure, X-rays carry risks, whether one is preg­nant or not. But as the Mayo Clinic notes, hav­ing an X-ray while preg­nant usu­ally poses no dan­ger to the de­vel­op­ing fe­tus. And ad­dress­ing a mother’s health is­sues could be vi­tally im­por­tant to both her and her child.

Af­ter all, the baby is not the only pa­tient in preg­nancy; the mother is an equal (if not more im­por­tant) pa­tient. If a woman de­vel­ops a health prob­lem that re­quires X-rays, med­i­ca­tions or surgery to di­ag­nose and treat, that prob­lem should be ad­dressed. Un­treated ma­ter­nal med­i­cal is­sues are not merely dan­ger­ous for the mother. If they are se­ri­ous enough, they can lead to mis­car­riage, pre­ma­ture la­bor or still­birth. So treat­ing the mother is also in the baby’s in­ter­est.

MYTH NO. 5 Preg­nant women should avoid vac­ci­na­tions.

Al­ter­na­tive-medicine prac­ti­tion­ers and those sell­ing “nat­u­ral” health ad­vice of­ten tell women to avoid be­ing vac­ci­nated while preg­nant. Green Med Info, for in­stance, warns read­ers of “the deadly truth about flu vac­cines and preg­nancy.” Kelly Bro­gan, a “holis­tic women’s health psy­chi­a­trist,” coun­sels her read­ers on “fol­low­ing your in­ner com­pass” and “re­ject­ing flu vac­cine in preg­nancy.”

It’s best to make sure you are fully up to date on your vac­ci­na­tions be­fore you be­come preg­nant, since some vac­cines (like the mumps, measles and rubella (MMR) and vari­cella vac­cines) do pose risks dur­ing preg­nancy. But oth­ers are safe, such as those for tetanus, flu and per­tus­sis (whoop­ing cough).

In fact, the per­tus­sis vac­cine also pro­tects ba­bies af­ter birth. Whoop­ing cough is one of the great­est in­fec­tious threats to in­fants. With the re­cent resur­gence of the dis­ease be­cause of un­der-vac­ci­na­tion, ba­bies younger than 6 months (and there­fore not fully vac­ci­nated) face se­ri­ous risks.

We’ve al­ways known that moth­ers can pass whoop­ing cough an­ti­bod­ies across the pla­centa . Im­mu­niz­ing or re-im­mu­niz­ing women in the third trimester boosts the pro­duc­tion of ma­ter­nal an­ti­bod­ies, thereby in­creas­ing the an­ti­bod­ies their ba­bies get. This can dra­mat­i­cally re­duce the risk of an in­fant con­tract­ing whoop­ing cough, with its high in­ci­dence of se­ri­ous com­pli­ca­tions and death. Per­tus­sis vac­cine is rec­om­mended for ev­ery preg­nant woman in ev­ery preg­nancy.

ALY SONG/REUTERS

Grace Yuan’s 3-year-old daugh­ter, Re­becca, touches the C-sec­tion scar on her mother’s belly in Shang­hai. Preg­nant women face con­flict­ing ad­vice on a range of health is­sues.

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