5 Things Every Pregnant Woman Should Know (Though Your Doctor Won’t Tell You)

Wednesday, April 17th, 2013

Jennifer Margulis, Ph.D., an award-winning journalist and a Schuster Institute Fellow at Brandeis University, has just released a new book called The Business of Baby. In it she takes on a number of controversial issues facing those who are thinking of becoming pregnant, are pregnant, or are new parents. Here she offers a guest blog post with her take on 5 key things that every pregnant woman should know. 

1. Prenatal vitamins can make you sick: Not all prenatal vitamins are created equal. Some “natural” brands, whether over-the-counter or prescribed by a doctor, contain harmful additives, including petroleum-based dyes like Red 40. The nausea you’ve attributed to pregnancy hormones may actually be from the vitamins you’ve been told to take.

2. Ultrasounds are not medically recommended: Though some doctors do them at every visit, routine ultrasounds are not recommended by the American College of Obstetricians and Gynecologists for normal pregnancies. There is no evidence that ultrasounds improve pregnancy outcomes but there is an increasing body of evidence that prolonged exposure to ultrasound can cause harm.

3. How much weight you gain is not as important as what you eat: Every woman gains weight differently but all pregnant women need nutritious, fresh, high quality food. The fat your body stores during pregnancy is there for a reason: to give you reserves for breastfeeding after the baby is born. It’s much more important to eat high quality protein, healthy fats, fresh vegetables and fruits, whole grains, and unprocessed foods than to worry about the amount of weight you’re gaining. Doctors actually look down on nutrition as irrelevant and unimportant, says Michael Klaper, M.D., director of the Institute of Nutrition Education and Research in Manhattan Beach, California. “There’s an inherent contempt for nutrition built into Western medicine,” Klaper explains. “Nutrition is a sissy sport among physicians.”

4. You can avoid gestational diabetes and anemia: With a healthy whole food based diet and enough exercise, most women can avoid common pregnancy problems. According to Stuart Fischbein, M.D., a Los Angeles based obstetricians with 30 years experience, the key is to eat proactively, avoiding processed sugar and doing enough exercise (to prevent gestational diabetes) and eating iron-rich foods (like eggs, red meat, and green leafy vegetables) along with foods high in vitamin C to help your body absorb the iron (to prevent anemia).

5. Your doctor believes birth is an illness: Growing a human being inside your body may be the most magical, spiritual, awe-inspiring time of your life, but your obstetrician has been taught to look for worse case scenarios and view your pregnancy as an accident waiting to happen. If you want a care provider who shares your wonder and a gentle birth, pick a well-trained midwife over a doctor.

Prenatal Exposure To Mercury And Childhood Risk For ADHD

Tuesday, November 27th, 2012

The role of prenatal influences on development can be profound. But it is still a very murky science, as was beautifully illustrated in Annie Murphy Paul’s “Origins: How The Nine Months Before Birth Shape The Rest Of Our Lives”. Case in point: a new study that looks at the role of prenatal exposure to mercury and risk for ADHD.

Forget about the study details – let’s cut to the two bottom lines of the study. First, documented mercury exposure during pregnancy (validated using gold standard methods) was indeed predictive of risk for ADHD in the offspring. Second, eating fish during pregnancy, which is sometimes thought to be a risk factor for mercury exposure, was protective with respect to ADHD.

So…what does a pregnant woman do with these findings?

Well, right now, not too much. This study did not identify the sources of mercury exposure, so it’s hard to say how to prevent it. And it’s not entirely clear which type of fish to eat, and what type to avoid.

Now, this is kind of where the science is at these days. It’s very important research, and not easy to conduct. But it’s worth keeping in mind, if you are following it, that it will be a long and winding road before the studies sort through all the complexities and possible contradictions and yield empirically validated guidelines.

Pregnant Woman via Shutterstock.com

Flu, Pregnancy, Autism: What To Make Of Exploratory Studies

Tuesday, November 13th, 2012

On the one hand, the recently published paper suggesting a link between flu in pregnancy and risk for autism is an important one. Researchers continue to look for clues for any of the multitude of risk factors that might contribute as partial causes of autism. There is certainly interest in the prenatal period and exposure to many potential influences. 

On the other hand, as a scientist and parent, I start to cringe when I see studies like this one getting translated into hyperbolic headlines. Why? Simply put, what we’ve really learned from this study is that we might want to try to further study the associations between flu, pregnancy, and autism. That’s it.

Now, that might seem like a puny contribution. It isn’t. But what you need to know is that all studies reported in scientific journals do not have the same goal. Some hone in precisely on a given topic and try to cement knowledge with rigorous hypotheses. Others, however, provide an initial clue that something should be looked at closer. That’s where we are at with the flu, pregnancy, and autism link.

You should think of this study as exploratory. Why? There are a number of reasons, and I’ll list just a few. First – the study relied entirely on mother’s recollections. This isn’t the optimal way of studying the association – not because moms (or anyone else) are unreliable, it’s just that the most precise way would be to use a number of methods (including prospective in-person assessment and reporting, medical records, etc) to record data that are not easy to catalogue. Second, the study looked at a whole bunch of potential factors in a very large sample. This means that the findings that come out as significant can be due to chance. While this is always the case in science, it’s especially so when there is a really big sample (simply because a large sample means very small results can reach statistical significance) and lots of potential associations are tested – and it’s the reason that science demands replication across a number of studies before we agree that a finding is established. Third, this point is reinforced by the finding itself – the risk increased from 1% to 2%. Any explanation in science is important, but when you look at the numbers this way it’s a bit more realistic (and sobering) than headlines that scream that the risk is doubled. Yes it was – from 1% to 2%. Think about the “margin of error” you heard about all through the recent presidential election with respect to polling – the same principle applies here. This difference could be a systematic result – or just chance. And right now the effect is rather modest. The bottom line is that more studies are needed to build on this to figure out exactly what is going on.

I’m a big fan of parents – and anyone who is interested – getting closer to science, especially new studies as they come out. But if we are going to support that, we need to explain more about the studies and what we think they mean, and don’t mean, right now. So here you go. Right now, it’s certainly the case that physicians and public health experts continue to suggest that pregnant women get vaccinated for the flu. If you are pregnant, talk to your doctor about that right now. Right now, extrapolating from these findings and trying to figure out if a child is diagnosed with autism because the mom got the flu when she was pregnant is not a productive exercise. Pointing a finger at a pregnant woman who is sick and saying that her unborn child will be diagnosed with autism is certainly not productive and would be misguided (not to mention hurtful). These exploratory studies are done to help guide future practices, not assign blame or create panic. They only provide a guide to future scientific projects that might shed more light and someday deliver more helpful guidelines for preventing autism.

Question marks via Shutterstock.com (because that’s the take-home message right now)

Antidepressants And Pregnancy: What Are The Take-Home Messages?

Monday, November 5th, 2012

A recent review paper published in Human Reproduction has shined a light on an emerging debate concerning the use of antidepressants in women who are seeking treatment for infertility. The issues extend, of course, to all pregnant women (whether or not they sought treatment for infertility), and they are serious and complex. Here I’ll summarize my take on the most important take-home messages. 

First, if you have seen the headlines about this study, you may think twice about getting treated for depression if you are trying to get pregnant or are currently pregnant. This is not the point of the debate. Any level of depression should be treated. The issue being discussed is how it should be treated.

The authors of the review paper make the argument that use of serotonin selective reuptake inhibitors (SSRIs) during pregnancy – which include the commonly prescribed drugs Celexa, Prozac, and Zoloft – is associated with a number of potentially serious problems. These include pregnancy complications, preterm birth, and neurobehavioral compromise in infants. There are studies which back up these claims (click here and here for recent papers on the topic). As the authors note, these studies do not provide definitive evidence – clearly more studies need to be done to get better estimates of the level of risk. But the current findings should, at a minimum, be on the minds of women who are dealing with depression when trying to get pregnant or currently pregnant. They need to be factored into considerations of the benefits, and risks, of taking antidepressants.

Expanding on that, perhaps the most important guideline to keep in mind is that SSRIs are most effective as a treatment for severe levels of depression. A recent review published in the Journal of the American Medical Association (JAMA) provided compelling data that SSRIs had no greater effect than a pill placebo when treating mild to moderate levels of depression. In contract, SSRIs were significantly more effective in managing severe depression.

Putting it all together, an argument can be made that women who are dealing with mild to moderate depression may want to consider using only non-drug treatments if they are trying to get pregnant or are pregnant. Many forms of psychotherapy are also effective but of course do not carry to potential biological risks of SSRIs. The more complex assessment of risk and benefits of SSRIs would apply to women who are suffering from severe depression. Severe depression can be a debilitating disorder and can compromise health and well-being. As there is no simple solution in this case – especially if a woman has a history of severe depression along with a history of positive response to an SSRI – the potential risks and benefits of SSRI use during pregnancy should be an active discussion point with both an obstetrician and psychiatrist. It may be worthwhile to consider, and try, only non-drug treatments. In this case the good counsel of the attending physicians and open discussion of the issues will be essential to promote the health of both mom and baby.

Pregnant woman via Shutterstock.com

Dads, DNA, And Choices

Thursday, September 27th, 2012

The scientific paper describing the increases in DNA mutations that correspond to increases in paternal age – published last month (click here to see my discussion of the scientific aspects of the study) – has generated lots of discussion about the need for reconsidering how age may affect paternity and fathering. See, for example, Lisa Belkin’s thoughtful discussion about the utility of men hearing the ticking of a biological clock.

It can be argued that the biological role of fathers, with respect to age, has not received as much attention because we think of the biological clock as primarily representing the probability of being able to reproduce – with those effects being, of course, most pronounced for females. What is now emerging into the public awareness (based on a number of studies conducted over a number of years) is that paternal age – like maternal age – may be associated with an increased risk for passing on certain genetic risk factors that may confer risk for disorders.

We may get to a point where there are risk charts that quantify the increasing probability of paternal mutations that correspond to age and associations with risk for various disorders in offspring (much of the interest right now comes from the potential links between paternal age and autism). Consider, for example, this chart showing the increasing probability of having a child with Down syndrome as predicted by maternal age.

The complexity here is that prospective parents have to consider, in most cases, probabilities rather than certainties (unless there is a screening for a known genetic disorder that runs in a family). Is a 1% chance, versus a .5% or a .01% chance, enough to change someone’s family planning? This is tough to answer. For some people, it may be highly influential. For others, social and personal factors may override such probabilities. What is clear is that genomic research will continue to deliver more and more probabilities in the future (near and far) – and the information that is generated will pertain to both prospective moms and prospective dads. And that prospective parents will have to make more and more complicated choices that are partially (but not fully) informed by genomics.

Statistics and probability via Shutterstock.com