Expecting Better

Last week I read an article that summed up how I knew and felt about pregnancy advice.  Well, not an article as much as an excerpt from a new book by author Emily Oster, Expecting Better: Why Conventional Pregnancy Knowledge is Wrong and What You Need to Know.  Excerpted from Huffpost here, she states how I went about things: I listened to my doctors, read the research, and made my own decisions based on what I thought the real findings indicated.

When I was pregnant with Calvin, I was in my second semester of my dual MS-Nutrition/MPH program.  I was taking a series of classes on the effects of diet and exercise during pregnancy -- in other words how and what a woman consumes when pregnant affects the life cycle of an unborn child.  I thought I'd learn all kinds of horrifying things in that class that would make me run to the hills.  I thought I'd learn that the medical advice about pregnancy was all based on rigorous scientific thought and that there would be large bodies of evidence to support outright avoiding things like alcohol, caffeine, cured meat, etc.  I didn't,  My new knowledge from my graduate school medical and nutrition classes taught me that most of the advice given to all pregnant women is overly cautious to say the least.

In the class, we learned to look at the scope of the research on a topic and make judgments about the quality of the evidence.  As a project, I had to do a literature review on alcohol during pregnancy.  Study upon study has been conducted in the UK, New Zealand, Germany, Denmark, and a host of other developed nations and shows that a small amount of alcohol during pregnancy had no negative effects.  These were all for quantities of alcohol somewhere around one glass of wine or one small beer less than 5 times a week.  Remember that, in the US, wine is generally served in larger quantities than in Europe, so that is to be taken into account.

Studies about alcohol consumption during pregnancy in the US, on the other hand, were all for amounts much greater than and more often that (5-7 drinks per week -- and usually more than 3 drinks at a time --  was where the studies started to show negative effects).  When I did my literature search, there were literally no studies in the US that I could find on what small amounts of alcohol might do, and there was disagreement over what "small" was.  Now, the experts say that there has been no safely established amount.  What they won't tell you is that no studies have been done in the US to test that hypothesis.  Since they know that moderate-to-large amounts of alcohol is harmful, they can't in good conscience test it out on an unborn fetus until there is a large enough body of evidence from other countries that it might be safe to.  What we can do, though, is look at the large, longterm observational studies from countries with relatively similar genetics, more moderate drinking patterns (not the binge drinking of young people in the US), and less stringent medical advice, and draw our own conclusions.

I understand that, from the public health perspective, we can't say that it's OK for everyone to drink while pregnant.  What about alcoholics?  Nope.  What about people who have next to no ADH (the enzyme necessary to digest alcohol prior to its getting into the blood stream)?  Nope.  Many Asians and American Indians have very little ADH, but there are plenty of women of other races/ethnicities who can't hold their liquor.  I can see why medical professionals can't just make a blanket statement that it's OK for everyone to have small amounts of alcohol during pregnancy, because the fact is that it's probably not for everyone in the US.  We'd probably put lot of babies in harm's way if we opened it up like that.  But from my research, if you're used to having a drink and alcohol doesn't go straight to your head, you're probably fine to have a drink or two a week.

That's just the case of alcohol.  There are plenty of other studies like that for the other things we're advised to avoid while pregnant.  But the fact is that we're so worried about hurting our unborn children that we may be stressing out about what we're not supposed to do than it's worth.  No one tells you that stress also has a serious negative impact on unborn children.  It's associated with having children with higher risks for anxiety, depression, and behavioral problems (especially in boys), and I have to wonder whether part of the increased autism rates since the 80's may be attributable high stress pregnancies (though I have done no research to back this supposition whatsoever).  Knowledge is awesome.  But sometimes, there's a reason that ignorance is bliss. Somewhere in there, it would be nice if we could strike a balance.  Oh yeah, and try not to stress out about being stressed out.

And that's what I like about the approach that Emily Oster takes.  If you're feeling somewhat impinged upon by the advice, do some research, and come to your own conclusions about what you're comfortable with.  Different people come up with different decisions from the same information based on their comfort levels, and all the decisions are good.  I would also like to point out one place where I differ with Emily's thesis: if you're cool with following the medical guidelines, that's great, too!  I don't really expect that everyone cares enough or has the time or inclination to do the work that is required by such a task.  And the other problem is that a small subset of the American people have neither (a) access to academic journal articles and (b) the ability to read the statistical tables and results of said journals in order to draw their own conclusions in an informed way.  It's a tall order, and it's just as well we have public health and medical professionals making sweeping statements that are safe for everyone to follow.  But if you're curious and don't have the time, check out Emily's Oster's book to see what sparks your interest.