Are the rules of pregnancy ironclad?
BY LEAH A. ZELDES For Sun-Times Media August 15, 2013 11:08AM
What they’re saying
Oster’s book has stirred a lot of reaction:
» “There is no amount of alcohol in pregnancy that should be considered safe.” — Dr. Donnica Moore on “Good Morning America”
» “Maybe it’s safe to say none of us has all the answers? For me, it all goes back to the common sense thing: A glass of wine is probably fine, a bottle is probably less fine. But that’s just me.” —Blogger Jacqueline Burt on The Stir
» “There are definitely still questions about what’s safe and what’s not, but our stance on both caffeine and alcohol here at Parents [Perspective] is pretty simple: Why take the risk?” —Melanie Abraham, blogging on Parents Perspective
» “Emily Oster sifts through data to debunk myths about pregnant women & drinking. Light drinking is just fine, ladies.” — @RupaSubramanya via Twitter
» “Ms. Oster is an irresponsible person who should not be giving pregnancy advice.” — La Cru via Facebook
Updated: September 17, 2013 7:48AM
Many a pregnant woman has heeded medical advice and given up cocktails and caffeine for the entire nine months. However, a new book says moms-to-be need not follow this routine advice, resulting in heated online debates after the author, Chicagoan Emily Oster, was featured on the morning talk-show circuit this week. ¶ “Pregnancy medical care seemed to be one long list of rules,” Emily Oster writes in “Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong — and What You Really Need to Know” (Penguin Press, $26.95).
Oster, assistant professor of economics at the Booth School of Business at the University of Chicago, describes herself as a “health economist.” When she became pregnant with her first child, Oster was dismayed by all the do’s and don’ts, so she took a statistical look at the studies behind the rules.
Research about health issues, Oster said, looks at both “causation” and “correlation.” For example, “Does weight gain in pregnancy really cause your child to be obese later, or is it just that overweight women have overweight children because of lifestyle reasons?” Most recommendations, she said, are not based on findings of definite causes.
Dr. Edward Linn, Cook County Health and Hospital System chair of Obstetrics and Gynecology, noted that ethical considerations make what’s called “Level 1” research on human beings difficult. Scientists study rats in a lab where they control everything about their environment, while feeding one group a potentially toxic substance and withholding it from another. They can’t cage expectant mothers for nine months while making them drink coffee. So much research on pregnancy outcomes looks at less reliable surveys of groups, often based on the subjects’ own report of what they did or didn’t do.
“We really lack the ability to do rigorous studies,” he said. Factors such as genetics may mean that some women carry more risks than others. Doctors simply don’t know, so they tend to be cautious, Linn said.
“The brain is probably the last thing to form,” said Linn. “We don’t know what the window is or what the dose is,” so doctors can’t say when it might be safe for a pregnant woman to have a glass of wine without danger of fetal alcohol syndrome, which causes physical and mental birth defects. “It’s a high-stakes game,” Linn said.
Oster’s book isn’t due out util Tuesday, so Linn did not know what kinds of potential harm she explored. A couple of cups of coffee a day will probably not harm your fetus, he agreed, but pregnancy puts a big strain on a woman’s organs, and caffeine might increase woman’s cardiac load or irritate an already overactive bladder.
One of the most surprising things her research found, Oster said, was an increased risk of birth defects from gardening. Women are usually told not to clean cat boxes during pregnancy because of the danger of toxoplasmosis, which can cause blindness and other problems later in life to infected infants. A healthy indoor cat poses few risks, Oster said, but the soil in your yard may contain the parasites. “You would much rather clean out the litterbox than garden,” she said.
Linn, a cat lover, agreed. “You can get your cat tested,” he said, and keep it inside. Pregnant women who own dogs might be at greater risk, Linn said, since dogs often roll and dig in the dirt and can bring the parasites home in their fur.
As for alcohol and coffee, Oster sets out the research in her book, but does not provide specific recommendations on the amounts a woman safely can have during pregnancy.
Cigarettes, though, are another matter. “If you have to give up one thing, it should be smoking,” she said.
Leah A. Zeldes is a free-lance writer.