Yes, Pregnant People Still Have a Brain

Content note: brief mention of birth defects and miscarriage

When I first saw those two, thin purple lines show up on a pregnancy test, I was excited, nervous, and overwhelmed (like most first-time parents). I began daydreaming of what my child would look like, if they’d be shy or outgoing, what they’d be when they grew up…but first, I had to get through the pregnancy! So, also like most first-time parents, I decided to read up on all the latest pregnancy research and advice to keep myself and my baby healthy.

And then I got very confused.

A few things made perfect sense, like avoiding smoking while pregnant. If it’s not healthy to do when you’re NOT pregnant, it stands to reason that pregnancy doesn’t suddenly make it “okay.” But then I read about all this other seemingly random stuff I needed to avoid. Sushi? Cat litter? Deli meats?!? What was wrong with THOSE things? What terrible, horrible things could happen to my baby if I was exposed to them?

And then there were things that were okay in moderation, but everyone seemed to have different ideas about what “moderation” meant. For example, coffee: while some sources I read said to cut it out entirely, others said two cups a day was fine. What would happen if I drank more than that? Unclear. Is it “okay” for me to drink two cups a day, but BETTER if I didn’t drink any at all? Not sure. And how was it determined that two cups was the limit? Who knows.

As I dug more and more into these questions, the discussions and articles usually ended up something like this: this thing we’re talking about MIGHT be bad for the baby, but we don’t really have any proof. But isn’t it better that you just avoid it altogether? Why take the risk, however small it is? You want your baby to be healthy, don’t you?!?

Sorry, but…I call BS.

I personally found it insulting that pregnant people were being told, routinely and without serious scrutiny, to avoid things in their lives without any evidence to support most of these recommendations. And how do you resolve conflicting information that you’re given, especially when it’s given by doctors and other trusted health care professionals? If no one is providing any evidence to support their claims, how are we supposed to make reasonable decisions about what’s best for us and our babies? It’s not good enough to just handwave these questions away while saying “it might be harmful, so just don’t do it” without any justification.

Take, for example, the deli meat thing. Why are pregnant people supposed to avoid eating deli meat in pregnancy? The rationale is that you want to avoid getting listeria, a serious infection that does have documented bad outcomes for fetuses and pregnant people (and non-pregnant folks too!). And you CAN get listeria from deli meat. But you can also get exposed to listeria in many, many other foods too. Listeria outbreaks in the US in recent years have been linked to cantaloupes, celery, sprouts, and ice cream. And for a lot of listeria infections in the US, the source is ultimately never identified. Bottom line: listeria is scary and you don’t want to get it when you’re pregnant (or, any time, really), but avoiding deli meat will not take away that risk.

Another example: I’m a major skin care nerd, and just about anything you read will tell you to avoid retinoids (retinoic acid, retinols, retinaldehyde, etc) in your skin care while you’re pregnant. The rationale is that oral vitamin A pills (like Accutane) is associated with serious birth defects, so topical vitamin A (retinoids) should be avoided “just to be safe.” But in my personal research, there has been no compelling evidence to prove that a cream you put on your skin is associated with an increased risk of birth defects, and certainly not as high as an oral medication which goes into your bloodstream.

And look, I get it. Doing research on pregnant people is hard and ethically tricky, and the results can be unclear even IF a study is done. But maybe it’s time to shift that paradigm and start including pregnant folks in these discussions. It’s time to stop treating us like we don’t have a brain.

Here’s a novel idea: why don’t we provide people with the latest data in proper context, in a way that they can understand, and trust that they’ll make the best decision for them and their baby?

I acknowledge that for some people, anything that might increase the risk of miscarriage or birth defects (even theoretically) should be avoided if at all possible, and that is completely understandable and valid. The point is that all pregnant people should be afforded the courtesy of learning about what’s known and not known (or incomplete), and allow them to make a decision that’s informed and right for them. Stop the fear-mongering; it’s not helping anyone, least of all those who are pregnant.

We deserve better!

If you’re interested in this topic, I’d recommend Expecting Better: Updated Edition by Emily Oster (my source for the facts about listeria) and The Science of Mom by Alice Callahan.