It’s 8:30 a.m., and I’m already hungry for my second breakfast. In fact, I’m starving every couple of hours. And when I eat, an ever-expanding list of worries plagues me—am I eating too much? Am I gaining weight too fast? Am I eating the right thing? Is this food safe for the baby?
In 1668, François Mauriceau, the top obstetrician of seventeenth-century France, wrote that “The pregnant woman is like a ship upon a stormy sea full of white-caps, and the good pilot who is in charge must guide her with prudence if he is to avoid a shipwreck.” While the medical literature on pregnancy reads differently today, the underlying attitude hasn’t changed all that much. When it comes to making the right food choices for a healthy pregnancy, it can feel like we’re navigating a stormy sea of obesity, BPA, listeria, and—most of all—conflicting recommendations.
I’ve read the official recommendations from medical organizations and the government, the somewhat more relaxed approach of some hip baby books, the panicked questions and exasperated answers on online pregnancy forums, and the more guarded and nuanced results from the primary scientific literature. Add recommendations from my mom and my doctor to the list and it’s almost a guarantee that there will be no single, stable answer to any question about food and pregnancy.
Take alcohol. The official recommendation from the U.S. government to abstain from alcohol during pregnancy has been around since 1981—and is now a powerful cultural force. The idea that pregnant women shouldn’t be drinking alcohol is so ingrained that simply not ordering a drink can quickly start the rumor mill. Seeing a pregnant woman drinking—say, in an episode of Mad Men—can be quite shocking. “She shouldn’t be doing that!” we gasp, smug about our superior knowledge of medical science and perhaps a bit surprised that any of the baby boomers survived at all. This feeling is just one of the cultural side effects of scientific “facts”—in this case, the very real risk of fetal alcohol spectrum disorders that can result from drinking during pregnancy. When facts have been augmented by old-fashioned paternalism, traveled through layers of bureaucracy, translated by different doctors, and guided by individual experiences, we get a complicated cultural phenomenon that can be remarkably different in from country to country.
Most large studies—like this 2012 study looking at drinking habits of 1,628 Danish women during pregnancy—have found no adverse effects whatsoever when there’s a limit of about one drink a day. French women, for example, are much more likely to be shocked that you’re not drinking; a glass of wine during dinner is normal, even during pregnancy. It’s not that French women are constantly drinking alcohol and espresso, smoking cigarettes, and eating soft cheeses (other big no-nos in the States). Instead, the cultural expectation of moderation is much stronger: in America we stare and shake our heads in disgust; in France, women are trusted to moderate their drinking.
Almost every food that’s not allowed during pregnancy is similarly complicated. Those gooey French cheeses that pair so well with the wine we’re not supposed to be drinking are also off-limits. Cheeses that are soft, young, or made with unpasteurized milk are considered especially dangerous, because these conditions can favor the growth of Listeria monocytogenes, a bacteria that can lead to miscarriage or stillbirth. Listeriosis is a serious infection, and listeria outbreaks can definitely begin with cheeses—but in the past five years, only four of the eight documented outbreaks were actually traced back to cheese. The rest were in ice cream, bean sprouts, caramel apples, and cantaloupe.
Even as a scientist, I find these stories of risks and statistics overwhelming. I can know, scientifically, that some alcohol is fine and that most cheese is safe—but I still avoid them. I’ve started drinking non-alcoholic beer and decaffeinated coffee, something I would have scoffed at just a brief seven months ago. I’ve given up sushi and my cavalier attitude towards foods that have a reputation for harboring pathogens. It’s not that being pregnant has clouded my scientific judgment; deciding what food is good to eat involves a lot more than just science. Our “common sense” about what foods are healthy is affected by scientific studies, by doctors, by food manufacturers, and by tradition and culture. It’s no wonder that each decision feels like we’re narrowly avoiding a shipwreck when we’re eating for two.