1 Drink a Little Wine! Why Itâs Okay to Break Most of the Pregnancy âRulesâ
I was only seven months pregnant, but felt as if I looked a hundred months pregnant, with a bulging belly that was even more pronounced on my petite 5-foot, 2-inch frame. Wearing a navy blue tunic, maternity stretch pants, and rubber Crocs (the only shoes my swollen feet would fit into at the time), I inelegantly plopped down at a tiny wood table on the front patio of a sushi restaurant on a busy thoroughfare near my Brooklyn neighborhood.
âIâll have the spicy tuna roll,â I told the Japanese waitress, âand a glass of rosĂŠ.â
She didnât bat an eye, despite my ordering not one but two forbidden-to-pregnant-lady items: raw fish and alcohol. I felt defiant. I dare one of these people to judge me, I thought, making eye contact with everyone who passed by. Any person who saw me locked eyes and then quickly looked away. (In hindsight, it was less that anyone was judging me and more that New Yorkers really just donât care how you live your life.)
The Japanese waitress probably didnât feel the need to shame me because in Japan, pregnant women eat plenty of sushi. Japanese doctors recommend it as part of good neonatal nutrition.1 The dietary restrictions Americans put on pregnant women are largely excessive, which Iâll explain in more detail in this chapter.
It feels like there is so much conflicting advice out there: Eat balanced meals, but donât eat soft cheeses, lunch meat, sushi, or anything, really! Indulge in some wine, but you might be damaging your kid. (The actual guidelines, just for reference, recommend avoiding high-mercury fish, raw or undercooked meat and fish, unpasteurized dairy, more than one cup of coffee a day or too much caffeine overall, any and all alcohol, and deli meats and other food that may be vulnerable to a bacteria called listeria, which can cause late miscarriage and stillbirth.)2 Youâre eating for two, but donât gain too much weight! Luckily, you donât have to be too hard on yourself because you really canât fuck up your kid if you do all of the aboveâas long as itâs in moderation.
Bottoms Up! Itâs Okay to Drink a Little
Doctors tell pregnant women not to drink because there is a dearth of studies on the effects of light to moderate alcohol consumption while pregnant. Not that I blame science; it would be unethical to tell one pregnant woman to remain sober, another to try one drink a night, a third to consume a couple of glasses nightly, and a fourth to try a bottle a night ⌠and then measure the IQs of all their kids years later.
But as a result of this âcarefulâ science, the few studies that exist are flawed. For example, a frequently cited study of 2,000 women published in 2001 in the journal Pediatrics found that even one drink a day could cause behavioral problems in their unborn children later.3 However, when you delve into the results, you see that 18 percent didnât drink at all and a whopping 45 percent of women who had one drink a day also reported using cocaine while expecting. Perhaps it was the kind of behavior that would lead a pregnant woman to do illicit drugsâand not the occasional beerâthat led to childhood behavioral issues. Yet the cocaine angle is rarely, if ever, mentioned when this study is brought up by the media, doctors, or well-meaning parents on the playground.
However, abroad, where itâs more culturally acceptable to drink while pregnant, large-scale studies have shown statistically insignificant differences in childrenâs behaviors and IQs between nondrinking mothers and mothers who classified themselves as light drinkers (depending on the country, thatâs two to six drinks per week) while pregnant.
I was particularly drawn to a study that got a lot of press attention when it was published in 2016. Some headlines declared that the study proved it was okay to drink while pregnant. Others were more cautious, with a variation of, âHealth risks of light drinking in pregnancy confirms that abstention is the safest approach.â4 When I dug into the study itself, the results seemed to confirm the former: Up to four drinks a week of either beer or wine, which is the limit recommended by the U.K. Department of Health, is totally fine.5
I called up one of the studyâs senior researchers, Dr. Luisa Zuccolo, to break it down. She was friendly but guarded, speaking to me from her home base at the University of Bristol. She explained that her team looked at 5,000 prior papers studying the effects of drinking alcohol while pregnant and examined the results of twenty-six relevant studies.
âI think the devil is in the details to be honest with you,â she explained, adding that âcommunication in this case is really tricky.
âFor example, when we talk about limiting eating tuna because of mercury, itâs okay to say, âLimit yourself to two portions of tuna a week,â because people arenât going to become addicted to tuna.â But booze âis very different. For some people, itâs harder to stop. They feel more relaxed with their friends, and theyâve had three drinks and maybe theyâll have a fourth.
âSome argue this is paternalistic,â she admits. Indeed: It seems that doctors think pregnant adult women canât control themselves enough to stop after one glass of wine, so they just tell us not to drink at all, like weâre toddlers who need reprimanding. Still, âsome people are better at stopping themselves than others,â Dr. Zuccolo concedes. So you should know this about yourself: If you are the kind of person who lets go of all your inhibitions the minute you have a drink and donât think youâll be able to stop, then just donât drink while pregnant. If a glass of wine with dinner or after a hard day helps you relax, well, thatâs fine then. The stress relief has major health benefits too.
âAnxiety raises cortisol in pregnancies,â Dr. Zuccolo says. A chronically increased rate of cortisol, otherwise known as the âstress hormone,â has been linked to an increased risk of anxiety, depression, digestive issues, headaches, weight gain, memory impairment, heart disease, trouble sleeping, and more, according to the Mayo Clinic.6 This is why, she says, that doctors tend to downplay situations such as a woman finding out sheâs pregnant a couple days after going on a bender. (I downed two bourbon cocktails the week before I found out I was expecting my firstborn, Everett.) âWe do not want to cause alarm unnecessarily such as that the mom gets really stressed out about alcohol in pregnancy before she realizes sheâs pregnant. Demonizing that definitely doesnât help. A burden or sense of guilt doesnât help.â (Another friendâs doctor advised her to continue using pot while pregnant to avoid stress. But you should check with your doctor before doing this.)
So why all the caution with Dr. Zuccoloâs research? The study found that up to four beers or glasses of wine a week may very slightly increase your chance of having a smaller baby if he or she is born prematurelyâbut drinking wonât make you more likely to deliver prematurely. And itâs pretty obvious that your baby may be slightly smaller if delivered earlier regardless of whether you occasionally have a beer with dinner.
This study caused blaring headlines about how alcohol equals smaller babies, but it never said how much smaller the babies could be. A baby born at four pounds faces the potential for many more health issues and longer hospital stays than a baby born at eight pounds. When I asked Dr. Zuccolo about this, she said that the weight difference is so small, itâs negligible, âso you would not be likely to say this baby really suffered from their mom drinking half a glass of wine every month.â
Some research shows that babies born to mothers who have an occasional drink actually have better outcomes than mothers who completely abstain. A 2010 study of 3,000 pregnant women in Australia, another place itâs more culturally acceptable to drink, looked at behavior issues at age two, and then followed the kids until they turned fourteen. It showed that kids of light drinkers (classified as two to six drinks per week) are âsignificantly less likelyâ to have behavior issues than children of moms who didnât drink at all.7 Another Australian study found no difference in IQs between children born to moms who had one drink a day compared to those who completely abstained. (That study of 7,200 women also tested the kids again at age eight and found, you guessed it, no difference in IQs.)
As statistician Emily Oster explains in her excellent book, Expecting Better, âresearchers tend to find that women who drink moderately in pregnancy have children with higher IQ scores.â This is due to the fact that women who drink moderately tend to be better educatedâwhich plays a much more important role in how kids grow up than the occasional glass of sauvignon blanc. As Dr. Zuccolo says, many studies donât take into account the life situations of their subjects. Data is only taken on whether the parent drinks or doesnât drink, but other factorsâsuch as their education, income, marital status, and ageâare not considered. And all of these things can skew the research. Then, sweeping generalizations are made for large groups of people based on a small number of people studied who may have exceptional life circumstances.
Itâs Okay to Get Your Caffeine Fix
Another controversial drink while expecting: coffee. Some doctors say to avoid it altogether because it can increase your chance of miscarriage. Many of my friends didnât have any and instead suffered through caffeine-withdrawal headaches. I settled on half-caf for my second pregnancy, with Otto. Oster, the statistician and author, explains this tenuous link to miscarriage: Many pregnant women are too nauseous in the beginning of their pregnancies to drink very much coffee. Those who arenât nauseous continue drinking it as usual. But women who arenât as nauseous are more likely to have a miscarriage.
So perhaps it wasnât the coffee that caused the miscarriage, but the lack of nausea that was a telltale sign of an impending miscarriage. After all, women who drink other caffeinated beverages such as Coke or tea arenât more likely to miscarry. As with drinking alcohol during pregnancy, weâre looking at flawed research because it would be unethical to conduct an experiment where one group of pregnant women drank an entire carafe of coffee a day, another consumed a couple mugs, and others abstained, and then measure all three groups for miscarriages later. Oster also found no statistical likelihood that women who drink coffee while pregnant give birth to smaller babies, so she decided up to four cups a day was okay during her own pregnancy.
My doctor had me ditch green tea when I was pregnant, which was harder for me than coffee at the time. I dug into the research and determined that she was probably overreacting. Tea contains an antioxidant called catechin, which has been linked to a bunch of health benefits, such as lowering your risk of heart disease, stroke, and cancer. Unfermented green tea has the highest amount of catechin, followed by oolong, and then black tea. Some studies have found that consuming more than three cups of tea with a lot of catechin per day can inhibit your absorption of folic acid. A folic acid deficiency may increase your risk of delivering a baby with a condition called spina bifida (SB), where an infantâs spinal cord doesnât form properly. So if you want to drink a little tea, go for itâbut just donât drink gallons per day. Using data from nearly 7,000 moms,researchers found the following: âOur data do not support the hypothesis that tea consumption overall increases the risk of SB.â8
Why You Should Indulge Those Cravings
The pee stick had hardly turned pink when the cravings for lox set in. Morning, day, and night, I dreamed about smoked salmon. But advice on the Internet was mixed: Was I supposed to eat it or not? It all seemed to depend on whom I asked. My doctor at the time, who was overly cautious in most of her advice, told me with a wink and a half smile that it was okay to consume it. So, on a trip to London, I dug in. And when I got home, I continued to pile it tall atop Brooklyn bagels. And I munched on it as a snack. (To this day, Everett loves to eat lox, and I joke that this probably explains it. He gets all kinds of funny looks when he noshes down on âfishiesâ as a five-year-old.)
But the idea that I couldnât find a place that definitively told me whether itâs okay to eat lox points to an issue. Pregnant women are told to avoid a laundry list of foods, ranging from soft cheeses to deli meats to raw fish. There are a number of government agencies in the United States that have released guidelines regarding which foods pregnant women should avoid. One goal of the Food and Drug Administrationâs endless list9 is to lower the chances women would eat anything that could possibly have been infected with the harmful bacteria listeria.
When you dig into the statistics, as Oster did in Expecting Better, you see that two foods were responsible for 30 percent of listeria outbreaks during the ten-year period between 1998 to 2008: queso fresco, a Mexican soft cheese, and turkey deli meat. Letâs say youâre craving a sandwich, so you choose ham over turkey. As Oster found, eating ham would lower your risk of listeria from 1 in 8,333 to 1 in 8,255. (Meanwhile, your risk of getting in a car accident during the course of your lifetime is 1 in 114âand pregnant women still drive every single day.)10
The rest of the listeria outbreaks are random, such as pine nuts found in hummus, celery, or cantaloupe. Even ice cream experienced a huge listeria outbreak in 2015. So how can you prevent yourself from getting listeria? Keep your refrigerator below 40 degrees Fahrenheit, donât eat things that have been sitting in your refrigerator a long time or at room temperature for longer than two hours, do eat pasteurized foods, and wash your hands well and often, says the American College of Obstetricians and Gynecologists.11
In the meantime, why are pregnant women spending so much time anxiously tracking every single ingredient they put in their mouths when theyâd lower their chance of miscarrying if theyâd avoid just two foods: queso fresco and turkey deli meat? Hereâs yet another instance of sexism, as government officials and doctors apparently couldnât believe that women were capable of taking our own precautions to avoid a smaller list of foods. Easier to just ban everything! Pregnant or not, Iâm not going to eat sushi sold at a gas station. But while pregnant, itâs important to just make sure that sushi is consumed in moderation (like all foods), mostly avoid high-mercury varietals like tuna, and only eat in clean restaurants.12 In the United States, itâs a law that all sushi must be flash frozen before served, anyway, which kills most bacteria and parasites.13
Fighting Depression? Donât Ditch Your Antidepressants Cold Turkey
Millions of women are taking antidepressants,14 and itâs normal to be concerned about how the medicine will affect your unborn babyâand your own mood if you stop. Most antidepressants are totally fine, especially when compared to the alternative: A depressed mom may not take care of herself, including getting good prenatal care. The Mayo Clinic also reports that depression during pr...