Monday, February 25, 2013

Dietary restrictions during pregnancy


I actually wrote this post in French first, then I realized that some Anglophones in my social circle would benefit from this information, so I’m cross-posting it in English (sorry for those of you who read both languages, just skip this post; but for the rest, hopefully this will help shed some light on the subject).

There is a point I want to tackle right off the bat, because it is sometimes a controversial topic: the fact that there are far more restrictions today than 30 or 60 years ago. Some people think that doctors nowadays impose too many restrictions. I know some in the generation before me (and in the one before that) who say that during their pregnancy, they ate many things that I won’t eat now, and that their baby was just fine. Sure. But that is not how I see it. For me, the "new" restrictions were unknown before, but thanks to medical advances and changes in eating habits, we know them now. It's like smoking: 50 years ago, women continued to smoke during pregnancy, because the medical world did not have enough data to pinpoint the problem. But today, we know that smoking is harmful to the fetus, and we know why, so it is recommended that pregnant women do not smoke. Fifty years ago, it was also acceptable to put the baby in a basket on the front seat of the family sedan, but if you did that today, your child would be placed in foster care until a social worker can determine whether you are a fit parent! Same goes for the restrictions that were previously unknown. And like I said, there are also restrictions that are common today, but that did not exist before because the food they affect was not as widespread then. For example, in 1980, a pregnant woman in North America would not have been told not to eat sushi, probably for the simple reason that it was far from commonplace at the time.

So there are certain foods that should be avoided altogether, and others that should be eaten in moderation. I’m giving you a list that I prepared after doing my own research, but I'm not a doctor! If in doubt, check with your obstetrician to see what he recommends. I tend to prefer to take too many precautions rather than not enough, but it is a personal choice. I hope I have identified all the foods that are of concern to me in this list, but I could have forgotten some, so this list is not exhaustive (even though it is long).

Foods to avoid
- Raw animal products, including:
·         raw eggs, unless they are pasteurized (this includes artisanal ice cream with a custard base, some desserts like chocolate mousse or molten cakes, poached eggs, homemade mayonnaise, custard, raw cookie dough, spaghetti carbonara, etc.. );
·         raw milk and its derivatives (such as certain cheeses);
·         deli meats, smoked meat, meat that is still a little rare (like steak, juicy hamburgers or duck magret), some pâtés and sausages;
·         smoked salmon, sushi;
·         shellfish (unless you cook them yourself);
·         unpasteurized honey.
- Raw vegetables if they have not been washed well (especially if they come from the garden or farmers’ market), because of the risk of toxoplasmosis.
- Sprouts, such as alfalfa, because of potential bacterial contamination.
- Unpasteurized fruit juices (unless you make them yourself and drink them immediately).
Please note that all this is because of the risk of contamination by bacteria such as listeria, e. coli or salmonella, so if for example you decide to order vegetarian sushi, you must make sure that they are not prepared on the same surface as raw sushi, not cut with the same knife, not handled by the same person.

Foods to eat in moderation
- Caffeine. Normally, a pregnant woman is entitled to 180 mg. of caffeine per day, which is equivalent to a small cup of coffee. You can of course drink decaffeinated coffee, or prefer to use your quota of caffeine for soft drinks, tea, chocolate, mocha in a dessert, etc.
- Certain allergens, such as nuts. According to the studies I've read, eating too many or too few nuts during pregnancy increases the risk of a nut allergy in the child, but there is a comfort zone of optimal consumption which does not alter the risk (risk that persists minimally anyway). I’ve decided not to change my consumption of nuts: I eat them, but not super often, maybe a few times a month.

Foods to avoid or to eat in moderation, depending on your sources
- Alcohol. All my sources say to avoid in the first trimester. Although many doctors say you can then drink a glass of wine per week, other studies (such as this one) conclude that alcohol is never safe during pregnancy. And let me interrupt you right away: alcohol does not evaporate during cooking! This has been proven by America's Test Kitchen (see here if you subscribe). Basically, for braises and dishes cooked with a lid, the percentage of ethanol does not change, even after hours of cooking. For flambés and things cooked uncovered, you end up with about 5% ethanol. It is up to you to decide what percentage you’ll tolerate, either in a glass or a plate. To help you: nonalcoholic cooking wine and substitutions (chart and article.) (If you want original drinks, I recommend Martinelli's sparkling apple juice, which I loved and which can pass for champagne, as well as Welch’s sparkling grape juices. Avoid some natural soft drinks by Fentiman's, such as their ginger beer, which contains a small amount of alcohol due to natural fermentation. For a natural ginger drink, I highly recommend Oogavé brand, which served me well for a few months. I also liked the San Pellegrino lemonade.)
- Soy. Some studies show a link between soy consumption during pregnancy and inhibition of male secondary sexual characteristics (if the fetus is male), including beyond adolescence! This is because certain soy molecules resemble certain female hormone molecules (the famous phytoestrogens). So there are scientists who say that we should completely stop eating soy during pregnancy until more is known, and others who say that soy consumption is acceptable, but it should be moderate. There are of course also studies that conclude that soy has no negative side effects, is super healthy, and that a pregnant woman should eat it every day, but these studies are so often funded by Monsanto that I do not believe a word! So I reduced my intake of soy, but did not eliminate it completely. It's a shame, because I had started cooking with tofu and edamame, and I wanted a good miso soup, soy sauce or Tofutti products...
- Some herbs and spices, such as sage (increases the risk of miscarriage during pregnancy and reduces milk production thereafter), purslane and raspberry leaves (both cause uterine contractions) or juniper (increases the risk of miscarriage and reduces fertility). Note that there are dozens of herbs that should not be taken during pregnancy; I encourage you to look up a list for yourself or to speak about it with your doctor. So I had to give up trying my pumpkin gnocchi and sage recipes last fall, as well as some stuffings. And since I do not see myself making homemade gnocchi with an infant in my arms, it will have to wait until fall 2014! Note that these herbs can be found in cooked dishes, but also in salads and herbal tea, so beware!
- Fish: some fish (cooked!) can be eaten in moderation, while others should be avoided altogether. The fish usually containing low levels of mercury, such as salmon or tilapia, or canned light tuna are safe (about 5 or 6 oz. per week), but other fish like swordfish or tuna steaks should be avoided.
- Artificial sweeteners: this depends on your doctor or the organization you trust. Some say to avoid them altogether, even if you are not pregnant, and others say they are always safe. In general, though, it is recommended to avoid consumption of saccharin and to eat other artificial sweeteners (sucralose, aspartame, etc.) in moderation. But I avoid them anyway, pregnant or not.

It always depends on your sources, actually, and on how much you trust them. For example, the book What To Expect When You're Expecting, which is THE benchmark of English-speaking North America, recommends tofu, soy milk, edamame and all that jazz, while I'm trying hard to reduce my intake of soy during my pregnancy. But this book, although very useful, is not necessarily known for the accuracy of its contents. (For example, it says that the more heartburn a pregnant woman experiences, the more hair her baby will have, while other reliable sources say that is an old wives’ tale.) And again, that’s not to mention medication, essential oils, cosmetics and everything!

Actually, it is a bit like Russian roulette. It's not that eating sushi automatically leads to negative effects on the fetus, but the risk is relatively high. That being said, during pregnancy, it is certain that at some point, you will eat something you shouldn’t, either because you didn’t know all the ingredients it contained or because you had simply forgotten. Usually, everything will be fine anyway, so just remember to do better next time, that's all!

Finally, to get back to the comparison with smoking, I see it as follows. We know that smoking increases the risk of lung cancer, and it is written as a warning on all packages. Does it mean that all smokers will develop lung cancer? Of course not. Does it mean that non-smokers, those who avoid even second-hand and third-hand smoke,  will never have lung cancer? Again, unfortunately not. But the latter are stacking the odds in their favor, while smokers take a calculated risk. I simply choose to put the odds in my favor.

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