Information overload poses health risks during pregnancy

Pregnant women are so overwhelmed with messages about what to do and what not to do that many are tuning out. They keep boozing and smoking in alarming numbers and most make only minor modifications to their diet, the leading study of Australian womens’ health shows.

Nearly 80 per cent of pregnant women drink alcohol, and 30 per cent of pregnant smokers keep smoking despite official health advice to quit while pregnant.

A typical sample of brochures provided to women during pregnancy.
A typical sample of brochures provided to women during pregnancy. Photo: Women’s Health Australia

“We think one of the reasons is there is so much information given to women while they are pregnant,” says Deborah Loxton, deputy director of the Australian Longitudinal Study on Womens’ Health which began 20 years ago and now tracks more than 58,000 women across four age groups.

Avoid soft cheese. Avoid deli meats. No pate, no bean sprouts. Eat well-cooked meat but not burnt. Don’t eat stuffing.

French hospitals are offering pregnant women up to $460 to quit smoking after a study showed that one in five fail to ...
French hospitals are offering pregnant women up to $460 to quit smoking after a study showed that one in five fail to kick the habit while expecting.. Photo: Julian Kingma

These rules from the NSW government Food Authority aimed at minimising the risk of food poisoning in pregnancy are just a few of the dozens of recommendations in brochures and booklets routinely given to pregnant women by hospitals, pharmacies and other health services.

“There are more rules and regulations and more recommendations than women have ever had before,” says Associate Professor Loxton of the University of Newcastle. She says the advice to pregnant women needs to be reviewed to prioritise the most important messages.

“Everything just goes in the bag or the folders. There’s nothing there that communicates what is the most important thing to do.”

In 2009 the National Health and Medical Research Council guidelines changed to say that the safest option for pregnant women is to abstain from drinking if they are pregnant, planning a pregnancy or breastfeeding.

Emily Oster has analysed hundreds of the studies used to justify pregnancy rules.
Emily Oster has analysed hundreds of the studies used to justify pregnancy rules. Photo: Matthew Gilson

A study of 1577 women who drank alcohol before becoming pregnant found that over half those who reported a history of binge drinking – defined as having five or more drinks on a single occasion – continued the practice during pregnancy. Heavy alcohol use during pregnancy is known to be harmful to the unborn child.

But “the jury is well and truly out” on whether drinking at low levels during pregnancy is harmful, Associate Professor Loxton says. “We say while there is no clear evidence that it is harmful, there is no clear evidence that it is not. So the recommendation is that abstinence is the safest.”

US health economist Emily Oster of Brown University analysed hundreds of the studies used to justify pregnancy rules for her book Expecting Better, Why the Conventional Pregnancy Wisdom is Wrong and What You Really Need to Know. She concluded women could be comfortable with “one or two drinks a week in the first trimester, and up to one drink a day in the second and third trimester”. But the speed of consumption was important: “no vodka shots!”

Associate Professor Oster says women are seeking rules to minimise harm to their unborn child and experts are very conservative in their advice. The result of this culture of fear is that “any time there is any hint that something might be harmful – even if the evidence is terrible – there is another new rule”. But many of the studies had been misinterpreted or were faulty in the first place, she found.

“People tell you not to do so many things, eventually [you reach] the point where you think ‘Well, I ate some extra ice cream, so I might as well do everything else!'” This is “of course wrong”, but the instinct is understandable, says Associate Professor Oster.

After her exhaustive research, and a couple of pregnancies of her own, what are her top three tips?

1. Don’t smoke.
2. Do some pelvic floor exercises.
3. Pick a doctor or midwife you like and trust who listens to you.