I love sushi—living in California this is no surprise. Lucky for me my office is across the street from one of the best local sushi restaurants in town. It’s a favorite destination for me, my staff, and my patients. I recommend it to everyone—EXCEPT my pregnant patients. Why? Because I am inherently cautious.
We know raw fish is more likely to contain parasites or bacteria than cooked fish is. Sushi-related infections are rare, but this doesn’t erase my concern about the risk of adverse outcomes, mercury exposure, and the potential complications of treating an infection should one occur. As an ob-gyn, this is my job. It’s my business to consider potential problems, make my patients aware of them, and advise them to avoid unnecessary risks. If you really want to have some sushi, it’s a good idea to eat only cooked or vegetable sushi.
My goal is not to worry or alarm my patients, but to make suggestions based on solid, high-quality research. I use evidence to guide my recommendations, support my practice, and help my patients make healthy decisions for themselves and their fetuses. That’s why a recent essay by an economist and mom, who asserts that many common pregnancy recommendations are not fully supported by evidence, caught my attention.
Ob-gyns understand there’s often conflicting data and that the changes we suggest during pregnancy can sometimes be overwhelming: nine months can seem like an eternity when you have to give up your favorite things. Sometimes we even look back and realize our advice missed the mark. I remember a time when bed rest was prescribed for many patients with preterm labor, which we now realize accomplished little. But as doctors, we’re continuously learning. Advising patients to avoid things that we KNOW can cause harm is a good practice. Why take the risk of drinking alcohol when you know it could cause a problem? Given the risks, most patients don’t want to use their own child as a test subject.
In other areas, the evidence is very clear. For example, obesity and its impact on pregnancy, the fetus, and a woman’s long term health. Research has shown that excess weight gain increases the risk of maternal and neonatal complications. Obese women have a higher risk of having children born with birth defects. Excess pregnancy weight also increases the risk of maternal obesity eight to 10 years after delivery, especially if women do not lose their pregnancy weight within six months. I would argue that we have not focused enough on weight gain. Ob-gyns could go even further to support women on appropriate weight gain and exercise during pregnancy and healthy weight loss and exercise after delivery.
Certainly it is up to women to make their own decisions during their pregnancy. It’s also important for ob-gyns to remember not to lecture patients, but to partner with them to help them achieve the healthiest pregnancy possible. We must stay tuned in to the recommendations put forth by ACOG and the dedicated practicing physicians who spend countless hours reviewing the latest literature and developing guidance and best practices for ob-gyn care. And it’s also OK to listen to that precautionary voice in the back of your head. Evidence first, but better safe than sorry.
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