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Pregnancy do’s and don’ts — Part 1

©MFMER

Being pregnant means you’re about to swim in a sea of “do’s and don’ts.” Mostly don’ts. Co-hosts Angela Mattke, M.D., and Nipunie Rajapakse M.D., discuss the many foods that society tells pregnant women to keep off their plates. What’s science? What’s fiction? What’s in between? Learn all about:

*          The big reach and risky business of listeria: Why soft cheeses, deli meat, packaged salads and, brace yourself, ice cream can be carriers

*          Safer ways to eat sushi

*          Why you should always wash raw fruit and veggies, and leave dealing with the cat’s litterbox to your partner

Read the transcript:

Dr. Angela Mattke:

Welcome to the “Mayo Clinic Moms” podcast. We’re having candid conversations and answering difficult questions about pregnancy, raising kids, and everything Mom-related. I’m Dr. Angela Mattke, and I’m a mom of two and a pediatrician at Mayo Clinic Children’s Center in Rochester, Minnesota. My co-host is Dr. Nipunie Rajapakse, who’s a pediatric infectious disease doctor at Mayo Clinic, and is also pregnant. Today on our episode, we’re going to be talking about all the do’s and don’ts of pregnancy.

Dr. Nipunie Rajapakse:

There are a lot.

Dr. Angela Mattke:

There are a lot, and I feel like everything in pregnancy is a ‘don’t’. There are very few things that are on the do list.

Dr. Nipunie Rajapakse:

I agree. It seems like there are so many restrictions, and expectations to give up so many different things.

Dr. Angela Mattke:

Yes.

Dr. Nipunie Rajapakse:

Hopefully we can help shed some light on where some of these things come from.

Dr. Angela Mattke:

Especially the evidence behind these things, where they come from, and are some of them truly evidence-based, or not? I guess that’s the question we’ll get to a little bit, here. During my pregnancies, I was so sick — need-to-vomit sick. I would run out of the patient room.

Dr. Nipunie Rajapakse:

Oh, goodness.

Dr. Angela Mattke:

Sign-Out-During-Residency sick, like, all of my residency colleagues knew I was pregnant at seven weeks because I was vomiting everywhere; and the only thing I wanted during pregnancy — the only craving — was kombucha.

Dr. Nipunie Rajapakse:

Oh, my goodness.

Dr. Angela Mattke:

And fruit.  But you know, kombucha is considered a raw food. That’s potentially on the don’t list because there might be a theoretical risk of potentially having foodborne illness associated with it. But the mom part of me — the person who couldn’t keep any food down, the only thing I wanted was kombucha. And I gave up so much. I have already been a vegetarian for pretty much my whole life. I exercise; I don’t drink alcohol. The only thing I want is kombucha! Just give me a kombucha. I did some research on it, and I decided to take a calculated risk. It’s probably not the best thing to be saying as a doctor, but I decided I’m going to have an occasional kombucha so I can stay hydrated. It was the only thing I craved, and I love the fruity ones, like with mango; that was my flavor. That’s the only thing I wanted. What I want you to kind of talk about a little bit today – because you are a pediatric infectious disease doctor, and this is your wheelhouse. I want to go into and shed some light on the do’s and don’ts. What are some of the don’ts during pregnancy, but also, I guess, first, are you having any cravings?

Dr. Nipunie Rajapakse:

Yes, Angie. I think this is one of the most challenging parts. I think we all have that thing that we want to eat or drink during pregnancy. Even though there may be some level of risk associated with it, sometimes it’s really hard to give up completely. I was really interested. Before I was pregnant myself, I just accepted all of the advice that was out there. There are so many things that you hear, and I never really questioned it because a lot of it sounds like it makes sense.

Dr. Angela Mattke:

Yeah, it does.

Dr. Nipunie Rajapakse:

But once I was having to personally make some of these decisions — so my thing was sushi, so I love sushi, and it was really hard to give it up. And the thought of giving it up for nine months was something that I was just not willing to accept on superficial face value of what I was reading online. And thinking through it as an infectious disease specialist, I couldn’t really come up with a super clear justification for why it was so much higher risk than other foods.

Then when I was looking into it more, for example, in Japan, sushi is one of the staples of their diet — there are pregnant women in Japan that eat sushi throughout their pregnancy. Then I was interested in whether there’s a higher risk of certain things? Do they see higher rates of certain infections there? The deeper I delved into this, the more I started also thinking about some of the other recommendations out there. I will say, maybe I’ll start with sushi because that is near and dear to my heart. In pregnancy, obviously, any sort of foodborne illness or any infection in pregnancy can increase your risk of, for example, things like preterm labor or delivery. Definitely food safety and being careful with food is an important thing that we recommend for everyone. Where it becomes tricky is identifying which foods are higher risk than others. Obviously, you want to have a healthy, balanced diet and make sure your baby gets all of the nutrients. There are great things in fish like DHA or omega-3 fatty acids for example, that are important for brain development.

Dr. Angela Mattke:

Yes, yes.

Dr. Nipunie Rajapakse:

Exactly. And then especially when it comes to fish, there’s also things like mercury, and so that’s another aspect to think about in terms of how much and where you’re eating it, or what types of fish you’re eating. From an infectious disease perspective, though, I think one of the things is the types of foodborne illness that we worry about. Specifically, mostly with certain types of parasites, the rates are really low in the United States because here, for any fish that you serve raw or sushi-grade fish, there’s actually a requirement that it be frozen.

Dr. Angela Mattke:

Oh, I didn’t know that.

Dr. Nipunie Rajapakse:

Yeah.

Dr. Angela Mattke:

Interesting. Okay.

Dr. Nipunie Rajapakse:

That really takes care of most of the issues related to parasites now. My approach, I will say, has been to have sushi while I have been pregnant. It’s not something I’m planning to eat every day or every week.

Dr. Angela Mattke:

Yeah.

Dr. Nipunie Rajapakse:

But if I really want it, I will eat it. I’m not going to go, for example, to a gas station and buy sushi there. I will go to a good restaurant to get it. I think as long as they are practicing careful food handling practices, I think the risk is low.

INTERMISSION

Are you thinking about getting pregnant, or maybe you’re a current mom-to-be? Or are you like myself, and you’re in the midst of raising kids and you’re looking for practical evidence-based advice from Mayo Clinic experts? Mayo Clinic Press has got you covered. We have a series of four books, starting from Fertility and Conception to Guide to a Healthy Pregnancy, Guide to Your Baby’s First Years, and the last book in this series, the one I was the medical editor of, Guide to Raising a Healthy Child. You can find these amazing books from Mayo Clinic Press wherever books are sold or on the Mayo Clinic Press website.

BACK TO THE SHOW

Dr. Nipunie Rajapakse:

The other big ones that we hear about in pregnancy are soft cheeses and deli meat. I think those are two things that I have avoided. The risk with those relates to a type of bacteria called listeria that for most normal, healthy people, might cause a stomach flu or mild illness; but in pregnancy, it can be especially severe and can result in miscarriage, stillbirth, and infection within the newborn as well. That can be life-threatening.

Dr. Angela Mattke:

Absolutely.

Dr. Nipunie Rajapakse:

That’s definitely not one that you want to mess around with, but I was also kind of interested in understanding a bit more; it’s a relatively uncommon infection. So I looked back at the listeria outbreaks that have happened over the last 10–20 years, which are easily available online because the CDC investigates them, and a report publishes what they find. I was actually honestly astounded at the variety of different foods to which listeria has been linked.

Dr. Angela Mattke:

Okay. So very familiar. Yeah.

Dr. Nipunie Rajapakse:

With the deli meats and cheeses — but in the last 10–20 years, there have been outbreaks related to cantaloupe. There have been outbreaks related to caramel apples and packaged salads.

Dr. Angela Mattke:

Okay.

Dr. Nipunie Rajapakse:

Sprouts, fresh cheeses, queso fresco, for example — there have been multiple outbreaks.

Dr. Angela Mattke:

Even though it’s pasteurized.

Dr. Nipunie Rajapakse:

Those probably are not pasteurized but made with fresh milk, and certain deli products are as well. Ice cream was on the list. There was an outbreak related to ice cream.

Dr. Angela Mattke:

Ice cream? You’re not taking ice cream away from me.

Dr. Nipunie Rajapakse:

So this is the thing. When you look at the variety of different things, it’s impossible and probably not safe to tell someone to avoid–

Dr. Angela Mattke:

What are you left eating? Just only eating cooked carbohydrates, I guess? I don’t know, yeah.

Dr. Nipunie Rajapakse:

Exactly. There are also going to be downsides to having such a restricted diet in terms of the nutrients you get. So I think we have to be realistic when it comes to these.

Dr. Angela Mattke:

Absolutely. For sure.

Dr. Nipunie Rajapakse:

Raw or unpasteurized milk products, we know are high risk. We don’t recommend ingesting those. Deli meats, for example, should be cooked to steaming hot. I think those are practical, realistic things for people to do, but other things you may have a bit more leeway with, and it can be quite unpredictable. Thankfully, we have a great food safety system in this country. And if you’re worried about certain things, there are places online where you can look to find out the latest. I think there are so many things to be worried and anxious about in pregnancy. I think we all want to do everything right.

Dr. Angela Mattke:

Yes. Yes.

Dr. Nipunie Rajapakse:

But obsessing about some of these things is probably not helpful as well, so I’ve tried to take a bit of a pragmatic or realistic approach as an infectious disease specialist. I look at everything, assess its infectious disease risk, and certain things are higher risk and while other things are lower risk. There are few things in life that we do that are zero risk.

Dr. Angela Mattke:

Exactly.

Dr. Nipunie Rajapakse:

So it’s kind of judging based on your own risk tolerance and your lifestyle–what you’re willing to accept. Those are some of the food-related things. The other foodborne infection that can cause specific issues during pregnancy is a parasitic infection called toxoplasmosis, maybe one that people are familiar with, but not super common as well. You may not hear so much about it. I think the context that most people hear about it in is related to cats and changing the cat litter. I think everyone is pretty familiar with that recommendation that pregnant women shouldn’t be handling cat litter.

But people are maybe less familiar with the fact that toxoplasmosis can be found in the environment. Gardening, for example, especially if you have cats or animals in your neighborhood, if you ingest soil bacteria that enter and get under your nails or something like that, can be one of the ways you can get toxoplasmosis. And not washing fruits and vegetables — so having dirt contamination of fruits and vegetables and eating them is a probably an even more common way to acquire toxoplasmosis than from a cat even. I think making sure that you wash produce really well is important and just good hand hygiene if you’re doing gardening or other outdoor activities. Toxoplasmosis can also be transmitted through undercooked meat, fish–shellfish as well. Making sure that you cook those things through if you’re eating them is another way that you can reduce your risk. We see much lower rates here than, for example, in parts of Europe; so if you’re traveling or doing things like that, it’s also important to understand what’s going on in the places that you’re going to.

Dr. Angela Mattke:

The toxoplasmosis is really interesting because I’ve been using that as an excuse not to change the cat litter for, like, 18 years with my husband. Theoretically I couldn’t garden either or do all the things when I’m pregnant. Don’t tell my husband about those. Does that sound good? What about caffeine in pregnancy? I gave up coffee during pregnancy because I just couldn’t stand the smell of it. Not because I didn’t want it. I still had caffeine in tea and stuff like that from time to time. But what’s a safe amount of caffeine during pregnancy?

Dr. Nipunie Rajapakse:

Yeah, so this was another one that I was interested in. I am a coffee drinker. I didn’t drink a huge amount. I usually had one or two cups a day before I got pregnant. Generally, the recommendations now are less than about 200 milligrams of caffeine per day is likely safe. That’s about one or two cups of coffee per day. Different coffee products can have different amounts, so it’s important you look at exactly what you’re having and see what the caffeine content is. There were some studies that suggested that maybe excess caffeine intake could result in a higher rate of miscarriage. Given my age and already being at relatively high risk, I did give it up for the first trimester because it’s kind of when the risk is highest; but I have gone back to having one cup a day in the morning. I need it to function at this point. I missed it.

Dr. Angela Mattke:

Yep! Especially because you’re exhausted during pregnancy.

Dr. Nipunie Rajapakse:

Yeah. I missed it when I had given it up. I decided that was something I was willing to compromise a bit on.

Dr. Angela Mattke:

The take home message: stay away from the energy drinks, basically–the things with massive amounts of caffeine in them. Do you want to summarize for us some of the do’s and don’ts, of the don’ts list of things that have pretty clear evidence? And some of the things that are ‘assess your own risk.’

Dr. Nipunie Rajapakse:

Yeah. Pretty clear don’ts are avoiding unpasteurized dairy products, avoiding deli meats, unless they’re heated, which I think is very reasonable. Alcohol is the other one that often comes up on this list as well. Also, if you look at the recommendations of all of the major pregnancy or pediatric organizations, they all say there’s no known safe level of alcohol during pregnancy. Certainly, many women decide to just completely give up alcohol. That being said, I also looked into this a bit more, just to see what the evidence and the data is behind it. Obviously, this is not something that we can do the highest level of clinical trial and randomized people at this point.

Dr. Angela Mattke:

That is not ethical.

Dr. Nipunie Rajapakse:

We do know that high levels of alcohol intake, especially early in pregnancy, can result in fetal alcohol syndrome, which can have lifelong consequences for children. There have been some studies that have looked at varying amounts; and when you look at practices across the world, especially different parts of Europe, there are different philosophies about alcohol intake. In some countries, it is not unusual for pregnant women to have a glass of wine or something like that. Even though we can’t do a randomized trial, we do have this natural experiment of different parts of the world doing different things and being able to follow the outcomes. Generally, most of those studies have been pretty reassuring when it comes to low levels of alcohol intake during pregnancy. So a glass a day or less generally has been the cutoff that they’ve used in that those children don’t seem to suffer major untoward effects in terms of their development. Because the threshold has not been firmly established — if you want zero risk, then the recommendation is to not have any alcohol during pregnancy, which I think is a reasonable thing and many people choose to do that.

Dr. Angela Mattke:

Anything else that you want to add in the don’t list?

Dr. Nipunie Rajapakse:

I think just common-sense things that we would recommend for everyone. It’s summer now, people are doing, things like–a lot of grilling outside. Making sure that you’re following all the foodborne illness precautions in general is probably the most important piece of advice. You’re much more likely to get sick from something routine that doesn’t necessarily pertain to your pregnancy specifically. And so, following that advice is really important.

Dr. Angela Mattke:

Thanks everyone for joining today. Make sure you don’t miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoy this episode and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We’ll see you next time.

Angela Mattke

Angela C. Mattke, M.D.

Dr. Mattke is the medical editor of Mayo Clinic Guide to Raising a Healthy Child and  a pediatrician in the Division of Community Pediatrics and Adolescent Medicine at Mayo Clinic Children’s Center in Rochester, Minnesota.

Nipunie Rajapakse, M.D.

Dr. Rajapakse is a pediatric infectious diseases physician at Mayo Clinic in Rochester, Minnesota. Her clinical focus includes management of pediatric infections. Her primary research interests include studying ways of optimizing antibiotic use in children (antimicrobial stewardship) to decrease antibiotic resistance and other harmful effects. She has worked for the World Health Organization and has an interest in global health and outbreaks of emerging infectious diseases.

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