Home' Trinidad and Tobago Guardian : August 26th 2013 Contents A36
body & soul
Guardian www.guardian.co.tt Monday, August 26, 2013
Pregnant women face a lot of dos and don ts
when it comes to food and drink, as in other areas
of life. Working out where to draw the line is not
always easy---though having a good head for sta-
tistics can help.
"When I first found out I was pregnant, I really
wanted to have a cup of coffee. It was first thing
in the morning. And then I thought all of a sudden,
Oh my gosh---am I even allowed to have one cup
of coffee? " recalls Emily Oster, an associate professor
of economics at the University of Chicago.
She turned to the internet and found, not sur-
prisingly, that there was no consensus. Then she
found that even books disagreed... and her doctor
didn t always agree with the books. Some writers
said pregnant women should avoid coffee completely.
Others advised drinking no more than two cups.
Yet others drew the limit at three.
"I ve read books that said six. And so I felt like
there must be an answer to this," says Oster.
"The answer isn t both zero and six. Surely there
is an actual number in here, and I wanted to try to
understand both why there s so much disagreement
but also really what is the right decision."
Using her statistical training, Oster decided to
review the medical literature herself.
It is fine to have two cups a day, she concluded.
But she describes herself as "more of a two-to-four
cups a day coffee lady"---and at this level, she says,
the evidence appears to be mixed.
"Early on I felt terrible, and I was not really able
to have any coffee which was very sad for me, but
once I got into the second and third trimester and
I was feeling better, I often had three cups a day
and I felt comfortable with that.
"When you look at more---at six or eight cups of
coffee---there is some more evidence that that might
be risky." Oster, now the proud mother of a healthy
two-year-old girl, has gathered together her work
in a book, Expecting Better. She hopes that where
the evidence is mixed, readers can consider the facts
and make their own decision, based on what they
are personally comfortable with.
It is difficult to draw firm conclusions, she says,
because most of the studies are not randomised---
it wouldn t be fair to divide pregnant women under
study into two random groups and ask one group
to drink coffee and the other to drink none.
Consequently, Oster says, the people involved in
the studies differ in many ways that could affect
the course of their pregnancies, not just in their
"The big issue is that caffeine consumption cor-
relates very strongly with how nauseous you are. A
lot of pregnant women are very sick, especially early
on---the women who are sicker tend to drink less
"But we know that being sick is a sign of a healthy
pregnancy. And so when we see that women who
drink less coffee also have more successful preg-
nancies we don t really know if that s just about
coffee or whether it s really a confounding factor
from this nausea." But coffee was just one item on
a long list of forbidden, or semi-forbidden, items
that Oster wanted to investigate. Alcohol for example.
Some health services, like the National Health Service
in England, recommend that women avoid alcohol
altogether in pregnancy, but Oster says she decided
that on the available evidence, she felt comfortable
having three glasses of wine---in total---in the first
trimester, and then half a glass three or four times
a week in the second and third trimester.
"One thing that comes out very quickly, which
is very important to emphasise, is that heavy excessive
drinking in pregnancy is very dangerous. That s
something you see very clearly in the data.," Oster
"But when I looked at the evidence on having an
occasional drink---a couple of drinks a week maybe
in the first trimester, up to a drink a day in later
trimesters---I found that the evidence suggests that
"We don t have large randomised trials, but we
do have a lot of high-quality studies which show
that the children of women who drink occa-
sionally have very similar outcomes to the
children of women who abstain." This is
not the view of the UK s National Health
Service. Dr Vivek Muthu, director for
healthcare at the Economist Intelligence
Unit and chief executive of the healthcare
evidence consultancy, Bazian, says the evi-
dence suggests that even a low alcohol
intake can risk damaging the developing
"Therefore the best and simplest advice
which the NHS gives out is not to drink
at all," he says. And while the risk of damage
might be lower the less alcohol the pregnant
mother drinks, that doesn t mean, Muthu
says, that the magnitude of the damage
will be lower. "The consequences could be
just as bad as with higher levels of intake,
and could result in permanent and severe
physical and mental disability," he says.
He adds: "There are additional difficulties
around defining from the evidence what a
low intake would be in terms of units of
alcohol, and how this might be interpreted
by different people in practice." (BBC)
Coffee and wine: How much can pregnant women have?
YOUR DAILY HEALTH
News and Advice
There is a wide divergence in opinions on
how much alcohol women are allowed to
consume during pregnancy.
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