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Economist questions pregnancy rules

Author challenges conventional wisdom

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Many women find the time they have with doctors is limited and it can be hard to get the answers they seek, says Emily Oster.

MATTHEW GILSON /PENGUIN PRESS / THE ASSOCIATED PRESS Enlarge Image

Many women find the time they have with doctors is limited and it can be hard to get the answers they seek, says Emily Oster.

NEW YORK -- Emily Oster isn't a baby doctor. She's an economist and a mom who wanted to know more about all those rules handed down to women after the pregnancy stick goes pink.

Only two cups of coffee a day! No alcohol. Beware deli meats.

Being pregnant, she said, felt a lot like being a child, so she decided to take a deep dive into research covering everything from wine and weight gain to prenatal testing and epidurals. What she found was some of the mainstays of pregnancy advice are based on inconclusive or faulty science.

To this data-cruncher, an associate professor in the University of Chicago's business school, those magical nine months became a question of correlation and causation.

Some of her conclusions? Weight gain during pregnancy is less important than a woman's starting weight and not gaining enough may be more harmful. Light drinking is fine (up to two glasses of wine a week in the first trimester and up to a glass a day in the second and third trimesters). And much of the evidence supports having three to four cups of coffee daily, which made Oster very, very happy.

There's more, of course, and not all of it runs counter to standard medical advice. And she happily reports in Expecting Better, her book corralling all the research for other women to share, that her two-year-old daughter, Penelope, is healthy and happy.

The book, from Penguin Press, is out this week. A conversation with Oster:

 

AP: Have you written the "Freakonomics" of pregnancy?

Oster: I think it's right that it feels a little bit like 'Freakonomics' because Steve (Levitt) and I are both economists, but the goal here was really to write down an approach that was right for me. The approach being thinking carefully through all of these decisions, getting the best data that you can and then structuring the decision in a way that takes into account your personal preferences, tolerance for risk and all the kinds of things that we should be thinking about every day.

 

AP: Do you anticipate blowback from women and doctors because you're an economist and not a medical professional who helps manage pregnancies?

Oster: There's a real sense in which pregnancy should be something you do with your doctor, but I think for a lot of women the time you have with your doctors is limited and it can be difficult to get all of the answers to your questions.

 

AP: Are most pregnant women ill-informed? Are doctors and other pregnancy professionals lax in keeping up to date on research that might lead to more specific recommendations?

Oster: I think we see sometimes where practice lags behind recommendations. Not all practitioners, obviously. As an example, in the case of prenatal testing, even though more recent recommendations don't favour the 35-year-old cutoff as much, that's still a highly practised thing, so I think there's a sense in which there is some slow creep of knowledge.

I actually think pregnant women are really well-informed but I think that there's a tremendous amount of confusing and conflicting information out there. You could read every pregnancy book and every pregnancy website and come away thinking on some topics, I have no idea what the real facts are.

 

AP: Isn't that what the American Congress of Obstetricians and Gynecologists is for? They have committees to vet research and keep up to date.

Oster: Yeah, it is, and actually in a lot of cases I found that women would do quite well to read the ACOG opinions. There were a few cases where I thought perhaps they were overly cautious but actually there's a lot of settings in which I think that would be a great place to start. There are certainly times in which practice hasn't really caught up to those opinions.

A lot of the choices women need to make in pregnancy, it's sort of not possible for ACOG to tell them the right answer. For example, if you think about prenatal testing you're thinking about a case in which you're trading off more information about the baby for some small risk of miscarriage. Ultimately that needs to be combined with women's own ideas about how they feel about a miscarriage versus how they feel about a developmentally delayed child and that's not something a recommendation can tell you. That's something you need to learn to think through on your own.

 

AP: That leads me to the vices, including alcohol. You and ACOG differ on that. ACOG recommends no alcohol.

Oster: I think we can all agree heavy drinking and binge drinking, even occasionally, is very dangerous, and I say that in the book. What I found is there are a large number of quite good studies with a lot of women that show having an occasional glass of wine does not seem to pose a problem, that children of pregnant women who drink occasionally have similar or in some cases even better outcomes than children of women who abstain. This is a very personal choice. In some other countries, the recommendations are it's OK.

 

AP: When in this country did pregnancy become this exercise in self-denial? Are women needlessly suffering?

Oster: Sometimes. I think we've moved this way over time and in some ways it's very good, thinking through pregnancy and parenting in a thoughtful and careful way. I think that's great. But I think there is, sometimes, this kind of shaming aspect to pregnancy.

 

AP: The editors at Parents.com have already called some of your recommendations flat-out dangerous to pregnant women, particularly your views on alcohol and caffeine consumption.

Oster: Many of the OBs that I have spoken to and many of the women who I have talked to about the recommendations from their doctors have told me that the doctors say, 'Yeah, it's fine to have a couple glasses of wine.' This is a conversation which will continue to evolve.

 

-- The Associated Press

Republished from the Winnipeg Free Press print edition August 20, 2013 C11

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