Have pregnant women always been scared by food?

What to eat. What not to eat.
Sept. 15 2004 6:55 AM

Food Fright

Today's pregnant women are afraid to eat sushi, tuna, peanut butter, aioli, coffee, bologna, and more. Was it always this way?

Illustration by Nina Frenkel

I've got to confess: I'm in my eighth month of pregnancy, and so far I have sheepishly eaten several slivers of air-dried Serrano ham, a few crumbles of blue cheese, and one shimmering piece of yellowtail nigiri. Then, there's the red wine. It started with furtive thimblefuls (just to taste a new wine at the restaurant where I work!) but has spiraled out of control into a biweekly half-glass. All of these items are on the do-not-consume list for pregnant women, but no one seems to be able to tell me how much of a risk occasional lapses like mine pose to my baby. Food, which has always been my great delight in life, has now begun to freak me out.

I'm clearly not alone. As Alex Kuczynski observed in the New York Times, incessant warnings from doctors, friends, and the Internet tend to give the modern pregnant woman a nasty case of "pregnancy paranoia." The list of sketchy comestibles is almost comically long. Alcohol is an obvious no-no even though it's unclear whether or how moderate drinking could lead to fetal alcohol syndrome or miscarriage. We are also told to avoid deli meats (listeria risk), sushi (parasite risk), coffee (possible miscarriage risk), soft and blue cheeses (listeria again), peanut butter (allergy risk), tuna (mercury risk), liver (retinol poisoning risk), aioli (salmonella risk), herbal teas (untested medicinal effects), and any meats cooked less than shoe-leather tough (toxemia risk). It's understandable that modern women think they live in a time when it's particularly stressful to be pregnant. But are the vigilance and anxiety that accompany pregnant women to the dinner table really all that new?

As long as women have been carrying children, they have received advice, often dour, often from men, about what to eat and drink. Even Plato had his rather common-sense saying: "Children shouldn't be made in bodies saturated with drunkenness." But alcohol hasn't remained off-limits throughout history: According to historian Janet Golden, in the 18th and 19th centuries, alcohol was prescribed to pregnant women as a tonic to treat "deranged stomachs" (the contemporary term for morning sickness). Even though nutrients had not yet been discovered, women were still directed to eat or avoid certain foods. It was believed that a mother who consumed sour, spicy food might produce an ill-tempered baby, and mothers were sometimes urged to eat "young meats" like lamb and veal in the interest of their own young offspring.

Illustration by Nina Frenkel

Childbirth, of course, used to be a more deadly business for mothers and newborns—one that may have stoked apprehension in many new mothers but may have also prompted a certain fatalistic repose. In the 1880s German Dr. L. Prochownick developed a high-protein, calorie-restricted diet intended to help expecting mothers limit the weight that they—and thus their fetuses—would gain during pregnancy. The theory was that a smaller baby would make for an easier delivery. We now know, of course, that low-birth-weight babies have a harder time surviving. But low-pregnancy-weight gain remained a major recommendation even as modern obstetrics (prenatal consultations, C-sections, antibiotics) helped maternal mortality rates shoot downward in the midcentury. Doctors worried about the effects of substantial weight gain on a mother's overall health. The low-weight-gain imperative was supported by the spurious view, popular through the 1960s, that the fetus was a "perfect parasite," siphoning off its nutritional needs from the mother's body, regardless of her diet (a notion that no doubt set a mother's mind at ease when it came to her prenatal eating habits).

Although eating too much was long discouraged, the role of dietary nutrients became clearer throughout the 20th century; doctors began to recognize that a good diet could have a positive impact on maternal and newborn health, even if they did not agree on specifics. As the century progressed, supplements and vitamin-rich foods, like cod-liver oil and liver, became more commonly recommended for mothers to be. Moderate alcohol use was not forbidden, but liquor was shunned as a source of "empty calories" not worth the potential weight gain. It has only been since the 1980s or so that, in the United States, the hazard of a malnourished baby has trumped the potential complications of the postpartum mother's being overweight, and women are given more workable guidelines for weight gain: 25 to 35 pounds for an average woman, 15 to 25 for an overweight one. (In the midcentury the recommendation for an average woman maxed out at about 20 pounds, and some overweight women were even encouraged to lose weight.)

But as weight became less of an obsession, the relative safety of everything a mother consumed became more of an issue. In the 1980s the popular mothering-advice business exploded with the publication of the best-selling What To Expect When You're Expecting series. (WTEWYE itself has sold over 10 million copies since its 1984 debut.) The books, which continue to be an essential part of the pregnancy library, exposed women to a wealth of information about pregnancy, but they were also notorious for their puritanical tone, particularly on issues of nutrition. The WTEWYE "best odds diet" demanded not only increased vitamin, protein, and iron consumption from expecting mothers, but urged them, while they were at it, to seriously restrict salt and fat intake and to give up refined flours and sugars. The nutritional companion to What To Expect, called What To Eat When You're Expecting, scolded, "Nothing offers your baby less to grow on than sugar. Every calorie refined sugar supplies could better come from foods that yield a nutritional return, which is reason enough to offer it to your baby as rarely as possible." At the core of this thinking is the overwhelming notion that no action a mother takes is without direct consequence for the baby. "Your baby equals what you eat." (The times have changed a bit: A recent third edition of What To Eat boasts an "all-new (guilt-free!) attitude.")

The WTEWYE books were not so much the cause of pregnancy paranoia as the crystallization of a trend that was already in the works. One reason for the new parental vigilance might have been the newly available images of unborn children. Until the late 20th century, Americans had never been so aware of the prenatal life of a fetus: The spread of ultrasounds and amniocentesis in the '70s and '80s gave women a glimpse of their babies in utero while Roe v. Wade sparked the legal movement toward what Golden calls "fetal personhood." At the same time, childbirth professionals became increasingly legally liable for anything that went wrong with a child's delivery, so instead of offering common-sense advice, many health-care professionals were understandably inclined to tell women how to avoid all possible risks. The surgeon general's 1989 warning about alcohol use during pregnancy, for example, called for absolute abstention, even though fetal alcohol syndrome develops almost exclusively in the offspring of alcoholic women.

In the wake of WTEWYE's success, dozens of pregnancy guides sprang up in print and on the Internet, many with "don't" lists outnumbering "do" lists. And this is a key problem with contemporary pregnancy advice, on culinary matters and otherwise—the emphasis on fears of a poisonous environment, rather than on positive steps that can help the baby's development. On babycenter.com, the massive Web site for parents and parents-to-be, for example, the paid content, which is presumably the site's most desirable, consists largely of anxiety-focused information: baby equipment recall alerts and a long list of "Is it safe" questions and their heavily qualified answers.

Before the window into the womb opened up, pregnancy's anxieties stemmed more from a lack of information than its overabundance. As my mother, who was pregnant in the '60s and '70s, said: "We certainly knew something could go very wrong, but there was not too much we could do about it." A woman who made the effort to eat liver and onions once a week was pretty proactive in those days. But thanks to a surfeit of information, today's expecting mothers have a sense of culpability about every bite they eat and sip they take—even if they don't know precisely how risky such behavior is. As much as I wish some of the information available were more conclusive, I have come to accept that there will probably never be a double-blind study on the effects of raw yellowtail on fetal development. I do know I'm looking forward to the sushi party I'm going to have in celebration of my baby's birth. Or do I have to wait until I'm done breast-feeding?

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