As The Toast searches for its one true Gal Scientist, we will be running a ton of wonderful one-off pieces by female scientists of all shapes and sizes and fields and education levels, which we are sure you will enjoy. They’ll live here, so you can always find them. Most recently: So What Is It You Do?
I do Bad Mommy science.
Well, it’s a little more complicated than that. I am a doctoral student in epidemiology and biostatistics, and my particular area of research is in reproductive and perinatal pharmacoepidemiology. This means that I study medication use in pregnancy and its possible effects on both the mother and her children. I’m especially interested in medications that affect the central nervous system, like psychiatric meds and some pain medications, and their possible effects on neurodevelopment in childhood.
I chose this area for a number of reasons. I started down this path because the field is so complex, and the causal mechanisms so convoluted, that it just seemed like the best, most awesome, coolest project I could pursue. I love a good puzzle. You have to think about why women take medications (because their illness is more severe than women who don’t take them? Because they’re less risk averse? Because of differences in education or access to health care?), what other substances they’re also taking (opiates plus triptans? antidepressants plus benzos? meds plus cigarettes?), whether those substances could plausibly cross the placenta in large enough doses to cause harm, and what systems could be affected if they do. And then when you’ve got a reasonable handle on what you think is going on, you need to fit an appropriate statistical model to try to figure out how much of the effect you’re seeing is due to chance, and how much is really related to the medication. It is, to quote a previous Gal Scientist, FASCinating.
But I do have other reasons for focusing on this research area. In case you didn’t know, in the US, more than 70% of pregnant women take at least one prescription medication (Mitchell et al. 2011). For most medications on the market, the clinical trials that were used to get those medications approved systematically excluded pregnant women. There are excellent reasons for doing this, but they’re also a really good example of a Catch-22: pregnant women are excluded from clinical trials because of the potential risks to fetal development, but because pregnant women are excluded, we don’t know what those risks might be.
This leaves pregnant women and their physicians hopelessly mired in confusing information about medication safety. Most of the literature is either based in animal research, or in observational studies. Animal research can make valuable contributions, but I think even the bench scientists would agree that studies in animals are the beginning of understanding effects in humans, not the end. Observational studies, without getting into the very technical details, can be valuable but are incredibly complex: it’s very difficult to disentangle the exposure you’re interested in (the medication) from all the other potential factors that tend to cluster around that exposure.
Not to mention, while some effects of taking a medication during pregnancy may be visible in the short term, like limb malformations in babies exposed to thalidomide, other effects may take years or even decades to see, like the increased risk of vaginal cancer in women whose grandmothers took diethylstilbestrol. Diethylstilbestrol, or DES, was prescribed to pregnant women to prevent miscarriage, and was on the market for more than thirty years. Doing the kind of studies that can detect effects that occur over years or decades isn’t just practically difficult: it’s also enormously expensive.
The expense, as well as other considerations, often leads to epidemiologists cobbling together study cohorts from existing data. This works really well if you work in one of the Scandinavian or European countries that have comprehensive cradle-to-grave population registries. But if you’re interested in working with the US population, the situation is a bit murkier. We often end up relying on administrative data- that’s the electronic detritus left behind when you or a hospital files a claim with your insurance company*- and while administrative data is better than nothing, it’s far from perfect. When I use Medicaid data to study antidepressant use in pregnancy, for example, I know exactly how many times a women filled a prescription for an antidepressant, but I don’t know whether she actually took the medication, and I don’t know how severe her depression is. I can imperfectly infer the latter from her history of other medication use or psychiatric hospitalizations. For the former, the only way to really figure this out is to conduct a validation sub-study, which takes a lot of time and money.
All of this is by way of saying that the research out there is valuable, but it isn’t perfect. So what should women make of these studies that show possible risks for medication use? I’m still learning, but I have some suggestions:
1. First, and most importantly, talk to your health care provider, and definitely don’t make any changes to your medications on your own. Remember that epidemiology studies usually cover huge, diverse populations and report aggregate risks. You might have a specific cluster of risk factors that make a medication more or less safe for you, and the only way to figure that out is to talk to your doctor.
2. If you are able to read the actual published article, or its abstract, see if it reports on the absolute risk, as well as the relative risk. Here’s an example: imagine that you have a study with 100,000 women. The article reports that exposure to Medication X results in a doubling of risk for Birth Defect Y. This sounds terrifying, and it’s the way that many articles report results. But the key is to understand what the baseline risk really is.
A doubling of risk could mean that the rate of the birth defect goes from 0.1% in the unexposed population to 0.2% in the exposed, or from 10 to 20%. In the first case, exposure to the medication results in 100 extra cases, while in the second, exposure results in 10,000 excess cases. The relative risks are the same, but the public health impact is orders of magnitude different. You can see this in action in a recent article linking antidepressant exposure in pregnancy to risk of autism in children (Rai et al. 2013): while the authors did find an increased relative risk, they also note that exposure to antidepressants accounted for less than 1% of the autism cases they found. In this study, in other words, antidepressant use is not to blame for the autism epidemic.
3. When you read the article, check whether the authors examined the effects of the underlying illness, as well as the medication. Pharmacoepidemiology studies almost never have great information on illness severity, especially when the illness is something like depression, because severity isn’t easily measured, even with unlimited time and funds. If both the illness and the medication might cause harm, it’s very difficult to disentangle the effects (this is a phenomenon called confounding by indication, if you’re curious.) For example, some of the recent studies on antidepressants in pregnancy suggest that the differences between exposed and unexposed children may be largely due to depression itself, and that once analyses make adjustments for the severity of depression, the differences disappear.
4. Try to figure out how skeptical the authors themselves seem about their findings. This may seem counterintuitive, but the more an article talks about all the ways their findings could be wrong, the more I trust that the authors have done a careful, thoughtful analysis. When I read an article, I try to frame my skepticism like this: what specific piece of knowledge would make me doubt these results? Imagine that you read a study showing that drinking coffee during pregnancy causes low birth weight, but the study doesn’t include information on maternal smoking. I know that smoking is related to coffee consumption and also to birth weight, so in this case I’d probably be pretty skeptical of the results, and the study authors should be too. If they did some further analysis to figure out how much smoking could have affected their results, I’d be more inclined to trust the study; if they don’t mention it, I immediately start to wonder what else they’ve missed.
5. If evidence really begins to accumulate in a particular area, you can usually find a meta-analysis or at least a systematic review that gathers more than one study together and attempts to make sense of the totality of data. Do I think the lay public should be responsible for this? God no. Cochrane reports sort of make my brain hurt, and I’ve been doing research in this area for the better part of (gulp) nine years. But I think this is a good illustration of the idea that you should never base a medical decision on just one study, which, for all of the reasons I’ve listed above, is pretty much guaranteed to be imperfect.
Doing this kind of research leaves me with all kinds of conflicted feelings at times. Whenever I find harmful effects associated with medication exposure, I’m both excited and disappointed. The excitement is for my career, because significant differences get you published in higher-impact journals, and publications, as a previous mentor liked to intone, “are the currency of academia.” The disappointment is because in a perfect world, pregnant women would be able to take a medication they need without worrying about its possible effects on their baby. And because I’m interested in a group of medications that treat illnesses like depression and chronic pain that are sometimes seen as less “real” than cancer or hypertension, I worry that my work contributes to the stigma surrounding these illnesses, and might make it more difficult for pregnant women to get appropriate care.
I think that this conflict has made me a better scientist. It’s made me more careful in how I think about findings that might lead to changes in medication use recommendations. I try to think about the results of my studies in terms of their usefulness to health care providers as well as to the research community. At the end of the day, I have to believe that more information is better than less, and that my main responsibility is to do careful, rigorous work that moves the field forward.
I’ve never been pregnant myself, so I don’t have any first-hand experience of how it must feel to be told at every turn that anything you do wrong could have terrible and lasting effects on your children. I’m sympathetic to the rash of blog write-ups and comments that blast these studies, even though at this point I’ve pretty much had to stop reading them. I hope this article has done a reasonable job of conveying that those of us who do work in this area are doing the best we can to answer complex questions with less-than-ideal resources. And I really hope that it will help you to put risks in context, next time you see an attention-grabbing headline about medication use in pregnancy.
*In case this isn’t clear: administrative data are completely de-identified, meaning that there is no possible way for a researcher to link a woman in a database to a real person out in the world.
***
References
Mitchell, Allen A, Suzanne M Gilboa, Martha M Werler, Katherine E Kelley, Carol Louik, and Sonia Hernández-Díaz. 2011. “Medication Use During Pregnancy, with Particular Focus on Prescription Drugs: 1976-2008.” American Journal of Obstetrics and Gynecology 205 (1) (July): 51.e1–8.
Rai, D., B. K. Lee, C. Dalman, J. Golding, G. Lewis, and C. Magnusson. 2013. “Parental Depression, Maternal Antidepressant Use During Pregnancy, and Risk of Autism Spectrum Disorders: Population Based Case-Control Study.” British Medical Journal 346 (April 19): f2059–f2059.
Tags: gal science, mollie wood, mommies, parenting, pregnancy, science
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This is so brilliantly timely, because I’m quietly freaking out about the acetaminophen/ADHD study that the news was covering yesterday. I haven’t tracked down that study and I don’t know if I’ll be able to make any sense of it when I do. Any thoughts on that particular study, Gal Scientist Wood?
(Also, god damn it if pregnancy isn’t, for me, a fight to the death between my belief in Better Living through Chemistry and my stoic lineage urging me to Just Tough It Out.)
My husband sent me an article about that study first thing this morning. Awesome, because that’s the ONLY THING I CAN TAKE already. I’m not pregnant yet, but hoping to be soon, and I had just assured him that it was fine for me to pop a Tylenol for a headache. I replied that I’d just have to make do with a glass of wine.
I was just talking to a friend about this! My husband announced last night I should not take Tylenol anymore (currently pregnant) and I was like, um, what? The story I read said 37% higher risk but didn’t include the absolute risk which, ugh, come on! It also said there was correlation between women who took it regularly for 20+ weeks and a higher risk, which makes me skeptical that occasional use is much of a danger.
Great article. It seems like such an understudied field (for all the reasons you said) and it’s just one more cause of anxiety during pregnancy.
That study is so frustrating, especially because if you have a fever during pregnancy, you might want to treat it because fever during pregnancy is correlated with autism. Damned if you do..
Anyway, the LA Times article about the study had some slightly reassuring numbers regarding the absolute risk: “the baseline incidence of ADHD-like behaviors in children who weren’t exposed to acetaminophen in utero was about 2.5%. Among those who used the medication at some point during pregnancy, the rate was 3.4%.”
I’m not a doctor or anything, but those low percentages made me feel better that I did take Tylenol while pregnant. I suppose I’d probably try to tough headaches out next time around, but then a study will probably come out finding that maternal pain during pregnancy is associated with developmental disorders!
Ooh, you read a better story than I did. Thanks!
this is so confusing to me! so the RISK of ADHD increases by 63%, but the actual occurrence is still only 3.4%?
Yep, you’re got it right. The risk of ADHD is small, so multiplying it even by 63 percent still gives you a small number of total cases.
The 3.4 percent number from the LA times article were from any exposure over the course of the pregnancy. Apparently the relative risk is a bit worse (the 63% vs 29%) for people who took it over the second and third trimesters, but the article didn’t break out all the absolute and relative risks for each way of looking at the data.
I should have linked! It’s a pretty measured take. http://www.latimes.com/science/la-sci-tylenol-pre…
Maybe think of it this way: a 10% raise is (probably) a lot more money for a lawyer than it is for a fry cook.
It’s really frustrating when (otherwise very good) articles like the JAMA ADHD one don’t put the findings in absolute as well as relative terms.
Thank you for looking into that more. I had to take acetaminophen long term during my pregnancy, because I was dealing with a pain issue that regularly results in hospital bed rest and narcotics (Tylenol > narcotics in pregnancy, right?), and I was starting to get paranoid that MAYBE EVEN TYLENOL ISN’T SAFE, and maybe I’ve put my kid at risk for ADHD. (Tylenol is treated as the gold standard for medications that are safe for pregnancy!)
It is such an annoying mind battle! Sometimes the mind grows weary though, and you just have to have a Tylenol or Zyrtec or Unisom, or you will just have to have four shots of tequila instead.
Delurking, as a pregnant woman who spends a good deal of time resisting the urge to freak out. Considering how controversial the diagnosis and medication for ADHD are, it’s hard to imagine there’s not a lot of subjectivity going on in this study (especially since they relied so much on self-reporting). It looks like a big part of what the study measured was official hospital diagnosis and prescription of ritalin: http://archpedi.jamanetwork.com/article.aspx?arti…
I feel like it’s not too surprising that a mother who did not take a single, lonely tylenol (i.e. the only “safe” OTC painkiller for pregnant people) during all 9 months of pregnancy might also be type of mother who would be less likely to seek a ritalin prescription for her child.
I’m just frustrated that this is going to create another reason to shame pregnant women.
Hi ellebeaux!
That’s a good point about mothers who use less medication also seeking less medication for their children, and the study does not address that. I don’t think we can discount the results of the study, though: when the SDQ is used, which doesn’t rely on stimulant prescription, we still see similar results. Also worth noting: there’s evidence of a dose response, meaning that more use of acetominophen –> higher risk of ADHD-like symptoms.
But I understand your frustration, and you’re probably right: there are women who will feel like they aren’t even allowed to take tylenol during pregnancy, even though the study shows very small effects.
Hi Madge! I only just finished the ADHD article, so these are just some early impressions, but:
(1) This is the second (I believe) study to implicate acetominophen exposure as a risk factor for behavioral problems in kids. The other study (full disclosure, I work with some of the authors on that paper, which is based in Norway) compares sibling pairs and also found a significant effect of exposure. I don’t believe that these two studies show a strong enough effect to make a blanket recommendation to all pregnant women, but I do think if you’re worried, it’s worth discussing risk factors with your OB, like what other medications you’re taking. But let me reiterate, I am definitely Not That Kind Of Doctor!
(2) I also looked at the supplemental materials for the ADHD study, where they did analyses within sub-groups of women, i.e. women who had joint disease during pregnancy, or women who had fevers. The findings don’t change much, which should give us some confidence in the results.
(3) As the LA Times write-up mentions, the base rate of ADHD in the study is pretty low, so even an increase of 37% isn’t a huge number of children. I do which the study had reported risk differences, though: it would make the results much easier to understand!
Look how normal and nice and informed you seem!
It’s part of my protective coloring!
Major kudos for this article (from a fellow public health researcher)! I hear you on the conflicted thing–I find it difficult to justify to laypeople, and sometimes myself, all the uncertainty generated by (and necessary to) this sort of research, especially when it feels like everything in academia takes sooo loooong and feels like such a small contribution to our general knowledge. But, as you said, more knowledge is better than less, especially when it’s well-done.
Better incremental than excremental, I like to say.
This is awesome. I love #4.
This is such a good series, I am so glad it has a home here at The Toast.
Thanks for the really great article, Mollie!
Aw, thanks!
This is really great, but as a highly-educated but non-science/medical/PH person who’s had to do her own medical research, reading and understanding peer reviewed science and medicine articles can be intimidating and really challenging if not nearly impossible.
I can imagine- I mean, I’m a bone fide Gal Scientist and it usually takes me an hour and a couple of readings to do a close read on articles that I want to cite for a paper or use as a guide for methods.
At the risk of sounding defensive, though, I’m just not sure what the solution is. Scientists tend to rail against poor science reporting, and I think that’s fair to an extent, but I think we could also be better about communicating results.
What do you think?
I’m not terribly sure what the solution is, either, at least realistically. In a magical world in which we all ride unicorns, I’d like a layman’s version of the abstract or summary available on all advanced-level articles.
Or possibly doctors who had constantly-refreshing encyclopedic memories of every issue ever, and no biases when it came to the people they were treating.
(I had to do my own medical research because a NP told me I was too fat for my specific type of birth control, and the best conclusion I could get out of said research was “most likely not, but we have literally no fucking clue,” so I have a chip on my shoulder about this particular experience.)
I was just saying to a friend the other day that the line between “Oh, cool, no one has studied this before!” and “Oh, shit, no one has studied this before” is fine and ever-moving. Before I started working on my dissertation, I had no idea that medication use in pregnancy was so laughably under-studied. And for “medication use in pregnancy” you can certainly substitute in any one of a number of areas, most definitely including obesity. Tracing the history of medical research absolutely reveals the prejudices of the medical and research community.
My recent “oh, shit” moment was medication use in people with suicidal behavior.
Also, just the general lack of actual evidence-based medicine. Terrifying!
I had an anthropology teacher who marked us down for using big words – her point was, if you can’t say what you need to say in a very easily-understood way, there is very little point in saying it.
The studies themselves can be dense and full of all the technical things they are full of, but researchers should write abstracts that are easy for people to understand at least…
If I may make a case for the jargon-y abstract: most journals limit you to about 250 words, and in some cases, the jargon is just a more efficient way of getting your point across.
There are a couple of journals, especially the more clinically-focused ones (JAMA, BMJ, plenty of others) that require you to sum up the implications of your study in bullet-point form, which I actually think makes more sense than simplifying abstracts. I think it would be great if we had to send in plain-language summaries with each manuscript submission. I also work with a researcher who makes youtube videos that outline the results of her studies, which I love and plan to start doing.
I was SO crunchy when I was pregnant, and when I started getting heartburn really bad (for the first time in my life) in my third trimester, I refused to take anything for it, and then when I went in to see my midwife and mentioned it she did an epic eyeroll and was all “do you want permanent damage to your esophagus? Start taking some Tums, dummy” and then I never had any problems ever again and my kid can pee on the pot and everything.
God, I was also crunchy, but I’m starting to feel downright reactionary these days. I’m part of a local mom group on Facebook and the ladies there are constantly suggesting things like elderberry syrup to prevent measles and probiotics to combat PPD. I should probably leave the group before I start telling everyone to just freaking vaccinate and take a goddamn antidepressant.
I know! I also used to be, like, lukewarm about people having homebirths and now I think it’s nonsense.
I remember my moment of turning away from the crunch came about midway through pregnancy, when I ordered a book about hypnobirth. When it arrived I was so excited and I sat down to read it and on the first page it talked about Druids and how “native women” don’t feel the pain of childbirth – it’s all in your head you silly white lady doncha know – and there was a picture of a pregnant woman with a crystal on her belly. And I literally threw the book across the room, which is the only time in my life i have done such a thing.
I had quote unquote natural childbirth and the only lasting benefit is that I get to bring it up a bunch so that people ask me a bunch of questions about it so I can preen.
Mr. LF and I are currently taking a Bradley Method childbirth class, which is a wee bit crunchier than we’d like, but not too outlandish. The teacher likes to go on about the disadvantages of drugged and Cesarean births, and it is kind of hilarious, as Mr. LF was born by CS to a drugged up mother, and takes it all personally… (I also enjoy goading him about it now. “Maybe if you’d come out of a vagina and then bonded properly, you’d know how to put your dishes in the dishwasher!”)
So, my point is, there are all kinds of benefits for your child, including not being taunted later by a spouse about not knowing how to do chores.
I was crunchy enough to go au naturale and even sort of meditated through it but, by god, those types of books are awful. So many mystical natives!
My turning away moment came after the birth, when I realized I had not the slightest interest in cloth diapering.
THE BOOKS. And the playing with stats! Ooof. The way “infant mortality” numbers are used, when perinatal mortality is the relevant number. The way we give birth in the US may be all jacked up, do not get me wrong, but the people who advocate UNASSISTED CHILDBIRTH on mothering.com are reckless and awful. It’s one thing to give birth at home with a CNM (though I wouldn’t, nor would I recommend it to others), but the idea that you should just read a lot of books and hide in your bathroom until you have a baby is BAD. It is a bad idea.
HA, I started my labor at a freestanding birth center with CNMs (hippie credentials WHAT) and had to do a non-emergency transfer to the hospital partway through. When the midwives told me I had to transfer, my doula (why yes I also had a doula) gave me my list of options, which included “we could go home and attempt an unassisted birth.”
I’m pretty sure she was telling me in the interest of full disclosure and consent and would have tried to talk me out of it if I’d said yes. But even in the middle of a contraction, I rolled my eyes. I’m with you. Hospitals are jacked in many ways, and their policies most certainly slowed my labor and irritated the bejesus out of me. But unassisted homebirth?!? Yeah. That is playing with fire.
I’ve never visited mothering.com, but my FB group moms were recommending colloidal silver for ear infections today, so I think I’ve got enough crazy in my life.
Colloidal silver is a decent anti-microbial, but you use it to prevent infections, not to treat them. (Ie. it’s used in expensive snazzy leg ulcer dressings to promote healing, reduce exudate, and reduce infection risk)
Yeah, I think those legit uses are what lets snake-oil salesmen claim their “homeopathic” versions aren’t just overpriced water.
I guess I was never super super crunchy, but my turning away… let’s see, first there were various medications to try to prevent preterm contractions. Antibiotics for infection. Steroids in case the baby was born prematurely. Then various medications to treat Cholestasis of Pregnancy. Next came the drugs to induce, and then the epidural drugs, and probably antibiotics again… am I remembering everything? Who knows.
Oh, the fun. I was all set mentally for a natural childbirth, or so I thought, but there was no way that was going to happen when my irritable uterus was already giving me five-minute long contractions before I was started on Pitocin. Heh. That’s one of the things I hate about books/people like the above — they’re bad enough already, but then when they presume their techniques will be wonderful for EVERYONE, regardless of risk factors etc.? Ugh. The rage. I CAN’T WALK IT OFF MY WATER BROKE AND THE NURSES WON’T LET ME GET UP.
(That said, Lamaze was a little tiny bit helpful before the epidural, I suppose. And the class had lots of good info besides pain management… but then, my Lamaze instructor was waaay more reasonable than the above-mentioned author, she never made any “don’t feel the pain” claims!)
Anyway. My girl is happy and healthy, so far. And once I got away from the hospital and the Motrin they kept giving me on an empty stomach, I was fine too. (I have never in my life thrown up as much as on the car ride home. It was awful.)
Oh god, I can only imagine how strong the desire for crunchiness is when you’re pregnant. It plays right into that desire to do the VERY BEST THING for your child, and it gives you a community that provides support and helps you feel special, and everything’s going to be organic cotton and happy babies and a community of women. If someone showed up at my nephrologist’s waiting room with that I’d have a reeeeeeal hard time not following them out the door.
I pretty much lived on Zantac during my third trimester and my daughter appears to be fine also. My ob said Zantac was fine, but a friend’s ob told her definitely not to take it. So confusing.
I lived on Zantac too (after my doc put me back on it), and it’s been widely researched and is considered to be safe: http://www.motherisk.org/prof/updatesDetail.jsp?c…
Perhaps your friend’s doctor figured that the paperwork saying “consult with your physician” meant “don’t take it,” or only wanted her taking anything with an A rating rather than a B+ (but does anything have an A anymore, if they’re now even questioning Tylenol?).
After a lifetime with a bum esophagus, I heartily recommend that everyone do everything in their power always to avoid heartburn. It’s just the evillest. I tried going off Prilosec when I was pregnant with my first, was miserable and chugging plain yogurt and baking soda in water, and then my OB said I could get a scrip for esomeprazole and I danced and rejoiced and was happy forever. This time around (five years later), my midwife barely blinked when I said I was taking Prilosec.
Zantac is still fantastic for occasional breakthrough pain and I have stashes of Tums everywhere around me.
Oh, you and your “my kid can pee on the pot” privilege! I went really crunchy with #1 (right up until the induced birth) and the giant jerk (40lbs, 2.5 years old) is content to wallow in his own feces forever and ever. I’m sure some ahole at mothering.com will tell me it’s because I had an epidural.
To be fair, though, when she misses the pot she looks at me disdainfully and says “Mommy, you got to clean it up.”
Obviously, the epidural is still in your child, making him unable to feel his poop.
This comment basically makes me laugh for a thousand years. Well done, ipomoea. Screw mothering.com and the idea that just because your baby did something, or somebody else’s baby did something, EVERYBODY’S baby follows the same pattern. Every human being is different. Same for their larval stage.
I just remember the terrible three months of trying to breastfeed and weighing her after every feeding and her just not putting on weight and then losing weight and taking her to Urgent Care and being told I needed to buy formula on the way home, and wanting to punch everyone in the face who said things on mothering.com like “sure, mothers SAY they tried to breastfeed, but they don’t really put in the effort.”
Oh, wow, I still have a lot of feelings about this!
mothering dot com is a nightmare shitshow and I hate it
I mean, I can really appreciate the spectacular dingusing apparent at babycenter and Yahoo answers, but thebump and mothering are so effing SMUG that I just want to feed all of their children McFlurrys and show them Terminator 2.
I quit MDC when the mods deleted three threads in a row of atheists trying to talk to each other about what it’s like to be atheists raising children. Apparently the peculiar problems we encounter that we really needed to have support for were just too offensive to live. That was… I think about seven years ago?
Fuck you, smothering dot com.
Wow, that is bananas.
My midwife was all, “Tums is calcium, you ginormous dork,” and then I ate Tums forever.
Thank you so much for the work that you do. When I was pregnant, it was so frustrating that basically everything (even my neti pot!) said that it wasn’t recommended for pregnant women, without consulting with a physician. Speaking as someone whose health isn’t perfect, the more information that allows doctors and patients to make informed choices, the better.
My doctor ended up pointing me to the Toronto Sick Kid’s Hospital’s resource for doctors and pregnant women, motherisk.org (so useful! They bring together the research about medications and herbs) to reassure me about my need to take certain medications.
Wait first I learn my OTC but not really OTC Zyrtec isn’t good (the one with the real drugs from behind the pharmacist) and now I can’t neti either??
I’m just going to be a snot nosed disgusting pregnant lady [in like 5 years] aren’t I?
I’ve never found a single study saying that neti pots aren’t safe for pregnant women (it’s just a saline solution going through your sinuses!). I’m pretty sure what I read in the literature that came with my neti pot meant “We’re not willing to conduct a study on pregnant women, and so our lawyers require us to state that we don’t know whether it will have any effects. Consult your doctor.”
Not a doctor or a scientist. But I am a Gal Neti Pot (?). I think it has something to do with contracting infections from tap water or a less-than-pristine pot (seriously, it’s revolting).
http://well.blogs.nytimes.com/2012/09/03/rare-inf…
That’s actually a really good point. The instructions are pretty explicit about only using water that’s been boiled, but my neti pot is plastic, which might be difficult to sterilize. (That reminds me: I try sterilizing my neti pot using the stuff I bought for bottle washing.)
My Dr says Zyrtec is fine. Who knows if he’s right, but I figure it’s better for the baby than me not actually breathing in any oxygen, so I take it once in a while…
Here’s all the information about Zyrtec (Cetirizine, under second generation antihistamines), and it sounds like it’s fine. http://www.motherisk.org/prof/updatesDetail.jsp?c…
Studies have been finding that second generation antihistamines seem to be a lot safer than first generation. My doctor also told me to take my Reactine (same type of drug), if I needed it.
My various prenatal health professionals (first nurse-midwives, now OBs) have all been fine with my daily zyrtec and zoloft use.
Motherisk! It’s possible my post-doc plans involve camping on their doorstep until they give me a job.
Motherisk! They are amazing, and I can’t even imagine how cool a postdoc would be with them.
Basically, my initial prenatal visit (at my campus health services) consisted of my GP and me cheering about the fact that Motherisk exists.
I loved Emily Oster’s Expecting Better. She’s an economist, so take it with a grain of salt, but she is trained to interpret statistical results and she does a good job of summing up which pregnancy warnings are serious (I was surprised about the deli meat!) and which are exaggerated.
Yeeesssssss! Relative vs. absolute risk!! Never forget!
I fantasize about creating a computer virus that would prevent every news outlet from publishing articles that don’t include both.
This is a great post! I’m an epidemiologist currently working in diabetes research, and your recommendations for how to read and interpret scholarly articles and statistics are spot-on for ANY area of research. The best advice is to talk to someone who works or practices in that field – chances are, your health care provider knows about the study or has read that article, and can answer your questions.
Epidemiologist fistbump?
(I don’t know what it is, but I suspect it involves 2×2 tables)
This is great, and I massively appreciate it – it’s helpful to remember that medical research is amazingly complicated, and that pregnancy is doubly so.
This is fabulous, fabulous, fabulous. I am admittedly biased, because I work in medical research and just took my first Epi course (and loved it, oh my god, it was absolutely fascinating). More! More science! More talk about relative and absolute risks and specific clusters of risk factors!
I really wish there was a better solution to the lack of information on treatments in pregnancy, too. And I honestly don’t know how much of it is a very logical approach to reducing risk, and how much is that creepy sort of “once you’re pregnant, you’re just a host for your child” mentality that’s clearly still hanging around in the US. Particularly, I think, with the illnesses like chronic pain and depression that are seen as less real or valid- I think it becomes easier to say then “oh, just stop taking your meds, suck it up, you’ll get through it”.
As a person with bipolar disorder who hopes to become pregnant someday, I cannot thank you enough for doing this research. I hope you know just how important it really is.
Also, as a person with bipolar disorder, I have become really, really good at reading studies linked from the bullshit scare tactic news reporting articles my parents love to send me. I had actually heard of pretty much every study you mentioned in your piece/in the comments! Hahahahahaha *cries*
ETA: Also, I took epidemiology in law school (crossover course from our nursing and health studies school) so study reading is actually fun!
So timely! The boyfriend and I were just talking about this this weekend!
As an FYI, not just for pregnant womyn but for all ladies, there’s a huge issue with how FDA drug trials are conducted- they ended up excluding women from a lot of a clinical trials by law to protect any potentially pregnant women, then when they turned around on this and added women, the numbers have yet to catch up, so basically there’s a testing disparity.
So this is an issue because there are some serious biological differences in how a person with an XY and a person with an XX chromosome metabolize and store drugs. The most well known of this is that women and men’s livers and bodies metabolize alcohol differently which is why we’re not supposed to pull a Marion from Raiders of the Lost Ark (she was lucky not to die! Says my inner mother). In many cases this means that if you are a 120 lb and 5’3″ ft lady, and a 200lb 6’2″ man each taking the recommended dose of 2 tylenol PM it’s going to hit him on target and possibly knock you completely out, because the dosages are not tied to weight OR gender, so he’s probably much closer to the average clinical trial patient.
And that doesn’t mean we shouldn’t take any medicine, but there’s room for us all to be bigger skeptics about dosage and gender. And race! There’s another whole underrepresented clinical study population!
Ok off soapbox now.
Yup, and development! To my understanding (as someone who studies typical development, so not an expert here), it is rare for drug trials to occur on minors, and CERTAINLY not on kids/teens actively going through puberty, which has all sorts of fun effects on drug metabolism. And yet so many mental health concerns emerge during adolescence 🙁
Thank you! I swear Nyquil’s knocked me out for about 24 hours before. Yup, I’m about 120 lb. and 5’4″… actually, I was probably even lighter when that happened.
This was so great. I would like someone to give you a column where you review and discuss new research findings on this topic as they emerge. Also your username is a thing of beauty. I’m going to name my firstborn Anecdata (and it will be accurate).
Drugs – both legal and non-legal – during pregnancy is such a minefield. I heard a really interesting interview in the To The Best of Our Knowledge podcast the other day with a doctor about the whole “crack babies” phenomenon, and how it was really overplayed at the time, and how intertwined with racism and classism the whole idea of crack babies is. The main doctor who researched cocaine’s effects on fetuses at the time said he knew basically that cocaine had little impact on a child’s development but that he didn’t do as much to disabuse notions of a crack baby epidemic because he didn’t want to promote the idea that cocaine was fine to do in pregnancy. He also pointed out that most people who take cocaine heavily during pregnancy are also abusing alcohol, smoking cigarettes and potentially living in fairly unpleasant circumstances. And that living in poverty is much more dangerous for babies than cocaine. (But, you know, don’t do cocaine when you’re pregnant.)
Mollie! This was so fascinating! Although I too have not yet been pregnant, I hope to be in the next several years. I have long wondered about various medications I take and my ability to continue them while pregnant. I have always just assumed that I would have to discontinue them for 9 months. I am fortunate, however, that they are nothing that I could not survive without. I think your article gives a lot of hope to women who may postpone or avoid pregnancy altogether because of these concerns. Thanks for sharing this and congratulations!!
(and I totally knew you when!!)
Yay epi and biostats! I’m an MPH student in the same concentration, and this made me so excited about the field I’m getting into. Go you!
Dang, but all the things you touch on in this article are so fantastic and right in my wheelhouse. Balancing usefulness and communicating uncertainty! Trusting authors more when they are skeptical of their own results! Thinking about the stigma of invisible illnesses while you’re doing quantitative research! Please could you write the entire NYTimes science/health section?
Great article! And thanks to the commenters for mentioning motherhood.org