Not too many decades ago, pregnant women were advised to eat lots of liver, because the vitamin A was deemed good for their baby. They must have been somewhat surprised, then, when their pregnant daughters came home from seeing the midwife and declined their nice liver dinners on the basis that the levels of vitamin A were now deemed “bad”.
In a similar vein, French women are often amazed that pregnant British women (at least those who follow the nutritional advice set out by their midwife) don’t get to enjoy brie, and some American women are stunned that their British sisters don’t get warned off all forms of tea and coffee for the duration of pregnancy. Different nutritional ideas seem to come and go, as do the generations of pregnant women whose diets are – to whatever extent they take the advice – dictated by the nutritional wisdom of the day.
Fifteen years ago, I wrote an article in response to a bit of an upswing in nutrition-related research. I’m revisiting and revising this article today to look at what has and hasn’t changed and whether we have cause for optimism.
Does Chocolate make for Happy Babies?
Some of the nutritional advice seems like common sense, and some is based on fairly decent research, if you can keep up with it all. For instance, if you want to offer women nutritional advice linked to premature labour, fish oil still appears to reduce this risk (Middleton et al 2018), while I found some research many years ago showing that liquorice appears to increase it (Strandberg et al 2002).
Of course, there is always the opportunity to follow the advice of the studies you like, and ignore those you don’t. One of my favourite studies to offer for analysis when I taught students to appraise research was a Swedish study (Raikkonen et al 2004), which was particularly positive about the benefits of chocolate. These researchers asked mothers how frequently they ate chocolate during pregnancy, and, when their babies were 6 months old, asked them to rate their babies’ happiness.
The results showed a significant difference between the scores given by the mothers who ate chocolate every day of their pregnancy (who appeared to have very happy babies) and the mothers who ate chocolate occasionally or never (whose babies were, by comparison, less happy). The interesting thing (especially given that I was trying to teach critical thinking) was that it was hard to know whether this happened because substances from the chocolate make their way into the placenta or breast milk and make the babies happy that way; whether the effect of chocolate on the woman’s happiness makes the baby happy without there being a physical effect, or whether woman who eat chocolate every day are simply more happy themselves and thus see their baby’s happiness as being greater because of this. Or maybe the results came about by chance and there was no real effect at all?!
Celebrating Gastronomic Variety
Many people have come to understand that we are not all the same as far as nutrition is concerned. Some people thrive on being vegetarian or vegan, while others become pale and find most of their haemoglobin leaves their body at the mere thought of not eating meat. Some love no- or low carbohydrate ways of eating, while others couldn’t live without their potatoes or want to focus on whole and real food rather than limiting themselves to certain food groups. This seems to support the notion that we should individualise nutritional advice, and perhaps look for ways to help women find out what their own bodies need.
A good number of midwives that I know have felt this for a long time, suggesting that pica – the condition where women crave odd things – might be the body’s way of getting the nutrients it needs. To digress briefly, the things eaten by women who experience pica might also be changing with time. Coal, for instance, is not as widely available as it once was, at least in the UK, so women are seeking more modern oddments to eat. One example of this (and I promise I am not making this up) was the woman who loved to eat post-it notes, but only the yellow and pink ones; the green ones apparently didn’t taste good at all. Although some of us are still influenced by the view expressed long ago by Horner et al (1991) which described pica as a disorder, many pregnant woman, midwives and other birth folk see this as a natural and relatively common occurrence, and perhaps as a form of body wisdom that helps women get the nutrients they need (presumably even the trace ones that are hidden in post-it notes).
It’s not always as straightforward as listening to cravings, though. We know that, sometimes, we crave things that may not be wholly good for us, and there are a growing number of nutritionists who are analysing the biochemistry and other sciences that can help us understand why that might happen. But equally welcome are those who have helped us see that the idea of labelling food as ‘good’ or ‘bad’ may not be helpful, especially given the very unhealthy messages that have been forced upon many of us over the years.
When I first wrote an earlier version of this article, I concluded by saying that, “Perhaps the time has come for us to think about some of these debates and put nutrition, and the question of what we tell pregnant woman about this, higher up on the agenda than it currently is. Is there any value in continuing to offer lists of nutritional “dos” and don’ts” to woman? Do we want to give women the message that their bodies are generally good at telling them what to eat, or do we want to continue to convey the message that we know best? And are our – and women’s – bodies only wise when they crave the favoured nutrients of the day?”
Nearly twenty years on, I feel heartened that there is more and better information out there in the world in general. I am heartened by the increasing number of nutritionists, especially by those who are person-centred and veer away from the trends of the day or the one-size-fits-all approach. It gives me hope that we might all one day understand this important element of our health better than we currently do.
Horner RD, Lackey CJ, Kolasa K, et al (1991). Pica practices of pregnant women. Journal of the American Dietetic Association. 91(1): 34-8.
Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega‐3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD003402. DOI: 10.1002/14651858.CD003402.pub3.
Raikkonen K, Pesonen AK, Jarvenpaa AL et al (2004). Sweet babies: chocolate consumption during pregnancy and infant temperament at six months. Early Human Development. 76(2): 139-45.
Strandberg TE, Andersson S, Järvenpää A-L et al (2002). Preterm Birth and Licorice Consumption during Pregnancy. Am J Epid. 156:803-805.