Uncle Sam is ready to dish out more advice than ever before about how women should eat during pregnancy.
Scientists appointed by the government are reviewing questions and looking at studies about weight gain and the effects of supplements, beverages, and seafood. They’re evaluating whether eating certain foods during pregnancy will cause a child to be more prone to allergies later in life and how eating patterns could make pregnant women more likely to develop gestational diabetes or high blood pressure.
“We are paying close attention because they are the first-ever set of such guidelines anywhere in the world,” said Lucy Sullivan, executive director at 1,000 Days, an organization that focuses on early development. “There are a lot of things happening during that time period.”
There’s no shortage of blogs, books, and even unsolicited eating advice given to the 4 million women who give birth every year in the United States, and much of it is conflicting. Linda Antinoro, a nutritionist at Brigham and Women’s Hospital in Boston, says confusion about eating during pregnancy is common.
“People come in who have read everything under the sun and are Googling and getting contradictory information,” she said.
The government’s guidelines, updated every five years since 1980, aren’t expected to clear up all of the confusion. But the stakes are high. They affect not only what people perceive to be nutritious and the advice doctors give patients, but they also influence food labeling and federal programs that help low-income people buy food.
The latest focus comes as a result of the 2014 Farm Bill, which mandated that officials lay out more specific dietary guidelines for pregnant women, infants, and toddlers. Officials had already started taking a look roughly 10 years before the mandate because of the growing understanding among scientists about how eating during pregnancy affects a child’s future development.
The last version had some information for pregnant women sprinkled throughout, such as advising them to avoid alcohol, but did not spell out recommendations in one place. The previous report also directed pregnant women to check with other agencies to find out more details about what they should and shouldn’t be eating.
The new edition will come at a time when many U.S. women are in poor health when they become pregnant. Because most people living in the U.S. are overweight, and because half of all pregnancies in the U.S. are unplanned, many women are above the recommended weight when they conceive. Data show half of U.S. women gain too much weight during pregnancy, an issue the guidelines could help draw attention to.
“An increasing number of pregnant women in this country have chronic conditions such as high blood pressure, diabetes, obesity, and heart disease,” said Dr. Christopher Zahn, vice president of practice activities for the American College of Obstetricians and Gynecologists. “The impact of diet quality on maternal health is a public health concern and an area in which there is a knowledge gap with respect to the correlations between diet and maternal health outcomes.”
That knowledge gap is something that scientists looking at these questions will need to contend with. The scientists will issue a report to the government next year, but because there’s a shortage of studies about pregnancy, they may not be able to answer all of the outstanding questions they’ve been asked.
“In general, this isn’t a space where we have wildly good data,” said Emily Oster, an economics professor at Brown University whose book, Expecting Better, scrutinized advice women get during pregnancy.
This is partly because doing research involving pregnant women is an ethical challenge for scientists. Kathleen Rasmussen, who teaches maternal and child nutrition at Cornell University, noted that pregnant women are considered to be vulnerable human subjects. Parents worry about participating in medical studies that could backfire.
“The bar here is very high for the quality of the research that is needed,” Rasmussen said.
Moms-to-be shouldn’t expect all of their questions about eating to be answered by the guidelines. For example, the questions scientists are looking at don’t get into whether eating specific foods carry a higher risk of infection and are linked to miscarriage. A spokesperson from the U.S. Department of Agriculture said that was because they didn’t want to duplicate the work of other government agencies, such as the National Institute of Child Health and Human Development.
Ultimately, it will be up to officials from the USDA and the Department of Health and Human Services to decide what makes it into the final guidelines. As scientists continue to meet publicly about it, they will learn which areas are most controversial and will be in a position to make better guidelines when the science becomes more clear, Rasmussen said.
“Some of the process here is about taking stock, about asking, ‘What is it we know, and what it is we don’t know?’ Part of the final product could be recommendations about what we need to do more work on,” she said.
