The (mostly) well-meaning war on pregnancy

According to reports from the White House, taking paracetamol when pregnant will doom you to a “horrible, horrible” future of parenting autistic kids. Leaving aside the fact that there are far worse fates imaginable than having children with autism, this claim has been rapidly and adequately discredited elsewhere as being oversimplified and deterministic, if not outright inaccurate.

It’s also the latest in the endless stream of directives that pregnant women feel obliged to navigate, to keep their baby safe, and give it the best chance to thrive once born.

There are, for instance, the long lists of foods to be avoided while hapū – the soft cheeses, the deli meats, the sushi – even hummus has been identified as one of the bad guys. Pregnant women should eat oily fish but be aware of mercury toxicity. They should make sure any cooked food is served piping hot, and steer clear of the salad bar, while ensuring they get 5+ vegetables a day.

RFK Jr’s ‘ill-informed nonsense’ forfeits America’s mRNA vaccine leadership.  Faced with an endless stream of well-meaning but conflicting health advice from family, friends, neighbours and now, apparently, world leaders – is it any wonder mum’s reaching for the paracetamol?

How exactly is a mother to know what to eat? Where are the guidelines to support women to evaluate the risks for themselves and make their own decisions? How can they determine whether and to what extent their actions may affect their child’s development? How much responsibility should each individual woman be expected to shoulder?

These are questions I find myself asking in my research exploring Kiwis’ understanding of how early influences contribute to lifelong health. I’ve spoken with international experts in foetal development, nutrition, public health, and science education, as well as conducting surveys, interviews, focus groups and workshops with thousands of everyday New Zealanders. For most women I’ve discussed this with, the overwhelming sentiment is “whatever we do, it feels like it’s never enough”.

Oddly enough, I’ve never heard that from a father.

Our bodies are extremely sensitive to the world around us. All day, every day, our cells receive information about our surroundings – the things we put into our bodies, the chemicals and organisms we encounter, temperature, radiation, the ways we move, the things that trigger feelings of stress or calm – and respond accordingly.

Some of this information gets stored inside the cell nuclei in the form of epigenetic markers – tiny chemical switches that can activate or deactivate sections of our DNA. Epigenetic markers regulate the production of the different proteins our bodies need to function, in much the same way an orchestra conductor directs different groups of musicians to play more softly or more forcefully.

Whenever a cell multiplies, the DNA is duplicated, along with any epigenetic markers present. Unless something changes further down the line, future descendants of that cell will inherit the same pattern of gene expression. For a fully-grown adult comprised of trillions of cells, the impact of any environmental influence may go completely unnoticed. But all of us begin life as a single cell, which, over the course of nine months, will be multiplied again and again en route to becoming a fully formed human.

Just as there is no such thing as a perfect performance of Mahler’s 2nd symphony, or Beethoven’s 5th, there is no such thing as a perfect pregnancy

The epigenetic markers present in our cells direct the symphony of our growth, as scripted by the sheet music of our DNA. In a rapidly growing foetus, they have considerable potential to characterise physical and mental development – for better or for worse.

However, the resulting effects typically start out infinitesimally small and take decades to manifest in any measurable way. Scientists investigating the health impact of developmental factors such as prenatal nutrition tend to think in terms of lifetime risk trajectories, not differences that appear in early childhood.

They might find, for example, an elevated likelihood of eventually developing heart disease, or a predisposition towards cancer in later life. Studies can estimate the chance of a particular outcome and its potential effect, but with very few exceptions (I’m looking at you, thalidomide) it’s impossible to make such a clear-cut, definitive claim as ‘acetaminophen causes autism’.

Just as there is no such thing as a perfect performance of Mahler’s 2nd symphony, or Beethoven’s 5th, there is no such thing as a perfect pregnancy. At every juncture along the way, trade-offs are made – whether these are conscious choices made by a parent, or physiological pathways directing the differentiation of brain cells, heart cells, liver and lung cells. Every action taken – or not taken – comes with risks and possibilities. Sheer luck also plays a more prominent role than many health scientists would like to admit.

For me, the issue is not whether the proposed link is plausible, or even likely. Even if the claim were proven, the fact that the US President is – proudly, and in his own words – “not careful with what he says” shows a total disregard for the personal and societal impact of his announcement. This is particularly egregious coming from one who arguably holds more power than any other person in history to address some of the well-established issues affecting public health, rather than adding to the burden of those who are already vulnerable.

The persistent idea that mothers can control all, or even many, of the potential factors contributing to healthy development is unrealistic and puts far too much pressure on women who are already doing their best.

Research indicates that whatever affects mum also has the potential to affect baby – the toxic fumes from vehicle exhausts, second-hand smoke, increasingly prevalent seasonal wildfires, the quality of the water she’s drinking and the pesticides and preservatives in the food she’s eating.

Add to these the constant physical and mental demands of juggling work, care of older children, perhaps ailing parents as well. Somewhere, mum must find the time to exercise, and sleep. Consider the stress hormones that surge through her body each time she frantically calculates the trade-off between maintaining a nutritious diet versus paying this week’s rent. What if her morning sickness means she can’t keep the nutritious food down, anyway?

Let’s not forget, as well, that babies have two parents. There’s increasing evidence that a father’s health and environment, preconception, also has a role in foetal development, as epigenetic markers may be transferred across from the sperm at fertilisation. Likewise, from the egg, which originated decades ago when grandma was pregnant with mum. What factors influenced its formation?

The processes shaping early development are extraordinarily complex. Too complex to attribute to one woman’s poor health, or her good health, or her willingness or capacity to adhere to prenatal health guidelines. Now, more than ever, mothers don’t need to be told what to do. They need our support, and our commitment to prioritising actions that make the world a healthier place for everybody.

Yet, it’s precisely our tendency to treat the complex as though it were simple that results in a myopic focus on individual behaviours as targets for health interventions. Just like our bodies, our behaviours are products of the world we live in. If we stop looking for simple answers to complex issues, we may instead start to recognise the wider, underlying patterns that contribute to health and wellbeing in our communities.

Incidentally, pattern recognition is something many autistic people are particularly skilled at. Perhaps we should ask them to help us see more clearly, rather than trying to circumvent their very existence?