Asking this question in the first place… begs these questions: “Are there myths in medicine?” and if there are, “what might they be?” As a Registered Dietitian Nutritionist who has worked with pregnant women for a few decades, I believe there are two statements in particular that should be considered quasi-myths: “The fetus is a perfect parasite and takes from the mother all of the nutrients it needs for development.” And “Breast milk is the perfect food for a human infant.” In both statements, the word perfect is especially problematic. As with many “myths” – the ideas presented require clarification and context or they may lead to the spread of misinformation and result in negative outcomes. Let’s take a closer look.
Thankfully, you won’t easily find the first “myth” in print currently, but it was a common assumption when I first began my clinical career in the early 1980s. While I felt something was amiss, I lacked the academic band-width to challenge the absoluteness of the statement. Additionally, the idea that the fetus could be equated to a “parasite” was… honestly… repulsive! That aside, while most nutrition books cited adequate nutrition as a requirement for optimal fetal development, some obstetricians failed to endorse this and instead perpetuated the parasite concept.
How I came to really challenge the “fetus is the perfect parasite” notion was in trying to provide nutritional care to pregnant women with hyperemesis gravidarum (HG), which is severe nausea and vomiting during pregnancy. It was once considered a psychological problem and presumably resulted in the death of author Charlotte Bronte in 1855. The women I counseled suffering with HG were nutritional disasters and often experienced significant weight loss – with as high as 20 percent weight losses during the first and early second trimesters – translating to anywhere from 10 to 40 pounds lost. Some obstetricians I worked with dismissed my concerns for aggressive medical nutritional therapy using enteral or parenteral nutrition. How could that be… when women were told “good nutrition is good for the pregnancy”? If that were the case, then how could the opposite also be true? It made absolutely NO sense to me. This contradiction became obvious to me when I accidently found a case of vitamin K embryopathy in a child of a mother whose care I was part of! (1)
Why does nutrition before and during pregnancy matter? During the process of reproduction, the ONLY source of sustenance for the developing fetus is that which is transferred from the mother via the umbilical cord in the specific amounts required for each stage of development. The requirement for specific nutrients is time specific based on physiological development. There is no opportunity for a “re-do” after the fact. We are creating a totally new human person de novo, basically from “scratch.”
Nutrient-building materials for fetal development need to be present every day in the proper amounts – which includes energy, protein, fats, vitamins, and minerals as well as clean air and water. Failure to do so jeopardizes the health of the mother as she enters a catabolic state, in which her body tissues are broken down to provide nourishment. To believe otherwise is like thinking one can get blood from a stone!
I embarked on a mission to assemble a document pointing out how maternal nutrient deficiencies can adversely impact a pregnancy including increasing the risk for intrauterine fetal death—also known as stillbirth. Why did I tackle this thorny topic? Medical literature citing outcomes related to mild to moderate nausea and vomiting of pregnancy—commonly referred to as morning sickness—suggest a favorable pregnancy outcome. The outcomes from severe nausea and vomiting (HG) can have totally different outcomes for both the mother and fetus. I have cared for at least five women who have had both HG and fetal losses after weeks of severely limited nutritional intake with significant weight loss.
Many nutritional and medical complications are associated with poorly managed HG including spontaneous abortion (miscarriage) and in rarer situations, maternal death. I supported my theory with over 60 references in a paper, “Long term consequences of severe hyperemesis gravidarum including possible intra-uterine fetal demise” published by the Symbiosis on-line journal Gynecology, Obstetrics and Women’s Health, in September 2018. In October 2019 I plan to join colleagues at the Third International Colloquium on Hyperemesis Gravidarum to be held in Amsterdam with a poster based on this paper. (2-4)
Regarding the second “myth”: Breast milk is the perfect food for a human infant – I wrote a paper “Breast milk is conditionally perfect” which was published in the UK publication Medical Hypotheses in December 2018. (5) The point I made in this paper is the importance to continually evaluate the nutritional status of a woman during and after pregnancy and provide nutritional intervention if needed. To assume there are no deficits is to shortchange the newborn!
Finally it occurred to me that both of these statements could ONLY be absolutely true IF the woman was 100% adequately nourished before pregnancy and remained so during the entire gestation! A woman who is malnourished, for whatever reason, cannot share nutrients she does not possess! A similar analogy would be if a person wrote a check on a closed bank account—do they expect to get cash? In the animal kingdom, nature rarely allows a malnourished mother to deliver a full-term healthy offspring and then the means to produce optimal and adequate breast milk to nourish that offspring for the survival of both. A malnourished mother would have breast milk that reflects her malnourished status and as such, would be inadequate to promote optimal growth in her newborn. Animal experiments have demonstrated this many times over.
In September 2018 I was a panel member for the Academy of Nutrition and Dietetics webinar on “Malnutrition in Special Populations” and spoke on “Gestational Malnutrition.” I am currently completing a paperback book, “Take Two Crackers and Call Me in the Morning! A real-life guide for surviving morning sickness” planned for publication mid -2019. An e-version of this title is currently available online via Amazon: https://www.amazon.com/Take-two-crackers-call-morning/dp/0961306351.
Get to know Miriam Erick on our community page here: https://www.nutritioncommunicator.com/nutrition-communicator-com-communit.
“In pregnancy, there are two bodies, one inside the other.
Two people live under one skin.
When so much of life is dedicated to maintaining our integrity as distinct beings,
this bodily tandem is an uncanny fact.”
~ Joan Raphael-Leff
Toriello HV, Erick M, Alessandri JL et al. Maternal vitamin K deficient embryopathy: association with hyperemesis gravidarium and Crohn’s disease. Am J Med Genet A 2013; 161-417-429.
Erick M. Long term consequences of severe hyperemesis gravidarum including possible intra-uterine fetal demise. Symbiosis Online Journal of Gynecology, Obstetrics and Women’s Health. 4 (2): 1-8. September 20, 2018. ISSN: 2381-2915.
Erick M, Cox JT, Mogensen KM. LTE: Response to ACOG Practice Bulletin No. 189: Nausea and vomiting of pregnancy. Obstet Gynecol. 2018. May; 131 (5): 935.
Erick M. Hyperemesis gravidarum: a case of starvation and altered sensorium gestosis (ASG). Med Hypotheses. 2014; 82. 572-80.
Erick M. Breast milk is conditionally perfect. Med Hypotheses. 2018. Feb; 111: 82-89.
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