Am I ranting?

I decided that I don't get to be all high-and-mightly about the perceived paranoia of pregnant women without doing a little research. So, I'm going to tell you what I've found and the conclusions that I've made...

Pete and I went to eat at a Japanese restaurant while in Portland last weekend. A married-couple, also pregnant, friend of his declined to join us for dinner because of the sushi angle. Next time he talked to them, they exclaimed, "Did Liz really eat sushi?" For the record, no, not really. We ordered normally and then I picked out most of the raw stuff. Turns out I probably could've eaten the raw salmon and tuna (in small amounts so as not to accumulate mercury), but should've left the raw scallop alone. The ironic thing is that I accidentally ate the raw scallop because I thought it was cooked. Oops.

Ok here's a clip from the NYTimes:
"If you take raw and partly cooked shellfish out of the equation, the risk of falling ill from eating seafood is 1 in 2 million servings, the government calculated some years back; by comparison, the risk from eating chicken is 1 in 25,000. (Over all, 76 million cases of food poisoning are reported a year.)

The main risk of illness from non-mollusks isn't from eating them raw. Rather, as the Institute of Medicine reports, the problem is "cross-contamination of cooked by raw product," which is "usually associated with time/temperature abuse." In other words, no matter what you order in a restaurant, if it's not kept at a proper temperature and protected from contamination, you're at risk."

OK. So my "research" also shows that there is a small risk of getting a nematode (worm) from sushi, but there are two things to say about these worms: 1. They don't cross the placenta so no risk to baby and 2. They are very very very rare in sushi grade fish. Most people get them from eating raw fish that they have caught themselves. So, despite the gross factor of puking up a nematode, it seems like the risk of sushi has been pretty over-blown in pregnancy.

Not as much for listeria. Listeria monocytogenes is a type of bacteria that I learned about long ago in the large animal portion of my veterinary education. It causes livestock to "list" to the side (neurologic signs - good way to remember, eh?) and spontaneously abort. Apparently, it does the same things to humans, is 20x more likely to affect pregnant women than nonpregnant people, and it carries a mortality rate (not just morbidity, but mortality!) of 20%. This crafty bacterium survives and replicates happily at normal refridgeration temperatures, and it is only killed by thorough cooking. The CDC reports 2500 cases a year, which distills down to about 6 cases a day.

The foods implicated: deli meats and hot dogs labeled "ready to eat," undercooked chicken and meat, raw vegetables, soft cheeses, and, yes, sushi (although mostly smoked raw seafood). However, when I searched for actual outbreaks of the disease, it seems most cases came from processed foods (bacteria collects on meat slicers) or unpasteurized dairy products. The "soft cheeses" that women have been warned about for years (brie, feta, goat etc) only present a higher-than-normal risk if they are unpasterized, according to the current FDA position. Cheeses sold in the US grocery stores are all pasteurized. Bring on the feta.

Another contested food is honey. It can contain botulism spores, so apparently is unsafe to feed to children under 1 year of age. However, the GI system of adults, including pregnant women, is acidic enough to kill the spores. I am a huge honey fan. I've literally used it as a wound dressing in animals to great effect; honey contains unbelievable antibacterial, antifungal and antiviral properties. Beyond the "Don't-eat-anything" propaganda pregnancy websites online, I wasn't able to find a single case of food-bourne illness in pregnant women secondary to honey ingestion. Bring on the honey.

My conclusion after 1 hour of critical web-based, CDC, FDA and medline research on food-bourne illness in pregnant women? Everything in moderation. I don't think I'll start eating un-grilled "ready to eat" hotdogs anytime soon, and I'll probably lay off on the deli meat (it always did strike me as a little gross to eat turkey that looks nothing like turkey), but beyond that, I'm sticking to my guns.

I went off the raw milk, "pasteurization is bad" bandwagon in veterinary school when we learned all about Q fever, salmonella, campylobacter, and listeriosis. I still subscribe to the belief that many of these food-bourne illnesses have more to do with the attempt to produce vast amounts of the product in a tiny little cramped environment (modern dairies). I wonder about the actual risk of unpasteurized products that originate from small-farm, well managed dairies where the cows do not stand on mountains of their own fecal material. I wonder if reducing "fomites" (automatic milkers, skinners, slicers, etc) would reduce risk similarly to pasteurization. Is pasteurization the lazy-man's solution to food bourne illness? Why are products from family farms and farmer's markets so rarely implicated in outbreaks? Or are illnesses associated with these foods just underreported? I also sometimes wonder if we are doing our immune systems a disfavor by sterilizing everything with which we come into contact.

Our child will not be sterilized. With a large furry dog, two cats and less than adequate house keeping skills, it will be a miracle if she doesn't get a hairball in her first month of life. So, I figure, a few germs here and there will increase maternal antibodies...right?