Ambrosia Services

Friday's column: Sometimes, it's mom's health vs. baby's

Right from the start, we should have known something was wrong. But the study, published in the Journal of the American Medical Association last February, came as such a breath of fresh air that we didn't dare question it. Still, when an influential group of doctors bucked current baby-centric trends to suggest that the benefits of keeping depressed women on their medication during pregnancy might outweigh any potential risks to their unborn children, we should have noted just how remarkable it was.

Instead, we thought it was just a much-needed return to something resembling common sense: the notion that a woman's health rightly comes first in most circumstances, since, ultimately, it is her well-being that will help her baby thrive.

That all seems laughably naive now, in light of revelations first circulated on the Internet and extensively reported in Thursday's Wall Street Journal, that most of the study's 13 authors had financial relationships to the drug companies that manufacture the very antidepressants they were evaluating.

We should have known.

It's different when it's you.

As it turns out, there are an awful lot of things that we should know, but don't, about how to manage health risks during pregnancy. It is incredibly difficult to conduct a serious clinical trial -- the kind of study that typically yields the most clear, definitive results -- involving pregnant women because of the ethical and liability issues associated with exposing their babies to any sort of potential risk, whether it's from eating a certain food or taking a particular medicine.
So, at the moment, the prevailing American philosophy is that if it seems there might be any risk at all, it's better just to avoid the prospect entirely.

Like many women, I've rather sheepishly gone along with this, dutifully abstaining from all sorts of theoretical hazards.

In principle, this really bothers me -- I am the adult here, after all, and I do have a reasonable amount of common sense -- but, in practice, I find that a previously undiscovered conservative streak has come to dominate my psyche. If something should go horribly wrong with my child, do I really want to spend time asking myself if that fabulous meal at Sushi Samba might have been to blame?

There is, of course, a school of thought that says this is excellent preparation for motherhood, that I should be practicing the whole not-about-me-anymore way of life.

But there's also something a bit more complicated going on. The whole idea of pregnancy has changed radically. Rather than being a fairly routine part of adulthood, it is now (for those of us not in our teens, anyway) celebrated as an accomplishment, revered as something utterly sacred.

And while nobody really wants to go back to the ridiculousness of the bad old days, when you couldn't even say "pregnant" on TV, this obsessive celebration of gestation has some downsides, too.Early bonding has its price.

It begins with the now-standard early ultrasound, in which technology gives women an in-utero glimpse of the fetus they're carrying at a phase when, a couple generations ago, many women didn't even yet realize they were pregnant. This moving image packs an unbelievable emotional wallop, even for the most committedly pro-choice among us.

And, on through pregnancy, nearly every test, instruction and checkup emphasizes the unborn baby as a person separate from its mother, with interests that are not always shared and that are sometimes, as in the case of antidepressants, in direct conflict.

Once the baby's sex is established -- as it almost always is, these days, several months before birth -- the parents-to-be are routinely asked for the baby's name. Attributes of personality -- active, excitable, night-owlish -- are bestowed on kids before they ever enter the world.

When things are going well, this is fun and charming. But when things go bad, always-painful dilemmas are now doubly complicated, with new and complex emotions subtly tipping the scales toward ever-increasing levels of expected maternal sacrifice. Your own mental health is just a concept, but your baby has a face and a name.Research or marketing ploy?

The JAMA researchers say their ties to the big pharmaceutical companies had no influence on their study, which was funded by the government, not by private industry. They argue, essentially, that it's pretty much impossible to find any expert in their field who hasn't taken a speaking, consulting or research fee from a drug maker, so we all should just take their word that they weren't compromised.

It's impossible to know, of course. Which puts us right back to where we started.

We're looking for straight answers, for an objective assessment of risks over benefits. Instead, we get politics and marketing and who knows what else.

It's enough to make you long for the days when a pregnant woman could smoke a cigarette and grab a cocktail to soothe her nerves.

posted by Cheryl Levesque @ 5:31 PM