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Lifestyle in Pregnancy See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/25835221 Lifestyle in Pregnancy Article in Canadian family physician Médecin de famille canadien · October 1984 Source: PubMed Central CITATIONS READS 4 26 2 authors: Robert Bryce Murray Enkin Flinders University McMaster University 44 PUBLICATIONS 650 CITATIONS 149 PUBLICATIONS 5,877 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Clinical skills education in the MD program View project All content following this page was uploaded by Murray Enkin on 18 May 2014. The user has requested enhancement of the downloaded file. Robert L. Bryce Murray W. Enkin Lifestyle in Pregnancy SUMMARY SOMMAIRE While there is little doubt about the Bien qu'il ne subsiste que peu de doute quant a la relation entre le mode de vie et son influence sur le association of lifestyle and pregnancy resultat de la grossesse, on questionne enormement outcome, there is considerable doubt about la valeur nette, pendant la grossesse, des the net value of lifestyle adjustments during changements au niveau du mode de vie. On n'a pas pregnancy. Advice alone on nutrition, sexual demontre qu'a eux seuls, les conseils sur la activity, alcohol and smoking in pregnancy nutrition, l'activite sexuelle, la consommation has not been demonstrated to improve d'alcool et le tabagisme pendant la grossesse ont ameliore la situation et qu'ils pr'sentent en soi des outcome, and may, in itself, have adverse effets adverses. Certains effets benefiques peuvent effects. Beneficial effects may occur when se manifester lorsque les conseils s'accompagnent advice is accompanied by a program of social d'un programme de support social. support. (Can Fam Physician 1984; 30:2127-2130). IIIIIIIIIIIIIIIIIIIlljmlllj. ...... IIIIIIIIIIII 'OEM= ---------------Ml...IIMM.. Dr. Bryce, who has completed a our advice is encouraging; on other oc- woman looks after herself, no one else fellowship in Maternal Fetal casions, the results fall far short of our can look after her. However, we must Medicine and a master's degree in expectations. be careful to avoid the simplistic belief Design, Measurement and The pregnant woman is a particu- that advising a woman to look after Evaluation at McMaster University, larly favored and susceptible target for herself is the solution to further im- is on the staff of the Departments of that advice. She is specially concerned proving the outcome of pregnancy. Obstetrics and Gynecology and not only for her own wellbeing, but for Advice on lifestyle, to be appro- Epidemiology in Perth, Western that of her unborn child. She is rela- priate, must satisfy three fundamental Australia. Dr. Enkin is professor of tively young, perhaps not yet fixed in criteria. First, that if the advice is fol- Obstetrics and Gynecology at her habits, and thus capable of change. lowed, it will lead to benefit. Second, McMaster University, with an In addition, because she is generally that it is likely to be followed. Third, associate appointment in clinical well, we often have little else to offer and most important, that whether our epidemiology and biostatistics. her at antenatal visits. patients comply with our advice or Reprint requests to: Dr. M. W. A large part of antenatal care is not, the giving of that advice in gen- Enkin, Department of Obstetrics made up of advice-on diet, hygiene, eral will do more good than harm. and Gynecology, McMaster activities and habits. We tell the preg- University, 1200 Main St. West, nant woman to get plenty of rest, and In this paper we review some of the Hamilton, ON. L8N 3Z5. plenty of exercise; what to eat and lifestyle prescriptions and proscrip- what not to eat; how much weight she tions that have been used in the past should or should not gain. We tell her and are used today for pregnant "The most common form of remedy of- when she can have coitus, orgasm, women. On what evidence are these fered to pregnant women comes in the both, either or neither, and which of prescriptions and proscriptions based? guise of 'advice'. However, this is no life's other pleasures she may continue What side effects may they have? As ordinary advice, there being no option or must abjure for the duration of her examples, we will look at four areas to of refusal." 1 pregnancy. We have no shortage of which a great deal of attention has advice for her. Unfortunately much of been paid in recent years; diet and T HE ASSOCIATION between poor that advice is inconsistent, based on weight control, sexual activity, alco- health outcomes and undesirable unsupported opinion or conflicting ev- hol intake and smoking. lifestyles generally leads well-meaning idence, and potentially capable of physicians to 'improve' these out- causing harm as well as good. comes by advice to alter lifestyle for The importance of health habits can Nutrition the better. At times, the response to scarcely be denied. Unless a pregnant Despite the fact that diet is clearly a CAN. FAM. PHYSICIAN Vol. 30: OCTOBER 1984 2127 major determinant of postnatal to the physiologic changes in her me- The adverse effects of advice about growth, little is known about how, or tabolism which make her more resil- coitus during pregnancy have not been how much, the mother's diet during ient to deprivation, and her fetus less investigated. Williams 14th edition14 pregnancy affects the growth and well- vulnerable than hitherto has been be- comments bluntly about one such ef- being of the fetus. This lack of knowl- lieved". Except in situations where fect: "It has long been the custom of edge has not prevented professionals there are specific indications for inter- many obstetricians to recommend ab- from giving specific advice throughout vention, perhaps her appetite may well stinence from intercourse during the the centuries. Hippocrates advised that be the best guide to her requirements. last four to six weeks of pregnancy, a "dry foods are more adapted to the recommendation undoubtedly not car- softness of woman's flesh, and are bet- ried out in many instances. On occa- ter for the womb and pregnancy". He Sexual Activity sion the couples' drive in the face of also suggested that "food and drinks "Marital relations are to be re- the admonishment against intercourse that are not quite so good are to be pre- stricted, particularly near the men- late in pregnancy has led to sexual ferred' ' .2 On the other hand, some strual dates, and are strictly interdicted practices with disastrous conse- professionals advocated a more liberal where there is a tendence to abortion. quences. Aaronson and Nelson, for in- approach. Magnus, a 13th century All relations should be positively for- stance, describe fatal cases of air em- monk, cautioned that "to deny the bidden during the last months of gesta- bolism late in pregnancy as a result of pregnant woman any food she may de- tion. Non-observance of these rules air blown into the vagina during cunni- sire might cause the unborn child to may cause abortion, premature labor lingus." Less dramatic, but more die of weakness".2 and puerperal infection' .6 common, may be cases of marital fric- Obstetricians in the 19th century ad- Advice about sexual activity in tion and disharmony caused either by vised restriction of weight gain during pregnancy has softened somewhat sexual abstinence or guilt. pregnancy in the hope of making over the years. Williams' classic text smaller babies and achieving vaginal in its sixth and tenth editions suggest delivery in cases of contracted pelvis.2 that "in healthy persons sexual inter- Alcohol In the 1920s, observations of the course in moderation usually does no The association between alcohol weight gain seen in toxemia led obste- harm . but should be forbidden in and suboptimal mental development tricians to advise weight restriction to the last months of pregnancy". By the has been known for a long time. Aris- prevent eclampsia. An era of dietary 12th edition it admits that "even in the totle stated that "foolish drinking and restriction, especially of protein and last weeks it probably exerts less dele- hare-brained women for the most part salt, began, extending to the 1960s and terious effects than was formerly bring forth children like them- even to some degree today. More re- feared". 7, 8, 9 selves". 15 cently, many nutritionists have ad- Retrospective studies have shown Controlled experiments have estab- vised a high calorie, high protein diet an association between frequency of lished that heavy maternal alcohol to achieve maximal increase in fetal coitus,10 orgasm11 and preterm labor. consumption during pregnancy causes weight and development.3 It is difficult to argue that this associa- reduction in birthweight and an in- At least 17 controlled trials of die- tion is more than coincidental. Sexual creased incidence of congenital abnor- tary supplementation in pregnancy activity -generally declines in the last malities.16 Similarly, in humans con- have been undertaken.4 Eight of these weeks of pregnancy, making it more sistent association has been seen showed a decrease rather than an in- likely that a woman in preterm labor between heavy alcohol consumption crease in birthweight in the supple- will have had recent intercourse than and increased rates of spontaneous mented group compared to the con- one who gives birth at term. abortion, fetal growth retardation, and trols. Seven of the eight studies in Naeye,12 analyzing the data of the mental retardation, as well as a spe- which over 20% of the dietary calories NICDS collaborative perinatal project, cific dysmorphic syndrome. 17 were protein showed a decrease in found an increase in chorioamnionitis The risks of adverse outcomes with birth weight in the supplemented in women who had more frequent in- alcohol consumption in pregnancy are group.
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