“What’s ACTUALLY Pregnancy Safe (Vaccines, SSRIs, Tylenol & More) with Sabina Vohra-Miller

Here’s a run down of what we discussed in today’s episode: Introduction Why Expecting Parents Get So Much Conflicting Advice The Data Dilemma: Why Research on Pregnancy Is So Limited Understanding Correlation vs. Causation in Pregnancy Studies The Tylenol and Autism Controversy — What’s the Truth? The Real Risks of Avoiding Tylenol (and What Fills the Gap) SSRIs and Pregnancy: What the Evidence Actually Shows Balancing Mental Health and Medication Safety Vaccines and Pregnancy: Sorting Facts From Fear The Culture of Blaming Mothers for Everything When Over-Caution Does More Harm Than Good Finding Balance and Trusted Resources During Pregnancy Check in with today’s amazing guest: Sabina Vohra-Miller Website: vohramillerfoundation.ca Instagram: @unambiguousscience Disclaimer: The content in this episode is for educational and entertainment purposes only and is never a substitute for medical advice. If you’re struggling with with your mental or physical health, please work one on one with a health care provider. If you have heard yourself in our discussion today, and are looking for support, contact the free NEDIC helpline at 1-866-NEDIC-20 or go to eatingdisorderhope.com. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✨ Reach Your Weight & Health Goals — Without Dieting! Pre-order The Hunger Crushing Combo Method, Abbey’s revolutionary additive approach to eating well. Learn how to boost satiety, stabilize blood sugars, reduce disease risk, and improve your relationship with food — all while getting the best nutrient bang for your caloric buck. With 400+ research citations, cheat sheets, evidence-based actionable tips, meal plans, and adaptable recipes, The Hunger Crushing Combo Method is the only nutrition bible you’ll ever need. 👉 Pre-order today! 🛒 Where to Purchase: Amazon Barnes & Noble Amazon Kindle Apple Books Google Play Kobo Apple Books (Audiobook) Audible abbeyskitchen.com/hunger-crushing-combo • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✉️ Subscribe to My Newsletters: Abbey’s Kitchen Newsletter 📘 Check out my FREE E-Books: Hunger Crushing Combo™ E-Book Protein 101 E-Book 👋 Follow me! Instagram: @abbeyskitchen TikTok: @abbeyskitchen YouTube: @AbbeysKitchen Blog: abbeyskitchen.com Book: The Mindful Glow Cookbook • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 🎧 Don’t forget to subscribe on Apple Podcasts, Spotify, or wherever you listen — and leave us a review! It really helps support the show ❤️ 💬 If you liked this podcast, please like, follow, and leave a review — and let me know who you’d love to hear about next! ⭐ ⭐ ⭐⭐ ⭐ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Now, more than ever, we need someone on our side. But Rob Whitman? Whitman's votes drove up costs, cut Medicaid, and risked 350,000 Virginians' health care to pay for tax breaks for himself and his donors. He's not on our side. Shannon Taylor will fight corruption, cut taxes, and bring down costs. This November, vote for Shannon Taylor. She's for us. Paid for by HMP, the HouseMajorityPac.com. Not authorized by any candidate or candidate's committee.

• 0:29Speaker 01

  Because what we're talking about here is extrapolating the precautionary principle to a point where we're second guessing everything. And that's a slippery slope. When we use the precautionary principle out of context in these situations, it's not based on science. It's not based on evidence. It's based on beliefs.

• 0:51Abbey Sharp?

  Welcome to another episode of Bite Back with Abbey Sharp, where I dismantle die culture rules, call it the charlatan spinning the pseudoscience, and help you achieve food freedom for good.

• 1:05Abbey Sharp?

  Today, we are digging into that stage of the life cycle that affects 40 to 45% of people worldwide. One that is steeped in both hope and excitement, but also vulnerability and fear. Messaging about what to eat or avoid, what medications are safe or not, and whether vaccines help or do harm are overwhelmingly contradictory and paralyzing. At a such vulnerable and tumultuous time, never mind hormonal time in many women's lives, myths and half-truths thrive. And unfortunately, this is only getting worse. To help us sort fact from fiction,

• 1:49Abbey Sharp?

  I'm thrilled to welcome Sabina Volrop Miller, known on social media as Unambiguous Science. Sabina is completing her doctorate in clinical pharmacology and toxicology, and a lot of her work has centered around vaccine misinformation, which, my goodness, we've got a lot of right now.

• 2:10Abbey Sharp?

  Today's conversation, we will explore the origins of common pregnancy myths, how they spread, and what pregnant people, support partners, and health professionals can do to navigate a world of conflicting advice. We'll also talk about evidence-based perspectives on vaccines, medications, diet, and lifestyle during pregnancy, and how to counter misinformation without alienating or shaming. So whether you're pregnant, hoping to be, a partner, a healthcare professional, or just curious, this is an episode you will not want to miss. Very quickly, if you are new here, I would love if you would subscribe to Bite Back. It really does help me out.

• 2:52Abbey Sharp?

  And also, if you haven't heard, I have a brand new book coming out, The Hunger Crushing Combo Method, that is now on pre-sale and coming out January 13th. So I will be leaving links to all of the places that you can preorder in the show notes below. All right, friends, let's get into it.

• 3:17Abbey Sharp?

  Sabina, thank you so much for joining me. I'm very excited about this conversation.

• 3:20Speaker 01

  Me too, and I'm so happy that you're actually in Toronto and we're in the same hometown. It's amazing.

• 3:25Abbey Sharp?

  I know, that rarely happens. It's just, it's really nice to be able to connect in person. So this is great. So just to kind of set the stage here, because I feel like obviously, women's health has just always been shrouded in like so much mystery and like misinformation and just like fear mongering, you know, because historically, women have just not been part of a lot of research, and a lot of good research. But what is it about pregnancy specifically that just makes it such like a flashpoint for misinformation and fear mongering?

• 3:55Speaker 01

  You know, it's such a great, that's such a great question. And as someone who's also been pregnant, I've kind of gone through this myself, right? And I think that in pregnancy, there tends to be a heightened fear and anxiety. You have this responsibility where you're trying to look after, you know, something that you are, that is growing inside of you, right? And like, there is a lot of responsibility that comes with it. And so with that comes a lot of fear and anxiety, second guessing everything you do. Whether it's the right thing to do for your baby, whether it's the safe thing to do for your baby. And then also, of course, I think that because of this, there is a lot of room for grifters to sort of sneak in and play on that, right, anxiety. And so you see a lot of misinformation spreading because you have folks who are trying to take advantage of this.

• 4:39Abbey Sharp?

  Of course, of course. And and maybe you can kind of help us understand, like, why do we not have great data on women's health and pregnancy specifically? When it comes to like what is safe, what is not safe, we're kind of just in some cases flying blind or like you said, just kind of susceptible to what people saying on the internet.

• 5:00Speaker 01

  Right. And so when it comes down to clinical trials, right, we cannot ethically do a randomized controlled trial in the pregnant population, right? It's we don't know something is safe, we can give it to them, right? There's also, you know, I've spent a lot of time in biotech doing clinical trials and the issue also is that we don't really incentivize pharmaceutical companies to undertake studies in pregnancy or do pregnancy registries. So for instance, in pediatrics, you actually get an extension on your patent if you do pediatric trials. That doesn't happen for pregnancy. And so because of that, you know, it tends to be more post-market surveillance or post-market registries that have to come into place to actually gather this data. And not a lot of people do this, right?

• 5:45Speaker 01

  And then so what you end up with is because you can't do ethically randomized controlled trials, they tend to be things like observational studies, very often retrospective. So you have things like recall bias that sort of plays into it. And so the data is just not robust, right? And so we have, for instance, that the grade approach that we use very often in trying to analyze or assess the quality of evidence. But that typically would put your randomized controlled trial right at the top. But we don't have something similar to that to that in pregnancy where we can actually weigh the studies coming in. So yes, they're all going to be observational, but one observational study is not the same as another observational study. But we don't have a great way of quantifying what the differences.

• 6:30Speaker 01

  So they all end up being on the same level playing field when that's not necessarily the case.

• 6:36Abbey Sharp?

  Right, right. So I mean, we're seeing a lot of inconsistency in what the kind of results are. People are able to cherry pick and it becomes a dangerous world for grifters to kind of sneak in there for sure.

• 6:48Speaker 01

  Right. And so you also can't prove causality. That's the other issue when you're doing observational studies. Causality is something that is going to be very, very tricky and very difficult to actually, you know, come to. And then the other aspect of doing studies in pregnancy, and actually this is true in everything, but particularly so in pregnancy is we're looking at risk versus benefits. We have to look at that totality of evidence. So it's not just the risks of taking a medication. It's also the risks of not taking a medication. That also carries risks. And I think that risk tends to be downplayed in pregnancy. And risks of the medication tend to be overplayed in pregnancy. And so there needs to be a balance and, you know, a approach in that when we're looking at all of that.

• 7:32Abbey Sharp?

  Right. Oh my gosh, I could talk about that risk and benefit. We will, we will go into more of that. And so we obviously, we've established here that correlation doesn't, you know, it doesn't equal causation. We don't have great data to show causation when it comes to substances when it, during pregnancy. I want to kind of zone in on some of the more kind of controversial substances. And I think the big one that we're talking about right now is of course Tylenol in pregnancy or acetaminophen. Because the US administration has come forward suggesting that there is a link between Tylenol use, maternal Tylenol use in pregnancy and autism.

• 8:11Abbey Sharp?

  And before we get into like what the data actually says on that, where did this assertion even come from? Like what, what evidence do they have to make this statement?

• 8:22Speaker 01

  Right, and so over the period of the last like 10 years, every now and then, a very small study on acetaminophen kind of pops up that shows some sort of an association between the use of acetaminophen in pregnancy and your developmental concerns. And then what kind of transpired, what's happening in the US right now, is that there was a systematic review that was done by, you know, one of the authors was essentially the dean of the Harvard School of Public Health. And what they did, unfortunately, is they cherry picked some of this, again, like it comes back to the topic of like, not every study is the same, right? And so they cherry picked some of the lower quality evidence and sort of amplified it.

• 9:07Speaker 01

  And using that as the basis, they went ahead and made this, you know, big announcement, press by release announcement for, you know, saying that acetaminophen use in pregnancy causes autism. They literally used the word cause, like there was a causal in there, even though actually, if you look at even the systematic review that was done, there was no causality anywhere in that, right? And the hilarious part is that Marty Makary, the FDA commissioner, goes out and puts a forward and official statement that, you know, goes to every physician, healthcare provider in the US. And in his letter, he actually says two things. A, there's no causal link, so he himself says this.

• 9:47Speaker 01

  And he also says Tylenol or acetaminophen is like the only safe option in pregnancy.

• 9:53Abbey Sharp?

  Right.

• 9:54Speaker 01

  Right? So even within all of this chaos that they're bringing forward, they're, they don't have consistency themselves, and they know themselves that data just doesn't seem to back what they're claiming.

• 10:04Abbey Sharp?

  And what does the better research show?

• 10:06Speaker 01

  Right, and so we actually have some really good, properly done observational studies where we did sibling control trials. So the sibling control analyses are really important because we know things like autism, ADHD have a very strong genetic component.

• 10:21Abbey Sharp?

  Absolutely.

• 10:22Speaker 01

  So we call this familial confounding, right? And so what they did in these studies, this one specific one that actually was just published a year or so ago, they looked at around Two point five million children and it was a long study. It was from nineteen ninety five till I think two thousand nineteen. And what they did is they compared siblings. So one sibling would be exposed to acetaminophen in utero. And then they compared it to a sibling within the same family that was not exposed. So that's where you're sort of controlling for genetic components. And the interesting part with the study is that when they did not control for the sibling, they they they actually saw a very small association. The second they control for it, there was no association found, right?

• 11:05Speaker 01

  And so with this news coming in the US, you know, we have several different agencies and medical bodies who went back and said, okay, we'll look at all the data again, right? And so SOGC, which is the Society of Obstetricians and Gynecologists of Canada, said, fine, we'll go back, we'll review all of the data again. And they did that and they came back and said, actually, if you look at the the studies that are done really well, there is absolutely no causal link that we can see. And there is global consensus on this. So it's not just, you know, Health Canada put out a statement, SOGC did. Of course, in the US, our counterparts, which is ACOG, did, the Society for Maternal Fetal Medicine did. Our European colleagues came out and said the exact same thing, right?

• 11:49Speaker 01

  So there's global consensus that there's absolutely no causal link whatsoever. Particularly when you do the studies that are that are done the right way, we don't see that link.

• 11:59Abbey Sharp?

  Right, yeah, and and you know, I I touched on this in my episode with Dr. Tommy Martin. And just, you know, it's it's it's so terrible because now we're in a situation where women are either going to let their fevers go untreated, which we know untreated fevers is an actual risk factor for, you know, neurodevelopmental issues, including linked to autism, ironically. And, you know, the danger is not just in, you know, avoiding Tylenol, it's is what are we replacing that Tylenol with, right? And now we have people like Nancy Mace suggesting, oh, take Advil instead of Tylenol. What is the risk of that?

• 12:39Speaker 01

  Right, that's exactly it, right? So it's not like, as you mentioned, it's not just the risk of not taking it, but what are you then replacing it with? And so Nancy Mace goes on Bill Maher's show, which obviously is really, really highly viewed, goes on and says, well, there's other safer options to take like Ibupro or Advil. And I'm like, oh, when I saw that video, the audible gasp that came out of my mouth, because we have now known for a very long time that actually ibuprofen use in pregnancy can cause some serious issues, like kidney issues, aneurotic fluid issues. And then, of course, it prematurely closes ductus arteriosus, which is really, really not good for the fetus, right? And so now you're replacing something that we know is safe to take, obviously, you know, when it's medically indicated,

• 13:24Speaker 01

  at the right dosages for the shortest duration, which, by the way, we say for every medication in and out of pregnancy. That's the same even if you're not pregnant. And now we're taking that and we're replacing it with things that we know for sure can cause serious issues for the fetus. And, and, you know, like, my question here is, what's the end goal? What are we doing here, you know?

• 13:45Abbey Sharp?

  We're just trying to make women suffer.

• 13:47Speaker 01

  We are, we absolutely are. And like, we're going to see worser outcomes for both the pregnant person and for the fetus, the baby. We're going to see worser outcomes with these decisions that are coming from institutions that technically should be most credible, right? We look up to them, even in Canada. We look to the US for their guidelines and we really shouldn't be anymore.

• 14:08Abbey Sharp?

  Right, what a travesty. I want to switch gears and talk about SSRIs, which are, you know, a class of medication typically used for depression, anxiety, other mood disorders. And the FDA recently came out claiming that there is an increased risk of birth defects when women are taking SSRIs in pregnancy. What does the best quality research actually tell us here?

• 14:30Speaker 01

  Yeah, so here is another case where we've actually found, you know, similar, small studies that have shown a very, very slight increase in certain birth defects. But if you actually look at some of the bigger studies, we don't see any issues with cardiovasculars or cardiac birth defects or other birth defects. The big studies- Don't actually show this to us and same with neurodevelopmental. I know that's come up with the SSRIs and SSRIs too. And again, when you look at some good data, the good studies do not show this at all either. And then, you know, what we end up seeing are people who either discontinue or do not take their medications in pregnancy, which end up, you know, as we talked about, having even worser outcomes. And we've known that for a very long time,

• 15:14Speaker 01

  right? And, and I myself have spoken to patients who were struggling because they discontinued their SSRI in pregnancy, and they were not doing well. And it's, it's, it's unnecessary suffering. And so again, here, the data does not really show that. With the big studies, no real birth defect issues. In fact, there was perhaps, you know, a small increase in what we call pulmonary hypertension of the newborn. It was a 0.3% increase, which is really, in the grand scheme of things, not significant, particularly considering the benefits of actually being on an SSRI. And the one thing I also want to clarify is not, we're not, this is not, you know, a candy shop where you go when you buy your candy,

• 15:58Speaker 01

  you come out. To get SSRIs, you know, you definitely need to see healthcare providers. There's a very, very careful stepped approach that we take.

• 16:07Abbey Sharp?

  Right.

• 16:07Speaker 01

  Right? There are guidelines on this. There are stepped approaches that we take where we actually look at non-pharmacologic interventions before we actually approach the pharmacologic interventions, right? And that is medicine. This is how medicine is done when it's evidence based, right? And so we're not just giving out medications willy-nilly without actually taking that careful, you know, considered approach to the full, full health of the person. And yeah, and it's just, there's so much disinformation on this area. And it's just, it's one of those things that's really frustrating because I used to hear this 15 years ago, 20 years ago, when I was, you know, working specifically in this field. And 15 years later, nothing has changed. We're still there.

• 16:50Abbey Sharp?

  We're still, you know, not acknowledging that women's mental health actually matters.

• 16:55Speaker 01

  Exactly.

• 16:56Abbey Sharp?

  It's this constant narrative. This, this is just woven into. Motherhood, you know, like the myth of motherhood, that we just should be all, you know, self-giving. And so we should suffer for our children, including our own mental health, just muscle through it, you know, like do whatever's best for your baby. When in fact, not taking that SSRI that you may actually need is not best for a baby, right?

• 17:20Speaker 01

  No, not best for baby at all.

• 17:22Abbey Sharp?

  We actually have research that it can, you know, you know, untreated mental health disorders and pregnancy can almost double the risk of preeclampsia, double the risk of preterm birth, increase the risk of child developmental issues by 80%. So abstinence is not better, right?

• 17:38Speaker 01

  IUGR is another one, where the low birth weight too, right? And then we also have issues with, you know, bonding with the child. And let's not forget that in fact, postpartum and pregnancy-related depression and, and, you know, mental illnesses in pregnancy actually have resulted in very high rates of suicide.

• 17:59Abbey Sharp?

  Right.

• 17:59Speaker 01

  And we can beat around the bush over here because what, what an actual child needs is a mother who is actually able to function as well, right? And is alive to take care of their child. So yeah, it's not good for the mom. It's not good for the baby. It's good for no one.

• 18:16Abbey Sharp?

  No one, no one.

• 18:32Abbey Sharp?

  Are there specific classes of medications that may be safer in pregnancy?

• 18:37Speaker 01

  So there are some classes that definitely have more data than others. But in general, you know, the, the idea is that most SSRIs, most SSRIs are considered safe in pregnancy. The issue with which one to take in pregnancy ends up being very complicated because it depends on, you know, your own personal history, what works for you. And that has to be, you know, a much more detailed conversation with your physician. Generally speaking, you know, It's it's it's you come to the right medication for you based on a whole host of considerations. So again, it's not something that is done and you just walk into a shop, you buy something, you come out. That's not how it is. It's a very careful approach to it and it's the same with SSR.

• 19:18Speaker 01

  So definitely there are some that have more data than others, but at the same time, that's not the only consideration that has to be taken.

• 19:26Abbey Sharp?

  Of course, yeah. Okay, so we gotta talk about vaccines because you know, the media has been going off about again, vaccines causing autism, we're seeing a drop in vaccine uptake, that's a huge problem right now. But also, women while pregnant, taking vaccines has has often been a really big controversial topic, whether that's the COVID vaccine, flu vaccine, MMR, you know, boosters, what have you. And I remember when I was pregnant with my first, I had done my research, my doctor recommended getting the flu shot because you know, flu season was upon us. I did not want to get sick while pregnant. I it's like terrifying. And some of my close circle was like, Abbey, you can't, you got the flu shot?

• 20:12Abbey Sharp?

  So and so told me that that causes X, Y, and Z. And despite, you know, all the hell literacy that I had, it took me to a dark place. I was spiraling. Did I do something wrong for my baby? You know, was something bad gonna happen? Was everyone gonna come after me after the fact, say, told you so is because you took that that that that flu vaccine? What does the research actually say on the safety of vaccines while pregnant?

• 20:36Speaker 01

  Yeah, I mean, I totally get that because again, it was one of those things that I went through too. And and you know, as healthcare providers, as someone who, you know, I I didn't grow up in Canada, right? And grew up in North America. I actually grew up, you know, in a country where we didn't have great access to vaccines. And I remember standing in line, you know, out in the heat for like three hours in school, getting our vaccines. And we all knew the importance of getting it. And so when I moved to Canada and, you know, when I was pregnant, I did not understand the the the anti-vax or the vaccine hesitancy that I was seeing across, I joined mom groups and that that is where like I was. Wait, people don't like vaccines? Why? Are you like, what? Like, it's just, it was completely, it was shocking to me.

• 21:20Speaker 01

  And and and then when I was pregnant, like, I couldn't help but but think in the back of my head, I know this is safe. I know this is what I should be doing. The back of my head, you have those little voices that just sit there. Exactly. And and you know, and so I totally understand when that happens, even with people who unders- who are in this, in like the scientific fields, who understand the importance of vaccines. Um, but I think, you know, what's really important here is we take vaccines in pregnancy for two reasons, right? One is to protect yourself. Yeah. Because remembering that pregnancy is an immunocompromised state, right? Because you need fetal tolerance. You wanna make sure you're keeping the fetus. And when that comes, you know, slight immunocompromised um states,

• 22:02Speaker 01

  which is why you end up being at a higher risk for even things like listeria, right? Um, but that also means you end up having complications from influenza or from COVID that would be far worse because you're pregnant versus if you were not, right? And we've seen that even um with all the data coming out with the COVID nineteen infections in pregnancy, how it increases the risks of, you know, forget, we're not even talking about the fetus and the baby right now. We're just talking about the actual pregnant person. Um, the number of people during, you know, the COVID first waves, when we didn't have the vaccine, who were intubated and pregnant. Um, I was hearing stories about this from my healthcare provider friends all the time.

• 22:44Speaker 01

  Because you are in an immunocompromised state, you are at a higher risk for complications from flu, COVID, etc. So that's one of the reasons why you take, you know, vaccines in pregnancy. But then there's actually a second reason why you take vaccines in pregnancy. And this is true for, say, the T-DAP, which is where the protesters, the whooping cough part, right? And also now the RSV vaccine. And you do that actually to pass on protection to the baby when the baby's born before they can get their own protection, right? And this happens through um specific antibodies called IgG antibodies and through transplacental transfers. So it basically is through the placenta, you're transferring antibodies from you to the fetus. That the baby can then have for the first few weeks to months after birth, right?

• 23:29Speaker 01

  And so if you look at the data for TDAP for pertussis specifically, what we do it for them to prevent whooping cough.

• 23:36Abbey Sharp?

  Right.

• 23:36Speaker 01

  Until they can get their own vaccine at two months. If you actually look at the studies that show that people who get the the TDAP vaccine in pregnancy, reduce the risk of whooping cough in the baby by eighty five percent in the first two months, eighty five percent.

• 23:52Abbey Sharp?

  Whoa.

• 23:53Speaker 01

  And actually for hospitalization, it's way over ninety percent, right? And so this protects them for the first two months when they're so susceptible to whooping cough and so susceptible to like, you know, dying from whooping cough, right? And so this protects them until they can actually get their own protection. So, yeah, so there's two reasons why we want to give vaccines in pregnancy, protect the person, but also to pass on these antibodies. It's the same with influenza and COVID vaccine. My advice usually to people, I get this question all the time is, should I time my COVID vaccine or my influenza vaccine so that it is in the third trimester where I can actually pass these antibodies to the baby? And my response always is, protection for you first.

• 24:34Abbey Sharp?

  Yeah.

• 24:34Speaker 01

  So if, you know, if you are right now in first trimester, for instance, and you know flu season is coming up, you get the flu shot to protect yourself before you even talk about, you know, the the transfer of antibodies to the baby. So, yeah, two reasons for doing this. And like, we know, we have so much data now on a lot of these vaccines, like there was a, actually at the recent American Academy of Pediatricians, they're, they had, they're having their current meeting going on right now. There was a presentation, so I haven't read the full paper yet, but the presentation actually looked at one point two million women who received the COVID nineteen vaccine. So we have.

• 25:11Abbey Sharp?

  Yeah.

• 25:11Speaker 01

  So much data, so much data. And for influenza, decades and decades worth of data that shows that these vaccines are completely safe when taken in pregnancy and offer so many advantages to both pregnant person and baby.

• 25:26Abbey Sharp?

  That is so validating, I'm sure, so validating for for so many, you know, folks who are listening at home who either are going through this right now or were going through this and it's still causing them some kind of like, you know, some anxiety just thinking back, like, what if this causes long term problems? I really appreciate that. And it just feels like, you know, the anxiety of around that. It's so much worse for me and baby than like anything a theoretical substance could ever do, even if that substance could theoretically do harm, which as you've established, it does not. But yeah, speaking of mom shaming and scaring women, you know, I remember when I was

• 26:06Abbey Sharp?

  pregnant with my first, you know, the mom group game is is toxic. It's scary. And every single time somebody would ask a question like, oh, you know, is this cream, like this body cream safe? Is this brand of makeup safe? Can I dye my hair? Can I eat this? Can I drink coffee? Whatever it is, you know, and and there would always be people being like, well, we don't know. So just don't do it. Just don't do it. Just avoid it. Just avoid it, you know. And we obviously talked about the risk benefit of some of these lifesaving medications like acetaminophen and things like that, which is much more clear. But for things that we don't need, but we want, like getting our nails done, or dying our

• 26:45Abbey Sharp?

  hair, or using our favorite brand of makeup, what might be the risk of like an over cautious approach where people are just saying, hey, we don't know. So just don't do it. Just don't do it.

• 26:56Speaker 01

  Yeah. And so, you know, that's, this is where I feel sometimes the precautionary principle can be overused, right? Because what we're talking about here is extrapolating the precautionary principle to a point where we're second guessing everything. And that's a slippery slope. Because right now, when we use the precautionary principle out of context in these situations, it's not based on science. It's not based on evidence. It's based on beliefs.

• 27:23Abbey Sharp?

  Yeah.

• 27:24Speaker 01

  Right? And so, and that's problematic.

• 27:25Abbey Sharp?

  Yeah.

• 27:26Speaker 01

  Because that slippery slope then takes you to the next slippery slope where you make these decisions based on beliefs and not evidence.

• 27:32Abbey Sharp?

  Right.

• 27:33Speaker 01

  And so that's kind of where I have a huge issue with it. Because where do we stop? Where is that end line? At what point do we say, okay, this is getting a little ridiculous, right? Because I mean, I've, I've, I want, in my past life, when I was a student, I was actually a counselor on mother risk.

• 27:52Abbey Sharp?

  Oh, yes.

• 27:53Speaker 01

  And so that's I, you know, my degree is in neonatal toxicology, right? And I've actually had questions from people where they've said, Is is tap water safe for me to drink? Or should I be drinking bottled water? But like at that point, you're second guessing everything that you're doing. And there's there's no benefits that come from this, right? There's only harms that come from this. So I think we have to understand that when we're overextending the precache principle, it ends up being counterproductive. In fact, it can actually cause active harms.

• 28:23Abbey Sharp?

  Yeah.

• 28:24Speaker 01

  Um, and again, this is the place where it becomes so much easier for grifters to like sneak their way in and push things that have even worser.

• 28:34Abbey Sharp?

  Mm hmm.

• 28:35Speaker 01

  Um, you know, data or worser, um, for lack of a better word, options or alternatives, right? And so that's kind of where I get really, really, really anxious because, okay, so A, you know, we're extrapolating this, but B, now you're taking something you probably should not do or should not take because someone told you that what you were doing is unsafe.

• 28:59Abbey Sharp?

  Right.

• 29:00Speaker 01

  Um, so that's, yeah, it's just like, it's a slippery slope. Where do you stop?

• 29:03Abbey Sharp?

  Oh, my gosh, you know, I was just thinking about like another downside to to this kind of over cautious approach. And it's like, you know, that sometimes the behavior that maybe we have been told to limit or restrict becomes extrapolated and then misinterpreted to the point that now we're avoiding things that we should be engaging with. Like, a very good example is when people hear, oh, you know, avoid or reduce high mercury fish. And then in their head, they're like, well, I gotta avoid all fish in pregnancy. When we actually want people who are pregnant to eat more fish because we know there's so many benefits like DHA and things like that. Another one is like with the recommendation, okay, don't start an extreme, brand new exercise regime.

• 29:47Abbey Sharp?

  Like if you've, if you've never worked out before, don't like start doing boot camps every single day. That's now extrapolated to, oh, don't do any exercise at all. When again, exercise is very important. Um, it, it, that also can be a really big problem with this, oh, don't do this, becomes don't do anything.

• 30:07Speaker 01

  Right. And so like your example of the mercury, for instance. Great one, because now we're talking about that mercury on in vaccines too, right? And so, so we start with something that's scientific, right? We start with like, okay, there are certain fishes that have high amounts of mercury that you consumption that you probably want to limit. And then it goes to, oh, but I'm just now going to extrapolate the science and on beliefs. Talk about the mercury in vaccines, even though we know it's not, you know, there's difference between methyl versus ethyl mercury. The amount of it, et cetera, right? And so it starts with science, but then very quickly goes down to your beliefs.

• 30:45Abbey Sharp?

  Correct.

• 30:45Speaker 01

  I mean, and so, and then where are we going to extrapolate that next to?

• 30:48Abbey Sharp?

  Yeah, yeah. Unfortunately, the folks who are perpetuating this misinformation are people who don't understand that science or the nuance. Or the dose makes the poison, or any of these like really, really critical concepts that, you know, science communicators do. Which is what actually determines whether something is safe or not.

• 31:07Speaker 01

  Yeah.

• 31:08Abbey Sharp?

  You mentioned mother risk a moment ago. I didn't know this about you. That's actually what I kind of wanted to ask about because mother risk really changed the game for me in my first pregnancy. For those who don't know, mother risk was, you know, a Canadian kind of service based out of Toronto sick kids.

• 31:28Abbey Sharp?

  Basically, you could call them at any time and speak to a healthcare professional like you. Who could help you understand the, you know, what the data actually said on specific substances and medications and things like that. So I was literally calling them every single week, being like, can I take this? What do you think of this? And really it does help you work out that risk benefit analysis, which, you know, even a lot of doctors aren't able to do. They're just kind of like, well, we don't know, so don't take it. And it's just like, well, my mental health will suffer. And they were really fantastic and unfortunately they are no more. Are there any other resources that, that, you know, moms to be can access that would be helpful like that?

• 32:11Speaker 01

  Yep. So in the U S, there, there are a counter press that we have in the U S is called Mother to Baby. So they're part of the Otis, the Territoryology Information Services in the U S. So it's mother to baby. They have similar fact sheets. If you are a complex case, you can actually speak. It's through email for us and then you can actually speak to. You get referred out to someone who has a maternal fetal specialty, so mother to baby in the US. In Canada, unfortunately, right now, we do not have any service that offers the same kind of, you know, information the way Mother Risk did. However, five years ago,

• 32:48Speaker 01

  I tried to bring it up and I am actually in the process of. Come on. I know, I know. I haven't, I haven't talked very much about it because the process of actually getting all the reviews done for all the medications is long. And we want to make sure we don't run into similar issues that we did with Mother Risk. We want to make sure we're doing this perfect. You know, very robust with really, really clear guidelines, et cetera. And so the program in Canada is called, or in Toronto, is called First Exposure. Because, you know, it's exposure. Yes. We didn't want to have the word risk in there because it's not always, anything that risk, using that word itself. Words matter. Exactly. It gives you that connotation that everything you're doing is risky.

• 33:32Speaker 01

  And it's not necessarily risky. And so we wanted to get rid of the word risk. We also wanted to be more inclusive, so that's why we don't even have the word mother in there. But it's called First Exposure. And so we're starting to actually go through the databases of what are the most commonly used medications? And exposures in pregnancy, what does the data show about it? And then we have a team of incredible experts in all of these subspecialties coming together to actually put this. But the work is slow because, you know, we're doing our due diligence and due diligence doesn't happen overnight. And, and I'm excited about it. It's, it's, you know, so if you go to the First Exposure website, you will see we are, we do have a health topic on mental

• 34:14Speaker 01

  health medications. We have topics on cold and flu, which I know is going to happen. You know, soon we have health topics and medic information on questions that we're getting very often, usually trendy topics like GLP-1. Which, you know, we've had lots of talk about this, especially because people end up getting pregnant while the world are taking it. So we are trying to do this. We're trying to fill the need in Canada. It's a long way to go. We're also looking for provincial and federal support. I'm putting this out there.

• 34:46Abbey Sharp?

  Yes, I was gonna say, like, is there like a GoFundMe page? Because I feel that this is so important.

• 34:52Speaker 01

  It is. It is incredibly important. So we are, our next phase is trying to look for provincial or federal funding as well. And so if anyone from the province or the feds, help Canada, hello. If you're listening to this, we'd love some funding for this work as well. But yeah, so currently it is being funded by my foundation. But, you know, this work, there is a lot to be done, as you know, and we're seeing even more and more misinformation in this area. So it is so timely, so important, and there's a huge need in Canada.

• 35:26Abbey Sharp?

  I am so happy to hear that. And I'm so glad that I brought that up. Thank you so much, Sabina. This was being, this has just been so enlightening, and I'm sure really reassuring for a lot of, you know, parents or parents-to-be, or, you know, people who, you know, thought about getting pregnant but were scared to because of all of this that's going on right now. So I really appreciate it. We'll be leaving links in the show notes to all of your amazing content at AnAmbiguous Science. And yeah, please do keep fighting the good fight. It's very hard out there.

• 36:01Speaker 01

  It is. It is. It is. But you know, I think there's also hope in this, right? And I think that's what I try and catch on to every single day, as do you. That's why we do this work, right?

• 36:11Abbey Sharp?

  Oh, 100%. Thank you.

• 36:13Speaker 01

  Thanks for having me.

• 36:15Abbey Sharp?

  Well, friends, I am definitely, without question, done being pregnant. But I still found this episode so validating and reassuring because, you know, even with all of my science literacy and research, and the fact that I am not even pregnant, a lot of these loud accusations right now still give me major anxiety. Because it feels often like

• 36:40Abbey Sharp?

  You know, if something were to be wrong with my kids, all eyes would be on me. Like, someone is going to say, "Oh yeah, it's that flu shot she took," or "It's the coffee she drank." So I really found this conversation super validating. But speaking of coffee, I want to end this discussion with some of the foods that we often hear that we should avoid or limit in pregnancy. And they're typically divided into two major categories: direct substance risks and food safety risks. Now, the clearest example of a direct substance risk in pregnancy is alcohol. As we know, that exposure to alcohol is linked to fetal alcohol spectrum disorders,

• 37:22Abbey Sharp?

  growth restriction, and neurodevelopmental problems. Another example of this is fish high in mercury. So, things like shark, swordfish, king mackerel, and some types of tuna. Mercury can cross the placenta and can affect babies' developing brain and nervous system. So, our guidelines recommend limiting these species while still encouraging lower mercury fish because they have a lot of those great omega-3 benefits. Vitamin A in excess, especially from supplements or liver products, can also increase the risk of birth defects. Whereas, high levels of caffeine have been associated with miscarriage and low birth weight

• 38:04Abbey Sharp?

  in some studies, which is why most authorities recommend no more than 200 to 300 milligrams or one to two cups of coffee per day. Pretty much, in all of these cases, at least to our knowledge, the risk of harm is dose-dependent. So, eating a single serving of swordfish isn't going to independently give your kid a cognitive delay. Now, in contrast, the other major category of foods that we hear about limiting are those that are more likely to cause foodborne illness. And a single bout of severe food poisoning can cause miscarriage, stillbirth, or preterm birth.

• 38:47Abbey Sharp?

  And this is why guidelines often advise that we avoid Or take extra precautions with foods like unpasteurized cheeses, deli meats, raw sprouts, undercooked meats, sushi made with raw fish, and unpasteurized juices or milks. You maybe have never gotten sick from your favorite sushi spot before, but pregnancy does suppress the immune system, making us more vulnerable to serious infections. So the FDA, for example, has noted that one in six cases of listeriosis in the US occurs in pregnant people. So while the absolute risk of foodborne illness from, let's say, deli meat is relatively low, the relative risk is high enough

• 39:30Abbey Sharp?

  to consider taking some extra precautions when you've got baby on board. Now, the third, I guess, bonus category of foods that we hear about limiting are those that are more a theoretical risk, usually based on faulty or incomplete science that doesn't take into consideration the dose that makes the poison. So for example, if you do a deep enough dive in like pregnancy forums, you'll maybe see the recommendation to avoid pineapple in pregnancy because the enzyme bromelain has been shown to cause uterine contractions in rats and Petri dishes, which I guess theoretically could cause a miscarriage. But we have zero credible evidence

• 40:15Abbey Sharp?

  that this is an actual thing. And even if bromelain could induce early labor, you would likely need to consume dozens of whole pineapples in one sitting, possibly like multiple times. And even if you tried doing that, you would get diarrhea long before it affected the uterus. So bottom line takeaways here, folks. Pregnancy can be a time of overwhelming uncertainty and anxiety, where our bodies and choices feel constantly judged and under surveillance. And no matter what choice you make, there will always be someone telling you that you're doing it wrong or that something is unsafe. The truth is, science doesn't give us absolute certainty.

• 41:00Abbey Sharp?

  About every single exposure or decision. What it does is give us probabilities, patterns, and context. That means that every pregnant person, together with their healthcare team, has to weigh the risks and benefits for themselves. Sometimes the bigger danger comes not from what you eat or take, but from the stress and guilt that comes from feeling like you can't get it quote-unquote right. So as you move through your pregnancy, remember, you do not need to be perfect. You just need to make the best decisions you can with the information available for your body and your baby. And that means balancing evidence, medical guidance,

• 41:41Abbey Sharp?

  and your own values, not the endless noise of opinions around you. And on that note, thank you again to Sabina Vohra Miller for helping me fight back against misinformation online. Signing off with Science and SaaS, I'm Abbey Sharp. Thanks for listening.

• 42:08Speaker 00

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