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

Episode Date: October 14, 2025

Here’s a run down of what we discussed in today’s episode:IntroductionWhy Expecting Parents Get So Much Conflicting AdviceThe Data Dilemma: Why Research on Pregnancy Is So LimitedUnderstanding Correlation vs. Causation in Pregnancy StudiesThe 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 ShowsBalancing Mental Health and Medication SafetyVaccines and Pregnancy: Sorting Facts From FearThe Culture of Blaming Mothers for EverythingWhen Over-Caution Does More Harm Than GoodFinding Balance and Trusted Resources During PregnancyCheck in with today’s amazing guest: Sabina Vohra-MillerWebsite: vohramillerfoundation.caInstagram: @unambiguousscienceDisclaimer: 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.  🥤 Check out my 2-in-1 Plant Based Probiotic Protein Powder, neue theory at www.neuetheory.com or @neuetheory and use my promo code BITEBACK20 to get 20% off your order! Don’t forget to Please subscribe on Apple, Spotify or wherever you get your podcasts and leave us a review! It really helps us out. ✉️ SUBSCRIBE TO MY NEWSLETTERS ⤵️Neue Theory newsletterAbbey's Kitchen newsletter 🥞 FREE HUNGER CRUSHING COMBO™ E-BOOK! 💪🏼 FREE PROTEIN 101 E-BOOK! 📱 Follow me! Instagram: @abbeyskitchenTikTok: @abbeyskitchenYouTube: @AbbeysKitchen My blog, Abbey’s Kitchen www.abbeyskitchen.comMy book, The Mindful Glow Cookbook affiliate link: https://amzn.to/3NoHtvf If you liked this podcast, please like, follow, and leave a review with your thoughts and let me know who you want me to discuss next!

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. Welcome to another episode of Bite Back with Abby Sharp, where I dismantle die culture rules, call it the charlatans spinning the pseudoscience and help you achieve food freedom for good. 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 a sort fact from fiction, 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 got a lot of right now. In 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 were new here, I would love if you would subscribe to Byteback. It really does help me out. And also, if you haven't heard, I have a brand new book coming out, The Hunger Crust.

comb method that is now on pre-sale and coming out January 13th. So I'll be leaving links to all of the places that you can pre-order in the show notes below. All right, friends, let's get into it. Sabina, thank you so much for joining me. I'm very excited about this conversation. Me too. And I'm so happy that you're actually in Toronto and we're in the same hometown. It's amazing. I know. That rarely happens it's just it's really nice to be able to connect it in person so this is great um so just just 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 um but

what is it about pregnancy specifically that just make it such like a flashpoint for misinformation and fear-mongering. You know, it's such a great, that's such a great question. And as someone who's also being 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 there is a lot of responsibly 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. Of course, of course. 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 are saying on the internet. Right. And so what it comes on to clinical trials, right, we cannot ethically do our randomized control 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? And then, And 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, 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 control trial right at the top. but we don't have something similar 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 are. So they all end up being in the same level playing field when that's not necessarily the case. 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. 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, 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 approach in that when we're looking at all of that. 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 Cedaminopin. Because the U.S. administration has come forward suggesting that there is a link between Tylenololian. use, maternal Tylenol use in pregnancy, and autism. And before we get into like what the data actually says on that, where did this assertion even come from? Like what evidence do they have to

make this statement? Right. And so over the period of the last like 10 years, every now and then, a very small study on acetaminopin kind of pops up that shows some sort of an association between the use of acetaminopinin in pregnancy and neurodevelopmental concerns. And then what kind of transpired what's happening in the U.S. 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.

And using that as the basis, they went ahead and made this, you know, big announcement, pressed by release announcement for, you know, saying that acetaminopin 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 McCurry, the FDA commissioner, goes out and puts a forward an official statement that, you know, goes to every physician health care provider in the U.S.

And in his letter, he actually says two things. A, there's no causal link. So he himself says this. And he also says Tylenol or acetaminopin is like the only safe option in pregnancy. Right. Right. So even within all of this chaos that they're bringing forward, they don't have consistency themselves and they know themselves that data just doesn't seem to back what they're claiming.

And what does the better research show? 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. 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 2.5 million children, and it was a long study. It was from

1995 till, I think, 2019. And what they did is they compared siblings. So one sibling would be exposed to acetaminopin in utero, and then they compared it to a sibling within the same family that was not exposed. So this is 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 actually saw a very small association. The second they control for it, there was no association found, right? Wow. And so with this news coming in the U.S., 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 Kynacologists 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 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. S.S.G.C. did. Of course, in the U.S., 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?

So there's global consensus that there's absolutely. no causal link whatsoever, particularly when you do the studies that are done the right weight, we don't see that link. Right. Yeah. You know, I touched on this in my episode with Dr. Tommy Martin and just, you know, 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

Mays suggesting, oh, take Advil instead of Tylenol. What is the risk of that? 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 Meher'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, and I saw that video, the audible gas 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, kidney issues, amniotic fluid issues. And then, of course, it prematurely closes the ductus arteriosis, 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, 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, you know, like my question here is, What's the end goal? What are we doing here? You know? We're just trying to make women suffer. We are. We absolutely are. And like we're going to see worse or outcomes for both the pregnant person and for the fetus, the baby. We're going to see worse or 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 U.S. for their guidelines. And we really shouldn't be anymore. Right. What a travesty. I want to switch gears and talk about SS.

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? 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 SNRIs do. 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 worse our outcomes. And we've known that for very long time, right? 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 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, 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. Right. 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 health of the person. And yeah, and it's just, there's so much disinformation on this area. And it's just 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. We're still, you know, not acknowledging that women's mental health actually matters. It's this constant narrative. 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? No, not best with baby at all. We actually have researched that it can, 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?

IUCR 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, you know, mental illnesses in pregnancy actually have resulted in very high rates of suicide. Right. And we can beat around the bush over here because 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. No one. No one. Are there specific classes of medications that may be safer in pregnancy? So there are some classes that definitely have more data than others. But in general, you know, the idea is that most SSRIs, most SNRIs 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 a much more detailed conversation with your physician. Generally speaking, you know, 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 SSRI. 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. Of course, yeah. Okay, so we got to 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 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 was like, terrifying. And so in my close circle was like, Abby, you can, you got the flu shot. So and so told me that that causes X, Y, and Z. And despite, you know, all the health

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 going to happen? Was everyone going to come after me after the facts? They told you so. It's because you took that flu vaccine. What does the research actually say on the safety of vaccines while pregnant? Yeah. I mean, I totally get that because, again, it was one of those things that I went through too. And you know, as health care providers, as someone who, you know, 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 anti-vax or the vaccine hesitancy that I was seen across. I joined mom groups and that that is where like, I was like, wait, people don't like vaccines. Why? Are you like, what? Like, it's just, it was completely, it was shocking to me. And then when I was pregnant, like, I couldn't help but think in the back of my head, I know this is safe. I know this is what I should be doing. In the back of my head, you have those little voices that just sit there. Exactly. And, you know, and so I totally understand when that happens, even with people who are in, like, the scientific fields, who understand the

importance of vaccines. 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. Because remembering that pregnancy is an immunocompromised state, right? Because you need fetal tolerance. You want to make sure you're keeping the fetus. And when that comes, you know, slight immunocompromised states, which is why you end up being at a higher risk for even things like Listeria, right?

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 with all the state are coming out with the COVID-19 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. The number of people during, you know, the COVID first waves when we didn't have the vaccine who were intubated and pregnant, I was hearing stories about this from my healthcare provider friends all the time because you are in an immunoccurts.

compromise 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 TDAP, which is for the protests, 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 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?

And so if you look at the data for TEP, for pertussis specifically, what we do it for them to prevent whooping cough until they can get their own vaccine at two months. But if you actually look at the studies that show that people who get the T.DAP vaccine in pregnancy reduce the risk of whooping cough in the baby by 85% in the first two months, 85%. And actually for hospitalization, it's way over 90%. 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. 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 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 actually at the recent American Academy of pediatricians, 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 present. actually looked at 1.2 million women who received the COVID-19 vaccine. So we have 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. That is so validating. I'm sure so validating for so many, you know, folks who are listening at home who either are going through this right now or

we're 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 is 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 pregnant with my first, you know, the mom group game is, it's 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 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. You know? And we obviously talked about the risk. benefit of some of these life-saving 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 dyeing our hair or using our favorite brand of makeup, what might be the risk of like

an overcautious approach where people are just saying, hey, we don't know. So just don't do it. Just don't do it. 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. Yeah. Right? And so, and that's problematic. Yeah. Because that slippery slope then takes you to the next slippery slope where you make these decisions based on beliefs and not evidence. Right. And so

that's kind of where I have a huge issue with it, because where do we stop? Where is that endline? At what point do we say, okay, this is getting a little ridiculous, right? Because, I mean, I've, I want, in my past life when I was a student, I was actually a counselor at on mother risk. Oh, yes. And so that's, you know, my degree is in neonatal toxicology, right? And I've actually had questions from people where they've said, is tap water safe for me to drink or should I be drinking bottle wall. But like at that point, you're second-guessing everything that you're doing. And 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 precaution principle, it ends up being counterproductive.

In fact, it can actually cause active harms. 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, you know, data or worseer, for lack of 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. Right. So that's, yeah, it's just like, it's a slippery slope. But where are you? Oh my gosh. You know, I was just thinking about like another downside to to this kind of overcautious 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 got to 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. Like 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 very important. That also can be a really big problem with this. oh don't do this becomes don't do anything right and so like your example of the mercury for instance is a 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 ethel mercury, the amount of it, et cetera, right? And so it starts with science, but then very quickly goes down to your beliefs. Correct. Right. And so, and then where are we going to extrapolate that next to? Yeah. Yeah. And fortunately, 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,

that, you know, science communicators do, which is what actually determines whether something is safe or not. Yeah. You mentioned Mother Risk a moment ago. I didn't know this about you. 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. 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, you know, moms to be can access that would be helpful like that? Yeah. So in the U.S., there are a counterpress that we have in the U.S. is called Mother to Baby. So that part of the Otis, the Territology 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 first, 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 U.S. In Canada, unfortunately right now, we do not have any service that offers the same kind of, you know, information the way mother was did. However, five years ago, I tried to bring it up. And I am actually in the process of, come on, I know, I know. 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 Rescue. 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,

called first exposure because you know it's exposure. We didn't want to have the word risk in there because it's not always anything that risk using that word itself. Word matter. Exactly. It gives you that connotation that everything you're doing is risky 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 and all of these sub-specialties 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 I'm excited about it. So if you go to the first exposure website, you'll see we are, we do have a health topic on mental health medications. We have topics on cold and flu, which I know is going to happen. You know, soon we have health topics and medical information on questions that we're getting very often, usually trendy topics like GLP1. Oh yeah. Which, you know, we've had lots of talk about this, especially because people end up getting pregnant while to 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. Yes, I was going to say, like, is there like a GoFundMe page? Because I feel that this is so important. 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 i am so happy to hear that um 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 we're scared too 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 an ambiguous science. And yeah, please do keep fighting the good fight. It's very hard out there.

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. Oh, 100%. Thank you. Thanks for having me. 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, 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, 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 in some studies, which is why most authorities recommend no more than 200 to 300 milligrams or want 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 food-borne illness. And a single bout of severe food poisoning can cause miscarriage, stillbirth, or preterm birth. 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 U.S. 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 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 bromulane 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 that this is an actual thing. And even if bromuline 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 try 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 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 health care 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, 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, and your own values, not the endless noise of opinions around you. And on that note, thank you again to Sabina Volra Miller for helping me bite back against misinformation online. Signing off with Science and SaaS, I'm Abby Sharp. Thanks for listening.