Did your OB/GYN warn you about peanuts? Would you sign a petition to change policy?

Posted on: Sat, 03/11/2006 - 6:28am
anonymous's picture
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Joined: 05/28/2009 - 16:42

I was wondering how many of the moms out there (especially ones with any form of allergic condition) were warned by their ob/gyn or healthcare provider to avoid eating peanut products during pregnancy and/or nursing.

My ob/gyn didn't warn me (and in fact, she was quite clueless about allergies in general) and my daughter was diagnosed with PA via a RAST test after a bout of severe eczema as an infant. And I ate PB almost every day I was pregnant! A friend of mine also ate a lot of PB during pregnancy, and 2 of her 4 children have been diagnosed with PA so far. My neighbor's grandchild also has PA.

There's no way this can be caused by genetic factors only.

I've been seriously considering starting an online petition that will ask the ACOG (organization that sets the standard of care for ob/gyns) to mandate that ob/gyns advise their atopic patients of the risks of eating peanut products during pregnancy.
Do you think I would get a decent number of people to sign such a petition?

One of the reasons my ob/gyn gave me for not advising patients (besides the fact that the ACOG doesn't offer any guidance to doctors on this issue) was the lack of "category 1" evidence. There is, however, category 3 evidence out there. Category 1 and 2 evidence may be unethical to obtain, as they involve randomized control trials, and researchers would have to knowingly be asking moms to eat something that could potentially harm their child...

On a different note, I've been trying to figure out what environmental factors could be at work in the case of PA and food allergy in general. Did you know that nuts and nut products are almost always contaminated with aflatoxin, and that this category of toxin (mycotoxins) is known to have detrimental effects on the intestinal immune system? Also, in the late 80s, right after a severe outbreak of aflatoxin in the nation's corn crops in 1988, the FDA raised the action levels for aflatoxin in animal feeds... Guess when they started to notice a sudden increase in peanut allergy? Right after 1988.

To read more, please see my website: [url="http://home.columbus.rr.com/foodallergy/mycotoxins_and_food_allergy.htm"]http://home.columbus.rr.com/foodallergy/mycotoxins_and_food_allergy.htm[...

Posted on: Sat, 03/11/2006 - 7:36am
Anonymous's picture
Anonymous (not verified)

Stephie's Mom, my children are 10 and 8, which means I was pregnant awhile ago compared to some. No, my ob/gyn didn't mention anything about food allergies of any kind at that time.
I can't remember if I mentioned to him or not when I was pregnant with my second child that my first born had been diagnosed with PA - I was 7 months pregnant when we found out Jesse was PA.
However. I did see him two years ago and I did ask him about PA then. If anyone spoke with pregnant Mothers nowadays (or two years ago nowadays). He said that yes, the hospital he worked out of, St. Michael's Hospital in Toronto, when you were pregnant, you were referred to a nutritionalist to speak with and then do have something that they speak to you about with regard to FA's.
At the time, I wasn't in a position to ask him if I could see one of the people because I had come into Toronto specifically during March break (two years ago this week really) to see him because of some middle-aged difficulties I was having, so it's not like I came with a *mission* if you will.
But I do remember asking him about it and feeling some sort of reassurance from him that at least now someone was speaking with pregnant women.
Not sure if that really helps or not, but I remember I did ask him and got the answer I gave you and I also remember having the feeling that I wished I had had more time, in Toronto, at that time, to follow-up to see what exactly was being said.
As far as my own personal experience, given that I would have been pregnant 11 years ago or nearly 12, I don't know, but I certainly don't blame my ob/gyn. It wasn't something that was prevalent as much as it is now, even when I was pregnant with my two. KWIM?
I keep watching different articles I come across in parenting magazines and I was shocked by a recent one that I read in a new magazine in Canada and the introduction of pb and peanuts weren't at the age that I expected it *should* be now with what we know. I couldn't remember the exact name of the magazine because I was going to post about it here. I know I wasn't pleased.
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Sat, 03/11/2006 - 9:11am
becca's picture
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Joined: 05/22/2001 - 09:00

Someone in my OB office recommended I eat nuts(to help get healthy proteins on a poor appetite). It was mentioned by me in that office about my dd's PA, and this was my second pregnancy!! becca

Posted on: Sat, 03/11/2006 - 9:32am
anonymous's picture
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Joined: 05/28/2009 - 16:42

I was pregnant with #1 in 1996. I was low in iron/protein, so my OBGYN told me to eat peanut butter since I'm not a great meat eater. I hadn't eaten much PB before that - wasn't all that fond of it aside from the occasional Reeses cup - but after my DR. told me to eat it for the good of the baby (and myself) I ATE IT EVERY DAY. My son was BORN allergic - covered in eczema and he reacted the very first time he tasted peanut (PB) at 15 mos.
I have been convinced all along that eating the PB while pregnant is what caused my son's PA.
I also feel that WIC should not provide PB to their clients with children under 7 years of age. (I know that last statement is controversial, but...) I'm not exactly sure how that program works, but I know that PB is one of the foods that is "WIC approved."

Posted on: Sat, 03/11/2006 - 9:35am
solarflare's picture
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Joined: 02/07/2002 - 09:00

I never expected my OB/GYN to know a ton about food allergies. Isn't expecting that about as silly as going to an urologist to get a bunion treated?
The one time a nurse practitioner mentioned that I should eat nuts, I just told her I had a child at home who has anaphylactic allergies to nuts and that I don't ever eat them.
Our allergist feels that it's uncertain that avoiding an allergen during pregnancy and nursing will make an allergy to it less likely, so other than avoiding foods high in mercury and things I was already avoiding because I like to get close to Jason, I didn't bother avoiding anything else or getting too spastic about cross contamination.
------------------
Cheryl, mom to Jason (8 MFA including peanuts, tree nuts, shellfish and egg)
Joey (6 NKA)
Allison (3 MFA including milk, butternut squash, several fruits and suspected shellfish allergies, avoiding tree nuts, RAST - for peanut)
Ryan (born 12/27/05) nka *knock on wood*

Posted on: Sat, 03/11/2006 - 10:02am
Andrea L's picture
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Joined: 12/29/2005 - 09:00

While it is very controversial, I definitely feel mothers to be with atopic histories should be made aware of the possibility. My husband has asthma, I have eczema and we both have environmental allergies. I never thought I'd have kids w/ food allergies since no one in our families had food allergies. I ate nuts while pregnant w/ my first, avoided during breastfeeding just because a friend had read it was a good idea. While in the hospital, I asked to speak with a dietician. I asked if it was recommended to avoid all nuts or just peanuts. The dietician said she'd have to do research, then, I was told just peanuts! When my daughter was 4 months old, I was referred to a dermatologist for terrible eczema. She was the first to discuss the possibility of allergies, RAST test + for peanuts, dairy,egg and wheat. My daughter's allergist recommended I avoid all nuts with my second pregnancy and while nursing. I am more than willing to do this and had I been told of the high chance of us having kids with food allergies for my first pregnancy, I would have done it then as well. It is worth the sacrifice to try and avoid food allergies in my kids, even if it is controversial. I think it should be the OB/GYN's responsibility, they educate us on other things to help ensure a healthy child, why not food allergies?!?. It's just very frustrating, the lack of knowledge about food allergies.

Posted on: Sat, 03/11/2006 - 10:26am
MommaBear's picture
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Joined: 09/23/2002 - 09:00

Quote:Originally posted by Stephie's Mom:
[b]One of the reasons my ob/gyn gave me for not advising patients (besides the fact that the ACOG doesn't offer any guidance to doctors on this issue) was the lack of "category 1" evidence. There is, however, category 3 evidence out there. Category 1 and 2 evidence may be unethical to obtain, as they involve randomized control trials, and researchers would have to knowingly be asking moms to eat something that could potentially harm their child...
[/b]
Just wondering.......would [b]Corvallis Mom [/b] be willing to explain "category 3 evidence"? [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Sat, 03/11/2006 - 1:11pm
new2PA's picture
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Joined: 10/18/2003 - 09:00

Not much of a peanut fan here, so I'm sure I didnt eat peanuts/peanut butter w/any of my pregnancies, and I only have 1 child w/PA.
I'm not sure if I was ever advised to avoid certain foods, particularly peanuts, b/c that would have been trivial to me...advice to avoid something that I already didnt eat probably was forgotten quickly.

Posted on: Sat, 03/11/2006 - 1:18pm
Corvallis Mom's picture
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Joined: 05/22/2001 - 09:00

I would if I thought I had a definitive answer... was hoping you would, MB! All I can think is that this meant a DBPC study with large numbers, rather than epidemiological studies or small number studies without a control group.
So specifically designed studies rather than data collected from a population after the fact. (Is this what you meant?)
I also think it is a bit premature to advise anything either way... as more evidence becomes available, it would appear that some form of early dosing might be protective. Just not enough data out there.
SO no, I wouldn't sign any such thing. If people decide that this is best for themselves, that is one thing. But I'm not willing to take on the responsibility of pressuring physicians to take a stance which might in ten years time be proven HARMFUL. Just my opinion.
Not looking to get flamed, okay?-- I know I'm in the minority with this position, but I just don't think the link is established. I think it is premature to base a clinical practice on a something which is only suspected of contributing to a problem. If this link were even wholly credible, don't you think doctors like Wood, Burks, and Sampson would be all over the news talking about THE CAUSE of PA?? Prenatal/breastfeeding consumption doesn't even get a mention. Why not? I think it's because there isn't an established causative link.
Remember, the target population mostly wouldn't have a clue how extreme avoidance would need to be, and neither would their physicians. And what else would you have women avoid? Milk? Eggs? Wheat? Anything that is ubiquitous in the culture's diet is a problem for atopic children.
I agree that it is a wonderful idea. IF it proves to be correct. The problem is that there is some evidence to suggest that such advice could be harmful, and also some to suggest it could be beneficial. Physicians take an oath to stick with the status quo until it is quite clear that a particular course of action will not result in patient harm. That is why many things are considered "experimental" for a long time.
Sorry... stepping down off soapbox for now... but it wasn't clear to me what she was saying there. Maybe to a physician it might be. But as a research scientist, I just know a good paper when I read it, even if I don't "grade" it. KWIM? I suppose I pay attention to where it is published and even to the names of the researchers doing the work... and most of all to the quality of the experimental design.

Posted on: Sun, 03/12/2006 - 12:16am
Kelseymom's picture
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Joined: 11/20/2002 - 09:00

My PA child is now 8. I started eating PB when I was pregnant in part because a book - What to expect when you are expecting - said it was a good source of protein. At the time I was not aware that we had a history of FA in our family. When we found out my daughter was allergic to peanuts I found out that my father had food allergies (wheat, etc.) as a child.
I do think the possible link should be made known but I'm not sure what the best way is to do that.

Posted on: Sun, 03/12/2006 - 12:32am
Anonymous's picture
Anonymous (not verified)

Corvallis Mom, I liked your post. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
See, for me, Stephie's Mom, I did answer your question. Did my doctor warn me? No, he didn't at the time.
However, as someone else posted above, I wasn't eating a lot of peanuts anyway and certainly not pb. I haven't eaten pb since I was a child.
If I consumed anything *suspect* when I was pregnant with my PA son, it would have been tree nuts. I've always loved them more than peanuts.
So, I've never thought that what I ate during my pregnancy and breastfeeding caused my son to be PA because honestly, I didn't eat very many peanuts. It just makes no sense to me, personally, for that connection to be made - again, for me.
I would have to see what they are handing out at my doctor's office (or the nutritionist is) to see how the warning is worded.
If I look at my history - it involved environmental allergies. There are no food allergies on either side of the family.
So, even at the time, I wouldn't have considered myself "high risk" for that type of information.
Does that make sense?
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
------------------
"That was Polanski. Nicholson got his nose cut."

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