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Question: Is it dangerous to wait too long to get pregnant?

Robert Rubino: Well, I think the benefits are they tend to be more mature women and maybe a little better able to deal with the frustrations of being a parent.  The health consequences are, you know, there’s a higher risk for chromosomal conditions, gestational diabetes, hypertensive problems.  Twinning starts to increase as you get towards forty. So these are all pressures that women face.  And then they have their career pressure so a lot of women aren’t even thinking about having children until, you know, they’re done with graduate school say and find a suitable partner in life.  So there’s kind of social pressures pushing them to have children older and older, but these are health conscious women, so now I’m starting to see a little bit of a drift back to where women are starting to think about family sooner ‘cause they know there’s health risks to getting older so they’re kind of getting pressed from both ends.  My advice to women is the minute you think you’re capable, start having kids.  And I think to a certain extent, they see on TV or in a magazine a woman who’s forty-five, forty-six having her first and usually that woman’s had help and those are often problematic pregnancies.  So they shouldn’t have the notion, “Gee, I’m thirty-seven.  I have plenty of time.”

Question: Are women feeling pressure to have children earlier in life?

Robert Rubino: Yeah.  I see essentially a lot of angst about, “Well, I spent all this time, money and effort and I’m just starting to rise in whatever my field is.  I really don’t want to sidetrack that right now.”  I always try to give them perspective and try to tease out what’s really their goal.  Is their goal to have a family or is their goal really to pursue their career and try to give them the reassurances they need whichever way they choose to go.  I also tell folks that it’s not always that you have to have your careers in parallel; maybe you want to have them in sequence.  Do your career for, you know, to age twenty-eight, twenty-nine and it’s family time; well then put that career on hold and have your children and not have the kind of angst of serving both masters, the kids and the career simultaneously which creates a lot of stress and then maybe go back to the career after a few years.  I think nobody’s ever really given them that other perspective and I see more women doing that now and I think doing okay with that.

Question: Can women really enjoy a glass of wine while pregnant?

Robert Rubino: On a personal level, I think that’s probably fine after the first trimester.  What’s the party line on that?  We know of no safe level of alcohol during pregnancy.  And that’s true.  Now my wife, who also happens to be a physician, you know, if we went to a wedding while she was expecting and there was a champagne toast, I’d let her have a glass.  I mean she could have had it on her own too, but she would turn to me and I said, “Sure, why not?”  I think in general, like your mother always told you, you know, all things in moderation.  So personally, I think a glass of wine here or there later in the pregnancy is probably not gonna harm much, but I couldn’t tell a patient that with a boatload of data behind me.  So until the data is out that small amounts of wine are harmless in pregnancy, I can’t tell patients that it’s harmless, but I think my anecdotal experience is it is.  I’ve had plenty of women who say, “Thank you and I’ll still have my glass of wine once in awhile.”

Question: Do you advise pregnant women against eating meat and fish?

Robert Rubino:  You know, again, these are all risks that you have to be aware of, but you also have to be careful about not creating a panic or hysteria about it.  The fish, the biggest concern we have is canned tuna fish so the guidance we give and where I practice in the state of New Jersey we had some guidelines a couple of years ago about once a week or less of canned tuna fish.  And I think that’s probably a reasonable guideline and I think more of like a tuna steak there’s less of a risk for something like that.  Salmon, again, we worry about that getting into the food chain.  I still think the benefits of fish and the omega-3 oils and things like that are still worth the risk, so I don’t tell them to eat fish every day, but I think it should be part of their diet, but again in moderation once a week or less.  We’re even giving fish oil now as part of the prenatal vitamin which helps with brain development and cognitive development.

Question: What other diet advice do you give pregnant women?

Robert Rubino: I think eating for two is kind of old hat because if you eat for two, that’s double your caloric intake and you don’t need that while you’re pregnant.  Basically, you need two hundred extra calories a day.  So I tell folks, especially in the first twelve weeks, eat what satisfies you, you know, except for high doses of caffeine and soft cheeses and things that we worry about where with caffeine, there’s a risk potentially for miscarriage at high doses in the first trimester and for soft cheeses and deli meats, there’s the rare risk of listeria contamination so we have them avoid that.  But, you know, if crackers and peanut butter and jelly sandwiches satisfy them and keep them from throwing up, I say go ahead. After the first trimester, we’re gonna get a little more careful because now they can tolerate more foods.  Peanut butter is another thing though.  There is- potential exposure to peanuts may increase the risk for allergy in children so I tell them if that’s they only thing you could eat, do it in moderation.  And that seems to be agreeable to most folks.  And also the US Department of Agriculture I think recently came out with some information where women can actually log onto their website, and I forget the exact web address, but it kind of helps you tailor make your diet while you’re pregnant and kind of takes into account your body type and your eating habits and spits out a diet for you that is useful and healthy.

Recorded on: 04/29/2008

Robert Rubino addresses the physical and psychological pressures of having children.

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