Own it: Amy Schumer is still barfing in pregnancy

Amy Schumer‘s ongoing pregnancy with severe nausea is following the comedian into the second trimester of her pregnancy — and she shared it with fans in her second graphic vomiting video on Saturday.

Back in November, Schumer, 37, was hospitalized for hyperemesis gravidarum — a condition marked by persistent sickness and can lead to dehydration and weight loss.

According to People the health crisis caused the I Feel Pretty star to postpone dates on her comedy tour. And though she’s since returned to the stage and powered through, her vomiting hasn’t stopped.

On Saturday, Schumer posted an Instagram video of her getting sick over a toilet. “Hi I thought it might be fun to see me throwing up in a public bathroom,” she said.

Sorta like this food safety asshole (upper right).

Pregnancy food safety messages should probably include Listeria

There’s a lot of pressure on moms-to-be. When I was a dad-to-be, I supplied some of that  pressure. Throughout Dani’s pregnancies I became the food police in our house — no soft cheeses or cold deli meats made it to Dani’s plate, most didn’t even make it in the house. Everything was been temped during cooking.

I read pretty well every paper I could on Listeria, and Doug and I discussed the merits of broad food surveys and listeria growth in blue-veined cheese. It was a bit ridiculous, but I hear that first time parents sometimes can be obsessive.

Over time I’ve become much less obsessive, have been better at employing risk communication even within my own home. My goal is to give folks info that can help them make risk decisions; not tell them what to do.

Tonight I read an article on food safety for moms-to-be. It started promising, except for the yelling (the headline, 4 STEP FOOD SAFETY GUIDE TO KEEP YOU SAFE DURING PREGNANCY) and went further downhill when all the blogger highlighted was the generic, sanitized messages of cook, chill, clean and separate.

Disappointing that there’s no mention of Listeria, the foods that are high risk for the pathogen – and how to manage the risks.

Missed opportunity.

Another reason to dislike: Jury rules Chipotle discriminated against pregnant employee

Brenna Houck of Eater, citing the Washington Business Journal, reports a U.S. District Court jury in Washington, D.C., awarded Doris Garcia Hernandez $550,000 in compensatory and punitive damages this week after finding her former manager had discriminated against for being pregnant.

amy.pregnant.listeriaBased on the filing, back in 2011, Hernandez informed her manager — referred to only as “David” — that she was pregnant. Following the disclosure, she claims he began restricting her water and bathroom breaks. Hernandez alleges that her boss required her to “announce” to other staff members when she needed to use the restroom and he would then “approve her bathroom breaks so that he could cover her work position for her.” The manager also refused her requests to leave work and attend her prenatal doctor’s appointment. Hernandez chose to leave anyway and was publicly fired in front of other employees and customers the following day.

According to the U.S. Equal Employment Opportunity Commission, “the Pregnancy Discrimination Act (PDA) forbids discrimination based on pregnancy when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoff, training, fringe benefits, such as leave and health insurance, and any other term or condition of employment.” Likewise, “if a woman is temporarily unable to perform her job due to a medical condition related to pregnancy or childbirth, the employer or other covered entity must treat her in the same way as it treats any other temporarily disabled employee.”

Unfortunately, pregnancy discrimination is common in the restaurant industry and Chipotle has been sued before for similar cases. In February, a federal grand jury in Cincinnati, Ohio, ruled in favor of three former managers who sued the company for gender discrimination citing sexist behavior and unfair firing due to pregnancy.

Listeria, advice, and pregnancy

My  latest from Texas A&M’s Center for Food Safety. Check them out on the Intertubes at http://cfs.tamu.edu/.

HomePage_Soliloquy_powellsworld_MayMy second grandson will be born about the time this is published and, with five daughters, I’ve had my share of conversations about what moms-to-be should and should not eat.

I learned a long time ago that preaching is futile: telling people what to do just doesn’t work.

I can cite lots of risk communication research to support this view, but I’d rather have a chat, provide information, and see where it goes.

It’s a confusing mess of informational goop out there, with a newspaper and even Toronto Sick Kids hospital saying it’s OK for pregnant women to eat “unpasteurized cheeses, shellfish and other ‘edgy foods.’” 

They’re not edgy, they’re microbiologically risky because the immune system of expectant moms is ratcheted down by a factor of 10 to avoid harming the fetus. To say the rates of listeriosis is lower in France where pregnant woman eat unpasteurized cheese (and this applies to any refrigerated, ready-to-eat foods) is to ignore deficiencies in surveillance. One of the largest French cheese producers said it was switching to all-pasteurized in 2008 because it didn’t want any more bodies – born or unborn.

An outbreak of Listeria in cheese in Quebec in fall 2008 led to 38 hospitalizations, of which 13 were pregnant and gave birth prematurely. Two adults died and there were 13 perinatal deaths.

A Sept. 2008 report showed that of the 78 residents of the Canadian province of British Columbia who contracted listeriosis in the previous six years, 10 per cent were pregnant women whose infections put them at high risk of miscarriage or stillbirth.

The majority — nearly 60 per cent — of pregnant women diagnosed with listeriosis either miscarry or have stillbirths.

jaucelynn.pregnantA few months ago, my daughter e-mailed to ask, “So I know I can’t eat deli meat due to risk of Listeria but what about pepperettes?” (apparently they’re a Canadian thing).

I said they’ve probably been heat-treated if they’re commercially available, but copied Chapman to get another opinion.

I failed.

Dr. Ben wrote back that “most are shelf stable based on acidity and water activity (pH and Aw) — they have been fermented and dried (not cooked). “Sometimes they are smoked. Sometimes not.

“I’d cook it because you’d have to know that the pH and Aw was correct and what the steps were to validate the process.

“They are probably fine, but hard to know without the specifics.”

We all make our own risk decisions. And around pregnancy, some folks — like Chapman — choose to be super-cautious.

When our partners were pregnant, Chapman and I would have arguments about whether brie cheese made from pasteurized milk was safe because of its ability to support Listeria growth in a post-processing contamination scenario, and my wife would look at me and go, “nerd.”

She was right. And it was of no help to the pregnant ones (the toasted brie on crackers apparently did help).

What I’ve found through all these pregnancies is the enormous amount of conflicting advice provided to the moms-to-be.

It’s stressful enough being pregnant (not that I would know) without having Dr.-this-that giving bogus advice.

And from Dr. Oz to the Food Babe, the BS detector is rising in public circles.

Back in 2000, the American media was filled with coverage of lLsteria after the 1998-1999 Sara Lee Bil Mar hot dog outbreak in which 80 were sickened, 15 killed and at least 6 pregnant women had miscarriages. Risk assessments had been conducted, people were talking about warning labels, and especially, the risks to pregnant women.

About the same time, I was at a meeting and watched a pregnant PhD load up on smoked salmon, cold cuts and soft cheese for lunch and wondered, do I say something?

One of the biggest risks in pregnancy is protein deficiency. What if smoked salmon, cold cuts and soft cheeses were this woman’s biggest source of protein? (Turns out they were.)

Another big risk factor is stress. I didn’t want to freak her out. Besides, who the hell am I to say anything?

This competes with the duty of care in that, if you have knowledge of something, you have a responsibility to act. 

amy.pregnant.listeriaI sat with the woman during lunch and chatted about babies, her aspirations and how she was feeling. Eventually I introduced the subject of Listeria by talking about a risk assessment that had recently been published by the U.S. Food and Drug Administration, and that maybe she would be interested in looking at the results.

I felt sorta goofy.

And the pregnant woman? When I saw her at another meeting a couple of months later, she thanked me for providing her with information about Listeria and risky foods for pregnant mothers.

But I’m just providing information – the peer-reviewed kind. It’s that duty of care thing.

It’s more than just hope and faith I wish for my daughter and her birth. She knows her science.

Dr. Douglas Powell is a former professor of food safety who shops, cooks and ferments from his home in Brisbane, Australia. 

DISCLAIMER: The views and opinions expressed in this blog are those of the original creator and do not necessarily represent that of the Texas A&M Center for Food Safety or Texas A&M University.

 

What is safe to eat when pregnant?

Daughter 2-of-5, who is due shortly, asked food safety dad, I know to avoid deli meats, but is it OK to eat pepperettes?

jaucelynn.pregnantI asked Chapman (it’s his job, he’s in extension).

“Most are shelf stable based on pH and Aw – they have been fermented and dried (not cooked). Sometimes they are smoked. Sometimes not.

“I’d cook it because you’d have to know that the pH and Aw was correct and what the steps were to validate the smoking (if that was used).

They are probably fine, but hard to know without the specifics.”

Good advice.

In related news, preclinical research demonstrates for the first time that refocusing an expectant mother’s immune cells to prevent them from attacking the fetus may be a therapeutic strategy for preventing pregnancy complications like stillbirth or prematurity.

Scientists at Cincinnati Children’s Hospital Medical Center report their findings March 9 in the Journal of Clinical Investigation. They suggest restricting the pregnant mother’s immune cells from the placenta (the maternal-fetal interface) can protect against pregnancy complications during maternal infection and complications not triggered by prenatal infection.

The study sheds new light on an entrenched public health challenge – premature birth and the related pregnancy complications of preeclampsia, spontaneous abortion and stillbirth. One of every 9 infants in the United States is born premature, or before 37 weeks of pregnancy, according to the U.S. Centers of Disease Control. There remains no effective therapy for these pregnancy complications, and babies born too early are highly vulnerable to death or long-term developmental abnormalities.

Nosestretcher alert, food porn, 2015

The new year brings new guesses as to what will be the next big food thing, when really it’s just an exercise in food porn.

And sometimes dangerous.

grass-fed.beefThe Epoch Times predicts that grass fed meat will be hot because blah… blah … blah … oh, “grass-fed is virtually free from the threat of E. coli outbreaks – another major plus for meat-eaters.”

No it’s not:  handle and cook carefully, and use a damn thermometer (Last night I was having dinner with mom-in-law and Sorenne at a steakhouse while Amy was doing French club stuff at this conference in Vancouver. When the server asked how I wanted Sorenne’s sliders, I said, 165F. When she asked how I wanted my steak I said, 140F. She insisted they had a thermometer out back but …).

And from the New Zealand Herald, in advice every pregnant woman should ignore, the author says it’s false that “pregnant women should avoid eating unpasteurized cheeses, shellfish and other “edgy” foods.”

amy.pregnant.listeriaThey’re not edgy, they’re microbiolgically dangerous because the immune system of expectant moms is ratcheted down by a factor of 10 to avoid harming the fetus. To say that rates of listeriosis are lower in France where pregnant woman eat unpasteurized cheese (and this applies to any refrigerated, ready-to-eat foods) is to ignore deficiencies in surveillance and that one of the largest cheese producers said it was switching to all pasteurized in 2008 because it didn’t want any more bodies – born or unborn.

Listeria still isn’t nice to pregnant women (and others)

This study describes trends in the incidence of pregnancy-related listeriosis in France between 1984 and 2011, and presents the major characteristics of 606 cases reported between 1999 and 2011 to the French Institute for Public Health Surveillance through the mandatory notification system.

amy.pregnant.listeriaThe incidence of pregnancy-related listeriosis decreased by a factor of 12 from 1984 to 2011. This reduction was a result of progressive implementation of specific Listeria monocytogenes control measures in food production. A lower incidence of pregnancy-related listeriosis was observed in regions with a lower prevalence of toxoplasmosis. Given that dietary recommendations in pregnancy target both toxoplasmosis and listeriosis prevention, we suppose that recommendations may have been delivered and followed more frequently in these regions.

Cases reported between 1999 and 2011 (n=606) were classified as maternal infections with ongoing pregnancy (n=89, 15%), fetal loss (n=166, 27%), or live-born neonatal listeriosis (n=351, 58%). The majority of live-born neonatal listeriosis cases (n=216, 64%) were preterm births (22–36 weeks of gestation), of whom 14% (n=30) were extremely preterm births (22–27 weeks of gestation). Eighty per cent of mothers reported having eaten high risk food during pregnancy. A better awareness of dietary recommendations in pregnant women is therefore necessary.

Eurosurveillance, Volume 19, Issue 38

D Girard, A Leclercq, E Laurent, M Lecuit, H de Valk, V Goulet

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20909

 

Listeriosis, caused by Listeria monocytogenes, is an important foodborne disease that can be difficult to control and commonly results in severe clinical outcomes. We aimed to provide the first estimates of global numbers of illnesses, deaths, and disability-adjusted life-years (DALYs) due to listeriosis, by synthesising information and knowledge through a systematic review.

Methods

We retrieved data on listeriosis through a systematic review of peer-reviewed and grey literature (published in 1990—2012). We excluded incidence data from before 1990 from the analysis. We reviewed national surveillance data where available. We did a multilevel meta-analysis to impute missing country-specific listeriosis incidence rates. We used a meta-regression to calculate the proportions of health states, and a Monte Carlo simulation to generate DALYs by WHO subregion.

Findings

We screened 11 722 references and identified 87 eligible studies containing listeriosis data for inclusion in the meta-analyses. We estimated that, in 2010, listeriosis resulted in 23 150 illnesses (95% credible interval 6061—91 247), 5463 deaths (1401—21 497), and 172 823 DALYs (44 079—676 465). The proportion of perinatal cases was 20·7% (SD 1·7).

Interpretation

Our quantification of the global burden of listeriosis will enable international prioritisation exercises. The number of DALYs due to listeriosis was lower than those due to congenital toxoplasmosis but accords with those due to echinococcosis. Urgent efforts are needed to fill the missing data in developing countries. We were unable to identify incidence data for the AFRO, EMRO, and SEARO WHO regions.

Funding

WHO Foodborne Diseases Epidemiology Reference Group and the Université catholique de Louvain.

The Lancet Infectious Diseases, doi:10.1016/S1473-3099(14)70870-9

Noordhout, Charline Maertens De, Brecht Devleesschauwer, Frederick J. Angulo, Geert Verbeke, Juanita Haagsma, Martyn Kirk, Arie Havelaar, and Niko Speybroeck

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)70870-9/abstract

Pregnancy associated listeriosis – clinical characteristics and geospatial analysis of 10 years in Israel

Whenever I talk, I make sure the women in the crowd know about Listeria and what to do.

amy.pregnant.listeriaThis is an additional reason why.

 

Clinical Infectious Diseases

Hila Elinav, Anat Hershko-Klement, Lea Valinsky, Josef Jaffe, Anat Wiseman, Hila Shimon, Eyal Braun, Yossi Paitan, Colin Block, Rotem Sorek, Ran Nir-Paz, the Israeli Listeria Study group

http://cid.oxfordjournals.org/content/early/2014/06/27/cid.ciu504.short

Listeria illnesses, deaths, and outbreaks — US, 2009–2011

Whenever I get the chance to talk – a food safety lecture, a journalism discussion, coaching girls’ hockey – I always work in a reference to Listeria and the risk for moms-to-be.

I have five daughters; one of my daughters has a son; and yet the knowledge of Listeria risk is fleeting.

Doctors and medical types usually don’t help.

The U.S. Centers for Disease Control reports today that older adults, pregnant women, and persons with immunocompromising conditions are at higher risk amy.pregnant.listeriathan others for invasive Listeria monocytogenes infection (listeriosis), a rare and preventable foodborne illness that can cause bacteremia, meningitis, fetal loss, and death.

Nationwide, 1,651 cases of listeriosis occurring during 2009–2011 were reported. The case-fatality rate was 21%. Most cases occurred among adults aged ≥65 years (950 [58%]), and 14% (227) were pregnancy-associated. At least 74% of nonpregnant patients aged <65 years had an immunocompromising condition, most commonly immunosuppressive therapy or malignancy. The average annual incidence was 0.29 cases per 100,000 population. Compared with the overall population, incidence was markedly higher among adults aged ≥65 years (1.3; relative rate [RR]: 4.4) and pregnant women (3.0; RR: 10.1). Twelve reported outbreaks affected 224 patients in 38 states. Five outbreak investigations implicated soft cheeses made from pasteurized milk that were likely
sorenne.hockey.olympics.10
contaminated during cheese-making (four implicated Mexican-style cheese, and one implicated two other types of cheese). Two outbreaks were linked to raw produce.

Almost all listeriosis occurs in persons in higher-risk groups. Soft cheeses were prominent vehicles, but other foods also caused recent outbreaks. Prevention targeting higher-risk groups and control of Listeria monocytogenes contamination in foods implicated by outbreak investigations will have the greatest impact on reducing the burden of listeriosis.

Refrigerated, ready-to-eat foods are out for moms-to-be; we heated soft cheeses, even the ones made from pasteurized milk. Pregnant women with listeria infections often have only mild symptoms or a fever, but their infections can result in miscarriage, premature labor and serious illness or death in their newborns, the report noted.