I really enjoy Erica Chidi’s content! Thanks for including her in ParentData.

Another newsletter I’d love to see: something on fertility and the world of IVF and ART and just forms of family building that aren’t based solely on heterosexual sex.

With regards to today’s (2/5/24) post on parenting adolescents, as usual Professor Oster offers carefully considered suggestions and thoughts. My family is grown, and it all resonated! One additional good book I would like to put forth is Dr. Frances Jensen’s “The Teenage Brain”. It helped me and I was told it helped a lot of other parents (I gifted the book to many others when they would share their experiences parenting teens). In short, when you can place typical teenaged shenanigans into developmental context, it makes them slightly less vexing. And her advice to “never say no” – because that abruptly ends all future communication about an event or purchase that your teen is considering – was life changing! You can, of course, say “no”, but you only want to do that AFTER a boatload of fact-finding (“…where is the party? How will you get there? What time do you think you might be home? What are you going to wear?) AFTER you have all sorts of invaluable data, then (and only then) you can let your teen know why you don’t necessarily think it’s a good idea. And they may well ignore you and go/ buy it anyways. BUT, when things go south, as they often do, you’ll be the person your teen recalls as someone who who was willing to have a conversation with them, and share your (based on life experience) concerns. Good luck out there! The teenage years are a real challenge. All stages of youth can be described as a period when “ambitions outstrip abilities”, but perhaps none more than the high school years. Toddlers can’t drive. Third graders have no interest in intimacy. Middle school students can’t get jobs two towns over…

I stopped traveling for work when my kids hit the teen years. Leaving then when they were infants and little kids broke my heart (and also gave me wonderful alone time, TBH), but they didn’t need me at home 24/7, and their spending time with my spouse and other caregivers was beneficial, too. But as teens they NEED you there. YOU, not someone else. Present, even if 99% of the time, it’s in the background.

Hi Gillian! Ever since I (and my mom actually) entered my late reproductive stage, I want to go to sleep every time the barometric pressure drops. Have you heard of this before? Why might this happen hormonally?

Yesterday I spent 15 minutes wailing in the shower after my husband left to do the daycare drop off. There were no tears, but guttural sounds as I threw myself a bathtub pity party. Three months of irregular periods, pajama-drenched nightshirts, and don’t-talk-to-me-about-my-irritability irritability… could I really be entering peri-menopause 18 months postpartum at 40? I had spent 7 months doing IVF, had a challenging pregnancy, and have struggled postpartum while returning to my job in academia, and now this. While recognizing all of my privilege, I still need to say, being a woman is so hard. Thank you to the universe for dropping Gillian Goddard’s Hot Flashes into my inbox… I’ve forwarded it to my husband and my OBG appointment next week!

This is an incredibly informative article! Thank you so much for sharing your insight. As an AA woman in my late 30s it’s helpful to know the signs of late-reproductive stage and pre-menopause stage and what to do when those changes start to occur. I’d be curious to learn more about these hormonal changes and conception (both naturally and via IVF) as more women continue to have babies later in life. Thank you to the whole team for your work! More of this content please 🙂

Regarding Gillian’s first newsletter: I am 40 and on hormonal birth control but skipping the placebos to avoid having my period (don’t need it for actual birth control due to husband’s vasectomy). This is very convenient especially since I wear a pessary for prolapse, but I worry sometimes about what other information I am missing by not having my period. This newsletter ended by saying that hormonal birth control can help with some symptoms in one’s 40s but I am curious for any information about taking it continuously and also what I am missing by not getting the information I’d get if I wasn’t on hormonal birth control. Thanks.

Really appreciated Gillian Goddard’s article “Is This Perimenopause?” I’m 34 and have already noticed some of the changes she outlines as part of late stage reproductive years and it helped me worry less! I so appreciate having the information. It’s wild how little I and many of my friends actually know about our own bodies despite being so well educated and curious people.

Regarding the toothbrushing, if it is at all helpful there’s an Elmo toothbrushing song that is pretty catchy and cute. To go along with Emily’s suggestion about YouTube, perhaps they’d enjoy watching that music video!https://fb.watch/q4DntJgeUK/

To Bundled up: I know Emily mentioned the HEPA filter, but I want to re-up that suggestion. We got smaller air purifiers from Home Depot (also sell them at Costco) for each kid’s room and now a larger one for our basement that indicates the air quality while it operates. My younger kid (now 1.5) used to have constant stuffy noses, and they’ve been MUCH better since we put in the air filter. (It also helps with stinky diaper smell.) The one in the basement has refreshed the air from the cat box and general basement musk – and we now hang out in the basement much more. I’d imagine something similar might save your fireplace. Good luck!

When we were weaning our kid off the bottle (way past 14mo) we started watering the milk down gradually so it became less satisfying. He mainly used it as a pacifier at bedtime, not ingesting very much. Over time he did forget about it.

We feed our kids dairy but I’m not sure it’s true that they have to have it. Vegan kids and kids with dairy allergies do OK with alternate nutrient sources as far as I know.

RE: sticky film left by estrogen patches, a friend who has been on them longer than I advised me to cover the patch with a paper tape. It prevents the edges of the patch getting gummy, and the whole thing comes off cleanly, with no residue.

I enjoyed the article on pre-natal supplements and which are most critical. For those supplements, I’d love to understand how important it is to take them perfectly every day or if say 2-3 days a week is fine?

Regarding prenatal vitamins – you mention vitamin A as a component but the WHO explicitly recommend that pregnant women NOT take vitamin A supplements except if specifically indicated because too much vitamin A can be harmful to foetal development. This is also something to flag in relation to fish oil supplements since one of the most commonly available – cod liver oil – is extremely high in vitamin A.

Regarding prenatal vitamins. My wife continues to take prenatals after giving birth 4 months ago. She doesn’t have a vitamin deficiency. Is taking prenatal vitamins post-pregnancy recommended? If so, how is this different than taking a normal multivitamin?

Thank you for the article on Prenatal vitamins and the larger supplement discussion. It seems like a regular vitamin (not specifically labeled ‘prenatal’) would suffice (with another DHA supplement if one wanted to add that. Is this correct? My Kirkland multi has all the specific nutrients you call out.

Similarly, I try to eat pretty healthy and wonder what the food equivalent of folate/folic acid would be. If I eat a spinach salad, with the daily recommendation of folate, do I need my vitamin that day? Thanks!

The post on prenatal vitamins definitely confirms what I suspected was true. The only thing I looked for was the USP labeling. It’s a small clue that the quality of the vitamin might be better than other brands. There’s at least some laboratory testing and standards in place. I don’t have time to research the fancier brands to investigate their manufacturing standards, so USP is a quick shortcut. Unless somebody knows something about USP that I don’t know…?

Also, slightly annoying that I press “add a comment” at the very bottom of all the posts, but I still have to manually scroll all the way back up to find the comment box.

Re: prenatal vitamins, this is absolutely anecdotal as far as I know, BUT. I have struggled in all my pregnancies with horrendous restless leg/restless everything that most of the usual recommendations have not helped. However, I have since heard that both iron and magnesium deficiencies can contribute to it and/or to muscle spasms. I am anemic during this pregnancy and I am currently supplementing both with iron and magnesium and it really helps – like, I can actually sleep many more nights than in my first pregnancy! I think there may be some studies that support iron and magnesium for muscle cramps, but I am not sure. I just wanted to mention it in case anyone else out there is suffering and it helps, since as noted in the post, it is unlikely to hurt (although as always, checking with one’s provider is a good idea).

On the vitamin issue, you likely do not need to supplement with folic acid later than the end of the first trimester. By then the defect either exists or not. It doesn’t form later.

If you want DHA supplementation but are vegetarian, there are pills from the algae that the fish eat, that apparently can work to supplement as well.

Is there an amount of DHA that is too much and could be harmful during pregnancy and breastfeeding? My eye doctor recommended I take 3,000mg of omega-3 daily. That seems like a very high amount compared to the 250mg that is in my prenatal vitamin.

The folate vs folic acid debate seems to be pretty contentious. I found this article slightly helpful but still didn’t get me all the way there. Everyone says there is some evidence that some people can’t digest folic acid but I can’t seem to find it from a reputable source and the CDC doesn’t agree with this comment. It would be helpful to understand this better.

Thanks for this about vitamins! To clarify, if you are planning more pregnancies, shouldn’t you continue to supplement Folic Acid after birth to keep the stores high for next time?

Does this research relate to breastfeeding and prenatal vitamins?

I’m catching up on the ParentData podcast and I wanted to say thank you for the episode “Staying Active, Starting Again.” I just returned to running after having my baby 6 months ago, and I’ve been having regular dizzy spells. I thought I’d been nourishing myself, but only after listening to that episode did it occur to me that I could be underfueling. I’ll admit that I feel a bit blindsided — I didn’t think I’d have to relearn everything about my body, including how to eat, but here we are. At least I know now that I’m not alone!

Great article Emily!

You used the example of a reduction in earnings of ~1%, which is $280 on a $45k income. I’d be curious to break up the earnings reduction by income bracket, to see if the reduction in earnings tends to affect certain income brackets more than others (obviously higher incomes have greater room for disparity).

Also, it’d be nice to see what the confidence interval is on that 1% estimate.

Thanks for a great post.

Regarding the Feb 20 post on younger siblings and worse long-term outcomes related to illness early in life, it seems to me that the most plausible explanation for these findings is “vulnerable child syndrome” rather than illness itself. This is a common phenomenon where parents of a child who requires hospitalization view their child as “vulnerable,” even if the illness fully resolves and has no long term consequences. These parents are more likely to take their kids to the doctor for minor illness or injury and generally parent them in a more cautious way. I wonder if this could account for the findings in the article, at least somewhat. -a pediatrician mom

Per the young siblings being worse off article- SO curious about if there’s a plan to do follow up study on younger sibs born in the “depths” of the pandemic when most folks were in lockdown and older sibs were in distance learning or otherwise at home. Would be so curious if removing many of the risk factors for disease in early infancy impact those long term outcomes that have causal claim.

Another request that comments on particular articles be reinstated; the discussions on various topics formed a significant value add to my subscription and the current format of “comment dump section just to give people somewhere to vent” is making me question continuing.

Regarding today’s post about second children having slightly lower earning potential/higher mental health struggles: it struck me as I took Sudafed for my fourth virus in two months that, even with the randomizing attempts, it’s possible that parents with two small children, in winter, getting sick themselves at higher rates, have fewer resources of time and energy to spend on engagement with their little babies that account for disparate outcomes later. Did any of the study variables account for that, or is it assumed that illness’ impacts on parents/parenting don’t matter much?

I’m not really clear how this works — are all the comments from different articles dumped together here?

I wanted to ask a follow up question on the article about younger siblings. Wouldn’t a relatively easy action item for people looking to have kids be to try to time their baby births to avoid winter? I heard a friend get this advice from their OB for exactly the reasons in the article (older kid who could make new baby sick particularly during flu season).

I always think of germs as a great thing for babies (unless it’s a fever before 3mo). Hygiene hypothesis! With our kids I don’t know how you could have isolated older sibling vs daycare as the source, as our younger started at 3mo. Do siblings start child care at a similar age, on average? Siblings AND daycare friends are petri dishes. Also parents are even more tired and run down and apt to catch germs themselves and pass them on. I’m still wondering about the causality here.

Just read the question and response sent out today on counting kicks from a hospital bed after kick counting literally saved my baby’s life. I think this is a recirculation and is really disappointing. There has been a lot of recent research on kick counting as one of the few science supported interventions to prevent still birth. I’m a big fan of Emily Oster’s work but this article really reduces my trust, especially since n anticipation of a new book about pregnancy with complications. I really hope the new book doesn’t dismiss this intervention without a proper review of the literature.

Question: Do we have any idea how many kids get flu shots at annual visits, vs elsewhere, vs not at all?

Our ped was spectacularly unhelpful with flu shots. We could only get them during the school day at specific times in very badly timed flu clinics. No thanks. But we always get them. Plenty of kids don’t even have peds, or don’t visit the month of their bday (we are often unable to schedule within months of the bday nowadays.)

Thank you for this great review. As an obgyn I have one comment regarding telling women to stop their birth control for 3-6months before conception. I don’t think this is always medically wise and certainly not always medically necessary. For instance, for women with polycystic ovary syndrome, I tell them to stay on their oral contraceptive pills up until the second they are ready to conceive. We know that women with PCOS, because of changes in sex hormone binding globulin (SHBG) production that positively effects their hormones, often have a ‘honeymoon’ phase of 3-4 months after coming off the pill where they are most likely to spontaneously ovulate and conceive. After this ‘honeymoon’ phase is over and SHBG goes back to normal, they will likely go back to irregular ovulation and cycles. Not to mention, if women are having very irregular cycles where they aren’t regularly ovulating and shedding their lining, this can lead to endometrial hyperplasia ( a precursor to endometrial cancer). Staying on your birth control until you are ready to conceive protects from endometrial cancer and may lead to better chances of getting pregnant in the few months you come off of it.

In addition, for my women with terribly painful menses, due to endometriosis or other, I want them to be pain free as long as possible- don’t come off your birth control that is working to keep you pain free and free of heavy bleeding (which can lead to anemia), until you are ready to get pregnant! If your birth control is suppressing endometriosis, this is a good thing! Don’t come off of a med that is suppressing your endometriosis until you want to get pregnant.

Also, many women want to enjoy life (ie hot tubs, alcohol, saunas, travel, attending big life events, etc) without worrying about exposing a potential fetus to these things. Stay on your birth control until you are ready to conceive to not worry about becoming pregnant before you are ready.

With all pills, IUDs, nuvaring, the birth control patch, and nexplanon- fertility should resume to normal within a month, if not less depending on where you are in your cycle when the method is stopped. The one exception to this is depo provera, where it can take 6 months to resume ovulation. That may be the one exception to considering birth control cessation far ahead of conception attempts- but here you might also consider switching from depo provera to another more reversible method until you are ready.

“But it can also happen right away, so be prepared for that possibility as well.”
Thank you so much for including that, that’s not talked about enough!
When I was 35 and thinking of trying to conceive I was told it might take a while (6 to 12 months) and OB said she’d give me Clomid in 3 months. I got pregnant the same month I stopped BC and was shocked (both in a positive and negative way). The timing was horrible and high stress, it took years of therapy postpartum and I’m convinced the stress and depression over the situation caused my highrisk for pre-term status. I wish I didn’t fall victim to the idea of ‘you’re old, it will take a while’ school of thought that is so pervasive.
My second took twice as long (one month total) at age 38.

Re: Data-Driven Conception
Loved this one. It’s always a treat when a ParentData article aligns with where I am in my parenting timeline.
One question I still have is about the effects of breastfeeding on women TTC. Maybe for a follow up piece? I would love to get into the nitty gritty on that subject.