Placentophagy among women planning community births in the United States: Frequency, rationale, and associated neonatal outcomes (2018)

We respond to the recent publication of Benyshek et al entitled “Placentophagy among women planning community births in the United States: Frequency, rationale, and associated neonatal outcomes.”1 The authors used data collected through the Midwives Alliance of North American Statistics Project (MANA Stats) to analyze demographic characteristics and motivations of women who engage in placentophagy. They evaluated neonatal outcomes of women who consumed their placenta and compared it to those who did not. This question is important considering a recent warning issued by the Centers for Disease Control and Prevention (CDC) due to a case in which a newborn infant developed recurrent neonatal group B Streptococcus (GBS) sepsis after the mother ingested GBS-contaminated placenta capsules.2 Because medical staff is unsure about how to respond to patients with interest in placentophagy,3 we recently published a comprehensive review on this topic, and we provided an evidence-based clinical practice guideline for medical staff.4 The predominant problem with the study by Benyshek et al1 is that it is based on the MANA Stats data which are self-reported data with well-known, scientific problems due to systematic bias. This bias includes selective reporting, reporting of less than half of cases, and likely not reporting adverse outcomes. This circumstance has already been discussed with regard to a previously published study on home births.5 No analysis based on MANA Stats can ever be evidence-based and it is therefore impossible to draw conclusions on outcomes when authors use biased data. In addition, the authors of the original study reported that the most frequently cited motivation for engaging in placentophagy was to “improve mood and avoid postpartum depression.” There is no evidence that placentophagy has any benefits, and specifically there is no evidence it can prevent mood disorders or depression. At no point did the authors make it clear that there is no indication for placentophagy. Our own publication is reported as sounding some alarms (page 2, right column) without mentioning that it is the only comprehensive evidence-based review, and it is therefore superior in evidence-based reasoning to the nonevidence reasoning of the MANA Stats data.4 The citation of our paper is a distortion of it and violates the scholarly standard of accurately reporting the content of papers cited. We agree with the authors that there should be discussion with all women who express interest in placentophagy. We also recommend that this discussion should include the evidence-based recommendation against placentophagy. Benyshek et al1 support an open-ended, nondirective discussion which is unprofessional because it is not evidence-based and does not address the absence of any benefits of placentophagy in the presence of potential harm. To conclude, the publication by Benyshek et al1 contributes to the poor body of literature on placentophagy, but it is based on unreliable data. As long as we lack reliable data, it will remain impossible to determine a recommendation on this practice. Therefore, as professionals we have the professional responsibility to discourage patients from this practice.