Please pass [on] the placenta.

Recently, safety concerns related to placenta encapsulation made headlines when the CDC released a case report about a baby in Oregon that suffered from Group B Strep sepsis–not just once, but twice. For many of you, this may have been the first time you realized that people eat placentas. But yes, placentophagy (as it’s technically known) is a thing. And it has become more common over the past several years.

Alternative medicine providers (as well as at least a couple Kardashians) cite a number of proposed benefits, including prevention of postpartum depression, increased iron levels, improved milk production, and–of course–boosting the immune system. Placentas are occasionally consumed raw, more frequently cooked, but far more commonly in a dehydrated form packaged into capsules. For those of you thinking that this sounds a little like cannibalism…well, it is.

For many people who choose not to consume the placenta, the reason is pretty obvious: they don’t find the idea appealing. There’s the cost as well–while the DIY stir-fry version may be free, most parents opt for encapsulation, which can cost a couple hundred dollars. But the biggest concern is the risk to the newborn, and that’s where the recent news coverage has been focused.

The placenta is known to transmit a variety of infections–herpes, HIV, syphilis, and rubella, among others. It isn’t sterile, and there are no standards regarding processing to ensure that placenta capsules don’t contain these infectious diseases. Asking the mother about her history of these diseases isn’t enough. She may be unaware that she had them, or–if she believes strongly in enough in the benefits of placentophagy–she may not be entirely forthcoming.

We have worked really hard over the past few decades to reduce the risks of infection in newborns, so I’m naturally concerned about birth practices that may increase these risks. I’ve written before about similar concerns about the practice of vaginal seeding (which has more plausible potential benefits than placenta capsules). But despite my hesitation, I’m not entirely convinced that placenta capsules were the cause of this baby’s illness–more on that later.

An Intro to Group B Strep

Group B Strep (GBS) is major cause of serious diseases like meningitis or bloodstream infections in newborns. This bacteria is carried by roughly a quarter of American women. This rate varies with the population being tested–I’ve seen numbers anywhere from 6-60%. Men carry GBS as well; it just doesn’t matter as much.  GBS can be spread sexually, as well as through food or environmental contact.

The term “carry” is important–it implies that the bacteria isn’t causing disease. GBS usually lives in the GI tract and vagina (if you have one), just like the trillions of other bacteria that colonize our bodies, without causing any problems at all. Occasionally, GBS can cause urinary tract infections or severe disease in older adults, but our biggest concern is the disease it can cause in newborns.

We divide neonatal GBS infections into two categories: early-onset and late-onset. Early-onset sepsis occurs within 1 week of delivery; the bacteria are transmitted from the mother to the baby during the birth process. Late-onset disease occurs between 1 week and 3 months of age. The way late-onset disease is transmitted is often harder to figure out. Some infants may become infected through breast milk, although this doesn’t happen often enough to avoid breastfeeding, even in mothers known to carry GBS. They may also become infected through contact with the mother or another family member that carries the bacteria. And many of them may pick up smaller numbers of bacteria during birth that reproduce in the baby’s GI tract before crossing into the bloodstream and causing disease.

It’s important to realize that this can happen even to infants whose mothers tested negative for GBS during pregnancy. The mother could have become colonized after the test was done. The test could have been wrong. The sample could have been collected or transported inappropriately. Or the baby could have picked up the bacteria from another source altogether. In a sick baby, a mother’s negative GBS status shouldn’t provide any reassurance.

Where this testing does help us is with prevention. In the past, rates of early-onset GBS sepsis were much higher than they are today. Now, pregnant women are typically checked for Group B Strep between 35 and 37 weeks, using a swab of the vagina and rectum. Those who test positive for GBS are given antibiotics during labor to decrease their bacterial load and reduce the risk to the baby. In GBS-positive mothers who receive antibiotics, the risk of the baby acquiring a potentially fatal disease decreases by 95% (from 1/200 to 1/4,000). That’s good medicine.

Because of the different ways it’s transmitted, rates of late-onset disease haven’t shown the same effect. Fortunately, it’s not as common. Late-onset GBS sepsis occurs in about 0.04% of newborns.

But enough about that–back to the case report.

This infant began to have symptoms of respiratory distress shortly after birth, and was transferred to the NICU. His blood culture grew GBS, and he was treated with antibiotics. He recovered well and was sent home after completing his treatment. Just a few days later, he became irritable and was taken to the emergency room, where he was again found to have positive blood cultures for GBS. He was treated again and, fortunately, recovered from the second infection as well.

So this infant had both early-onset and late-onset GBS infections. Presumably, the initial infection within hours of birth had nothing to do with the placenta, which wasn’t encapsulated and provided to the mother until three days after his birth. By far the most likely source for this infection was transmission from the mother during birth.

So where do the placenta capsules come in? Because it’s rare for a newborn to have recurrent GBS sepsis, his medical team began to look for a cause. They found that the mother had her placenta dehydrated and encapsulated, and had been taking these capsules daily since soon after his birth (but after his initial infection). They tested these capsules and found high levels of GBS bacteria which was genetically identical to that found in both of the infant’s blood cultures. That’s pretty good evidence that the original source of the bacteria for both infections was the same (and that the initial infection came from the mother during birth), but it doesn’t specifically implicate the capsules.

The medical team concluded that the second infection was the result of contact with the mother, whose level of GBS colonization was increased by taking contaminated placenta capsules. The mother’s breast milk was tested and did not contain GBS, so that doesn’t seem to be a likely source. The case report mentions that this was felt to be more likely than transmission from another family member, but it isn’t the only possibility.

While rare, recurrent GBS infections have happened before–and before placenta encapsulation was so common. The hypothesis about those cases was that there could have been low levels of GBS bacteria remaining in the baby’s GI tract after the treatment. After antibiotics were stopped, the bacteria could reproduce and cause the second disease. Honestly, that seems more likely to me. Maybe the placenta capsules weren’t to blame. But I don’t think we will ever know exactly what happened.

Benefits of Placentophagy- The Evidence:

So if there’s even a chance that placentophagy can cause harm, why would someone eat a placenta?

Well, as with many alternative medicine interventions, there’s a long list of proposed benefits. But there isn’t a lot of science to back them up.

There are some surveys in which women who engaged in placentophagy reported less postpartum depression. But surveys are extremely unreliable, as they are heavily influenced by the placebo effect and all sorts of biases.

I’ve seen links to a study from 1954 (yes, over half a century ago) that reported increased milk production–but this was also based on self-reported data with no control group. Similar studies performed after this also showed a similar increase in reported milk production with placebo capsules contained dried beef, implying that the placenta capsules probably didn’t have any benefit beyond placebo.

There are some animal studies that show that the placenta produces an opiate-like substance that may potentially help to reduce the pain associated with childbirth. But, even assuming this effect would be true in humans as well, consuming tiny amounts of dried, encapsulated placenta over several weeks isn’t likely to have any effect. We have other, more certain means of controlling pain. And it’s difficult to eat a placenta during labor.

The only double-blind, placebo-controlled human study looked at the effects of placenta capsule on women’s iron levels. Because anemia is a common problem during pregnancy and the postpartum period, this could be a beneficial effect. In this study, some women received either encapsulated placenta or a placebo of encapsulated beef. It’s important to note that this was a very small pilot study, with 36 participants, 13 of whom were not included in the final analysis for various reasons. Because of the small sample size and the bias introduced by the large percentage of people excluded from the results, we can’t really draw any conclusions from this study. But, for what it’s worth, swallowing placenta pills didn’t have a significant effect.

There was an article in a 2016 issue of the journal Placenta (Apparently there’s a journal called Placenta.) that reported the presence of several hormones in placental tissue. Most of these were present in low concentrations, and we still don’t know the effects–positive or negative–that they may have when consumed in encapsulated form.

Similarly, another article reported the concentrations of various nutrients and trace elements found in dried placenta. Many of them were present–as you might expect from any other human tissue, but not in high enough concentrations to think that they would have any significant effect.

Despite lacking any evidence of health benefits, many people remain convinced that placentophagy is beneficial. They point to the fact that people ate placentas in the ancient past (which seems to be true, although far less commonly than placenta encapsulators would lead you to believe). Regardless, the fact that people did something a long time ago, when we understood far less than we do today, is hardly a rational argument to accept this practice.

Another frequent argument is that many other mammals consume their placentas, so there must be a reason. I agree–there probably is a reason. That reason may have to do with the scarcity of food in the wild and not letting a source of calories and nutrients go to waste. Or perhaps the smell of a placenta would lure in predators that would present a danger to the mother and her young. But I’d argue that, for most of us, food scarcity and predatory animals are low on our list of problems and eating a placenta probably doesn’t do anything more for you than a bowl of beef stew.

The Bottom Line:

I have a great deal of respect for the placenta’s ability to provide oxygen and nutrients to a developing fetus–but perhaps this should be its only job.

It’s certainly possible that this infant’s illness could have had nothing to do with placenta capsules. But maybe it did. And while consuming placentas isn’t without risks, it is without any known benefits. Given the current evidence, there’s no good reason to think that eating your placenta–in any form–will benefit your health. And when the risks include giving your baby a life-threatening infection, I’d encourage you to pass on the placenta.


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One thought on “Please pass [on] the placenta.

  1. This study is most sobering of all: the number of women — both with and without past mental illness — who report that they would prefer eating placenta to taking pharmaceuticals suggests that the medical system has failed these women, and we need to do better. https://www.ncbi.nlm.nih.gov/pubmed/27854131