Associate Professor, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI

Dr. Allen reports she is a Nexplanon trainer for Merck.

SYNOPSIS: In this cross-sectional study of U.S. women who delivered at home or at a birth center, 30.8% consumed their placenta, and, of those, 58% consumed the placenta in a raw form. The most common reason for consuming placenta was to prevent or treat postpartum depression. There was no association between placentophagy and neonatal hospitalization or death within six weeks of birth.

SOURCE: Benyshek DC, et al. Placentophagy among women planning community births in the United States: Frequency, rationale, and associated neonatal outcomes. Birth 2018; May 2. doi: 10.1111/birt.12354. [Epub ahead of print].

Benyshek et al performed this cross-sectional study that used data from the Midwives Alliance of North America Statistics (MANA Stats) project, which is a web-based, secure, data collection platform. Midwives voluntarily enrolled in the MANA Stats project enter data regarding prenatal, birth, and postpartum care and maternal demographics. The authors analyzed data from May 2015, when questions regarding placentophagy were added, to the end of December 2016, and included 23,242 consecutive planned birth center or home births. The aim of the study was to describe the demographic characteristics associated with placentophagy, what formulation (raw/cooked/encapsulated) was used, why women consumed their placentas, and whether neonatal outcomes differed between women who consumed and did not consume their placentas. Neonatal outcomes included hospitalization in the first six weeks, neonatal intensive care unit (NICU) admission in the first six weeks, and neonatal or infant death.

The sample was typical of U.S. women who choose home or birth center delivery: The majority were white (85%) and married or partnered (95%), and half (50%) had a bachelor’s degree or higher education level. Two-thirds (69%) delivered at home and one-third (31%) delivered at a birth center. A total of 30.8% of women consumed their placenta, 47.1% did not, and 22% were unknown. In adjusted analyses, the strongest predictors of placentophagy were primiparity (adjusted odds ratio [aOR], 1.65; 95% confidence interval [CI], 1.53-1.78), pregravid history of depression or anxiety (aOR, 1.75; 95% CI, 1.58-1.94), and home vs. birth center delivery (aOR, 2.21; 95% CI, 2.04-2.39). Placentophagy was less likely in New England states compared to states on the west coast (aOR, 0.52; 95% CI, 0.44-0.61). Among the 5,923 women for whom a reason for placentophagy was known, the most common motivation was to prevent postpartum depression or improve postpartum mood (73.1%), followed by prevention or treatment of anemia (14.2%), improved lactation (4.6%), and improved energy (4.5%). The method of placenta preparation was known for 94% of participants. The most common method was encapsulation by either dehydrating and pulverizing the raw placenta (48%), or cooking the placenta and then dehydrating and pulverizing it (37%). An additional 9% of women consumed the placenta raw as part of a smoothie drink or other form. After adjustment for primiparity and intrapartum transfer, there was no association between placenta consumption (aOR, 0.87; 95% CI, 0.74-1.03) or whether the placenta was raw or cooked (OR, 1.01; 95% CI, 0.77-1.33) on neonatal hospitalization in the first six weeks. Also, there was no association with NICU admission, and the data were inconclusive for neonatal death. There were no deaths in the cooked placenta group and one death in the raw placenta group, which was attributed to a rapidly progressive neonatal sepsis in an infant with Down syndrome occurring on day 14. There was no autopsy performed.

COMMENTARY

Placentophagy is the practice of consuming the placenta after birth. Although common in mammals, there is no current human society that routinely practices placentophagy. Nevertheless, the practice has become more popular in recent years. The placenta can be eaten raw or cooked and often is encapsulated or consumed in smoothies or tinctures. There are commercial companies that will process the placenta, typically through steaming and dehydration into 100 to 200 capsules for ingestion. The cost is roughly between $200 and $400.¹ There are no scientific studies showing any benefit from placentophagy, despite claims that it will prevent postpartum depression, increase energy, and increase lactation. Existing studies include only self-reported surveys or anecdotal reports. In the only double-blind, randomized, controlled trial, Gryder et al evaluated the effect of placenta ingestion on maternal iron status among 23 women. No difference was found in maternal iron levels up to three weeks postpartum.²

There are possible harms associated with placentophagy, even if the placenta is cooked. Namely, there is no regulation of the processing steps that are taken to encapsulate the placenta. Human placentophagy is not regulated by the U.S. Food and Drug Administration nor any other agency. Therefore, there is no guarantee that the placenta has been steamed to high enough temperatures to kill all viruses and bacteria.¹ In 2017, the Centers for Disease Control and Prevention (CDC) reported a case of a term infant who was readmitted to the hospital because of late-onset group B Streptococcus (GBS) agalactiae sepsis five days after completing treatment for early-onset GBS.³ These authors determined that the uncooked placenta capsules the mother was consuming three times daily tested positive for the identical GBS isolate. Furthermore, toxins do accumulate in the placenta as part of its function, so it may contain minute quantities of heavy metals and/or other substances. In a recent review in the American Journal of Obstetrics and Gynecology, Farr et al concluded that there was no proven benefit to human placentophagy and possible harms; therefore, clinicians should counsel patients against the practice.¹ The CDC also has advised against placentophagy because of possible contamination of the capsules.³

Benyshek et al used an existing data set that tracks births at home and at birth centers in the United States. They rightly supposed that this would be a population more likely to practice human placentophagy. The data were entered by midwives who volunteer to be part of the program. Therefore, it was not a population sample or complete record of women who delivered at home or in birth centers in the country. The authors estimated that 30-40% of practicing midwives were contributing data to the MANA Stats program during the study period.⁴ In addition, as with any medical record study, there will be limitations related to the quality of information entered. There may be missing data, and neonatal outcomes were tracked only for six weeks. There also was no information on any maternal outcomes from placentophagy. So, although this study does not provide definitive proof of the safety of human placentophagy, it does offer an interesting picture of the practice in the United States.

Benyshek et al speculated that women in western states are more likely to practice placentophagy because of more liberal state laws regarding placental release from hospitals. Only four states have legalized placental release on request (Hawaii, Oregon, Mississippi, and Texas).¹ Other states do not have regulations, and hospitals frequently create their own policies, allowing release if pathological exam is not required and the woman signs a waiver. Benyshek et al also found that primiparous women and women with a history of depression and anxiety were more likely to practice placentophagy. This makes sense, as women undergoing their first birth often have more stress in the transition to parenting. This also implies that pregnant women should be educated about the signs and symptoms of postpartum depression as well as evidence-based treatments that do exist to help them. Finally, pregnant women need to be educated that there is absolutely no scientific evidence that placentophagy provides any benefit. At the very least, it is a waste of money. At most, it could be harmful.

REFERENCES

1. Farr A, et al. Human placentophagy: A review. Am J Obstet Gynecol 2018;218:401.e1-401.e11.
2. Gryder LK, et al. Effects of human maternal placentophagy on maternal postpartum iron status: A randomized, double-blind, placebo-controlled pilot study. J Midwifery Womens Health 2017;62:68-79.
3. Buser GL, et al. Notes from the field: Late-onset infant group B Streptococcus infection associated with maternal consumption of capsules containing dehydrated placenta—Oregon, 2016. MMWR Morb Mortal Wkly Rep 2017;66:677-678.
4. Cheyney M, et al. Development and validation of a national data registry for midwife-led births: The Midwives Alliance of North America Statistics Project 2.0 dataset. J Midwifery Womens Health 2014;59:8-16.