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The Facts Behind Pregnancy Rules

No caffeine, no alcohol, no sushi, goes the standard mantra for pregnancy. Is that right? Plus: NASA’s moondust mission.

(Flickr/MissJanetB)

(Flickr/MissJanetB)

Guests

Emily Oster, author of “Expecting Better: Why the Conventional Pregnancy Wisdom is Wrong — and What You Really Need to Know.” (@profemilyoster)

Dr. Jeanne Conry, president of the American Congress of Obstetricians and Gynecologists. Assistant physician in chief at The Permanente Medical Group in Roseville, California. (@conryjeanne)

Closing Segment On NASA Moondust Mission

Emily Lakdawalla, senior editor of the Planetary Society blog. (@elakdawalla)

From Tom’s Reading List

The New York Times: Pregnant, and Disputing the Doctor – “During her pregnancy, Emily Oster didn’t appreciate her doctor’s habit of issuing blanket rules: Don’t gain more than 35 pounds. No need to discuss amniocentesis — you’re not 35. No eating in the delivery room.”

Associated Press: Book Challenges Pregnancy Strictures — “I think we see sometimes where practice lags behind recommendations. Not all practitioners, obviously. As an example, in the case of prenatal testing, even though more recent recommendations don’t favor the 35-year-old cutoff as much, that’s still a highly practiced thing, so I think there’s a sense in which there is some slow creep of knowledge.”

Excerpt: ‘Expecting Better’ by Emily Oster

Interview Highlights

Emily Oster on drinking alcohol in moderation during pregnancy:

“It’s very clear that excess drinking during pregnancy is bad. I think everyone agrees on that. I think when you turn to light drinking, there’s more disagreement. I think many obstetricians like mine will tell you a couple drinks, a few drinks a week is fine. I wanted to understand the source of that disagreement, and I think for many women, especially when faced with conflicting advice, there’s the impetus to go to the source and understand. And I think when you look at the data, you see a variety of pretty large, well designed studies which show that the children of women who drink in moderation — I think it’s very important to be clear that that means no more than a couple a drinks a week in the first trimester, no more than a drink a day in later trimesters — that the children of women who drink at those levels don’t show any additional complications relative to women who abstain. And so I suggest that many women may look at that and think perhaps it’s OK to have the occasional glass of wine, but that really this is something where we should be encouraging people to look at the data and think about this decision.”

The National Organization on Fetal Alcohol Syndrome disagrees with Oster and issued this statement outlining the dangers of drinking during pregnancy. Dr. Jeanne Conry agreed with NOFAS:

“We know that alcohol consumption is the leading known cause of mental retardation in the United States. It is associated with lifelong learning disabilities, with birth defects, neurological behavior impairments. Alcohol crosses the placenta. And it is clearly avoidable. There is no known benefit of alcohol during pregnancy. So that puts it into perspective. We’ve got alcohol spectrum disorder. Clearly we all realize that high intake of alcohol is associated with some of the more severe complications. But what we haven’t been able to show is any level that is absolutely safe. To give you an example: University of Washington, where some of the largest, long term studies have been done … where fetal alcohol syndrome was first diagnosed and identified as a disorder several decades ago. They’ve got longitudinal studies, so long term studies of children with it, and they found that 1 in 7 was born to a mom who had low to moderate alcohol intake. What they said was they could not predict which child was going to develop fetal alcohol syndrome or some part of the spectrum. They could not predict which mother was going to give birth to a child with fetal alcohol syndrome or some aspect of the spectrum. So if we cannot predict which amount or which one is going to be a risk, then we’ve got 9 months and we recommend abstinence. We say you’re better off not consuming any.”

Oster took issue with Conry’s citation of the University of Washington study, saying that it was not a peer-reviewed study. Oster also noted that the women were drinking 1 to 8 drinks a week in the first trimester, and it was unknown how much they were drinking at a time.

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  • Ima

    I got a lot of contradictory advice during my pregnancy, and it left me both confused and a bit stressed out. Thus, my advice to a pregnant woman is DON’T LISTEN TO ANY ADVICE and trust your instincts.

    • 65noname

      what if your instinct is to smoke tobacco? Do cocaine? Jump out of planes without a parachute?

      • Ima

        And you think these people are the kind that would listen to advice?

        • 65noname

          huh?

  • lilybeth12

    How much time do you have? I am 7 months pregnant with our first child, and there is no end to the advice. Most of it is well meaning and helpful. The bit I’ve grown to hate is the “sleep while you can” adage. I can’t sleep, I can’t get comfortable,I need the bathroom every 5 minutes, and the scarlet thing is I potentially have 3 more months to look forward to.

  • Belinda Evil-Cackle Franke

    If you think pregnancy advice is confusing, just wait until the baby is born. I’ve been told I’m a terrible mother for having a drink while breastfeeding and that I’m a great mother for breastfeeding at all. That’s not the half of it.

    • lou

      drinking while breast feeding (without pumping and dumping) is no different than drinking while pregnant and no different that handing the alcohol to your baby.

      There are a dozen ways alcohol can your your little one because their brain is still developing. Alcohol interfere with that on a molecular level. Development is delicate and one change can have cascading effects,

      I wouldn’t call you a bad mom, but I would hope you would look into the biology of it all and you’ll see why it’s a bad idea.

      Breastfeeding is great in that it has hormones that stimulate mylenation but alcohol is a chemical that prevents it. unmylenated neurons don’t work, it’s like unplugging them,

      Please reconsider.

  • JF

    Echoing Belinda’s comment, things only got more confusing after the pregnancy is over and the baby’s come out. My older daughter is now 6 and so I have been there and done that (but not quite over yet). In hindsight, my advice is everybody (including your child) is different and there is no golden rule that applies to everyone. Keep an open mind and listen to the rules/advice and decide if this works for you / child. Sometimes gut instinct is required. Relax and have the confident that everything will work out at the end.

  • MadMarkTheCodeWarrior

    Sorry, Emily… To Doctor Conry’s point, why even consider taking the risk of drinking without solid evidence that alcohol in low levels is safe during pregnancy. It’s only 9 months.

    WIth the precious live within you, why take any risk at all? Why gamble during the nine months that will define the future of your child?

    • Kestrel

      Agree completely. Why would a person ever, ever risk the health of their child just to serve a food/drink desire? How selfish! As you say, it is only nine months. Even if there is no conclusive proof, we all know that alcohol is a poison, that cigarettes are poison, and that caffeine is absolutely a drug. Sacrifice for the sake of your child. This is what being a parent is all about.

    • robroy777

      Because the data seem to indicate that low levels of alcohol consumption are safe (also, see Europe or the US from the 1930′s-70′s where most women drink/drank during pregnancy).

      • vadoglover

        Actually, the data I’ve seen in discussions on this appear to indicate that alcohol passes into amniotic fluid, where forming organs are directly exposed to it, is NOT processed by a baby’s not yet formed liver, and can cause problems. Do you really want to risk your child’s IQ and mental health in order to have a cocktail? Just how badly do you need a drink? Sheesh.

        • robroy777

          The data indicate that low alcohol consumption is actually associated with INCREASED IQ so your argument is moot (probably confounded by socio-economics).

          Alcohol probably does pass through the placenta but small, slow drinking clearly is NOT a problem to the fetus (again, see Europe, France specifically,, which has 1/3rd our infant mortality rate despite huge prevalence in moderate drinking among pregnant mothers).

          The whole “bathed in alcohol” slogan is PR-spin and hype without actual evidence of harm because no studies can be done that randomly assign light drinking vs no drinking for pregnant women.

          Since there are no RCT’s, use commonsense and evidence that shows light drinking is fine. Hype and spin to guilt mothers, treats them like children, and promotes 100% risk reduction, which is impossible.

  • Lindam

    For those of us who have worked with children with fetal alcohol syndrome or effects, abstaining from alcohol for nine months is a small sacrifice to avoid a child who struggles with learning, behavior, attention problems for life!

  • monicaroland

    The teenager in this link is going away for life for killing a 5-year-old.
    http://www.buffalonews.com/city-region/falls-teen-gets-22-years-to-life-for-strangling-5-year-old-cheektowaga-girl-20130905
    His attorney said he is on the fetal alcohol spectrum. For all the years that I taught struggling 8th grade readers, I would do a pregnancy unit that included information on FAS. All my students learned that even one drink is too many for a pregnant woman.

  • 65noname

    this is more of oster’s phoney university of chicago neo-econ junk. Basically, she says that “well, I found a doctor who said it’s o.k. to drink so even doctors disagree.” That’s like the neo-cons who claim that climate change is not a scientific fact by saying “well, a scientist told me that it’s all junk science so even scientists disagree about whether the climate is changing”.
    She has already been forced to publicly retract her major thesis concerning the “missing million asian women” as being scientifically incorrect. This another of her glib-sounding, neo-iconoclastic opinions.
    And, by the way, she claims that her area of acadamic expertise is the science of “decision making”. She and her mainstroke lived in a third floor walk-up when they decided to get pregnant. Because oster would be doing most of the dragging up of the baby and baby carriage, she asked that they move to a first floor home. According to her, he would only agree to do so if she did all the house hunting (they both had fulltime jobs). She agreed.
    What’s clear is that oster needs to work on her “decision making” concerning choosing partners before she starts rewriting the science behind whether pregnant women should drink alcohol.

    • robroy777

      Personal attacks are the sign of a weak (or no) argument.

      • 65noname

        To argue that to say that she does not provide any evidence to support her arguments is a personal attack is sophistic. And, yes, I wonder how someone who makes the decisions that she makes can claim that to instruct others in how to make benefical decisions.

  • http://www.sevengrainsofsand.com/ Bill Callahan

    I noticed that your guests are arguing over statistics from various studies. Perhaps in the future, you could have an independent statistician review the studies before the show and then report on them during the show.

  • JL

    Some Eastern cultures have no medical prohibition on alcohol use during pregnancy, and their rates of birth defects and other medical complications are comparable to Western countries. Does Western medicine ignore the experiences of other cultures in this regard?

    • lou

      Where did you read that they are comparable? Do some more research.

    • Linda Q

      Some Eastern cultures? Which ones? What studies?

  • Mary Wissmann

    I think your guest’s comment about consuming alcohol during pregnancy is completely wrong. There is no know safe amount of alcohol, it is an avoidable risk and her comparison to driving a car is absurd. She is encouraging pregnant women to rationalize that anything they do is okay. If she wants to make the point that a pregnant woman should not freak out if she has a drink, I agree with that.

  • Katie

    I recommend an interesting documentary: Business of Being Born. I’m still far away from having a child, but the film points out the benefits of having a homebirth with a midwife vs controlled hospital environment. Something to think about, what do you think?

    • lou

      I’ve seen it. I find the end ironic lol. An emergency delivery and an underweight baby.

      As for home birth, one needs to weight the costs and benefits. There are some. With alcohol there is no benefit.

      For my I am thankful I chose a hospital delivery, I would have died at home. Had I not had complications I could see having a home water birth,

    • DaftPunkd

      Home delivery is good for pizza, bad for babies.

      The data show there is an increased risk of neonatal death with homebirth, and this is with a self-selected high SES, low-risk population. Homebirth midwives are not the same as certified nurse midwives, and have been shown to hide their mortality statistics.

      hurtbyhomebirth.com

  • JanaHod

    I can’t help bristling at what sounds a lot like the parents who are anti-vaccine. It’s a dangerous cost-benefit analysis that considers more the benefit to an individual’s ego (also called “listening to your body”) a higher priority than the benefit to society.

    • rogger2

      I agree completely.

      That’s also all I could think of while listening to Prof. Oster on this topic.

    • lou

      And no benefit to alcohol and only risk. I would never inject my child with a vaccine for my enjoyment, I would to protect them from pathogens.

      I have a child with FAS. He has heart, spinal, facial, skeletal, brain and tissue defects consistent with prenatal alcohol exposure. I breaks my hear that his natural mother never got the care she deserved. She learned and made better choices with her next one after seeing him there in the NICU, knowing her choices put him there.

      I have no anger for her though. I have anger towards those who had the power to intervene in the life of this very young mother, not just for my son’s sake, but also for hers. She knew she couldn’t raise him with all of the challenges he was going to face. She had to live with the guilt which, didn’t stop her from being in his life rather than hiding. She was honest about her use which saved him from even more testing and unknowns.

      Of all of the things she used during pregnancy, it was the alcohol that was most damaging.

      Each drink caused a little bit of damage when added up equaled Fetal Alcohol Syndrome.

  • Guest

    How can we view the launch tonight on-line?
    How far away do you expect to view the launch?

  • 65noname

    government radio needs to decide whether its programs are simply free advertising space for anyone who has written a book or whether it considers whether there is any value to the book. Actually, its clear that it has already decided.
    And, please, don’t argue “freedom of speech”. this program chooses amoungst literally hundreds of books and thousands of potential guests every week. Many, many are not on government radio programs. And if it is going to present a program that goes against the current pregnancy advice, which is often actually a good idea ,at least present a real scientist whose arguements are based on science not whim and personal antecdote.

    • robroy777

      She’s a health economics professor at U Chicago with a PhD from Harvard. So she’s a real scientist using real scientific data. Hence all the discussions about scientific “data.”

      • vadoglover

        She’s an economist. Giving opinions on biology. If she has any educational background at all in medicine, biology, or obstetrics, I didn’t hear it.

      • 65noname

        the facts that she has a science degree and, espically, the fact that she’s on the u of chicago econ faculty, don’t make her a scientist. you can start with the fact that she had to retract the conclusions in her Harvard thesis which was found to be scientifically wrong. Nor was it because of later scientific discoveries. It was because her methodology and so-called “decision-making”, her so-called specialty, was wrong. In any case, the fact that she has a science degree doesn’t change the fact that her aguments were based soley on antecdote and as for “discussions about scientific data” her “scientific data” consisted of her responding to every scientific study by saying “well a different scientist told me that …. ”

    • Miss_Lilianna

      AGREED! Today’s guest was almost hard to listen to. Most of the show was filled with personal anecdotes from a person with an annoying voice (vocal fry) and know-it-all attitude. I listen to Onpoint everyday and this one was a joke.

  • EA

    Is it really that difficult to say no to a glass of wine, a sandwich or sushi for 9 months?

    • Miss_Lilianna

      Seriously. Talk about first world problems. On point must be running out of ideas.

  • CA

    As a physician, I am always concerned with behavioral change in the context of medical advice. This is a huge problem in all areas, not just pregnancy. Most people do not want to make many/most/all of the changes needed to improve health because these changes usually involve giving up things we want. And we know, we are inclined to believe we should have what we want.
    Nothing in medicine is 100% – most data is applicable to most people, most of the time. Nevertheless, there are studies which show at least some risk of certain substances in pregnancy.
    For sake of argument, let’s say a small amount of alcohol and/or a small amount of alcohol in certain patients may not cause any problems. However, in practice, we have no way of knowing who those patients are beforehand. That means the risk has to be seen as applying to all pregnant women, not just some.
    BUT, no-one NEEDs alcohol or coffee or soft cheeses or sushi or deli meats. Why take such an unnecessary risk? To satisfy your taste buds…..? These substances are not vital and you should be able to do without them for 9 months in order to reduce your risk of having an unhealthy baby.
    If you NEED a glass of wine you better being seeing your physician — for other reasons.
    Dr. Oster is in no position to be telling other people what they can/should be doing – if she wants to encourage women to have thoughtful conversations with their caregivers – I’m all for it. But she has no experience in taking care of patients. Reviewing the study results is not the only part of the decision and does not make her an expert. She is misleading a lot of women with her overstatement of “why the conventional pregancy wisdom is wrong”. It may be open to discussion, but “wrong” is going too far.
    Women ultimately have the right to make their own decisions, however, physicians advise using the “conventional wisdom” because it is based on scientific data and years of experience. It is meant as one of the ways to do everything possible to ensure healthy babies.
    Dr. Oster should be able to give up wine and cocktails, and whatever else, for 9 months – her book is just a way to rationalize her own behavior.

  • lou

    Emily, you’ve been schooled!!! Go back to your day job and stop playing doctor.

    I will believe the PRESIDENT of the ACOG over you any day.

  • Tina Holcomb

    As an adoptive parent of 2 beautiful little boys, I would like to share my experience with you. The bio mom (my hubby’s daughter) partied while she was pregnant with our boys. Prenatal alcohol use was well-documented. We’ve had our boys since 2006, and our life has gotten rougher each year. Our oldest is almost 10, but on a 5-yr-old level. He can’t ride a bike or tie his shoes, and a stuck zipper will automatically cause a wild, uncontrollable meltdown. He has been diagnosed with Fetal Alcohol Spectrum Disorder, ADHD, and a seizure disorder. The doctors cannot tell us if he will ever be able to be independent. Our little one is almost 8. He is bright, outgoing, well-mannered, and eager to please….Just don’t make him mad. Earlier this year, he spent 20 days in a children’s psychiatric hospital for attacking his teacher. He was diagnosed with Bipolar Disorder and is now on powerful medications. The counselors, pediatricians, neurologists have all told me that FASD is an epidemic. We are raising a generation of mentally ill kids because drugs/alcohol use is so prevalant. Idiots like Emily Oster are encouraging the epidemic to continue, and it’s the kids who suffer for it. Prenatal alcohol damages brain cells, and the damage is permanant. Is it really worth risking a child’s life and future? If you wouldn’t put alcohol in your newborn’s bottle, why would you feed it to an unborn baby?

    • ferngilly

      Thanks for the first person perspective. I worked with a really sweet, loving kid who was affected by natal exposure to alcohol. She had similar experiences to the ones your kids also cope with.

      It’s upsetting and hypocritical that there’s such a stern line about some decisions which leave some individuals vulnerable to severe judgement (such as smoking cigarettes, while pregnant and non pregnant – not that I condone the activity in either context) while alcohol consumption is subject to less discrimination and scrutiny. There’s no difference between cigarettes and alcohol on a developing fetus. Each are toxic to a weak immune system, period. Thus, its not so much to ask that an expectant mother, who is choosing to have a child, make a sacrifice that will make her life easier in the long run.

    • Sy2502

      I feel for your situation, but I feel the need to put it into perspective. There are pregnant women who drink and have problematic children, just like there are those who don’t drink and also have problematic children. There are also pregnant women who drink and smoke and their children are just fine. Things are never black and white, there’s leeway in everything. A balanced perspective is always the best.

      • Katia

        That’s not really “perspective”. The overwhelming evidence is that there is no safe amount of alcohol to consume during pregnancy. I find it funny that Ms.Oster says “absolutely not” to smoking, but thinks drinking is OK.

  • FASDcrusader

    To compare the risks of driving to the risks of drinking while pregnant seems weak. As we approach FASD Awareness Day on Sept. 9, I ask Dr. Oster to spend a day with a teacher or family who is working with a child suffering with FASD to understand where the outrage is coming from . FASD is 100% preventable. Women who are not willing to make sacrifices in order to give their child an optimal chance in life should really consider being a parent! Now before someone jumps all over this, I realize that there are women who have addiction issues and become pregnant. They need professional help to minimize the damage. I am talking about women who are not willing to give up their Skinny Girl cocktail hour with the girls or glass of wine to unwind after work–HAVE A MOCKTAIL OR TAKE A WARM BATH instead! Why would you put your unborn child at risk when as you say there are other risks that are not as preventable (driving, pollution, pesticides etc). Alcohol crosses the placenta and is toxic to neural tissue. Mixed with nutrition, genetic and environmental issues–no one knows what is too much. So I ask you…would you give a newborn a glass of wine? a beer? a martini? Of course not! Every time a pregnant woman drinks, her unborn baby drinks too. Spread the word….According to the Canadian Public Health Agency. “No amount of alcohol of any kind, at any time”. Please stick to economics Emily.
    From a concerned adoptive Mom of two children living with FASD

  • Sarita

    I think one of the health care providers who called in hit on the crux of the matter: There is great fear of being sued. So, it seems like a lot of the advice that comes from OB/GYNs (and the ACOG) is rooted in what is or is not covered in their malpractice insurance. So, things like VBACs are discouraged because, well, the insurance company won’t insure a hospital or clinic that performs them.

    That example is more on a “stronger” end, I guess, than the conversation about having caffeine while pregnant, but my larger point is that, for a lot of reasons, the guidelines seem more rooted in fear of lawsuit than anything else.

    • Linda Q

      Huh?

      • Sarita

        Are you interested in an actual discussion? If so, “Huh?” doesn’t facilitate that.

  • kthom1972

    I honestly can’t believe what I am hearing. I am a Pharmacist – I have a PharmD, MBA, MHSA and a BS in Economics and Mathematics. I (along with many of the readers here) can provide a critical analysis of the research on any number of subjects. I find a great number of subjects interesting and many that impact my own life – as is the case here. That doesn’t mean that I am going to write a book and put my opinion out there for a wide audience as an “expert” – That would be irresponsible. I might strike up a conversation with friends and colleagues, but that’s about it..

    As a Pharmacist, I would NEVER, EVER recommend that a pregnant woman go ahead and have alcohol in any quantity. A 0.0000001% risk is way too much – you are talking about impacting the rest of your child’s life. If you do a risk-benefit analysis it’s a no-brainer given that the benefit of a glass of wine or coffee is so low.

    I have had women ask me about having several drinks before they found out they were pregnant. In that case, I would tell her not to worry too, too much, but be careful to avoid alcohol entirely during the remainder of her pregnancy. It’s past the point where she can do anything about it and worrying about it is going to do more harm than good, esp in a patient who is anxious generally or anxious about her pregnancy.

    My advice is that you should always view information of any kind with a critical eye – a quick internet search got me all the information I needed (see below). Both are clearly smart, well-educated and accomplished women. Make your own decision on whose medical advice you would take to heart.

    http://faculty.chicagobooth.edu/emily.oster/

    http://mydoctor.kaiserpermanente.org/ncal/provider/jeanneconry#tab|2|1|Professional|/ncal/provider/jeanneconry/about/professional?professional=aboutme.xml&ctab=About+Me&cstab=Professional&to=1&sto=0

  • Ewj

    I applaud Dr. Oster for her work. Women are infantalized in this patriarchical society where everyone other than the pregnant woman knows best. this is evidenced by most of the comments on this webpage. The directives and missives surrounding pregnancy are endless and leave a mother filled with guilt; which, is also bad for the fetus. We, as mothers, are constantly questioning what we could have done different and what we are doing wrong that may be the cause of any of problems our children face in life. Society in their condemnation of mothers has not left the era of the schizophrenogenic mother/”refrigerator mother” or the idea that bad mothering causes autism. We are bombarded by images of what the perfect mother should be and how we don’t measure up. It is time to let go of mother blame and give women the respect and honor they deserve for bringing life while suffering the judgment of others.

    • Linda Q

      So you will drink because this is a patriarchal society? Good thinking. BTW, you spelled patriarchal wrong.

  • WestDakota

    The show today was poorly produced, in my opinion. Emily Oster’s appearance on the show was billed with promises to “look at all the dos and don’ts of pregnancy and see which ones are truly backed up by the evidence.” Then, for a solid half-hour, the discussion was about nothing other than alcohol intake. Nothing! Why have Dr. Conry as a guest at all, when you knew she would only vociferously disagree with Oster on the alcohol issue? For balance? I suspect the real reason was to pump up manufactured drama. And predictably, drama and conflict was all I heard, rather than solid information on all the OTHER proscriptions of pregnancy, besides alcohol. The author should have been interviewed as the sole guest, as is the practice with nearly every other author interview I’ve heard on this program.

    Additionally, whoever was screening the calls should have been told to limit the number of calls pertaining to the alcohol issue, because there were so many other issues raised in the book (and which Tom promised would be discussed) that were getting no air time whatsoever.

    • Linda Q

      Why?

      • WestDakota

        Can you not read? I gave a reason for everything I said.

  • Sy2502

    Sometimes I feel some pregnant women treat their pregnancy as a special and rare disease. Have we forgotten we have been making babies since the beginning of time?

  • Sarita

    Thank you for the clarification. Perhaps I should have stated that practice patterns are rooted in fear of lawsuits? I was responding to the caller who verbalized fears of lawsuits when she said that if physicians don’t make certain recommendations, a patient could come back and sue. That’s a thoughtful statement, for sure, but what ends up happening is that pregnant women get treated like a monolith (e.g., pregnant women who exercise should make sure that their heart rates don’t go above 145 bmp).

    A normal response to that seems to be that some pregnant women decide to look at the research, discuss with their OB (or midwife, and on that front, it feels as though CNMs also practice evidence-based medicine yet have slight variations from OBs), and ultimately decide what’s best for their bodies and situations.

    And to clarify for you, I’m not saying that physicians shouldn’t fear lawsuits, but if that does play a part in guiding recommendations, it’s something to go back and review.

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