One of the challenging aspects to knowing the risks of placenta consumption is knowing the amount of bacteria present in the placenta women are ingesting. The specific bacterial colonization of each person and the preparation method can influence what will be left in the placenta for consumption.
A recently published study on the content of placenta for ingestion was done by Sophia Johnson and colleagues in the placenta lab in Germany. They conducted research that was published in a paper in 2018, Human Placentophagy: Effects of Dehydration and Steaming on Hormones, Metals and Bacteria in Placental Tissue. The study looked at the composition of raw and processed placenta including microbial content, trace minerals, and hormones. The published paper states the conclusion, “The preparation of placental tissue has a clear effect on the microbial contamination: dehydration causes a drastic germ reduction, steaming followed by dehydration causes an even greater reduction of microbial species. According to the Commission Regulation of the European Union [41], the dehydrated tissue does adhere to the microbiological criteria for food stuffs” (Johnson et al. 2018).
The 2018 placenta study explains that in examining the data, a host of bacteria were found in the raw placental tissue, including: “Lactobacillaceae, Corynebacterium spp, coagulase negative Staphylococcus, Streptococcus spp, Bacteroides spp, Peptostreptococcus spp, E.coli, Gardnerella vaginalis, Burkholderia gladioli, Achromobacter spp, Capnocytophaga spp and Candida albicans. Raw tissue contained the highest absolute number of microbes detected (13), followed by raw dehydrated tissue (5), steamed tissue (4) and steamed dehydrated tissue (2)” (Johnson et al. 2018).
The researcher’s conclusions were that the most thorough method of preparation, which involves steaming placenta to 70º C (158º F) followed by dehydration, drastically reduces microbial contamination. It is evident in the data, however, that even with the most thorough processing of steaming and dehydrating, there are still some bacteria present in the pills using this method. This paper discusses the risks with even the steam-dehydrated samples (the most thoroughly heated method): “Retained samples showed growth of Panbacillus macerans, a species that can produce histamine in preserved foods [43]. Ingesting high levels of histamine can cause food borne chemical intoxication. The produced levels of histamine correlate with the level of microorganisms found. In this study, only a low number of colony forming units of Panbacillus macerans was identified. Nevertheless, dehydrated placenta is not sterile and it cannot be ruled out that the encapsulated tissue contains other potential harmful bacteria such as enterotoxine producing Staphylococcus aureus or histamine producing Enterobacteriaceae. Depending on the vaginal flora of the placenta donor, transmission of resistant microbial species or potentially pathogenic bacteria such as Enterobacteriaceae, Gardnerella spp or Candida albicans to the placenta is possible” (Johnson et al. 2018).
The most well known risk associated with maternal placenta consumption was documented in a 2017 case report regarding a two week old baby that was rehospitalized for GBS infection from maternal ingestion of infected placenta capsules (Buser et al. 2017). The mother had tested negative for GBS in pregnancy, but nevertheless, shortly after birth her baby was found to be infected with GBS via transmission from the mother in labor. The baby was initially treated and cleared from the infection in the NICU and sent home at 11 days old. The mother’s placenta had been processed for encapsulation by a placenta encapsulation company, via dehydration in a temperature range of 115 – 160ºF (46-71ºC), and the mother began consuming the pills three days after the birth. Five days after being discharged home, the baby was readmitted to the NICU for late onset sepsis from GBS infection, with an identical strain to the GBS found in the mother’s placenta pills. This case has been extensively reviewed in the media by those in favor of, and those advising against, placenta encapsulation. There is some debate over whether the baby was reinfected with GBS from the placenta capsules the mother was ingesting, clouding the concern of this practice remaining a safe option or not. Regardless of this uncertainty over the direct mode of re-infection for the baby, the clear take away point in this case is the fact that when tested, GBS bacteria was found in the placenta pills.
While it is widely stated in popular media that only the single GBS case report has been published of an infant infection from placenta pills, a factor to be considered is that the vast majority of mothers ingesting their placentas may not be disclosing this fact to their healthcare providers, thus greatly limiting investigation into adverse outcomes. In their 2015 literature review on placentophagy, Coyle and colleagues discussed data involving a survey on maternal practices around placentophagy. The preliminary results showed that only 5% of women disclose placenta ingestion to their health care providers (Coyle et al. 2015). Additionally, a paper published in 2018 by the University of Las Vegas (UNLV) regarding outcomes for babies with this practice illuminates further concern with risks of infection. The UNLV research team that published this new study has published several recent papers on placentophagy, often in collaboration with placenta encapsulation businesses. The 2018 UNLV paper, entitled Placentophagy Among Women Planning Community Births in the United States: Frequency, Rationale, and Associated Neonatal Outcomes, was published in collaboration with the MANA Stats Registry. It looked at data that was reported by midwives on the outcomes of infants whose mothers ingested placenta. This UNLV paper came to the conclusion that has been widely seen in the popular media that placenta ingestion causes no risk to newborns when compared to newborns whose mothers do not ingest placenta. However, the details of the paper suggest a closer evaluation. This paper states, “Our data were inconclusive for neonatal death: the odds ratio is undefined because there were no deaths in the cooked group. The one neonatal death observed in the raw group was attributed to neonatal sepsis in an infant with significant congenital anomalies. The sepsis was rapid onset, occurring on day 14; the mother did not test positively antenatally for Group B streptococcus (GBS) and no autopsy was performed on the infant” (Benyshek et al. 2018). Their paper notes that there was an infant death from sepsis, and this infant’s mother had ingested raw-dehydrated placenta capsules. The UNLV paper goes on to describe details of the infant death in the study, “Down Syndrome affected infant, no heart or other major abnormalities per ultrasound so continued with home birth plans, feeding challenges but exclusively breastfed up to 14 d when seizures began, admitted to the neonatal intensive unit on day 14 and died within 5 h from acute rapid onset sepsis, disseminated intravascular coagulation and cardiac arrest, no autopsy, medical examiner thought not related to Down Syndrome but could find no explanation for sepsis” (Benyshek et al. 2018) (Italics added).
While being a genetic disorder with known complications and a shortened life expectancy, newborn babies with Down Syndrome do not typically die of “rapid onset sepsis,” as the medical examiner stated in this case. The paper states that they could not find the cause for the sepsis that killed this newborn, but does not expand on if there was disclosure to physicians regarding the fact that this mother was ingesting raw-dehydrated placenta, and if that factor was considered in the cause of death. The 2018 German placenta study showing a wide range of pathogenic bacteria present in placenta, along with Coyle’s findings that only 5% of mothers may be reporting to their healthcare professional that they are consuming their placenta, gives further credibility to the 2017 AJOG review on placentophagy recommendation that all healthcare providers should discuss and assess for placenta ingestion with their clients (Farr et al. 2017).
The authors of the UNLV paper conclude, “Placentophagy in any form was not associated with adverse neonatal outcomes.” They further state, “Data from the present study do not reveal an increased risk of NICU admission in the first 6 weeks, neonatal hospitalization in the first 6 weeks, or neonatal/infant death, for placentophagic compared with nonplacentophagic mothers” (Benyshek et al. 2018). One of the limitations of this study is that it is only giving data on midwives reporting admission into the NICU or infant death, not on other possible adverse outcomes of varying degrees of severity for the infants. The study is not going to capture information on poor infant outcomes managed in the pediatric office that don’t end up in the hospital in the early weeks. Poor growth and its complications due to low milk supply may not be addressed until after the 6-8 week midwifery postpartum care of the mother. See the section on concerns about maternal placenta ingestion’s effect on infant growth. Another limitation of this study is that the MANA Stats is not collecting data on if the midwife who is reporting the outcomes is the same person who is providing the placenta encapsulation services. It is becoming more common for midwives to be offering placenta encapsulation services, and collecting the data in this context may be a conflict of interest (Ioannidis 2005). While it is true that the data reported in the UNLV study does not necessarily indicate an overall increased risk in infant death as a result of placentophagy, there was an infant death from sepsis in the raw group that deserves closer evaluation. In addition, there are limitations in the study design, and any claims as to the safety of placenta consumption are premature at best. The UNLV paper discusses some limitations of the data collection, stating, “The data entered into the MANA Stats system come from medical records, which have well-documented limitations for the purposes of research” and “However, we expect that the outcomes reported here (e.g., NICU admission) were likely to be recorded in the medical record with a reasonably high degree of accuracy because of their importance to clinical care. In addition, though systems are in place to ensure that all births from participating midwives are captured, we cannot confirm with absolute certainty that no cases are missing.” (Benyshek et al. 2018).
This UNLV study is based on using the Midwifery Alliance of North America’s (MANA) data collection tool, called MANA Statistics Project (MANA Stats). The 2014 paper Development and Validation of a National Data Registry for Midwife-Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset describes the development of this tool: “Over the last decade, one of MANA’s key initiatives has been the development of the MANA Statistics Project (MANA Stats), a data collection system that captures perinatal and process-of-care data for midwife-led births in all settings. This unique and comprehensive Web-based registry was designed to facilitate research on midwifery care and normal physiologic labor and birth” (Cheyney, et al. 2014) (Italics added). However, the addition of placenta capsule ingestion to the MANA Stats registry is not consistent with the principal of studying normal physiologic labor and birth or traditional midwifery practices. There is ample evidence through the extensive anthropological research showing that maternal placenta ingestion is not a traditional human practice in any culture, nor is it a traditional midwifery practice. Since there is no history in midwifery practices worldwide, and is in fact a recent trend, it is important to study carefully its impact and not make the assumption that is is benign or even useful in humans. Ingesting encapsulated placenta is not the normal physiological process of a traditional, undisturbed birth and postpartum period. Maternal placenta ingestion is a very recent trend and alters normal postpartum physiology. Additionally, placenta ingestion presents a risk of infection for the baby that traditional midwifery has never had to encounter. The 2018 UNLV Placentophagy report using MANA Stats is examining a new trend of an altered physiological, non-traditional intervention on the birth process.
If we look at the 2018 UNLV paper using the MANA Stats report of how mothers are ingesting the pills, we see that approximately half are reporting they ingest raw-dehydrated placenta. The infant death from sepsis in the UNLV study was following the mom ingesting the raw-dehydrated placenta. The 2018 German study shows that in the raw-dehydrated method, placenta was found to still have five strains of bacteria remaining, including strains of staphylococcus and streptococcus, posing a clear infection risk. As far as hormonal content analyzed in this study, the same study shows that with the popular raw-dehydrated method, most hormones are destroyed; However progesterone was actually more concentrated than before the dehydration process. See the section on breastfeeding and hormones to see the risks to milk supply with introducing progesterone while breastfeeding. The data in the 2018 study also goes on the show that while the most thoroughly heated method (steam-dehydrated) reduces the bacterial content of the placenta the most, it also confers a 89.2% – 99.6% reduction in hormones levels. There is no preparation method that shows a complete elimination of bacterial levels in the placenta pills. As placenta encapsulation is a newly developed cottage industry, there are no regulations or guidelines for preparation. Various placenta encapsulators advertise that when using the steamed method, they use “gentle” steaming recipes to retain nutrients and hormones. Popular steaming temperatures range from 115-160ºF (46-71ºC) for undisclosed lengths of steaming times, which may lead to an unknown level of bacterial content in the finished product of placenta pills.
See additional risks of placenta ingestion for babies, for children and postpartum women
Download of the Open Access paper on reviewing research: Ioannidis JPA (2005) Why most published research findings are false. PLoS Med 2(8): e124.
Benyshek DC, Cheyney M, Brown J, Bovbjerg ML. (2018). Placentophagy Among Women Planning Community Births in the United States: Frequency, Rationale, and Associated Neonatal Outcomes. Birth 00:1‐10.
Buser GL, Mató S, Zhang AY, Metcalf BJ, Beall B, Thomas AR. (2017). 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 66:677–678.
Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S.
J Midwifery Womens Health. (2014). 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 59(1):8-16.
Coyle, C., Hulse K., Wisner, K., Driscoll K., Clark, C. (2015). Placentophagy: Therapeutic Miracle or Myth? Arch Womens Ment Health 18(5):673–680
Farr, A, Chervenak, F, McCullough, L, Baergen, R, Grünebaum A. (2017). Human Placentophagy: A Review. AJOG 218(4):401.e1-401.e11.
Ioannidis JPA (2005). Why Most Published Research Findings Are False. PLoS Med 2(8): e124.
Johnson, S, Groten T., Pastuschek J., Rödel. J., Sammer, U., Markert, U (2018). Human Placentophagy: Effects of Dehydration and Steaming on Hormones, Metals and Bacteria in Placental Tissue. Placenta 67; 8 – 14.
Young, S., Gryder, L., Zava, D., Kimball, D., Benyshek, D. (2016). Presence and Concentration of 17 Hormones in Human Placenta Processed for Encapsulation and Consumption. Placenta 43:86‐89.