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How to Soothe Common Pregnancy Discomforts: Heartburn

May 17, 2013 By FitPregnancy Leave a Comment

In this new series on Giving Birth with Confidence, we’re going to cover some of the most common discomforts that can happen during pregnancy and share tried-and-true ways to help soothe or eliminate them. Pregnancy can be an amazing time in a woman’s life, but it can also be challenging. The reality is that some women’s bodies accept and cope well with pregnancy and some don’t. In any case, having extra tools in your coping toolbox can go along way toward increasing your quality of life during the 4o-ish weeks of pregnancy.

Five Ways to Extinguish the Fire of Heartburn During Pregnancy

By Hillari Dowdle, freelance writer for FitPregnancy

It was heartburn that got me in the end. I could take the swelling, the back pain, the constant trips to the bathroom, the itchy skin, the fatigue, the sweating, the sleeplessness and even the psychological shock of seeing the scale tip 200 pounds. But the constant, searing pain of heartburn made the miracle of pregnancy seem more like a curse—by the middle of my third trimester, my mantra had changed from Please, let him be healthy! to Just get him OUT!

That fiery sensation known as heartburn happens when the lower esophageal sphincter (LES), a muscle responsible for keeping stomach contents in their place, begins to relax or leak. this allows stomach acids to flow upward into the esophagus, explains Suzanne Trupin, M.D., CEO of Women’s Health Practice of Champaign, Ill. Pregnant women are prime candidates for two reasons: First, the hormone relaxin—busy limbering up your joints and connective tissue for an easier birth—slows your digestion, meaning food stays in your stomach longer and triggers more acid production. Second, your growing baby exerts pressure on both the stomach and the LES, increasing the chance that acids will be pushed up into the esophagus.

So what’s an expectant mother to do? Follow these five tips to relieve the pain:

1. Eat less, more often
Overeating exacerbates heartburn, says rachel Brandeis, M.S., a registered dietitian in Atlanta who specializes in prenatal nutrition. “When you’re pregnant, there’s less room for your stomach to expand,” she explains. Maintaining a sensible diet will not only stave off heartburn in the short term, but throughout your pregnancy as well, because gaining more than the recommended weight puts more pressure on your abdomen, which can trigger the condition. Instead of three meals a day, aim for six mini-meals (See “Mini-Size Me” below) of no more than 1 1⁄2 cups of food each, Brandeis recommends. Smaller meals are easier for your body to digest.

2. Eliminate trigger foods
Identify the foods that intensify your heartburn and banish them from your diet. While there are no universally “banned” foods, common heartburn triggers include acidic foods, such as citrus fruits and tomatoes, greasy or fried foods, spicy foods, chocolate, coffee, carbonated beverages, and alcohol (which, as you well know, you should eliminate anyway!).

3. Focus on fluids
“Liquid-y foods are less likely to cause problems than solids, since they move through the stomach more quickly,” Brandeis says. Soups, smoothies, yogurt, milkshakes, protein shakes and puddings are good choices. Look for liquids that offer plenty of protein, such as milk and drinkable yogurt, and aim to make solids a little less so: “chew solid foods slowly and extremely well, until they’re almost liquefied,” Brandeis adds.

4. Sleep smart
To avoid nighttime heartburn, don’t eat anything for at least three hours before bedtime. Elevate the head of your bed by placing books under the legs, and if you’re not already sleeping on your left side, start now; stomach acids will have to travel uphill to reach the esophagus—no easy feat!

5. Time for Tums
It’s fine to find relief in a bottle of tums or rolaids or other calcium- containing antacids. However, “too much calcium can block iron absorption, so don’t take tums at the same time you take your prenatal vitamin,” Brandeis advises. By the time I gave birth, I estimate I’d ingested my own considerable body weight in tums. This overuse created calcium overload, which may have exacerbated my anemia. If you’re taking antacids 10 times a day (or more—as I was), talk to your doctor: she may want to check for ulcers or a hiatal hernia (where part of the stomach protrudes into the chest cavity), or prescribe medication.

Also, avoid antacids that list aluminum (such as aluminum hydroxide or aluminum carbonate) as an ingredient; it can cause constipation and can even be toxic in large doses. Remedies containing aspirin (such as alka-seltzer) should also be avoided during pregnancy; look for salicylate or acetylsalicylic acid in ingredients lists. You don’t want an antacid containing sodium bicarbonate (baking soda) or sodium citrate, either. Both are high in sodium, which causes water retention.

Mini-Size Me

Here’s a sample of what a day’s worth of small, healthful meals looks like:

1 cup of oatmeal with milk and 1 apple

1 cup of yogurt with fruit

1 ⁄2 peanut butter and jelly sandwich and 1 cup of vegetable soup

1 handful of whole-grain crackers and 1 ounce of your favorite hard cheese

2 ounces of chicken, 1 ⁄2 cup of mashed sweet potatoes and 1⁄2 cup of cottage cheese with fruit

Find eight more small snacks that are easy to make, packed with pregnancy nutrients and delicious at fitpregnancy.com/snackideas.

 

Did you experience heartburn during pregnancy? What helped you get rid of it? Share in the comments — women want to know!

 

Filed Under Common Discomforts, Featured Story, Health and well-being, Medications During Pregnancy, Nutrition, Pregnancy Tagged With heartburn

Reading Beyond the Headlines: A Closer Look at the Study on Antidepressants During Pregnancy

November 5, 2012 By Walker Karraa, MFA, MA, CD(DONA) 6 Comments

A recent study regarding the use of antidepressants has been gaining a lot of media attention. The actual study, The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond (Domar, Moragianni, Ryley & Urato, 2012) has been described by media with a fair amount of fear-based headlines. Safety regarding the use of a specific type of antidepressant medication, selective serotonin reuptake inhibitor (SSRIs), is an important topic of research,  as care providers from many fields address the prevalence and negative effects of depression and other mood disorders in pregnancy.

 

Understandably, pregnant women and their families may be greatly alarmed by these dramatic press releases, and in some cases may consider suddenly discontinuing their medication, without realizing the significant risks that accompany suddenly stopping medication. What do the experts say?

 

I asked the study’s lead researcher, Alice Domar, MD what advice she would offer a pregnant woman who is currently on one of the SSRI medications listed in the study to do, and she kindly offered this response:

 

“I would never recommend the sudden discontinuation of an SSRI during pregnancy. There are significant side effects associated with the abrupt cessation of antidepressants and we don’t know the impact on the developing fetus. The three main points we were trying to make with the paper were: 1) there are risks associated with taking SSRIs during pregnancy, 2) there are no clear benefits, and 3) each patient needs to have a discussion with her physician about her individual risk/benefit ratio.  There is a huge difference between a woman who is suicidal, who in all likelihood should remain on medication, versus women with mild or moderate symptoms who would benefit from a different approach, such as cognitive behavioral therapy, or physical exercise, both of which are very effective in the treatment of depressive symptoms.” –Alice Domar, MD (personal email communication, 11/2/12)

 

Another of the study’s researchers, Dr. Adam Urato, offered this follow-up:

“Your question is a good one (What would you advise a pregnant woman who is currently on one of the SSRI medications listed in the study to do?) and it is one I deal with several times each week as an Maternal-Fetal Medicine specialist.  I agree with Dr. Domar’s comments.  Sudden discontinuation of the SSRIs is not recommended.  They should be tapered for those who plan to discontinue them. The patient and their pregnancy health care provider (and their mental health provider) need to be aware of the scientific evidence regarding these drugs.  That evidence shows significant risk of pregnancy complications (like miscarriage and preterm birth) and no evidence of benefit for moms and babies.  In non-pregnant populations, alternatives like cognitive behavioral therapy and exercise appear to be as effective as the SSRI antidepressants and without the side effects and pregnancy risks.” (Personal email communication, 11/2/12)

 

Reaching out to experts in the field provided roundtable perspective. Christina Chambers, MPH, PhD, California Teratogen Information Specialist (CTIS) and director of the Pregnancy Health Information Line, had these thoughts:

“I agree with the authors’ comments. Caution is warranted, treatment makes sense when benefits are clear, and women with less severe illness might consider alternative approaches if they work, abrupt discontinuation without doctor’s advice is not a good idea, and care needs to be taken to address the issue of complications for mother and baby of untreated or poorly treated maternal depression. If a woman has questions, she should consult her doctor. She can also call the Organization of Teratology Information Specialists (OTIS) at 866-626-6847 to speak to an expert in this field.” (Personal email communication, 11/2/12)

 

Lucy Puryear, MD, immediate past president of Postpartum Support International (PSI) and Medical Director of The Women’s Place: Center for Reproductive Psychiatry offered:

“For women with mild to moderate depression psychotherapy and alternative treatments are absolutely the first choice. But for women with moderate to severe depression that is impairing functioning, antidepressants must be an option. Antidepressants do work in this population and save lives. Our challenge is to continue to look for the safest and most effective treatments for women during this vulnerable period.” (Personal email communication, 11/2/12)

 

PSI’s Executive Director Wendy N. Davis, PhD, agreed,

“We are most concerned that women will be unduly frightened by articles that discuss risks of antidepressants but do not discuss positive experiences or research studies that show little statistical relationship between SSRI use and pregnancy outcome. We want to connect women with reliable resources and experts in perinatal psychiatry so they can make thoughtful decisions about treatment options for depression and anxiety during pregnancy.”

 

A word about the science….

One of the pre-eminent researchers in the field, Adrienne Einarson of The Motherisk Program, shared some important criticisms of this study:

Here are my main problems with this publication:

1) It is said to be a review on treatment for infertility patients, however, one-third of the paper is about the lack of efficacy of antidepressants in general.
2) To say there is no evidence for effectiveness in pregnancy is true, but that is simply because there are no RCTs (randomized control studies), not because this has been proven.
3) All of the studies that were picked were ones that found negative effects, with no mention of how marginal the statistical significance really was.
4) The paragraph that is the most concerning is the one starting with “There is compelling evidence that SSRI use prior to and during pregnancy can pose significant risks to the pregnancy and to the short- and long-term health of the baby…” Of course there is compelling evidence when you choose your studies to fit your hypothesis.

This was a biased review, not a systematic one as reviews should be. In fact, there was not a single study referenced in this paper that did not find any harmful effects when there are many that have been published. (Personal email communication, 11/4/12)

 

When I was pregnant with my daughter, I had a sinus infection. I went to a general practitioner for treatment and shared that I was on an SSRI. You would have thought I told her I was shooting heroine every hour on the hour while tossing back jello shots and chain smoking! If I hadn’t had the science from my research treatment team at the UCLA Women’s Life Center, I could have easily been scared into stopping my medication. Instead I pulled out a collection of evidence-based research I carried in my purse and left it with her.

 

Unfortunately, for a woman who is pregnant and has depression, trying to decipher headlines and the seemingly constant stream of warnings might be overwhelming. Not to mention the stigma that accompanies depression and motherhood. Most don’t realize that to be that mom means you have to be constantly armed with proof that you are not harming your child. This is where having Adrienne Einarson’s insights can help you navigate the science, and advocate for your health and well-being.

 

Take Home Message:

If you are currently pregnant and taking an SSRI, do not abruptly stop taking your medication until you talk health care provider about risks and benefits for your individual care. If you feel you may be experiencing depression or anxiety and are pregnant, you deserve help with your symptoms. Not getting help has been proven to have negative effects on a developing fetus and increases the risk of pre-term birth, lower birth weight, and postpartum depression. Discuss your symptoms with your care provider immediately. I highly recommend using the resources available at OTIS (866) 626-6847 to address your concerns and questions.

 

____________________

Walker would like to thank Alice Domar MD; Adam Urato, MD; Christina Chamber, PhD, MPH; Lucy Puryear, MD; Wendy Davis, PhD; and Adrienne Einarson for their contributions.

 

Reference

Domar, A. D., Moragianni, V. A., Ryley, D.A., & Urato, A.C. (2012). The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Human Reproduction, Vol.0(0) pp. 1–12 doi:10.1093/humrep/des383

 

Other Resources:

Department of Health and Human Services: Depression During and After Pregnancy: A Resource for Women, Their Families, & Friends

Filed Under Depression in Pregnancy, Featured Story, Health and well-being, Media, Medications During Pregnancy, Pregnancy Tagged With depression, depression in pregnancy, medication

In the News: Asthma Medication During Pregnancy

November 2, 2012 By Cara Terreri Leave a Comment

According to a new study from the Netherlands reported by Reuters Health, more than one-third of pregnant women on asthma medications stop taking them during the first few months of pregnancy. These findings are alarming because asthma, when untreated and uncontrolled, can have negative affects on a developing fetus. Last year, we provided a blog post discussing the importance of keeping asthma controlled during pregnancy:

“It is important for pregnant women to remember that they are their babies’only source of oxygen. If a mom’s asthma is not controlled, both she and her baby are getting less oxygen. Although babies do not take their first breath until they are born, in utero they receive all their oxygen from the placenta (the blood connection between mom and baby). …untreated asthma is considered to be riskier than asthma controlled with medications in pregnancy.”

Regarding the safety of asthma medication, Reuters reports:

“Both the Global Initiative for Asthma (GINA) and the U.S. National Asthma Education and Prevention Program recommend that women continue taking asthma medications throughout pregnancy, because the risks of exacerbated asthma are greater than the risks of the medication.”

Further, GINA advises “there is not much evidence showing that asthma medications are harmful to the fetus.” In the article on our blog, OTIS teratogen information specialist Nadia Mohamedi talks about the low risks from certain asthma medications:

“The majority of women can control their asthma by taking an inhaled medication like albuterol or an inhaled corticosteroid. Inhaled medications act directly on the air passageways to decrease inflammation and open them up for breath. Because inhaled medications are not meant to be absorbed and distributed throughout the body like a pill you swallow is, very little of inhaled medications are absorbed into your blood and able to go to your developing baby. Thus, inhaled medications are usually considered to be of a low risk to the baby.”

Have you/are you experiencing pregnancy with asthma? Chime in — let us know your thoughts on the study and how your experience has been.

Filed Under Featured Story, Health and well-being, In the News, Medications During Pregnancy, Pregnancy Tagged With asthma in pregnancy

Breakouts and Babies: How Acne Medications Can Affect Pregnancy

June 27, 2012 By admin 1 Comment

By Chris Colón, MS, OTIS Education Committee Member

 

As many women can tell you, pregnancy brings a lot of changes: not only in your life, but in your body. Women can experience morning sickness, swelling in the hands and feet, and (of course) weight gain. Because of the changes in hormones, women can also notice a difference in their skin, from the “pregnancy glow” to acne breakouts. Typically, women would use whatever treatment works best for them to fight acne. But in pregnancy, everything a woman does can affect her baby, so it’s important to know what medications are safe to use during this special time.  Listed below are some common medications used to treat acne and the possible effects to pregnancy:

 

Isotretinoin (Accutane, Amnesteem®, Claravis, and Sotret) is taken by mouth to treat very serious cases of acne, and is usually only prescribed when other treatments have not worked. Isotretinoin is an artificial form of Vitamin A that is only available by prescription.  Studies have shown that taking even one pill of isotretinoin during pregnancy can cause birth defects in up to 35% of exposed pregnancies. Because this is considered to be a high risk, isotretinoin must be taken under the careful supervision of a doctor.

 

Women of reproductive age that decide to take isotretinoin are enrolled by their doctor into the iPLEDGE* program, which includes counseling about the risks associated with the drug in an unintended pregnancy. Women at risk for pregnancy must use two forms of effective birth control prior to starting the drug. Pregnancy tests are also done prior to taking isotretinoin. Women who are not considered at risk for pregnancy are not required to use birth control while taking isotretinoin. These include:

 

  • Those who have stopped having periods for 12 months in a row (menopause; confirmed by a doctor)
  • Those who have had both ovaries or uterus taken out by surgery
  • Those whose ovaries do not work and cannot get pregnant (confirmed by a doctor)
  • Those who commit to not having any sexual contact with a male at any time for
    at least 1 month before, during, and 1 month after the last dose

 

If a woman gets pregnant while taking isotretinoin, she should stop taking the medicine immediately and call her doctor right away. In general, it is recommended that women of child-bearing age avoid isotretinoin and other Vitamin A-based medicines, such as Acitretin (sold as Soriatane) and high dose Vitamin A (more than 20,000 IU per day).**

 

Tretinoin (Atralin, Avita, Retin-A, Renova, Tretin-X) is acne treatment called a retinoid, and is related to Vitamin A. It is a topical medication (applied to the skin) and is available by prescription. Although tretinoin is related to Vitamin A (like isotretinoin), it is not thought to be as harmful to pregnancy. Tretinoin contains a much lower dose of the active medication, which means that when applied to the skin, the amount absorbed through the skin would be very small. One expert suggested that the amount that is absorbed is equivalent to 1/7 of the Vitamin A found in one prenatal vitamin. This means that less tretinoin makes it into the mother’s blood and to the baby. If more tretinoin is used, the risk may theoretically be increased, so it is important to use this medication as directed. Because acne is considered to be a cosmetic problem, and due to the possible risks, it is usually recommended not to use this medication during pregnancy.

 

Tetracycline, doxycycline and minocycline are antibiotics used to treat acne and other conditions. These antibiotics are available by prescription and usually taken by mouth. Studies have not found an increased risk for birth defects when these antibiotics are used in the first trimester. However, use after 16 weeks is associated with discoloring of the teeth (permanent) and may temporarily slow down the growth of small bones.

 

So how are breakouts safely treated during pregnancy? Over-the-counter medications that contain benzoyl peroxide are considered safe for pregnant women to use. Skin treatments that contain salicylic acids, azelaic acids, and glycolic acids are thought to be unlikely to cause any risk to a pregnancy, because they are absorbed in small amounts through the skin. Before taking ANY medications or treatments during pregnancy, it is important to talk to a health care provider first.

 

Even women not planning on becoming pregnant aren’t out of the woods yet – almost half (about 50%) of all pregnancies are unplanned. Women who are sexually active should consider talking to their doctor about the effects medications can have on a pregnancy (planned or unplanned).

 

Have questions about exposures before, during, or after pregnancy? Contact the Organization of Teratology Information Specialists (OTIS) at 866-626-6847 or visit our website at otispregnancy.org.

 

*For more information on the iPLEDGE Program, visit www.ipledgeprogram.com

 

**Isotretinoin (Accutane) and Pregnancy. Retrieved from http://www.otispregnancy.org/files/isotretinoin.pdf

 

Chris Colón, MS, is a genetic counselor and a member of the OTIS Education Committee. OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and breastfeeding.

 

Filed Under Featured Story, Medications During Pregnancy, Pregnancy Tagged With acne during pregnancy

Skincare Products & Mercury: Understanding Labels to Protect Your Baby

April 6, 2012 By Cara Terreri 1 Comment

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor

What do you know about the safety of the cosmetics you use on your face and body every day? I’m not talking just about foundation and lipstick, but face cream, body lotion, stretch mark cream, skin lighteners, shampoo, and conditioner? Do you read — or understand – the labels on all of the products that you buy? What about the skincare products that you get as gifts?

 

On March 6, the FDA issued a press release alerting consumers and retailers about mercury poisoning/toxicity in women and in some cases, the entire family, as a result of exposure through skin lightening creams that were sold in the U.S. but manufactured outside of the country. A search of the medical literature found reports of mercury toxicity related to creams/lotions manufactured in Mexico and China, although the FDA site reports that these products have also been sold illegally in the United States in shops found in Latino, Asian, African or Middle Eastern neighborhoods. Online shops have no borders, so the possibility of purchasing a tainted product may be higher.

 

Mercury is divided into three types – elemental, inorganic, and organic. Organic is the kind that you find polluting streams and fish (methyl mercury).

 

Inorganic mercury is the type found primarily in batteries. It’s also been reported in some disinfectants, health/homeopathic remedies, and skin and acne creams and lighteners (illegally). Inorganic mercury can be labeled as mercuric chloride, mercuric acetate, and mercuric sulfide. In the case of lotions containing inorganic mercury, not only is the user exposed, but the entire household may be at risk as the lotion is exposed to air, becomes a vapor, and members inhale or ingest it.

 

Exposure to inorganic and organic mercury is a concern for the entire family, including pregnant women. It’s important to understand, however, that each type of mercury has potential risks depending on the route of exposure and the dose. Some forms are more readily available (absorbed into the body) if inhaled and some more available in the body if ingested.

 

Mercury crosses the placenta. High levels in the mom would be expected to produce high levels in the developing embryo or fetus. High levels of exposure in pregnancy have been associated with miscarriage. Studies of high levels of methyl mercury exposure (the kind typically found in fish) have been associated with neurologic disorders in the exposed infants/children (see http://www.otispregnancy.org/files/methylmercury.pdf). Studies of methyl mercury in pregnancy or children are more common than studies of inorganic mercury related to exposure from cosmetics or imported homeopathic remedies, which leaves a gap in our awareness and ability to treat individuals who have been exposed. This also means that it is difficult to know the levels that may be more or less harmful to the developing pregnancy.

 

Symptoms of mercury toxicity in the early stages include nausea, vomiting, and diarrhea. Symptoms of high acute exposure or chronic long-term exposure include kidney problems, gastroenteritis, metallic taste in the mouth, hypotension and shock, rashes, and excessive sweating, as well as others.

 

The FDA advisory reminds us of the importance of reading labels and understanding the potential risks with using hygiene products or cosmetics products (or supplements, herbal remedies, etc.) that are foreign-made. Per the FDA:

  • Check the label of any skin lightening, anti-aging or other skin product you use. If you see the words “mercurous chloride,” “calomel,” “mercuric,” “mercurio,” or “mercury,” stop using the product immediately.
  • If there is no label or no ingredients are listed, do not use the product. Federal law requires that ingredients be listed on the label of any cosmetic or drug.
  • Don’t use products labeled in languages other than English unless English labeling is also provided.
  • If you suspect you have been using a product with mercury, stop using it immediately. Thoroughly wash your hands and any other parts of your body that have come in contact with the product. Contact your health care professional or a medical care clinic for advice.
  • If you have questions, call your health care professional or the Poison Center at 1-800-222-1222; it is open 24 hours a day.
  • Before throwing out a product that may contain mercury, seal it in a plastic bag or leak-proof container. Check with your local environmental, health or solid waste agency for disposal instructions. Some communities have special collections or other options for disposing of household hazardous waste.

Cosmetic products in the U.S.are, unfortunately, not regulated by the FDA. Furthermore, while companies are required to properly label products, the FDA does not pre-approve cosmetic product labeling either. It is illegal to sell misbranded cosmetics in the U.S., but, again, the FDA does not regulate or approve “cosmetic” products.

 

Cosmetics are commonly used during pregnancy and typically a low concern to the pregnancy due to expected low absorption into the bloodstream and therefore low exposure to the pregnancy but it can’t hurt to be cautious and take a second look at the products we are using especially in light of this recent FDA warning.

For more detailed information on cosmetics, please visit the FDA website: http://www.fda.gov/Cosmetics/default.htm

References:

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm294849.htm

http://www.epa.gov/teach/chem_summ/mercury_inorg_summary.pdf

Mercury exposure among household users and nonusers of skin-lightening creams produced in Mexico – California and Virginia, 2010.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2012 Jan 20;61(2):33-6.

Sonia Alvarado is a bilingual (Spanish/English) Teratogen Information Specialist with the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide service that aims to educate women about exposures during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/lactation via CTIS’ toll-free hotline and email service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade. In addition, Sonia contributes to the service’s website, develops training materials for new CTIS staff, and is the supervising Teratogen Information Specialist trainer. Sonia attended San Diego State University and has worked in Tuberculosis Control for San Diego County’s Public Health Department. Sonia’s work has also been published through several tuberculosis studies. In her spare time, she loves to volunteer with the March of Dimes as an expert speaker on themes related to pregnancy.

 

CTIS Pregnancy Health Information Line is part of the Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. California women with questions or concerns about pregnancy exposures can be directed to (800) 532-3749 or by visiting CTISPregnancy.org. Outside of California, please call OTIS counselors at (866) 626-OTIS (6847).

 

 

Filed Under Featured Story, Health and well-being, Medications During Pregnancy, Pregnancy Tagged With mercury, skincare products

When Green Is Not Your Color: Coping with Morning Sickness

March 17, 2012 By Cara Terreri 1 Comment

Happy St. Patrick’s day! Today is the day when people across the globe wear green and make merry. But if you’re one of the many women who experience morning sickness (about half of all do), you likely won’t feel too merry. Morning sickness varies in intensity and length. Some women will experience mild symptoms, like nausea and food aversions, for about 12 weeks, while others may endure more intense symptoms, like vomiting, sometimes lasting throughout pregnancy. While there isn’t anything you can do to cure morning sickness, there are many things you can do to help ease your discomfort and lessen the intensity of nausea.

 

Give in to cravings. Morning sickness often comes with intense cravings to eat “bad” foods, like carbohydrate rich and high fat snacks. If that’s what you crave — give in. Sometimes, those foods do help your stomach feel better temporarily. And some relief is better than none, right?

Eat bland, eat small, and eat often. If you’re not craving anything, but need to eat, try eating very bland, small meals or snacks frequently. Eating often and in small doses helps aid in better digestion and keeps from overloading your stomach, which can lead to more intense nausea.

Electrolytes. If you’re vomiting, you need to counterbalance your loss of fluids. Try small doses of electrolyte enhances fluids. Be aware, however, to check the added sugar content of some electrolyte drinks. High sugar isn’t necessary and may only add to your nausea. (Vitamin Water is sweetened naturally through fruit juice as opposed to Gatorade, which is sweetened with high fructose corn syrup.)

Consider your environment. Food isn’t the only nausea trigger. Warm, stuffy rooms, heavy perfume, and even loud noise can all add to morning sickness.

Have a night cap. If you’re taking prenatal vitamins, they could be adding to your nausea. Consider taking your vitamins before bed and never take them on an empty stomach.

Ginger aid. Ginger has long been known to help ease nausea. It can be taken in many forms — in ginger ale drinks, in pill form, in hard candies, in tea, or by eating the root directly.

Slow to rise. When you wake up in the morning, get out of bed slowly. Getting out of bed too quickly, especially when you’re pregnant can make you feel faint, dizzy, or nauseous. Also, keep some water and a few crackers on your bedside table. Putting food in your stomach before getting out of bed can help quell the nausea.

Alternative therapy. Some women swear by alternative treatment to ease morning sickness, including accupressure, accupuncture, and chiropractic care.

Medication. For women with severe and debilitating nausea, which includes frequent or constant vomiting, prescribed medication may be the answer. Talk with your care provider about your options and any risks that may be involved. If  left untreated, severe vomiting can lead to dehydration, which can cause preterm labor.

 

What did you do to deal with morning sickness?

Filed Under Featured Story, Health and well-being, Medications During Pregnancy, Morning sickness, Pregnancy Tagged With morning sickness

American Heart Month: Learn the Facts About Heart Defects

February 20, 2012 By admin 1 Comment

By Lori Wolfe, MS, Genetic Counselor & OTIS President

 

We all know that February brings us Valentine’s Day, but did you know it is also American Heart Month? This month, heart symbols are everywhere you look! Recently, a call from a friend of mine made me stop thinking about candy and red paper hearts, and start thinking about beating hearts. My friend is very excited to be experiencing her first pregnancy and I have been sharing in her joy. Last week, she called in tears to tell me that her 20 week sonogram showed that her baby has a heart defect. This news came as a shock to Melissa and her husband Mark as there is no family history of heart defects on either side of the family. As Melissa knows that I am a genetic counselor and work with pregnant women, her first question to me was, “why did this happen to our baby?” So I began to share what I know with Melissa, which I will also share here with you.

 

Heart defects in babies are more common than you may think. In fact, congenital heart defects (CHD) are the most common birth defects that occur in babies. The good news is that, these days, almost all babies born with CHD survive into adulthood, and many live a normal lifespan.

 

So back to Melissa’s question, what causes heart defects and why is her baby affected? Sometimes there is a genetic link, so it is important to know if you have a family history of heart defects. Many times, we don’t know why the baby has a heart defect.  Birth defects happen randomly in 3 to 5% of all babies born. But we do know that about 10% of all birth defects, in general, are caused by exposure during pregnancy to things called “teratogens.” Teratogens refer to any exposure during pregnancy that can harm a baby. The good news is, these kinds of exposures are often preventable, which means that the resulting birth defects are potentially preventable too.

 

So what should you be especially aware of regarding your developing baby’s heart? We do know that over 80% of all women are exposed to a medication during pregnancy and there are some medications that can increase the chance that a baby will have a heart defect. These medications include:

  • Lithium, which is used mainly to treat Bipolar Depression Disorder.
  • Isotretinoin, a form of vitamin A that is found in Accutane and is used to treat severe acne.
  • Phenobarbital, a medication mainly used to treat seizure disorders.
  • Alcohol. Drinking alcohol during pregnancy can also increase the chance that your baby will have a heart defect.

 

It is always important to receive good prenatal care and avoid alcohol and illicit drugs when you are pregnant. If you are taking a prescription medication, you do need to be sure to talk with your doctor before you stop taking medication such as Lithium or Phenobarbital. Your doctor will help you decide if the benefits to you of taking the medication for your condition outweigh the small risk for a possible birth defect like a heart defect.

 

For all of the “Melissas” out there, know that you also have a friend to lean on for answers to your questions about preventing heart defects in the field of healthcare. If you have any questions about exposures during pregnancy or while nursing your baby, please call the Organization of Teratology Information Specialists (OTIS) at (866) 626-6847 or check us out at OTISPregnancy.org.

 

**Lori Wolfe, MS, is a board-certified genetic counselor and the president of OTIS. She is also the director of OTIS’ Texas affiliate, the Texas Teratogen Information Service (TTIS), which she founded in 1991. Visit its website at http://www.ttis.unt.edu/. OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and breastfeeding.**

 

Filed Under Complications and high risk pregnancies, Featured Story, Medications During Pregnancy, Pregnancy Tagged With congenital heart defects

Pregnancy and Asthma

September 7, 2011 By admin 1 Comment

By Nadia Mohamedi, OTIS Teratogen Information Specialist

                As a teratogen information specialist at OTIS, I frequently hear the same scenario regarding pregnancy and asthma. A mom is so excited that she is being “safe” in her pregnancy because she has come off all of her asthma medications. She is almost completely out of breath, exhausted from wheezing all night, and extremely limited in the activities she can still do. Despite her own suffering, she is proud of her heroic acts in saving her developing fetus from potential harm. Unfortunately, like many other breathless moms, she has been misinformed about the effects of asthma and asthma medications in pregnancy… and the truth often leaves her feeling a lot less like a hero.

The Breadth of Breath

Everyone knows that breathing is crucial to life, but do we really understand why? Let’s re-visit the basics. Breathing delivers oxygen to our lungs, where the oxygen is transferred to our blood, brought to the heart and then pumped out to all the cells in our body.  In fact, oxygen makes up 65% of our body mass!

Oxygen is crucial to a cell’s normal metabolism. Cells use oxygen as their primary source of energy. With oxygen, cells are able to carry out all of their marvelous acts like re-building old tissue, disposing of waste, and creating new cells. Without enough oxygen, our cells become weak and are more susceptible to viruses.

Cells that rely more heavily on oxygen to survive are the cells in our brain. While the brain only makes up 2% of our body weight, it uses up 20% of our oxygen. So, oxygen is also necessary for our mental processing, like memory, movement and thought. Brain cells are so sensitive to oxygen that they begin to die after a few minutes without it.

Asthma is caused by an inflammation in the air passageways, which prevents air from being able to enter the lungs. Thus, asthma is a serious condition that causes a person to take in less oxygen than they may need.

Breathing for Two

While not as fun as eating for two, it is important for pregnant women to remember that they are their babies’ only source of oxygen. If a mom’s asthma is not controlled, both she and her baby are getting less oxygen. Although babies do not take their first breath until they are born, in utero they receive all their oxygen from the placenta (the blood connection between mom and baby).  Now that we know how crucial oxygen is to life, it’s probably clear why a fetus that develops from a single cell to a full-functioning human needs it. In fact, untreated asthma is considered to be riskier than asthma controlled with medications in pregnancy. Here is why:

  1. Mom’s risk: Untreated asthma during pregnancy increases the mother’s risk for pre-eclampsia (a group of symptoms including high blood pressure, ankle swelling and kidney problems), excessive vomiting, vaginal bleeding, and premature and complicated labor. In fact, the more severe the asthma is in pregnancy, the more likely a pregnant mom will be hospitalized during pregnancy.
  2. Baby’s risk: Untreated asthma during pregnancy increases the baby’s risk for slowed growth, preterm birth (before 37 weeks gestation), and even death.

Just Breathe…Through Your Inhaler

You are not alone. Asthma affects 8% of all pregnancies. Although one-third of women experience an improvement of asthma during pregnancy, about one-third of women get worse. Asthma can also become worse in the second or third trimesters as your belly pushes up against your diaphragm, making it harder to breathe. Thankfully, while severe asthma is associated with more severe risks, better-controlled asthma is associated with lower risks. Thus, most asthmatic pregnant women will need to take a medication to adequately control their condition.

Most asthma medications have not been shown to have harmful effects on the baby. The majority of women can control their asthma by taking an inhaled medication like albuterol or an inhaled corticosteroid. Inhaled medications act directly on the air passageways to decrease inflammation and open them up for breath. Because inhaled medications are not meant to be absorbed and distributed throughout the body like a pill you swallow is, very little of inhaled medications are absorbed into your blood and able to go to your developing baby. Thus, inhaled medications are usually considered to be of a low risk to the baby.

Information about specific medications (albuterol, prednisone/prenisolone, inhaled corticosteroids, formoterol, salmeterol and montelukast) can be found on the OTIS Fact Sheet page on our website: http://www.otispregnancy.org/otis-fact-sheets-s13037. You can always call OTIS for individual risk/benefit analysis and speak with a counselor (like me J) directly by calling toll-free 1-877-311-8972.

Super Oxygenwoman

Be a real superhero this pregnancy by delivering one of the most essential elements, oxygen, to your growing and developing baby. Although it can feel taboo to take a medication during pregnancy, if you are feeling breathless, it is likely that your baby is also not getting enough oxygen. Remember, the benefits of treating asthma during pregnancy generally outweigh the potential risks of the medication. So, talk to your doctor, stay away from irritants (like smoke, dust, pollen etc.), and take control of that breath! And when you see your big and healthy baby take his or her first real breath, you can finally let your breath be taken away!

 

Nadia Mohamedi is a teratogen information specialist and also serves as a research assistant/interviewer for OTIS studies in San Diego, CA. She holds a BA in neurobiology and a minor in psychology from Harvard College. In addition to her work with OTIS, Nadia has worked for the Alcohol and Drug Abuse Treatment Program at McLean Hospital as well as served as a teacher’s assistant at a school for children with disabilities in Lima, Peru.

OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and lactation. Questions or concerns about medications and other exposures during pregnancy or breastfeeding can be directed to OTIS counselors at (866) 626-OTIS (6847) or online at OTISPregnancy.org.

Filed Under All Recent Articles, Health and well-being, Medications During Pregnancy, Pregnancy Tagged With asthma in pregnancy, medication

Vaccines Are Not a Piece of the Autism Puzzle

July 13, 2011 By admin 7 Comments

Please Note: Lamaze does not endorse any particular practice in terms of childhood or prenatal vaccination nor does the organization specifically teach childbirth educators how they should guide expectant/new parents in this topic. Lamaze does, however, encourage parents and expectant moms to research and investigate the most current, evidence-based information on vaccines, as well as to have open discussions with care providers in order to make the best decision for you and your family.

______________________________________________________________________________

By Alfred Romeo, RN, PhD

Here at the Pregnancy Risk Line in Utah, we hear from callers who are concerned about vaccine use during pregnancy.  Some moms are so concerned that they do not want to be vaccinated.

Much of the concern by parents has come from one poorly-done research study. The study, published back in 1998 in Lancet, made false claims about the measles, mumps, and rubella (MMR) vaccine and the preservative thimerosal.  The preservative thimerosal contains a very small amount of mercury, causing some concerns. Since that time, the medical journal that published the study has publicly stated the research did not show any link between the vaccine and its preservative thimerosal and autism.

Vaccines are one of the most important medical advances in modern times. We have seen worldwide control of devastating diseases like polio and smallpox and are making progress in reducing other diseases, like chicken pox, hepatitis, pertussis, and other illnesses. Vaccines keep our children healthy and reduce disabilities that have lifelong consequences.

Even with all the evidence supporting the safety and effectiveness of vaccines, some parents are still concerned.  In response to those concerns, vaccine manufacturers have reduced or eliminated the preservative thimerosal from vaccines.  Most children’s vaccines do not have the preservative.  Some of the current influenza, or flu, vaccines contain thimerosal at low levels that are safe for pregnancy and breastfeeding (see the Vaccines and Pregnancy fact sheet link below).  Preservative-free flu vaccines are available for anyone who still may have concerns. Even with the reduction and elimination of the preservative, the rates of autism continue to increase, further showing that neither vaccines nor preservatives were the cause.

What is autism and what causes it?  Autism spectrum disorders (ASD) are a range of conditions that include developmental delays, autism, and Asperger syndrome.  Children typically have problems with communication, behaviors, and social skills.  Currently, researchers think parents may pass on genes that may lead to ASD or that may become active after being exposed to something in the environment.  Some researchers also believe the drugs thalidomide and valproic acid may increase the risk for ASD.  Some of the symptoms of ASD, including communication and behavior problems, begin to be noticed as developmental delays when a child is about 18 months to 2 years old.

There is no cure for ASD, but early detection and treatment can help improve language, behavior, and social skills.  Parents can learn about developmental milestones and ask their primary care provider (medical home) if they have any concerns.

Autism is still a puzzle, but parents can track their children’s growth, take them for regular check-ups, and read to them to give them the best start possible.

 

Alfred Romeo, RN, PhD, works at the Pregnancy Risk Line, a partnership between the Utah Department of Health and the University of Utah.  His experiences include working as a nurse in newborn intensive care units, training medical homes in improving services, and training young adults with disabilities in leadership and advocacy.

 

The Pregnancy Risk Line is an affiliate of the Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. Utah women with questions or concerns about pregnancy or breastfeeding exposures can call 1-800-822-2229.  Outside Utah, please call OTIS at 1-866-626-6847.  OTIS is conducting several studies, including vaccine studies for influenza, meningitis, and the human papillomavirus (HPV). Women who have received these vaccines during their current pregnancy can call OTIS to volunteer to participate in the studies or learn more by visiting OTISPregnancy.org.

References:

http://www.otispregnancy.org/files/vaccines.pdf

http://www.bmj.com/content/340/bmj.c655.full

http://www.cmaj.ca/cgi/reprint/182/4/E199

http://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.html

http://www.pregnancyriskline.org

 

Filed Under All Recent Articles, Health and well-being, Medications During Pregnancy, Parenting, Pregnancy Tagged With autism, vaccines

Environmental Exposure, Pregnancy and Breastfeeding: Informed Choice and Reducing Stigma

November 3, 2010 By Walker Karraa, MFA, MA, CD(DONA) 11 Comments

By Walker Karraa, MFA, MA, CD(DONA) with special contribution by Sonia Alvarado, MPH, University of California, San Diego

This past week, I had the good fortune to hear former first lady Rosalynn Carter deliver the keynote speech at the Marce/PSI conference on perinatal mental health. Mrs. Carter has devoted her life’s work to helping those most vulnerable in our society, the mentally ill.  While her work has been on the full spectrum of mental illness in our society, her experience speaks directly to those of us who have had a mental illness in the perinatal period, preconception through one year post delivery. Her message was clear: End Stigma. In her new book, “Within Our Reach: Ending the Mental Health Crisis,” Mrs. Carter explains,

                “Stigma is the most damaging factor in the life of anyone who has mental illness.”

This could not be more true for women in childbearing years. I vividly remember being 8 months  pregnant, picking up my medication from a local grocery store pharmacy where the clerk questioned me as to my knowledge of the “risks” of taking medication while pregnant. My neighbor was in line behind me. I was humiliated, and demoralized regarding my treatment.

Mrs. Carter is quick to point out that the power of stigma to keep us from gaining the information we need to be well and potentially save our lives.

We are not unaccustomed to stigma in the birth world. We have used our voices and each other to make great strides to end stigma of breastfeeding in public, and having non-medicated childbirths with doulas if we wish. And it has been reassuring, good information which has helped us fight those battles. This is where my friend Sonia comes in, and the word, “Teratology.”

Teratogen Information Specialists (TIS) play a crucial role in arming childbearing women with information regarding the risks and benefits of environmental exposures, over-the-counter medications (OTC), prescription medications, and herbal supplements.

Given the fact that higher than 80% of women take at least one dose of medication (exclusive of vitamins) during pregnancy1, we deserve the right to  utilize teratogenic services to learn of the efficacy, risks, and benefits of in pregnancy and breastfeeding.

I am delighted and grateful to have interviewed Sonia Alvarado, Teratogen Specialist, Supervisor  at the University of California San Diego, as she offers how you can easily access this information and make a truly informed choice.

_________________________________________________

Walker: What is a teratogen?

Sonia: A teratogen is an environmental agent that has been found to cause a specific pattern of birth defects after exposure during pregnancy.  The agent could be a drug (prescription, over-the-counter, illicit, etc.), illness, chemical or radiation. Although teratogens are associated with a specific pattern of birth defects, not every affected infant will necessarily have all of the features. For example, a drug may be associated with five features, and some infants will have five and others may have only two. Finally, not every embryo or fetus is affected by an exposure during pregnancy; usually, its a percentage of embryos’ or fetuses.

Walker: What is a teratogen information specialist (TIS)?

Sonia: Teratogen Information Specialists or counselors are trained to evaluate an exposure(s) using medical evidence, including published research, and using established scientific principles including teratology principles.

Walker: Are you funded by pharmaceutical companies?

Sonia: No, the California Teratogen Information Service (CTIS) is funded by the State of California, Department of Education. The funding is constant every year.

Walker: What happens when a person calls the CTIS hotline? (800) 532-3749

Sonia: Every person who calls can expect a caring and interested voice at the other end. Risk assessments are based on the scientific evidence and teratology principles. We ask details about the pregnancy, including last menstrual period, number of pregnancies, spontaneous abortions (miscarriage), terminations, and stillbirths. We ask details about the exposure, including dose, timing (dates), frequency, etc. We ask for a first name and zip code, race/ethnicity only for demographic purposes, however, no one is required to give demographic information for the service as the service can be provided anonymously. We like to do an intake that includes exposures to other agents that may be a concern, such as fever, alcohol, cigarettes, etc. We offer information on recommendations such as flu and pertussis vaccines. Finally, a summary letter of the information we provide can be mailed or emailed to the caller.

Walker: What is one of the most common calls you receive?

Sonia: The most common calls are about hair color or other cosmetic products, and pesticides. The most common prescription call is about antidepressants. Most of our contact is through the telephone, however, we do have e-mail service available through our Website, and coming soon, we’ll have live chat available as well, during program hours (Monday through Friday, 9 am to 5 pm).

Walker: Can a mom take the fact sheets from the Website to her care provider/or have them call you?

Sonia: Absolutely! We welcome calls from health providers as we know that most are too busy to look up the research related to specific exposures. Additionally, by taking the fact sheets to the doctor or nurse, we help facilitate the care the pregnant woman needs and should receive.

Walker: Can you give us an example of a caller’s story?

Sonia: This service has been the recipient of literally hundreds of thousands of calls over the years and every call is absolutely important. Some women however, have stories so compelling that they stay in our memories forever.

Such was the case of a health professional who called our service. She called because she had received an emergency medication treatment for what was thought to be an ectopic pregnancy at the emergency department of a hospital. The medication was intended to save her life and terminate the pregnancy which was located in the fallopian tube. Her voice was steady, resigned even, as she explained that the treatment had been given in error. She did not have an ectopic pregnancy. It had just been too early to see her embryo on an ultrasound. We went over her exposure and we talked about the number of birth defects that were possible as a result of the exposure. We also talked about the potential that her baby might not be affected. She opted to continue her relationship with us through our follow up program.

During the pregnancy, she discovered that her baby did have birth defects, the range of which only became apparent after she delivered. Unfortunately for her, and her baby, the defects were devastating and her baby  girl died a few months after delivery, after many medical interventions. Although this story has a tragic ending, the mother let us know on several occasions that she appreciated having the counselors on our end to talk to. She found some comfort in giving us updates on her child’s health — both during the pregnancy and after delivery. Additionally, she enrolled  in one of our studies  during the pregnancy, which allowed her experience  to be used as part of our on-going research. She recognized that her experience was not unique and most likely would happen in the future to another woman. She wanted to contribute to the knowledge that we have about medication use in pregnancy to help us counsel more precisely and to help other women in the future.

Fortunately, most of our calls do not result in our having to deliver risk-assessments involving birth defects, and instead, most of the time, we are providing reassuring information.

With reassuring, evidence-based information, we can overcome any societal myth or stigma regarding our choices in pregnancy, birth and postpartum. Visit www.ctispregnancy.org today and see what you think!

California Teratogen Information Service (CTIS) Pregnancy Health Information Line is California’s only information service that provides FREE up-to-date and evidence-based information about the possible effects of:

  • Medications (over the counter and prescription)
  • Herbal supplements (vitamins, herbal preparations)
  • Infections or diseases (i.e. pertussis, herpes)
  • Recreational substances  (i.e. alcohol, marijuana)
  • Chemicals (i.e. hair dye, paint, cleaning products, cosmetics)
  • Physical Substances (i.e. X-ray)

These may affect the baby during pregnancy or while breastfeeding. CTIS experts are available to answer questions Monday – Friday via the toll-free hotline (800) 532-3749 or online at www.ctispregnancy.org. CTIS is a non-profit funded by the Department of Education and based at the University of California, San Diego School of Medicine, Department of Pediatrics.

The national partner of CTIS is OTIS www.otispregnancy.org

  1. Headley J, Northstone K, Simmons H, Golding J, ALSPAC Study Team. Medication use during pregnancy: data from the Avon Longitudinal Study of Parents and Children. Eur J Clin Pharmacol 2004; 60:355-61.

 

Sonia Alvarado has been a bilingual (Spanish/English) Teratogen Information Specialist with the California Teratogen Information Service (CTIS) Pregnancy Health Information Line for 11 years. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/lactation via CTIS’ toll-free hotline and email service, she provides educational talks regarding pregnancy health in community clinics and high schools. In addition, Sonia contributes to the service’s website, develops training materials for new CTIS staff, and is the supervising Teratogen Information Specialist trainer. In her spare time, she loves to volunteer with the March of Dimes as an expert speaker on themes related to pregnancy.

Filed Under All Recent Articles, Breastfeeding, Health and well-being, Medications During Pregnancy, Pregnancy