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Guide for a Healthy Pregnancy

WHAT TO AVOID DURING PREGNANCY

Many women wonder what’s okay during pregnancy and what is not. Smoking cigarettes and drinking alcohol can definitely harm your baby. But the effects of other substances, such as hair dye, are uncertain. If you don’t have to expose yourself to unknown risks, it’s probably best to avoid them.

These tips will help you have a healthy pregnancy. Talk with your clinician if you have other concerns or questions.

While you’re pregnant:

Don’t smoke

Smoking endangers you and your baby. When you smoke, you inhale carbon monoxide, nicotine, and hundreds of other chemicals. Most of these chemicals cross the placenta and can get into your baby’s body. They cut down on the oxygen and nutrients your growing baby needs. The more you smoke, the greater the risk. Switching to low-tar, low-nicotine cigarettes does very little to help.

Smoking during pregnancy increases your risk of miscarriage, premature birth, abruption (when the placenta separates from the uterus), and infant death, including sudden infant death syndrome (SIDS or “crib death”) after birth. Smokers have smaller babies compared to non-smokers. These low birth weight babies are more likely to have health problems than babies of normal weight. Smoke from other household members, or co-workers, is also unhealthy during pregnancy and after birth. Babies exposed to it are more likely to get respiratory infections like colds and ear infections.

If you or your partner smokes, quit as soon as you can. Because smoking is addictive, this can be hard. Ask your clinician about “stop smoking” programs like Great Start (see below) and other ways to quit. Some important phone numbers, email addresses, and websites follow:

American Cancer Society (Website: www.cancer.org)
Phone: 1-800-ACS-2345

American Lung Association (Website: www.lungusa.org)
Email: info@lungusa.org for advice

National Cancer Institute
Call the health information line at 800-4-CANCER.

Massachusetts Department of Public Health
Check out the Tobacco Control Program at
http://www.mass.gov/dph/mtcp

The Great Start Program

The American Legacy Foundation (Legacy) launched the “Great Start” campaign as part of a national initiative to reduce smoking during pregnancy. In partnership with the American Cancer Society, Legacy will sponsor for a minimum of one year a nationwide toll-free Quitline providing cessation counseling for pregnant smokers. The toll-free number for the Quitline will be 1-800-784-8669.

Callers to the Great Start Quitline will have the opportunity to receive free confidential telephone counseling sessions with a trained counselor who will help them to manage their attempt to quit. For further information, check out the American Legacy Foundation website (www.americanlegacy.org).

Don’t Drink Alcohol

Experts aren’t sure if it’s safe to drink any alcohol during pregnancy. But they know too much alcohol can cause birth defects, learning problems, and mental retardation. It is safest to stop drinking alcohol before you try to get pregnant. If you need help stopping, talk with your clinician or call Alcoholics Anonymous (listed in the phone book).

Drinking alcohol during pregnancy can seriously harm your baby. Your bloodstream absorbs alcohol quickly and passes it on to the baby. Drinking during pregnancy can cause fetal alcohol syndrome (FAS). This is a pattern of deformities of the face, head, heart, arms, and legs. Babies with FAS often grow slowly both before and after birth. Drinking during pregnancy also makes it more likely that babies will be low birth weight and have alcohol withdrawal symptoms, delayed development, mental retardation, and learning disabilities.

These problems are most common in babies whose mothers had more than five drinks a day. The effects of light or moderate drinking during pregnancy are less certain.

Drinking alcohol during pregnancy does nothing to improve your health or your baby’s, and it can be harmful. It is safest not to drink at all during pregnancy.

Be Careful with Medicine

Talk with your clinician about any medicines you take (even those you take occasionally, like asthma medicine). Some medicines can harm your baby, whereas it is important to keep taking others for your health. This includes prescription drugs and any over-the-counter medicines you buy in a drug store or supermarket. If a medicine you use is not safe, your clinician often can suggest safer ones. Although it is important to take certain medicines, in general, avoid all medicines except acetaminophen (such as Tylenol, Patril, Paroldo), and prenatal vitamins (if prescribed) if possible.

Most medicines reach your baby through your bloodstream. Whether medicine is prescribed by your clinician or bought over-the-counter it may affect your baby. A few types of medicines have well-known harmful effects, but the effects of most are not known.

Colds or respiratory infections are the most common reasons pregnant women require medication. The following medications are considered safe during pregnancy:

If you have environmental allergies, the following medications are considered safe during pregnancy:

There may be other safe over-the-counter (OTC) medications you can use. Our section on “Coping with the Discomforts of Pregnancy” addresses a few specific first line therapies including OTC medications. Also review your symptoms with your clinician to help decide the best choice. If you have any questions about whether you can take a certain medicine, call your clinician. Tell any clinician who prescribes medicine for you that you are pregnant.

Don’t Take Illegal (Street) Drugs

If you use illegal drugs, stop before you try to get pregnant. Drugs harm you and may cause your baby to be born very sick or addicted to drugs. Even occasional use of illegal drugs can hurt. Illegal drugs like cocaine and crack reach the baby, often with tragic results:

If you use illegal drugs, you can’t be sure of what you’re getting. But some of the other drugs known to cause health problems are:

If you use illegal drugs, stop now. Talk to your clinician as soon as possible. He or she can suggest places to get help – like support groups, counseling, treatment centers and clinics, family service agencies – and make sure you get any extra medical care that you need, or call Narcotics Anonymous (listed in the phone book).

Limit Caffeine

Caffeine’s main effect is increased alertness. Within one hour of coffee consumption, caffeine usually reaches its peak level in the bloodstream and remains there for 4-6 hours. Caffeine also stimulates the release of acid in the stomach, sometimes resulting in an upset stomach. Caffeine is also a diuretic, which means it helps eliminate fluids from the body and can result in water and calcium loss. Coffee, tea, colas (and some other soft drinks), chocolate, and cocoa all have caffeine.

Most experts agree that moderation and common sense are the keys for consuming caffeinated beverages in pregnancy. We recommend that you don’t have more than 200-300 mg a day. That equals about two five-ounce cups of coffee. (The typical mug holds eight ounces or more.) Check the caffeine counter for the amount found in certain drinks. It is also important that caffeinated beverages do not replace a pregnant woman’s daily intake of water.

Tea has less caffeine than coffee. Herbal teas like peppermint or citrus can be a good substitute, though you should be careful about which teas you choose and how much you drink. Large amounts of herbal tea can cause reactions in some sensitive people. For example, chamomile, goldenrod, marigold, and yarrow can cause allergic reactions like severe diarrhea and raised blood pressure. Other teas that can cause diarrhea are senna bark, hark, aloe, buckthorn, and dock. If in doubt about any herb, ask your clinician.

Caffeine Counter – You should have less than 200-300 mg of caffeine a day.

Food Type   Caffeine (mg)

Coffee (per 5 oz. cup)

Instant

66

 

Percolated

110

 

Automatic drip

146

 

1 cup coffee ice cream

58

Bagged tea (per 5 oz. cup)

Black, brewed 5 min.

46

 

Black, brewed 1 min.

28

Loose tea (per 5 oz. cup)

Black, brewed 5 min.

40

 

Green, brewed 5 min.

35

 

Green lapan, brewed 5 min.

20

Cocoa

Instant, 2 heaping tsp.

13

 

Chocolate milk

2-7

Chocolate

Hershey chocolate bar

10

 

8 oz. hot chocolate

5

 

1 oz. dark sweet chocolate

5-35

Soft drinks (per 12 oz. can)

Coca Cola

65

 

Dr. Pepper

61

 

Mountain Dew

55

 

Pepsi Cola

43

 

Red Bull Energy Drink

67

Avoid Overheating

Fevers raise your inner (core) body temperature. Studies link long-lasting fevers in the first trimester to a higher rate of miscarriage and open spine defects like spinal bifida.

If you get a fever, drink plenty of fluids and take acetaminophen (Tylenol, Datril, Panadol) to lower your temperature. Lukewarm showers may also help. Call your clinician if your fever is 100°F or more, or lasts more than three days.

Because the effects of a high body temperature are uncertain, you should avoid electric blankets, saunas, whirlpools, hot tubs, and steam rooms. You may use a hot water bottle to soothe tired or strained muscles or ligaments. Warm baths at home are also okay.

Try Not to Have X-Rays Done

In some cases, there are medical reasons to do x-rays. With careful shielding the possible benefits outweigh the very small risks. Tell your dentist or any clinician ordering x-rays that you are pregnant and discuss possible harms and benefits with him/her. If possible, he or she can shield your abdomen. X-rays are less likely to be harmful to a baby after the first trimester.

Be Careful with Chemicals

You probably come in contact with chemicals every day at home or work. Some chemicals are known to cause birth defects, but not enough is known about many others. Anything you touch or breathe may get into your bloodstream and reach your baby. So ask someone else to handle any items that may be harmful, including the list below, or at least think carefully before you do so:

Always read labels and follow directions and warnings exactly. Wear gloves and carefully wash any skin that touches chemicals. Avoid using paint or other materials that give off fumes, or at least open windows and keep the area well ventilated to keep fumes down. If you have symptoms like a headache or nausea, stop using the item and move to a fume-free area. Before handling any chemical you are unsure of, call your clinician.

Hair Color/Perm

Hair treatments include hair coloring, hair curling (permanents), hair bleaching, and hair straightening (relaxers). The amount of exposure, the timing during pregnancy, and frequency of use may be important factors when thinking about hair treatments in pregnancy. Since many different chemicals are used and manufacturers frequently change formulations, these general guidelines are offered based upon small doses, animal data and limited data in pregnant women.

Hair color and perms are considered to be low risk. Low levels of hair treatment dyes and chemicals can be absorbed through the skin. This minimal amount is not thought to be enough to cause a problem for the baby. If one is to be more conservative, it is recommended that exposure to these chemicals be avoided in the first trimester. Your hairdresser should use the most natural products available and provide a well-ventilated area for you. Because your hair may temporarily change during pregnancy, you should know that you might not achieve the desired result.

If you are a cosmetologist or work in a hair salon you may want to consider limiting the number of chemical processing hair treatments you do per day. Working in a well-ventilated area, wearing protective gloves, taking frequent fresh air breaks, and avoiding eating or drinking in your work space are all important factors that can decrease chemical exposures.

Sun Exposure

Your skin is more sensitive because of the hormones present during pregnancy. Use at least SPF 15 sunscreen during sun exposure. Avoiding UV rays will ensure healthier skin and less chance of skin cancer, hives or worsened chloasma.

There are many different kinds of sunless tanning lotions, creams, and foams that have very good results. Many of the new varieties have minimal odor and provide immediate color. The only concern is whether the active ingredient, dihydroxyacetone (DHA), is able to penetrate the skin. Studies do not confirm that it can, but some health care providers encourage women to wait until after the first trimester, just to play it safe. DHA has been used in cosmetics since 1960 and no problems have been reported. Even if you have used sunless tanners before, try a patch of skin first. Your skin may be more sensitive and irritable during pregnancy.

Tanning beds and booths are not recommended.

Bug Spray

DEET (N,N-ethyl-m-toluamide or m-DET) is the active ingredient in many common brands of insect repellant. Most insect repellants contain 10-25% DEET in the form of a lotion, spray, or oil that is put directly onto skin or clothing. DEET is the most effective and well-studied insect repellant on the market, and is particularly effective in preventing mosquito bites and tick attachment. DEET use is therefore the most effective protection against Lyme disease, West Nile Virus, dengue fever, yellow fever, and malaria.

DEET is used by approximately 50 to100 million people a year, with very few reports of harmful side effects. There have been reports of significant effects to the central nervous system among individuals who are sensitive to DEET or have been overexposed to DEET; however, most people will not have any adverse effects when they use DEET according to manufacturer’s instructions.

Products containing higher concentrations of DEET do not provide greater protection, they only last longer. For example, a product with 6.65% DEET would give about 2 hours of protection where as a product with 20% DEET would last almost 4 hours. Concentrations of 50% or higher do not increase the length of protection.

Try to avoid situations that will expose you to mosquitoes and ticks. If it is not possible to avoid these situations, the benefits of using a DEET product outweigh the possible harm. To minimize DEET exposure, an individual should use the lowest concentration to provide protection for the time they will be outdoors. Wearing long sleeves and pants and applying DEET to the clothing rather than directly on the skin can help to minimize your exposure

Pregnancy and Pet Care

Dogs – Overall, dogs do not pose any health risks for you and your developing baby while you are pregnant. The main concern is that large dogs might jump on your abdomen while you are lying down or sitting in a chair. The likelihood of any problem is extremely low, but if your dog is heavy and is in the habit of jumping on you, it would be best to begin training him not to do that.

Cats – The transmission of an infection called toxoplasmosis is the primary concern related to cats. Transmission occurs from contact with feline feces. If a woman is immune to toxoplasmosis before pregnancy, then the baby is safe. Approximately 15% of women in the United States are immune to the infection, and the likelihood of immunity is higher for women who have owned cats for a long time. Outdoor cats are more likely to have toxoplasmosis than cats that remain strictly indoors. Exposure to a cat’s feces will most commonly occur in the garden where cats bury their bowel movements or when you change the litter box. It is best to avoid changing the litter box because even the dust can create exposure. If you must change the litter box or work in the garden, wear gloves at all times and wash your hands when done.

Exotic reptile or amphibians – Lizards, iguanas, turtles, frogs, snakes and other reptiles or amphibians make for intriguing pets, but there is a risk to you and your developing baby. Exposure to the feces of these pets, direct or indirect, can result in the transmission of the salmonella bacteria, which can adversely affect your pregnancy.

The risk of transmission of the salmonella bacterial is an important concern for children under the age of five as well. Their immune systems are still developing and exposure to reptile feces puts the child’s health at risk. Unfortunately, the safest course of action is to have a reptilian or amphibian pet removed from the house until your child reaches his fifth birthday.

If you decide to keep your pet, here are some helpful hints to create a safer environment for you and your new baby:

Pet birds – If your bird is healthy, everything should be all right for you and your baby. Birds can transmit Campylobacter, salmonella, chlamydiosis, or some protozoal infections that could be contagious to humans. A complete exam by your veterinarian can determine the health status of your bird. Some birds, like cockatoos, are rather dusty. Running filters in your house can help remove the dust and dander from the air. Take your bird to the veterinarian for a health exam; tell the vet that you are pregnant. Always wash your hands thoroughly with soap and hot water following any handling of the bird or its cage. Avoid changing the birdcage; have someone else do it.

Lead Poisoning Prevention: What Pregnant Women Need to Know

Lead is a poisonous metal that can pass from a mother to her unborn child. Very high levels of lead can increase the risk of a miscarriage or cause the baby to be born too small or too early.

Lead poisoning can cause lasting damage to children’s brains, kidneys and nervous systems. Even low levels of lead can slow children’s development and cause learning and behavioral problems.

Sources of Lead Poisoning for Pregnant Women

How to Protect Your Baby Before Birth

The Massachusetts Lead Law protects children under 6 living in a home build before 1978.
The property owner is required to pay for the testing and fixing of lead hazards.
If you rent your home, you can call your local board of health for a free lead inspection.

In Massachusetts, children are required to have their first lead test when they are between 9 and 12 months old. Children must be tested again at ages two and three. Children who live in a high-risk community for lead poisoning need to be tested again at age four. Ask your doctor if you live in one of these high-risk communities.

Childhood Lead Poisoning Prevention Program 1-800-532-9751

PREGNANCY EXPOSURE INFOLINE 1-800-322-5014

Helpful Information is a Phone Call Away

The Pregnancy Exposure InfoLine is a telephone information service which offers pregnant women, the general public and health care providers practical information about exposures to medications and drugs, chemicals, and other exposures during pregnancy.

The InfoLine is part of the National Birth Defects Center and is staffed by physicians, geneticists and health educators who have special training to address concerns about exposures during pregnancy that could be harmful to the fetus.

COMMON QUESTIONS ARE:

Can the one glass of champagne I had on New Year’s Eve affect my pregnancy?
Although it is not recommended that pregnant women drink alcoholic beverages, small amounts of alcohol, such as a glass of champagne, are usually not harmful.

Can I have my hair dyed or permed during pregnancy?
Most experts agree that hair treatments are unlikely to pose an increased risk to the fetus and therefore the decision of whether to use them can be a personal one.

I took a cold medication when I was two months along. Is that harmful?
Some over-the-counter cold medications can be taken if necessary, but check with your healthcare provider about taking any cold medication in moderate amounts to treat your individual symptoms.

Is it safe to paint the baby’s room when I am expecting?
It is generally felt that pregnant women should avoid this task. Some chemicals in paints can be hazardous and are not very well studied for use in pregnancy.

Chicken pox is going around at the school where I work. What should I do?
If you have already had the chicken pox, you cannot get it again. If you have never had chicken pox, contact the hotline or your healthcare provider for more information.

EXAMPLES OF QUESTIONS WE DO NOT ANSWER ARE:

Which medication(s) can I take during pregnancy for a cold?
We do not make recommendations about which medications to take during pregnancy. We can only inform you of the potential risks medications may pose. The final decision should be made between you and your healthcare provider.

Can you provide me with a list of all the things I should avoid as well as what I should take during my pregnancy?
Questions that deal with how best to care for yourself during pregnancy should be answered by your health care provider. We are able to address specific concern(s) regarding particular exposures during pregnancy. (ex. What fish can I eat? OR How much Vitamin A can I consume?)

The InfoLine staff is generally able to reassure callers about these kinds of questions during pregnancy. The InfoLine is open Monday through Friday, from 9:00 a.m. to 4:00 p.m. All information will be kept strictly confidential and the service is free of charge. Information is just a phone call away.

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