I assured Emily that we love it when people call ahead of their pregnancy and ask these questions. Preconception health is a topic that does not receive as much attention as it deserves, and it is important for both Emily and her husband. Good preconception health care can impact fertility and make it easier to conceive, and also helps to improve pregnancy outcomes and the health of the baby.   

Here is a preconception prep guide– because if you are ready to have a baby, you want to take steps now to keep you and your baby as healthy as possible:

• Make a pre-conception checkup appointment: Begin by making an appointment about three months in advance with your obstetrical care provider. At that appointment you can confirm you are in good health. If you have any chronic conditions such as high blood pressure, thyroid disease, depression or diabetes you and your provider can make sure the condition is being managed effectively and confirm that any prescription or over-the-counter medications you are taking can be continued in the pregnancy. If you have a question about medications during pregnancy, MotherToBaby can help by providing you with information to bring to your appointment.
• Begin taking a prenatal vitamin: If you are not already taking a vitamin with folic acid this is a great time to start. The Centers for Disease Control and Prevention (CDC) recommend that all women who can become pregnant take a vitamin containing 400 micrograms of folic acid; this helps reduce the chances for certain birth defects such as spina bifida (when the spinal cord does not form properly).
• Review your vaccine status: During your preconception checkup, make sure that you are up to date on vaccinations such as the MMR (measles, mumps, rubella), Tdap (tetanus, diphtheria, whooping cough), influenza, and COVID. Planning ahead makes it more likely you will not get ill during pregnancy and helps protect the baby from getting infections from parents after birth.
• Get your body fit for pregnancy: Get regular exercise and consider whether you and your partner are at your preferred weight. If not, make plans to remedy that prior to attempting to get pregnant. You can also learn more about a healthy diet and nutrition. This is something that may improve fertility in both parents and lay the groundwork for a healthy pregnancy.
• Eliminate harmful exposures: It goes without saying that this is a great time to make lifestyle changes such as reducing use of alcohol, tobacco, and recreational drugs.  Addressing stress and mental health concerns up front can improve fertility, make the whole pregnancy experience better, and prepare you for the excitement and hard work of parenthood.
• Evaluate your home and work environment: If you and your partner are exposed to toxic substances like lead in your work or home environment, working to reduce those exposures is very effective when done ahead of the pregnancy.

MotherToBaby has many resources for Emily and her husband – and you!  We have fact sheets on medications, herbal agents and supplements, diabetes and other health conditions, illnesses and vaccinations, occupations such as veterinarian and dental, exercise, paternal exposures, and cosmetics (sunscreen, skin creams, nail polish, hair dye). There are also useful blogs and podcasts, and whole web pages on various conditions, and if you have questions, our information specialists are here to help.

The post The Baby-Making Preconception Prep Guide appeared first on MotherToBaby.

Popular Holiday Food & Drinks

Eggnog & Other Holiday Beverages

Eggnog seems to be a part of many holiday parties. Always be sure to check if the eggnog is homemade or not. Does it contain raw eggs, which can carry bacteria such as salmonella? If the eggnog was commercially made and packaged, then usually the eggs have been pasteurized, and the product may even have been heated prior to packaging. Also, always remember to check if the eggnog contains a little “holiday cheer” (i.e., alcohol) or not. It is common to add rum to eggnog, and we want to avoid alcohol when pregnant or breastfeeding (see our Alcohol Fact Sheet for more info). Other common holiday beverages include mulled wine, wassail, hot buttered rum, and of course wine and champagne. All of these contain alcohol as well, so it is best to avoid them and just stick with mocktails and non-alcoholic punch.

Smoked Salmon & Fruit

“Smoked salmon tastes wonderful on crackers with cream cheese! But is it ok during pregnancy?” one woman texted me. Here’s what I told her. Smoked salmon is still considered raw fish as it is cured rather than cooked, so should be avoided during pregnancy due to the risk of foodborne illnesses. If the salmon has been heated to steaming, any concern for bacteria has been reduced. See our Fact Sheet on Eating Raw, Undercooked, or Cold Meats and Seafood for more info. Sometimes you will find foods that contain meats that have been dried, such as beef jerky. Although beef jerky is high in salt, there are not any other known risks to eating this tasty food during pregnancy.

“What about a fruit plate containing papaya and pineapple? Are there some worries about eating those fruits during pregnancy?” another texter wrote. Both fruits do contain enzymes that have been thought to induce labor. Papaya contains papain, while pineapple contains bromelain. Yet when eaten at normal levels (not daily!), these delicious fruits have not been shown to have any negative effect on a pregnancy. Of course, we hope the fruit has been well-washed before cutting and serving!

Eggplant Parmesan

“When the main dish is served, can we enjoy the amazing eggplant parmesan? Or what about eggplant ratatouille?” Eggplant is low in calories and high in fiber. Do avoid eating it raw, but cooked eggplant can be an occasional part of your diet. The concern is that eggplant is part of the Nightshade family and contains alkaloids in the leaves and tubers that can be toxic. But eating the fruit alone has not been shown to have any risks during pregnancy, especially when cooked.

Tiramisu

“Will rounding out our holiday meal with a delicious dessert such as tiramisu need to wait until after pregnancy and breastfeeding?” Traditional tiramisu contains two forms of alcohol, both Marsala wine and rum. Plus, liberal amounts of caffeine in the form of coffee and espresso. We have already mentioned that alcohol should be avoided if pregnant or breastfeeding, but what about the caffeine? Low to moderate levels of caffeine use (200 to 300 mg per day) has not been shown to increase any risks during pregnancy. See our Caffeine Fact Sheet for more info.

Who knew that holiday menus could need extra thought and consideration during pregnancy and breastfeeding?! Plus, with the added stress of COVID-19 this year, and the warnings to avoid large gatherings, you may have even more questions now than ever. Hopefully, this information will equip you to sit back, relax, and enjoy the festivities!

The post Navigating the Holiday Menu during Pregnancy appeared first on MotherToBaby.

Preconception health and pregnancy planning present a terrific opportunity to assess a wide range of factors that can give your baby the best start. This blog will outline the things to consider, as I relayed to Tanya:

Your Personal Health

Are you generally healthy? If you already get headaches or have acid reflux, know that pregnancy can make these more frequent. Ask your doctor if the way you treat these common conditions should change once you are pregnant. Ask about your current exercise routine and if you need to alter it during pregnancy. Get checked for sexually transmitted infections because some may not show symptoms. Also discuss your medications – some should be stopped before you start trying to conceive, such as Valproic acid, leflunomide (e.g. Arava®), teriflunomide (Aubagio®), methotrexate, and isotretinoin (e.g. Accutane®) to name just a few. For others, you’ll want to weigh the risks vs. the benefits with your health provider before you conceive. Talk with your doctors now to make a plan.

Caffeine

Do you drink caffeinated coffee, tea, or soda? What about energy drinks, protein powders, or Kombucha? MotherToBaby’s fact sheet on caffeine may put your mind at ease and encourage you to think about all your beverage options.

Body Weight

Is your weight a concern? One of the best things you can do before conception is to get to a healthy weight. Women who are overweight or obese have increased risks for miscarriage, birth defects, gestational diabetes, high blood pressure and preeclampsia, and unplanned cesarean birth. Now is a good time to meet with a nutritionist or go on a sensible diet to get to a healthy weight in anticipation of pregnancy. Once you are pregnant, continue to watch what you eat but don’t try to lose weight. Weight gain is inevitable during pregnancy but guidelines from the American College of Obstetricians and Gynecologists (or ACOG, the leading professional society for OB/GYNs) advise women to gain anywhere from 11-40 pounds, depending on your pre-pregnancy weight. It’s a myth that you need to “eat for two,” so don’t set yourself up for postpartum weight gain by eating more than you should. After delivery of an average 7-8 lb. baby, you may lose 2 lbs. in amniotic fluid, 1.5 lbs. of placenta, 5-7 lbs. in blood volume, and 2 lbs. as the uterus returns to its normal size. That could still leave you with 10 pounds of excess weight, or more if you gained more weight during the pregnancy. Some women never take off those extra pounds, and their weight creeps up with successive pregnancies and age, which can lead to pregnancy complications and chronic health problems later on. See our exercise fact sheet for more information.

Chronic Health Conditions

Do you have chronic health conditions like diabetes, high blood pressure, migraines, asthma, high cholesterol, heart conditions, varicose veins, or anemia? Do you have an autoimmune disease like Crohn’s or ulcerative colitis, lupus, rheumatoid arthritis, ankylosing spondylitis, multiple sclerosis, psoriasis or psoriatic arthritis? Meet with your obstetrician for a “preconception” appointment to discuss how a pregnancy might impact your health, and how your health might affect a future pregnancy. Your specialist can provide an important opinion too. A maternal-fetal medicine specialist (MFM) is a doctor who specializes in high-risk pregnancies, and consulting with a MFM once you are pregnant could help you learn how to optimize your and your baby’s health.

Mental Health

What about your mental health? If you have a history of anxiety or depression, ADHD or other conditions, ask your psychiatrist and OB about treatment, and don’t make changes before you do. Many medications can be continued during pregnancy and while breastfeeding. In fact, mental health is incredibly important – for example, when a woman doesn’t treat her mood disorder or inadequately treats it, some studies suggest risks for miscarriage, premature birth, low birth weight, and preeclampsia. Talk therapy is vitally important too. And if you struggle with mental health concerns during the pregnancy, you are at risk for postpartum depression. Let’s face it – pregnancy and caring for a new baby is stressful, so now is the time to marshal your helpers – friends, relatives, therapists and doctors – to ensure you have enough support. Your obstetrician should ask about mental health but if not, speak up. Your doctor can be your ally here, helping you get treatment and addressing concerns related to pregnancy and postpartum mental health. And MotherToBaby can give you an overview of the research related to any prescriptions you might choose to take.

Dental Health

Have you seen a dentist lately? Oral health can impact a pregnancy, meaning that if you have swollen or bleeding gums, a toothache or an infection, it can increase risks to the pregnancy. If you need to have a dental x-ray, take antibiotics, or have local anesthesia for a dental procedure, these are generally acceptable during pregnancy, but best to complete before you get pregnant. Contact MotherToBaby for more details.

Your Workplace

Where do you work? MotherToBaby can give you information to minimize exposures in a veterinarian office, dry cleaners, salon, laboratory/hospital, imaging center, pest control service, or other business. Your occupational safety department can recommend personal protective equipment (PPE) and tell you about ventilation that may be in place to ensure workplace safety. Safety data sheets (SDS) give an overview of chemicals used in industry and are available online or at work.

Food Safety

Read up on food safety and learn how to minimize your exposure to foods that have commonly been associated with foodborne illness such as E. coli or listeria. Get in the habit of washing your fresh fruits and vegetables well. Check out other blogs on our website too.

Vitamins and Supplements

Have you started taking a prenatal vitamin? Are you getting enough folic acid? ACOG recommends that women take at least 400 mcg of folic acid before getting pregnant and at least 600-800 mcg/day once they are pregnant. This can help prevent birth defects of the brain and spinal cord. Call MotherToBaby if you want to learn the recommended daily intake for specific vitamins or minerals. In general, taking more than what is recommended is not advisable – we haven’t studied how mega-doses of vitamins may impact a pregnancy. Other supplements beyond taking a prenatal vitamin are not advisable either – the Food & Drug Administration (FDA) doesn’t supervise their manufacturing plants and past surveys have shown some supplements actually contain contaminants. Furthermore, we’ve seen instances where the label didn’t match the contents of the bottle and could cause ill effects. Pregnant and breastfeeding women should avoid herbal supplements unless specifically recommended by your doctor.

Alcohol, Cannabis, and Tobacco

Do you smoke cigarettes? Do you use cannabis for medicinal or recreational purposes? Do you drink alcohol? Recent research has demonstrated that marijuana use very early in pregnancy causes changes in brain development, which could result in behavioral or learning challenges we see later in the child’s life. Cigarettes increase risks for pregnancy loss, among other things. And alcohol is known to cause a variety of birth defects known as fetal alcohol spectrum disorder (FASD). We don’t believe that there is a “safe” amount of alcohol which when consumed doesn’t cause issues for a developing child. Now is the time to quit smoking, drinking, and using cannabis – your baby will be heathier for it. MotherToBaby can provide resources, or check with your doctor.

Vaccinations

Are you up to date on all your vaccines? Did you get a flu shot this past season? You don’t want a vaccine-preventable illness to have an impact on your pregnancy. Flu infection can increase risks for more severe symptoms, longer-lasting illness, pregnancy loss and premature delivery, which can have a lifelong impact on your baby. Flu vaccine helps prevent infection. Another benefit to vaccinating during pregnancy? Studies show the protection extends to your baby, and gives them a little extra immunity from birth until they can receive vaccines. Also good to know: some vaccines can be given and are recommended during pregnancy, like a flu shot or TDAP, but others are best given before you conceive to avoid a small risk of spreading the illness to the fetus (e.g. the measles, mumps, and rubella (MMR) vaccine, as well as the Varicella (chicken pox) vaccine) – so try to get these done at least a month before trying to conceive. Check your medical records to see the last time you received any of these vaccinations. If you don’t know if you were previously vaccinated, your doctor can draw blood to check if you have immunity.

Your Pets

Do you have a cat? There is some concern in pregnancy about an infection called toxoplasmosis, which is caused by a parasite that can be found in cat feces. Read our blog for more info on what you can do to prevent this infection if you have a fur baby at home.

Other Illnesses

Do your upcoming travel plans involve travel to a warm tropical place? Check out our Zika fact sheet to learn more before you book nonrefundable tickets. In general, women will want to wait to try to conceive for eight weeks from the time of your return home; the wait time is three months if your male partner travels with you. COVID-19 is also spreading around the globe and our fact sheet can give you the latest information on whether and how it could affect a pregnancy.

Finally, your obstetrician or primary care doctor would be glad to see you for a Preconception consultation. Make an appointment to discuss your personal history and health. It’s a great way to get you and your baby off to the best start.

The post Planning a Healthy Pregnancy appeared first on MotherToBaby.

But first, what is kombucha? Kombucha is a sweetened green or black tea fermented with a symbiotic colony of bacteria and yeast, otherwise known as a SCOBY. Symbiotic means that the bacteria and yeast work together in balance. If you’ve never seen a scoby, let me give you a visual: a pale, rubbery, gelatinous disk vaguely resembling some sort of extraterrestrial organ. Not something most people would find appetizing from the get-go! But once the scoby is added to sweetened tea and left to ferment for a period of weeks, the result is a tangy, bubbly beverage that is slightly alcoholic, which brings me to the first consideration I discussed with Carly about drinking kombucha in pregnancy.

Kombucha and Pregnancy

Alcohol

Kombucha contains alcohol as a natural by-product of the fermentation process. In the United States, beverages containing 0.5% or more alcohol by volume (ABV) are required to have a label that includes a health warning for pregnant women. Varieties with lower alcohol content (less than 0.5 % ABV) are not required to have the label. Nevertheless, the non-labeled varieties still contain alcohol. For non-pregnant women, these small amounts of alcohol do not have a known risk; but in pregnancy, the advice of major medical organizations is to avoid alcohol altogether. Especially since the alcohol content of kombucha is not always clear-cut.

Most of the time, the manufacturing process can stabilize kombucha after it is bottled. However, kombucha has been pulled from shelves in the past after it was discovered that fermentation in the bottle did not stop, increasing the alcohol content above the amount that would require the pregnancy-warning label. And determining the alcohol content of homebrewed kombucha is difficult. Homebrews can reach as high as 3% or more depending on the type of yeast used in the scoby, how long and at what temperature the tea ferments, and other factors.

The best way to avoid unnecessary alcohol exposure in pregnancy is to not drink kombucha for those 9 months. And what about during breastfeeding? If you do enjoy an “alcohol-free” kombucha from time to time, the small amount of alcohol it might contain is unlikely to have a negative effect on your infant. Yet waiting a couple of hours after drinking the kombucha before nursing again will allow time for your body to metabolize the alcohol from your blood and breast milk.

Bacteria

Another concern about drinking kombucha in pregnancy is the possibility of bacterial contamination. Using proper sterile techniques can reduce harmful bacteria in the product, but the best way to eliminate any bacteria that might grow during the long fermentation process is to pasteurize the beverage with a quick heat treatment before bottling. Kombucha purists may argue that pasteurization destroys the probiotics responsible for the health benefits that kombucha may provide. However, unpasteurized products are not recommended in pregnancy due to an increased chance of foodborne bacteria such as listeria and salmonella, which can cause pregnancy complications. Unpasteurized products to avoid include certain milk and dairy products, and yes, fermented foods and beverages such as kombucha.

Homemade fermented foods carry an even greater risk of growing foodborne bacteria since the sterilization methods used at commercial facilities are not available in one’s own kitchen. So when it comes to fermented products in pregnancy, store-bought selections that are pasteurized are the safest way to go. This means avoiding “raw” or unpasteurized kombucha, as well as homebrewed varieties.

Caffeine

A final consideration I discussed with Carly was caffeine. The general recommendation in pregnancy is to limit caffeine to about 200 milligrams (mg) per day. The caffeine content of kombucha can vary based on the type of tea used to brew it, and may fall somewhere in the 15-130 mg range. When calculating how much caffeine you’re taking in, consider all potential sources including coffee, tea, soft drinks, and chocolate. The MotherToBaby fact sheet on caffeine lists the amounts found in some common products, and can be helpful for tallying up your daily intake (be sure to also check your product labels). For example, if you already drink a cup or two of regular coffee in the morning, a bottle of kombucha might put you over the recommended amount of caffeine for the day.

If breastfeeding, keep in mind that caffeine passes into the breast milk and can cause some babies to be irritable or have trouble sleeping. While you might not need to avoid caffeine altogether while breastfeeding, limiting the amount you take in can up the chances of a good night’s sleep for both you and baby.

In the end, Carly decided that foregoing her beloved brew for the duration of her future pregnancy would be in the best interest of her developing baby. In the meantime, she’ll opt instead for water to stay well-hydrated, and for carbonated fruit spritzers and juices when she gets a craving for the uplifting fizz that kombucha provides. Cheers to that, Carly!

The post Kombucha and Pregnancy: Answers to Your Brewing Questions appeared first on MotherToBaby.

From gender reveal parties to pregnancy photoshoots and prenatal massage, pregnancies are being celebrated in new and sometimes extravagant ways. The travel trend of “babymoons” continues to grow in popularity and most go off without a hitch. Unfortunately, as a maternal-fetal medicine physician in Hawaii, I’ve seen my fair share of trips that do not go according to plan. If pregnant, consult your doctor or midwife, especially when flying or traveling far from home. Also keep these tips in mind if you are a considering a babymoon.

Women with high-risk pregnancy issues should consult their local maternal-fetal medicine physician to discuss any medical and obstetrical issues before putting a deposit down for babymoon. And what do you do if you end up being grounded? Save the money for a really fabulous push present!

Men-Jean Lee, MD, is a maternal-fetal medicine physician and associate professor at the John A. Burns School of Medicine at the University of Hawaii at Manoa practicing at the Kapiolani Medical Center for Women and Children. She is a member of MotherToBaby’s sister society, the Society for Maternal-Fetal Medicine, the only national, professional organization specifically devoted to reducing high-risk pregnancy complications. Dr. Lee’s research interests include maternal stress during pregnancy, diabetes, immigrant healthcare, and placental biology.

1. Bring Your Medications…And Use Them
   Do you need medications that you can only get in the U.S.? Certain life-saving medications cannot be obtained in other parts of the world. Or maybe you are supposed to be checking your blood sugars if you are pregnant and have diabetes? Just because you are on holiday, doesn’t mean you can let yourself go! Stick to your carb-controlled diet and your insulin, so that you don’t end up in a hospital where there is not a medical intensive care unit.
2. Is Your Pregnancy “High Risk”?
   Are you pregnant with twins or triplets? Did you deliver any of your older children earlier than 37 weeks? If so, you are at increased risk of preterm birth. Be aware that if you go into preterm labor on the beaches of Hawaii, you might get stranded and hospitalized in paradise until the babies are born! And if they are born “premie” or prior to 36 weeks, you might need to book a hotel to stay there until the babies are big enough to fly home.
3. Don’t Fly After 36 weeks…and for Some women, Don’t Fly at All
   Are you at the end of your pregnancy? Experts recommend that most pregnant women stop flying once they’ve reached 36 weeks gestation. Air travel is not recommended at any time during pregnancy for women who have medical or obstetric conditions that may be exacerbated by a flight or that could require emergency care (e.g. a history of DVT [blood clot in a vein] or a pulmonary embolus [blood clot in the lung], stroke, heart attack, uterine cramping, leakage of fluid from the vagina, shortened cervix, or vaginal bleeding). If you have one of these conditions or if your doctor told you it’s not safe, stay close to your OB care provider and the hospital where you plan to deliver.
4. Be Mindful of Zika “Hot Spots”
   The Zika virus poses serious threats to your developing baby (for more info, see MotherToBaby’s Zika Virus Fact Sheet). If your idea of the perfect babymoon is a tropical getaway, check to see if your destination has Zika-bearing mosquitoes. Parts of Mexico, South America, and most Caribbean islands are still on the Zika watch list. Unless you and your partner are committed to trading in your sunscreen for insect repellant or staying indoors with the windows closed, you might want to book a trip to picturesque Prince Edward Island!
5. Skip the Glass of Wine
   While in vacation mode, you may be tempted to indulge in a glass of wine, a beer, or a margarita, but don’t do it. There is no known safe level of alcohol consumption during pregnancy. Prenatal exposure to alcohol is the leading preventable cause of birth defects and developmental disabilities. Check out MotherToBaby’s Alcohol Fact Sheet for more info.

Women with high-risk pregnancy issues should consult their local maternal-fetal medicine physician to discuss any medical and obstetrical issues before putting a deposit down for babymoon. And what do you do if you end up being grounded? Save the money for a really fabulous push present!

Men-Jean Lee, MD, is a maternal-fetal medicine physician and associate professor at the John A. Burns School of Medicine at the University of Hawaii at Manoa practicing at the Kapiolani Medical Center for Women and Children. She is a member of MotherToBaby’s sister society, the Society for Maternal-Fetal Medicine, the only national, professional organization specifically devoted to reducing high-risk pregnancy complications. Dr. Lee’s research interests include maternal stress during pregnancy, diabetes, immigrant healthcare, and placental biology.

The post Guest Blog: Trouble in Paradise appeared first on MotherToBaby.

“Sometimes I forget I am adopted,” exclaims my sweet son as he grabs his backpack to head off to school. I had just let him know that his birthday this year falls on November 19th, National Adoption Day. “So cool! We will need to do something special this year on my birthday, to celebrate both my birthday and my adoption! See ya, mom!” To Shaun, adoption is as easy as one, two, three, and just a part of everyday life. As anyone who’s been through adoption knows, this is simply not the case much of the time. While adoption helped us complete our family, the process can be exciting, thrilling and scary all at the same time! When another woman is carrying the baby that will become your child, you worry. Was she drinking alcohol? Taking a pain killer? What if she was using illegal drugs?! It can literally lead to countless anxious days and sleepless nights. I understand these concerns as I shared the same worries.

November is National Adoption Month. What a perfect time to reflect on my own journey while preparing for Shaun’s 14th birthday on, so it turns out, National Adoption Day – November 19th. That time in my life was so powerful, but it was easier for me as I was part of MotherToBaby and knew where to find the answers to my questions.

My adoption journey has helped shape who I am today – a genetic counselor and a teratogen information expert who specializes in understanding exposures that can cause birth defects. The non-profit I work for provides this crucial service all across North America and I’m proud that my journey has brought me into a position to ease the minds of other prospective parents starting down the wonderful path of adoption. It reminds me of Austin and Drew, a prospective adoptive couple whom I recently helped in their adoption journey, “My partner and I did a lot of research as we started exploring adoption. After we started working with an agency, there were lots of questions about prenatal exposures, birth parent medical histories, etc. A lot of the information we found on these topics seemed to be contradictory and some of it was downright scary.” My job allows me to be on the other end of the line talking to this couple, and others like them, helping fill out intake forms and providing evidence-based answers to some of their questions. “Luckily for us, our adoption agency suggested we reach out to Lori. After our conversation we felt much more at ease and we felt like we had the information we needed to make informed decisions.”

My own journey has come full circle, utilizing my training to help those going through what I went through nearly 14 years ago. MotherToBaby specialists are here to help you too! As Rory Hall, Executive Director of Adoption Advocates, states, “couples approach the adoption process with so many myths about prenatal exposures and health concerns that might affect a baby. MotherToBaby experts help them approach adoption with relevant, scientific backed information so they can make informed decisions about the children they are hoping to adopt.”

Just before Shaun shuts the door to catch a ride to school, he pauses. A child wise beyond his years, he turns and says, “Mom, adoption is so good because your birth parents gave you up so you could have a better life. Love you!” And just like that, the anxiety, and struggle during the adoption process go back to their place of being a very distant memory. #WorthIt.

More about National Adoption Day
National Adoption Day has been celebrated across the United States for over twenty years, helping to raise the awareness of the many children who are in foster care waiting for permanent families. For more information, see www.childwelfare.gov. And when you are going through your adoption journey, and have questions about exposures during pregnancy, contact an expert at MotherToBaby. You can reach us by phone at 866-626-6847 or by text at 855-999-3525.

Lori Wolfe is a board certified Genetic Counselor and the Director of MotherToBaby’s North Texas affiliate. MotherToBaby aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free number and by email, Wolfe also teaches at the University of North Texas, provides educational talks regarding pregnancy health in community clinics and high schools, and counsels adoptive parents.

MotherToBaby is a service of OTIS, a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about viruses, alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets, email an expert or chat live.

The post Adoption: Sharing the Journey appeared first on MotherToBaby.

Have you ever had a pregnant friend tell you, “it is OK to have just one glass of wine now and then, that’s what my doctor said,” or “my mother drank beer when she was pregnant with me, and I turned out fine.” As a Teratogen Counselor (a birth defects expert), I hear these statements more than you would imagine. You may think it is common knowledge that there is no safe level of alcohol use during pregnancy, and that any use of alcohol while pregnant has the potential to harm the baby. Yet that message is not getting out there to everyone. Studies have long shown that heavy use of alcohol during pregnancy can cause Fetal Alcohol Syndrome, while more recent studies suggest that moderate use (and possibly even light use) can cause long term developmental problems in an exposed child. In fact, Fetal Alcohol Spectrum Disorder is thought to be the leading cause of developmental delays in children. Despite this, studies also show that 1 in 10 to 1 in 13 women continue light drinking of alcohol, even after they know they are pregnant. So I started thinking… Why do some woman continue to drink alcohol during pregnancy?

1. You Didn’t Know You Were Pregnant
Most women find out they’re pregnant when they are 4-6 weeks along – and many may not recognize the signs of pregnancy for quite a few months. So unless you are planning your pregnancy (50% of all pregnancies today are unplanned!), you may indulge in alcoholic beverages before you even know you are pregnant. Thankfully, the majority of women will stop using alcohol once they find out they are pregnant. But unfortunately, the damage could already be done. Harmful exposures (like alcohol) during those first critical weeks of pregnancy have the greatest risk of causing major birth defects. This is why experts at the Centers for Disease Control and Prevention (CDC) recommend that women avoid alcohol not only if they are pregnant or trying to become pregnant, but also if they are sexually active and not using an effective method of birth control.

2. Mixed Messages
It’s not uncommon for pregnant women to receive mixed messages from people they trust about how safe alcohol may be in pregnancy. Even her own doctor may tell her that an occasional glass of alcohol won’t harm her baby. There’s a lot of misinformation out there, even among healthcare providers! It’s important for you and your healthcare provider to keep in mind that the experts at the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics (among many others) advise that women avoid alcohol entirely while pregnant, because no amount of alcohol – even light-to-moderate amounts – can be considered safe for a developing baby.

3. It’s A Social Thing
Social pressure from family or friends can be strong. If a woman is used to going out on weekends with her friends and everyone has a glass of wine, she may feel that she needs to drink too, just to fit in. Plus many women feel that the risk of having just a little alcohol during pregnancy is low. These same woman may be doing everything else that they can to remove all other risks to their pregnancy, but they still continue to use alcohol. At MotherToBaby, we understand that the use of alcohol during pregnancy may have perceived benefits to a woman. But we also know that alcohol provides ZERO benefit for a developing baby, and, in fact, can only harm the baby. And because the exact amount of alcohol that could harm a baby is unknown at this point (and does vary woman-to-woman and even pregnancy-to-pregnancy), our philosophy is: WHY TAKE THE RISK?

4. It Helps Me Relax, De-Stress, and Just Deal with Everyday Life
Recently a 35 year old caller told me that she continued to enjoy a half glass of wine every weekend as a treat to herself. “Susan” (not her real name) knew that she was not supposed to drink alcohol, and she even said she got a lot of negative feedback from family and friends, yet she continued to drink throughout her pregnancy. Without realizing it, Susan and other women may be using alcohol to help deal with other unrecognized issues in their lives, such as depression and anxiety, high levels of stress, or little outside support for the pregnancy. At MotherToBaby, it is our job to help women understand how fragile and vulnerable a pregnancy can be to certain exposures; alcohol is one of the dangerous ones. While it may seem a hardship to give up alcohol entirely while pregnant, think about it this way: Pregnancy is only 9 months long (less if you base it on when a woman learns she is pregnant). If a woman is strong enough to survive childbirth, courageous enough to take on the toughest job on earth (parenthood), and resilient enough to survive that job, then abstaining from alcohol for the duration of a pregnancy is nothing. And if it means giving your baby a chance at the best possible start in life, then not drinking alcohol while pregnant is everything.

What Do We Know? There is not a known safe level of alcohol use during pregnancy.
We have known about Fetal Alcohol Syndrome for over 40 years now. Dr. Kenneth Jones, the doctor who first named Fetal Alcohol Syndrome in 1973 states: “When talking about the prenatal effects of alcohol, we usually think exclusively about the dose, the strength, and the timing of alcohol exposure. However, perhaps even more important are factors involving the mother – her genetic background and nutritional status to name just two. Without knowing those genetic and nutritional factors that are critically involved with the way a woman metabolizes alcohol, it is not possible to make any generalizations about a “safe” amount of alcohol during pregnancy.” Studies have shown moderate use, and possibly even light use, of alcohol during pregnancy can cause long term developmental problems in the exposed children. In fact, Fetal Alcohol Spectrum Disorder is thought to be the leading cause of developmental delays in children. Scientists are continuing to study how and why alcohol affects the developing baby, and in future years we will know more about this. But for now we do know there are always risks with drinking alcohol during pregnancy.

Lori Wolfe is a board certified Genetic Counselor and the Director of MotherToBaby’s North Texas affiliate. MotherToBaby aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free number and by email, Wolfe also teaches at the University of North Texas, provides educational talks regarding pregnancy health in community clinics and high schools, and counsels adoptive parents.

MotherToBaby is a service of OTIS, a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about viruses, alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets, email an expert or chat live.

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During pregnancy, many women make changes in their lives in order to have the best chance to have a healthy baby. I know I did during both of my pregnancies. These changes can involve their diet, exercise habits and other lifestyle factors. After birth, new moms may consider adding back some of the things they cut out over the last 9 months, including drinking alcohol. But is adding it back in that simple? During September’s Fetal Alcohol Spectrum Disorders (FASD) Awareness month, I thought I’d examine the topic of alcohol in breastmilk a little more closely for you. It’s a question I get frequently from the women who contact our service. As you probably know, for years, experts have been saying there is no known safe amount of alcohol use during pregnancy, but does alcohol affect a breastfeeding baby?

Before you raise your glass of favorite vino, here’s what research says…

Studies have shown that alcohol passes into the breast milk. The concentration of alcohol in the breast milk is close to the concentration of alcohol in the woman’s bloodstream. Alcohol can pass back and forth from the bloodstream into the breast milk. It’s a common myth that pumping and discarding breast milk will remove the alcohol from breast milk. Even if you discard pumped breast milk after drinking, alcohol still remains in your blood for a period of time, depending on how much you had to drink. The only way to get rid of alcohol from your system is to wait for your body to break it down and get rid of it. It takes about 2 to 2.5 hours for each standard drink to clear from breast milk. (A standard serving is considered to be 12 ounces of beer, 4-5 ounces of wine, or 1.5 ounces of hard liquor.) For each additional drink, a woman must wait another 2-2.5 hours per drink. Pumping and discarding, drinking water, taking caffeine, or exercising do not help your body get rid of the alcohol faster, because only time can reduce the amount of alcohol in the breast milk.

More misconceptions…

Another common misconception is that drinking during breastfeeding is recommended to help produce more breast milk. It used to be believed that beer raised levels of prolactin, a hormone in the body that plays a role in making breast milk. However, alcohol may actually reduce the amount of milk you produce. It is now known that alcohol lowers the release of another hormone called oxytocin. Lower oxytocin levels can affect the amount of milk that is released from the breast, meaning a baby may get less milk.

Alcohol’s known effect on baby

Many people wonder if alcohol affects a growing baby. Effects on infants from alcohol in breast milk are not well studied. There are some reports that babies whose mothers drink alcohol while breastfeeding may eat less and/or experience changes in their sleeping patterns. One study suggested problems with motor development following exposure to alcohol in breast milk, but other studies did not show the same results. There are many factors that can play a role in how alcohol can possibly affect a developing baby. Differences in genetics and metabolism of alcohol by both the mother and the baby may result in a wide range of risk. The risk may be different even in different babies from the same mother. At this time, it’s not clear how alcohol in breast milk can affect a developing baby.

Depending on the amount of alcohol you drink and the frequency with which you drink, you may not need to stop breastfeeding if you drink alcohol. You can speak with your health care provider as well as the baby’s pediatrician about how much alcohol you are drinking as well as all your choices for breastfeeding. You can also contact a MotherToBaby counselor at (866) 626-6847 to talk about alcohol and other exposures during breastfeeding.

Chris Colón is a certified genetic counselor based in Tucson, Arizona and proud mother of two. She currently works for The University of Arizona as a Teratogen Information Specialist at MotherToBaby Arizona, formerly known as the Arizona Pregnancy Riskline. Her counseling experience includes prenatal and cardiac genetics, and she has served as MotherToBaby’s Education Committee Co-chair since 2012.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847. You can also visit MotherToBaby.org to browse a library of fact sheets.

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Spring break 2014, which, for some, actually fell at the end of winter this year, is in full swing. Many students are back to school working diligently toward their degree. For some students, Spring break means a trip back home, a trip abroad for cultural education and for others, it’s a time to let loose on a warm beach, usually with one (or many) alcoholic beverages. Take the case of a young woman who went on holiday to the Caribbean after a particularly stressful semester at college. After returning to school and missing her period, she called the MotherToBaby service. She was frantic after recalling the amount of alcohol she had consumed during her seven days in the sun.

Social conventions that used to keep women from drinking alcohol publicly (or excessively) have changed drastically in the last two decades. Increased disposable income also enabled women to purchase their own alcohol instead of relying on men. Marketing, media and other societal influences have encouraged women to drink alcohol. These various factors have contributed to a higher number of women drinking alcohol during college, binge drinking during college and risking alcoholism. According to the Centers for Disease Control (CDC), the issue of women and alcohol drinking is an under-recognized problem. The CDC reports that approximately 24% of women 18-24 and 20% of women 25 to 34 report binge drinking. Binge drinking is classified as four or more drinks in one occasion. Studies suggest that college-age women may be binge-drinking in higher numbers than men. This may be due in part to the fact that many women do not know that the recommendations for alcohol drinking for men are different – and higher – than for women. These issues are very concerning because most pregnancies are unplanned and binge drinking is a threat to the healthy development of a pregnancy.

Fortunately, in the now worried “Spring Breaker” we spoke with, our counselor was able to reassure her after identifying her exposure as having occurred very early in pregnancy, prior to placental communication being established. However, the amount of exposure she had reported, four or more drinks daily, may have been a risk had it occurred later in the first trimester.

The U.S. Department of Health and Human Services recommendation for alcohol use by non-pregnant women is one drink per day (maximum of seven per week). Men have a recommendation of maximum two drinks per day. The reason that women have a lower dose recommendation is that women are more sensitive to the effects of alcohol. Specifically, the average woman that takes two drinks will have more alcohol in her system compared to a man drinking the same amount. This is due to a size difference, genes, and maybe, hormones too. Women are generally smaller than men and that means having less blood. Having less blood means less water. A woman’s body is made up of about 52% water and a man’s about 61%. Water dilutes alcohol, both in a glass and in the body. More dilution means less impact. Also, women have more fat and unfortunately, alcohol in fat can’t be metabolized as quickly and it ends up concentrating in blood.

There is an important enzyme(s) called alcohol dehydrogenase that breaks down alcohol. These enzymes are primarily stored in the liver and the stomach. These enzymes are found in greater abundance in men than women. The lower number of enzymes means that more alcohol gets into the blood and stays there longer.

Hormones may also play an important role in breaking down alcohol. Studies suggest that the premenstrual phase slows down alcohol and results in higher blood alcohol levels. There is some evidence that birth control pills that contain estrogen also slow the breakdown of alcohol.

So what does this all mean? Should Spring break mean all work and no play? Not necessarily. However, part of feeling empowered and making responsible decisions is learning the facts about how alcohol can affect us all differently. During April’s Alcohol Awareness Month, I encourage everyone to take a moment to think about those differences – It could make the difference in your future baby’s life.

Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about alcohol, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.

References:
http://www.cdc.gov/vitalsigns/bingedrinkingfemale/infographic.html

http://pubs.niaaa.nih.gov/publications/brochurewomen/women.htm

Jones, MK,,& Jones BM. (1984). Ethanol metabolism in women taking oral contraceptives. Alcohol Clin Exp Res, Jan-Feb;8(1):24-8

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