Years later, as a teratogen information specialist for MotherToBaby, I realized some of the best gifts for a healthy pregnancy didn’t come with ribbons and bows, but from awareness and education! For example, did you know the holiday buffet table could include foods that could potentially cause harm to a developing baby? Or, if not careful, decorating could put a pregnant person in a dangerous situation? Today I encourage pregnant people to master must-know safety tips long before putting together must-have gift lists this season. Here are a few of my tips:

Tip 1. Importance of Getting Vaccinated

It is recommended that pregnant people have a flu vaccine in every pregnancy and be current on Tdap vaccine and Covid 19 vaccines.  People who are 32-36 weeks pregnant are currently eligible for the RSV vaccine https://mothertobaby.org/fact-sheets/rsv-vaccine/. This vaccine can pass protection to the developing baby, helping lower the chance of severe RSV infection once the baby is born.  

Not only should a pregnant person be up-to-date on vaccines, but  anyone older than 6 months of age who will be around a newborn should be vaccinated.

Tip 2. Choose Wisely at the Buffet Table

Drinks like eggnog and spiced cider may contain alcohol https://mothertobaby.org/fact-sheets/alcohol-pregnancy. If you’re not sure what’s s in a beverage, ask the host. Also, avoid soft cheeses made from unpasteurized milk, as they may contain bacteria that can cause a serious illness for a developing baby called Listeria https://mothertobaby.org/fact-sheets/listeriosis-pregnancy, as well as increased risk of miscarriage, uterine infection, or premature labor. Meats like cocktail franks and pâté can also contain bacteria. Meats need to be thoroughly cooked so that bacteria are killed.

Tip 3. CMV (cytomegalovirus) May Be Lurking

CMV is a common virus that often has no symptoms. If a pregnant person gets CMV https://mothertobaby.org/fact-sheets/cytomegalovirus-cmv-pregnancy, the baby could be at increased risk for hearing loss, developmental delays, or birth defects. To prevent infection, pregnant people should wash hands after changing diapers, feeding children, wiping children’s noses, or handling children’s toys. Also, avoid sharing food, eating utensils, toothbrushes, and pacifiers with children.

Tip 4. Holiday Decoration Safety

Some artificial trees, strings of lights, and ornaments may contain lead. Use gloves or wash hands after handling decorations to reduce exposure. Because of changes in their center of gravity, pregnant people should stay off ladders and let others decorate the hard-to-reach places.

Tip 5. Manage Anxiety and Depression

Having a ‘happy holiday’ can mean lots of stress, especially when pregnant.  Anxiety https://mothertobaby.org/fact-sheets/anxiety-fact to have that perfect holiday is real. Depression https://mothertobaby.org/fact-sheets/depression-pregnancy can be triggered this time of year as well.  Don’t hesitate to ask for help if you are feeling overwhelmed with all the gift giving and holiday activities.  Stay in-touch with your healthcare providers because…. help is available!

I hope these tips are helpful. While my son did end up turning out to be just fine, I think I would have caused myself less stress and worry had I known these tips during my pregnancy. If you have questions, don’t hesitate to reach out to MotherToBaby by phone, text, chat or email.

On behalf of all of us at MotherToBaby, here’s to wishing you a happy and healthy holiday!

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Wash Your Cares Away

A simple over-the-counter (OTC) saline nose spray can rinse pollen, dust, and other allergy triggers from your nose. This option is not expected to result in an exposure for the pregnancy or to increase pregnancy risks.

Sleep, Magical Sleep

To help you sleep better, consider using OTC nasal strips to open your nasal passages at night. Use a pillow cover to reduce dust and other allergens. Also try sleeping with your head slightly elevated to help drain the sinuses and reduce inflammation.

Still Suffering?

It may be worth having a conversation with your healthcare provider about the pros and cons of various allergy medications. Before grabbing an over-the-counter medication to treat your symptoms, consider this:

• With any medication, take the time to read your labels. Some allergy medications marketed for cough and cold contain alcohol, which should be avoided during pregnancy. Also, multi-symptom formulas might contain additional medications that you don’t need. As with any medication in pregnancy, use allergy medications for the shortest amount of time needed, and follow dosing instructions carefully.
• Antihistamines: Older antihistamines like diphenhydramine (sold under the name Benadryl^® and other brands) and chlorpheniramine can make you sleepy, so they aren’t ideal for daytime use. Newer antihistamines, such as cetirizine (Zyrtec^®), fexofenadine (Allegra®), and loratadine (Claritin^®), are less likely to make you drowsy and have not been shown to increase the chance of birth defects or other pregnancy complications when used as directed.
• Eye drops: Allergy eye drops may contain antihistamines, steroid medications, or other active ingredients. Eye drops result in lower exposure for the pregnancy than oral (swallowed) medications do. However, some eye drops have been better studied for use in pregnancy than others have. Check with your healthcare provider or contact a MotherToBaby specialist for questions about your specific eye drop.
• Steroid nasal sprays: OTC options include budesonide, fluticasone, and triamcinolone (you can find the active ingredients listed on the label). Some older studies suggested that using oral steroid medications might increase the chance of cleft lip or palate and affect the baby’s growth, but newer studies don’t find this to be true. In addition, nasal sprays are not well absorbed into the bloodstream when used as recommended, so there is less exposure for the pregnancy. Compared to some other nasal spray ingredients, fluticasone might be absorbed in greater amounts, but these still would not reach the amounts seen with oral medications. No increased pregnancy risks have been seen specifically with OTC steroid nasal sprays.
• Decongestants: The overall research does not suggest that using decongestants for a short time would increase pregnancy risks. However, decongestants work by temporarily making the blood vessels narrower. There are concerns that this could limit the supply of oxygen to the placenta and the developing baby. Some healthcare providers recommend avoiding decongestants in the first trimester, and using them with caution any time in pregnancy. Short term use (3 days or less) of nasal spray decongestants results in less exposure for the pregnancy than oral decongestants do.
• Allergy shots: Most reactions to allergy shots (redness, swelling, itching) are not dangerous. If someone is already receiving allergy shots before they get pregnant, there is no general recommendation to stop during the pregnancy. However, there is a small chance that a person could have a life-threatening allergic reaction (anaphylaxis) if they are new to allergy shots or are building up their dose. For this reason, it is not recommended to start getting allergy shots for the first time or to increase the dose during pregnancy.

If you have questions about specific allergy medications during pregnancy, including those available by prescription, talk to your healthcare provider or contact us at MotherToBaby. Happy spring!

Select References:

Garavello W, et al. Nasal lavage in pregnant women with seasonal allergic rhinitis: A randomized study. International Archives of Allergy and Immunology 2010;151:137.

Joint Task Force on Practice Parameters for Allergy and Immunology. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020;146(4):721-767.

Seasonal Allergies. American College of Allergy, Asthma & Immunology. Available at: http://acaai.org/allergies/types/seasonal. Accessed May 15, 2023.

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It’s Friday afternoon and you have had a tickle in your throat since you woke up this morning, pressure behind your nose and in your forehead, and, a drippy nose. You are sure that you have a cold and it is not a flu or COVID-19. You have been trying to get a hold of your doctor because you want them to tell you what you can take because you are pregnant and worried about taking the wrong medication. With each hour that passes you know that it is unlikely that you will get a hold of them. Now you are worried about going into the weekend without medication.

What to do? You call MotherToBaby and you talk to a specialist about your concerns. We specialists hear the worry in your voice when you call us and it comes through in the chats and texts that you send us. Ideally, your doctor’s office would have given you a list of medications, ahead of time, that they approve for pregnant patients to take for common medical issues like colds, diarrhea, constipation, and others. However, pregnant people are reaching out to MotherToBaby specialists because this is not happening often enough.

What is a cold? A cold is caused by one of more than 200 viruses that result in inflammation of the membranes in your throat and nose. The symptoms can range in severity and you may know people who only experience one day of the most bothersome symptoms, such as congestion, and others that suffer from a cold for several days and have a lingering cough for weeks.

Fever

In most people, colds do not produce a fever. In adults, a fever is a temperature of 100.4°F (38°C) or higher. Even if your temperature is 99°F however, you may not feel well and want to take something. The most recommended medication for the treatment of fever, headache, and body pain in pregnancy is . Studies on acetaminophen use during pregnancy have not shown a higher risk to the developing baby.

Fever that is untreated and high in pregnancy is a risk for birth defects. A temperature of 101°F, over 24 hours, has been associated with risks for neural tube closure defects and others. You can read more about it here.

Is it a flu or a cold?

If you are unsure if you have the flu or a cold, check out this helpful CDC guide. If you think that you might have the flu, it is important to get into your doctor’s office because they can usually do a flu test in the office. If you have flu, the doctor can write you a prescription for antivirals. Antivirals are recommended for the treatment of flu in the general public including pregnant people. Data shows that early treatment of pregnant people with antivirals lessens the severity of the disease, and reduces hospitalization and mortality. According to CDC, antivirals should be started within 48 hours of the symptoms starting however, even if given after 48 hours, they show a benefit. Oral oseltamivir (Tamiflu) and zanamivir (Relenza) are antiviral medications that are FDA approved for the treatment of influenza (flu). We have a fact sheet on antivirals that goes over the studies and specific recommendations

Cough: medication options

Whenever a pregnant person takes a medication by mouth, the developing baby will almost certainly be exposed when that medication enters the mom’s bloodstream. It is a good idea to learn about the choices that are less likely to be a concern for the developing baby.

When you walk down the pharmacy aisle, there are rows of cough and cold products, some with many ingredients. In pregnancy, it is preferable to take a medication that has the least number of ingredients, taking only those ingredients that address the specific symptoms. In addition, because most cough syrups can contain up to 10% alcohol, it is important to select an alcohol-free syrup.

Cough lozenges and throat lozenges can have ingredients that add a sweet flavor such as honey, medications to numb (anesthetics), vitamins, and others. It is important to read the ingredient label. Menthol, honey, and other flavorings are not a known concern for pregnant people and are consumed in candy and food outside of cold remedies. However, consuming vitamins in cough lozenges may cause you to take too many vitamins, especially if you are already taking a prenatal.

Cold/Flu: non-medication options

Honey and warm tea/water may be helpful in relieving a sore throat from coughing and may thin secretions so that the cough is more productive. Concerns about infant botulism and warnings that children under one year of age avoid honey (and honey-containing products) have been misunderstood and many pregnant women think it applies to them as well. The warning against the use of honey only applies to infants less than 1 year of age.

Nasal Congestion: medication options

A stuffy nose makes it less enjoyable to eat, impossible to sleep, and causes painful sinuses. The over-the-counter nasal decongestant choices fall into two categories, oral and topical/spray. Oral (pill) decongestants include pseudoephedrine and phenylephrine. Nasal sprays may contain phenylephrine or oxymetazoline. Taking an oral decongestant means that your developing baby will be exposed to the medication. The nasal sprays reduce the chance of exposure to your baby, depending on the frequency of use and amount. Always read the labels and take as directed.

Nasal congestion: non-medication options

Nasal irrigation (bulb syringe, squeeze bottle, or neti pot): Studies of nasal irrigation have not shown a proven benefit on the duration or severity of colds, however, there are individual users that are committed to this treatment for colds and swear by its benefits. For pregnant women the most reassuring part is that it uses only water (use only previously boiled, distilled or sterile water to irrigate) so there is no medication involved and no exposure to the pregnancy.

Shower tablets/vaporizers: Effervescent shower vapor tablets have become quite popular as they often provide temporary congestion relief. These tablets are placed on the shower floor and as the warm water reaches the tablet, it dissolves, emitting a vaporizer-like effect. Typically, these shower tablets contain sodium carbonate and sodium bicarbonate (baking soda), and essential oils (peppermint, rosemary, eucalyptus, and lavender). While there are no studies on the use of shower tablets during pregnancy, the ingredients are used in many candles, lotions, and many other home products so exposure is likely already quite extensive. To date, information has not suggested that there would be a concern with the use of shower tablets during pregnancy.

Humidifier: The humidifier is used to add moisture to the air and provide relief from sinus pressure, dry skin and throat. It uses only water so there is no medication exposure.

Nasal strips: Nasal strips, also called nasal dilator strips, are marketed to individuals who have difficulty sleeping due to snoring and claim to help with congestion from colds. Although the websites do not include studies that demonstrate that these products help with colds, there is some evidence that they may help with snoring. Nasal strips do not contain medication and work by spreading the nose and widening the air passage, therefore a concern does not exist for use in pregnancy.

Electric blankets and heating pads: Electric blankets are sometimes used by people experiencing body chills from flu and cold. Electric blanket use in pregnancy is seen as controversial by some as some studies have suggested that there could be a risk from the heat or from the electricity. There is a theoretical concern that as with fever, electric blanket use might raise body temperature. A fever of 101°F or higher for an extended period of time during early pregnancy increases the risk for birth defects. The studies on electric blanket use during pregnancy have many limitations and have not consistently shown an adverse effect to pregnancy.

Remedies to Avoid

Vitamin C and zinc: When you have a cold, or believe that it is coming on, you could be tempted to reach for vitamin C and zinc. This is not recommended during pregnancy. First, there is insufficient evidence that vitamin C or zinc are effective in preventing or treating colds. Second, the doses of vitamin C and zinc in supplements for colds are much higher than recommended dose for pregnant people. The vitamin C dose recommended for pregnant people is 80 mg for teens and 85 mg per day for adults. The recommended dose for zinc is 12 mg for pregnant teens and 11 mg per day for pregnant adults. If you are taking a prenatal, it is very likely that it contains the vitamin C and zinc that you need for the day.

Non-steroidal anti-inflammatory drugs (NSAID): For most healthy pregnant women, over-the-counter pain relievers such as ibuprofen, naproxen, and aspirin are generally not recommended during pregnancy. However, some pregnant women continue to take these medications at specific doses under a doctor’s supervision, due to an underlying medical condition, and they benefit by taking them.

NSAID’s are associated with a risk for premature closure of the ductus arteriosus (a heart and lung condition) in the baby if the medication is used in late pregnancy, at higher doses

Herbal combinations: Herbal medications for colds and flu have not been studied in pregnancy, therefore, possible benefits or risks are not known.  Echinacea has been promoted as a cold remedy, however; a Cochrane Review of over twenty-four double-blind trials with over 4,000 participants did not find that it shortened the duration of colds compared to a placebo.

Prevention

Masks: Although, adults can spread flu a day prior to symptoms starting and can spread a cold up to a few days before symptoms appear, wearing a surgical mask once symptoms start may help reduce the spread of infection from coughing, assuming that the mask is worn correctly and it is the right type of mask.

Hand washing and hand sanitizer: Studies conducted in workplaces, colleges, and other locations have shown that frequent hand washing and regular use of alcohol-containing hand sanitizer reduces the spread of the viruses that cause upper respiratory tract infections (colds). The key is to wash your hands regularly, throughout the day, and avoid touching your nose, mouth, and eyes. Studies show that with common colds, the hands are the most common vehicle for self-infecting and that flu is more likely to spread from droplets in the air.

Antiviral-Kleenex tissues: Antiviral tissues have not been studied well enough to suggest that they prevent colds; however, they do contain layers of antivirals. Until more information is available, it is important to wash your hands after blowing your nose regardless of the tissue type used to prevent spreading the infection to others.

References:

Botto LD, Lynberg MC, Erickson JD. Congenital heart defects, maternal febrile illness, and multivitamin use: A population-based study. Epidemiology 2001;12:485-90.

Centers for Disease Control and Prevention. (2014). Seasonal Flu. Retrieved from http://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm

Centers for Disease Control, NIOSH Blog, April 9, 2020

https://blogs.cdc.gov/niosh-science-blog/2020/04/09/masks-v-respirators/

Chambers CD, Johnson KA, Felix RJ, Dick LM, Jones KL. Hyperthermia in pregnancy: a prospective cohort study. Teratology 1997;55:45.

Hubner, N-O., Hubner C., Wodny M., Kampf G., Kramer A. (2010). Effectiveness of alcohol-based hand disinfectants in a public administration: Impact on health and work performance related to acute respiratory symptoms and diarrhea. BMC Infectious Diseases. Retrieved from http://www.biomedcentral.com/1471-2334/10/250

Karsch-Völk, M., Barrett B., Kiefer D., et al. (2014). Echinacea for preventing and treating the common cold.The Cochrane Database of Systematic Reviews, 2014. DOI: 10.1002/14651858.CD000530.pub3

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It was a busy day in the audiology clinic, but my 10AM patient made me pause. I reviewed the medical records for this adorable 2 1/2 year old. His mother, a daycare provider, had contracted cytomegalovirus (CMV) early in her pregnancy. Unfortunately, there is nothing unusual about this. You can get CMV by contact with bodily fluids from a person who carries the virus. If mommy is caring for toddlers, either at home or in her place of work, she is at very high risk for coming into contact with diapers, runny noses, table tops and toys that may be infected with the virus. As many as 38% of toddlers who go to day care may have CMV, and they can pass it to other children, their families, or care givers.

The symptoms of CMV can be mild, or there may not even be any at all. Symptoms can include a little sore throat, fever, swollen glands and fatigue for a few days. But when mommy catches CMV during a pregnancy, there can be serious consequences to the baby in the womb. Congenital CMV infection occurs in 1 out every 100 to 150 babies that are born to mothers with CMV, although only about 1 in 5 of these kids will have long term health problems. (CDC.org)

In this case, the medical record showed that my patient did indeed test positive for the CMV virus at birth. The virus crossed the placenta, from mother to the developing fetus, causing the infection. But to the relief of all, in spite of a positive diagnosis of the presence of the virus in the baby at birth, there did not appear to be symptoms other than a little jaundice, which returned to normal within a couple of weeks. The family breathed a sigh of relief. Yet – here they were. The toddler (now 32 months old) was not talking at all. In fact, he was lagging farther and farther behind his peers developmentally.

After 40 minutes in the sound booth with this little boy I was able to confirm that he had a severe hearing loss in both ears. The fact that he had passed his newborn hearing screen suggested that the hearing loss had been getting worse over time. And a hearing loss of this degree surely had something to do with his delayed language development, and other possible developmental delays.

What can we learn from this challenging outcome? What could have been done?
For October’s National Audiology Awareness and Protect Your Hearing Month, I thought it was particularly timely to focus on the lesson learned from this little boy’s situation. More often than not, when a baby is exposed to CMV in the womb, especially early in the pregnancy, there will not be birth defects. In fact most babies will be born without symptoms or obvious defects. In one study (Naing et al, 2015) 18% of children born positive for CMV were without symptoms at birth, but later had a delayed onset of hearing loss. I would have liked to have seen a heightened level of suspicion that hearing loss may emerge with this child, because of his congenital CMV diagnosis. It may not be possible to stop the onset or worsening of this hearing loss, but repeat testing of his hearing every 4 to 6 months would have gone a long way toward early identification of the hearing loss, and earlier intervention with hearing aids and speech/language therapy.

Hearing loss is just one of the potential effects of CMV infection during pregnancy. To learn more about the broader range of effects, how to test for CMV, and how you can prevent infection, visit the CMV and Pregnancy fact sheet: https://mothertobaby.org/fact-sheets/cytomegalovirus-cmv-pregnancy/. And remember: a MotherToBaby expert is just an email, text message, live chat, or phone call away!

Heidi S. Neuburger, MS, MA, works as an infant laboratory coordinator as part of the technical staff at Indiana University’s Department of Otolaryngology-Head & Neck Surgery. She was program coordinator of MotherToBaby’s Indiana affiliate from 2014 – 2016.

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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