Back when the Zika epidemic was sweeping the western hemisphere, answering these travel-related questions was fairly straightforward. It was easier to know where there was a risk for Zika infection as governments and public health organizations around the world collaborated to identify and report cases. Since then, the number of reported Zika cases has fallen dramatically, but sporadic, low-level transmission continues to happen in some areas. Systems for detecting and reporting cases vary widely from country to country now, making it difficult to know the exact level of risk in any given area.

So, what’s a traveler to do?

First and foremost, all travelers should avoid mosquito bites to help prevent not only Zika, but also other diseases spread by mosquitoes. Preventing bites is important for everyone, especially those who are pregnant or planning a pregnancy and their partners. The best way to prevent mosquito bites while traveling is to use an Environmental Protection Agency (EPA)-registered insect repellent with one of the following active ingredients:

• DEET
• Picaridin (also known as KBR 3023 and icaridin)
• IR3535
• Oil of lemon eucalyptus (OLE)
• Para-menthane-diol (PMD)
• 2-undecanone

Other ways to help prevent bites during travel include wearing loose-fitting, long-sleeved shirts and pants, and sleeping in areas free of mosquitoes (such as accommodations with window and door screens or air conditioning, or sleeping under a mosquito net).  

Second, consider your destination.

Check for active Zika Travel Health Notices from the Centers for Disease Control and Prevention (CDC). Travel Health Notices indicate areas with known current transmission of Zika.

After checking for Zika Travel Health Notices, visit the CDC interactive Zika map. The map uses different shades of blue to broadly classify Zika risk in countries and territories around the world:

• Dark blue areas have reported Zika transmission in the past and there could be current sporadic or low-level transmission in some areas. As in any area, there could be delays in detecting and reporting any new outbreaks.
• Medium blue areas have the kind of mosquitoes that most commonly spread Zika, but they have not reported Zika cases in the past.
• Light blue areas are not known to have the kind of mosquitoes that most commonly spread Zika, and they have not reported Zika cases in the past.

Third, learn the recommendations.

Learn the recommendations related to pregnancy based on your destination (summarized below). Depending on where you’re thinking of going, CDC might advise that you avoid travel, take steps to prevent passing the virus to a partner through sex (sexual transmission), and/or delay pregnancy if you or your partner are planning to become pregnant. Preventing sexual transmission of Zika means using condoms or dental dams, not sharing sex toys, or not having sex for 2 months after travel (for biological females) or 3 months after travel (for biological males). If delaying pregnancy after travel, follow these same timeframes (2 months after travel for biological females and 3 months after travel for biological male partners).

Recommendations for areas with a Zika Travel Health Notice:

• If you are pregnant, avoid travel to these areas.
• If your partner is pregnant and you must travel to these areas, prevent mosquito bites and sexual transmission during and after travel according to the guidelines and timeframes above.
• If you or your partner are planning a pregnancy and you choose to travel to these areas, prevent mosquito bites, prevent sexual transmission, and delay pregnancy after travel according to the guidelines and timeframes above.

Recommendations for areas with current or past transmission (dark blue on the map):

• If you or your partner are pregnant and you choose to travel to these areas, be sure to prevent mosquito bites. If you are concerned about Zika, prevent sexual transmission during and after travel according to the guidelines and timeframes above.
• If you or your partner are planning a pregnancy, be sure to prevent mosquito bites. If you are concerned about Zika, prevent sexual transmission during and after travel and consider delaying pregnancy according to the guidelines and timeframes above.

For travel to all other areas with mosquitoes, take steps to prevent bites.

Lastly, talk to your healthcare provider.

Talk to your healthcare provider about any questions or concerns. They can help you consider the nature of your travel, your ability to prevent mosquito bites and sexual transmission, the risks associated with a potential Zika infection, your pregnancy plans, and any other factors specific to you, your partner, and your circumstances. 

MotherToBaby specialists are also available to talk with you about Zika or other travel-related exposures before or during pregnancy. Safe and happy travels!

The post Zika, Pregnancy, and Travel in a Post-Epidemic World appeared first on MotherToBaby.

Melissa is not alone. Many people contact MotherToBaby to find the most up-to-date information about vaccines during pregnancy. Protecting yourself from circulating viruses can also help protect your developing baby. Infections such as influenza, pertussis, rubella, chicken pox, and COVID-19 can cause serious problems in both a pregnant person and their developing baby.  In light of August being National Immunization Awareness Month (NAIM), let’s navigate through the current recommendations.

Plan to Receive Some Vaccines Prior to Pregnancy

You may have heard there are some vaccines you should not receive during pregnancy. These “live” vaccines are avoided as they are made from viruses or bacteria that have been weakened, but not killed. Due to the small chance that a live vaccine might cause the disease itself, live vaccines are not routinely given to pregnant people.

So how can you protect yourself and your developing baby from viruses like measles, mumps, rubella and chicken pox (varicella) if it is not recommended (also known as contraindicated) to receive the vaccine during pregnancy? Your healthcare provider can take your titers (lab test that measures the antibody levels in the blood) before pregnancy to make sure you have enough antibodies to help protect yourself from these infections during pregnancy. Low titer levels? You can safely receive the necessary live vaccines needed before that positive pregnancy test! Out of an abundance of caution (small possibility of that infection) it is advised to wait at least one month before becoming pregnant after these vaccines. This is just one reason why it is beneficial to have a pre-pregnancy health checkup and to discuss any future conception plans with your provider!

Keep Up with Recommended Vaccines During Pregnancy and Encourage Others to Do So, Too

So, which vaccines should you receive during pregnancy?

The Centers for Disease Control and Prevention (CDC) recommend all people who are pregnant receive the influenza vaccine each year and a Tdap (tetanus diphtheria pertussis) vaccine for each pregnancy, and the most up-to-date COVID vaccine when you are due. These vaccines are not live vaccines and have not been associated with an increased chance for birth defects or pregnancy complications. An exception would be the live attenuated Influenza vaccine which is intranasal (given through the nose).

The flu vaccine usually becomes available in September and is offered throughout flu season. CDC recommends getting a flu vaccine by the end of October despite flu seasons varying in their timing from season to season. This timing helps protect a pregnant woman before flu activity begins to increase. Protection begins about two weeks after you get the flu shot and lasts at least six to eight months. It is necessary to receive the seasonal flu shot each year to be protected in the current flu season. Getting vaccinated during your pregnancy may also help protect your baby from getting sick during the first 6 months of life! This is especially important because infants less than 6 months of age cannot receive the flu vaccine.

“I just had a Tdap vaccine a couple years ago – so I don’t need another one, right?” Melissa asked a very common question we receive regarding the Tdap vaccine during pregnancy. Although this vaccine is recommended for adults every 10 years, for people who are pregnant, receiving the shot in the 3^rd trimester (specifically 27-36 weeks gestation) can help the baby get as many of the mother’s antibodies as possible. After delivery, these antibodies provide some protection against pertussis (a very contagious respiratory infection) until the baby can receive his/her own dTAP vaccine (at 2 months of age). Additionally, if everyone who lives with you and any caregivers get the vaccine, it can lower the chance for the baby to get pertussis.

It is well known that pregnant people are more likely to get very sick from COVID-19 compared to those who are not pregnant. This is why is so important to receive your COVID-19 vaccinations when you are due, anytime during pregnancy, for the best protection against severe illness. CDC recommends one updated (no longer called “booster”) Pfizer-BioNTech or Moderna COVID-19 vaccine to be up-to-date:  https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html.

Pregnant people who receive vaccines can also share their experiences with maternal health researchers, like MotherToBaby. Our studies are published in medical journals and product labels, and can help others like you when navigating vaccine decisions in pregnancy.

There are no Vaccines to Prevent Some Infections

Many people are packing their bags for a getaway during these summer months. If you are considering an upcoming vacation or babymoon, it’s important to protect yourself from viruses and infections with the appropriate vaccines for that area. Where are you headed? Check with your healthcare provider regarding any specific travel vaccines you might need. CDC recommends discussing any travel plans with your provider 4-6 weeks before your trip. Contact MotherToBaby to check the information on any vaccines your healthcare provider recommends.

Zika is a virus that is usually spread by mosquitos. Being infected with the Zika virus during pregnancy is known to increase the risk for serious and lifelong problems for the baby. While there are no current outbreaks of the Zika virus, it can still be circulating in some levels in many countries and there is no vaccine or treatment currently for Zika! The safest approach during pregnancy would be to not travel to areas with any possible level of risk; should you choose to travel, it’s important to protect yourself using the recommended insect repellents among other ways to help reduce risk.

Although masks are no longer required in most public areas, this is still a great way to reduce the risk for infections and illness while around others! Good hand washing, good ventilation, air conditioning, staying outdoors as much as possible, etc. can also be considered.

After chatting with Melissa, she decided to make her appointment for her COVID-19 and Tdap vaccines (you can get them at the same time!) and will go in ASAP when the flu vaccine for this season is available. She felt reassured knowing she had decided to give herself and her developing baby the best protection from these illnesses as possible.  “Thank you for all this info! I just want to make the best choice for me and my baby – I feel so much better.”

Do you have questions about vaccines during pregnancy? Call, chat, text, or email MotherToBaby!

References:

https://mothertobaby.org/fact-sheets/vaccines-pregnancy/

https://mothertobaby.org/pregnancy-studies/

https://www.cdc.gov/vaccines/parents/by-age/pregnancy.html

https://www.cdc.gov/vaccinesafety/concerns/vaccines-during-pregnancy.html

The post Immunization Education: Everything You Need to Know About Vaccines Before and During Pregnancy appeared first on MotherToBaby.

But what about now? The number of reported Zika cases has fallen dramatically in recent years. However, the accuracy of reporting can vary widely from country to country, so the once-clear world map of Zika risk now appears much less well-defined.

One of the most common Zika-related questions we still get at MotherToBaby is, “How likely is it that I’ll get Zika if I travel to Country X?” (Or a variation of the same: “We went to Country X. Do we really need to wait 3 months before we try to get pregnant?”) One resource to help answer that question is the interactive world map maintained by the Centers for Disease Control and Prevention (CDC) to illustrate areas with Zika risk. Visit the map now and you’ll find four colors, each indicating a different level of Zika risk and the corresponding recommendations for pregnant people, their partners, and those who are planning pregnancy.  Let’s take a look at what each color means :

• Red areas have active Zika transmission. Travelers to red areas are at risk of Zika infection.
  • Pregnant people and their partners should avoid all unnecessary travel to red areas.
  • Couples and individuals who travel to red areas should wait at least 2 months (women) or 3 months (men) before trying to get pregnant, and have only protected sex during that wait time.
• Purple areas have had active Zika transmission sometime in the past, and there could still be sporadic cases. Travelers to purple areas might be at risk of Zika infection.

Pregnant people, their partners, and those who are planning pregnancy are encouraged to talk with their healthcare providers to make decisions about travel to purple areas. Careful consideration should be given to the risks and consequences of Zika infection in pregnancy, the nature of their travel, how much potential risk they are willing to accept, how soon they want to get pregnant (if they are not already), and any other factors specific to that individual or couple at that time.

• If pregnant people or their partners decide to travel to purple areas, they should take steps to minimize risk, including using insect repellent and considering the use of condoms for the rest of the pregnancy.
• People planning pregnancy who travel to purple areas should also take steps to minimize risk, including using insect repellent and considering following recommended wait times before trying to get pregnant (2 months for women, 3 months for men).

There is a sub-category of light purple, which shows higher elevations above 6,500 feet where mosquitoes that can transmit Zika don’t usually live. The chance of getting Zika in light purple areas is very low. However, be sure to consider if your travel plans would take you through dark purple areas on the way to these lighter purple zones.

• Yellow areas have mosquitoes that can transmit Zika, but have not had reported cases of Zika transmission. Travelers to yellow areas are at low risk of Zika infection.
  • All travelers to yellow areas should take precautions to prevent mosquito bites.
• Green areas do not have mosquitoes that can transmit Zika and have not had any reported cases of Zika transmission. Travelers to green areas are not at risk of Zika infection.
  • There are no Zika-related travel recommendations for green areas.

Given that many countries are included in the purple category, how does this map help you know what your risk really is if you travel to a purple area? The answer is that it doesn’t. Purple only tells you there is some level of risk. Here’s why purple—and we at MotherToBaby—can’t be more specific:

• Reliable data for every country around the world simply does not exist.Since Zika virus is no longer considered a public health emergency, many resources that once helped support global data collection have moved on to other, more pressing issues.
• The level of risk within a purple country could change without us knowing right away.The ability of any country to quickly identify and report cases depends on resources, logistics and other factors. This means there could be delays in detecting and announcing any new outbreaks.

The bottom line is that our post-Zika-epidemic world requires that we take the health of current and future pregnancies into consideration when planning travel. Ask ourselves how much potential risk we are willing to accept when we book our vacations and business trips. Does that mean that couples and individuals who want to have children should never go to areas that ever had Zika? Not at all! But if they are currently pregnant, or are not willing or able to effectively prevent pregnancy for at least 3 months after traveling, they might prefer to visit one of the many areas where there is no known risk of Zika. (Think yellow! Think green!)

MotherToBaby is here to answer your questions about Zika or other exposures before or during pregnancy. Happy travels!

The post Special Edition Baby Blog: What Do All the Colors Mean? Zika, Pregnancy & Travel in a Post-Epidemic World appeared first on MotherToBaby.

COVID-19:

Try as we might, we can’t escape it or wish it away. We are, in fact, still in the middle of a pandemic, with new variants appearing and cases still rising and falling unpredictably in most places. Traveling on public transportation (such as airplanes, ships, trains, subways, taxis, and ride shares) can make getting and spreading COVID-19 more likely. So can being in crowded indoor spaces, especially if not everyone in those spaces is fully vaccinated against COVID-19 and/or wearing a mask. Having COVID-19 in pregnancy can increase pregnancy risks such as stillbirth and preterm delivery. So, how can you eliminate or reduce your chance of exposure to the virus?

• Avoid public transportation. If you must travel, using your own vehicle with members of your own household is the safest bet. Using drive-thrus or packing your own food to stop and eat along the way is safer than eating in crowded restaurants full of other holiday travelers.
• If you must travel on a plane or use other public transportation, wear a well-fitting mask the whole time (this is required), stay at least 6 feet away from other travelers when possible, and wash your hands/use an alcohol-based hand sanitizer frequently. Most importantly, make sure you’re fully vaccinated before you travel, including getting a booster dose when you’re eligible.
• Did I mention making sure you’re FULLY VACCINATED before travel? It’s the single best way to reduce the chance of getting very sick if you’re exposed to the virus that causes COVID-19. Pregnancy and being very sick don’t go well together, so this one is really, really important, whether you’re traveling or not. MotherToBaby has helpful resources on the COVID-19 vaccines and booster shot, and you can contact us to talk through any questions or concerns you may have about getting the vaccine.
• Even if you’re fully vaccinated, you might still consider wearing a mask indoors during holiday gatherings (and elsewhere), especially if you’re getting together with people from different households coming from different places. If everyone else at the gathering also wears a mask indoors, even better.  
• Find more tips and information about safer holiday celebrations and travel in the time of COVID at this link: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/celebrations.html.

Influenza (the Flu):

Flu season carries its own risks for people who are pregnant. Like COVID-19, having the flu during pregnancy increases the chance of being very sick compared to people who aren’t pregnant. Many of the same precautions that apply to COVID-19 apply to the flu as well:

• Get the flu shot. Like the COVID-19 vaccine, the flu shot can be given at any time during pregnancy, and can even be given at the same time as a COVID vaccine or booster. The sooner you’re vaccinated, the sooner you and your pregnancy will have good protection against becoming very sick from the flu. And (bonus!) getting vaccinated in pregnancy may pass some protective antibodies to your developing baby.
• Avoiding public transportation and crowded indoor spaces will also reduce your chance of exposure to the flu virus. Washing your hands frequently/using an alcohol-based hand sanitizer is also an excellent flu prevention technique.

Zika:

Yes, Zika is still around. There are no known “outbreaks” of Zika anywhere in the world at this time, but there is ongoing, low-level, sporadic transmission in some places. Having Zika during pregnancy increases the chance of serious and lifelong effects for a developing baby. There is no vaccine against the Zika virus.

• The safest course in pregnancy (or if you’re trying to conceive) is to avoid travel to places with a chance of exposure. Unfortunately, it’s virtually impossible now to know the exact risk of being exposed to Zika in any given country, but if you must travel, you can use the CDC’s Zika map to help you plan.
• If you travel,use insect repellent and take other precautions to help avoid mosquito bites, such as wearing long sleeves and pants. If your partner travels with you, take steps to avoid sexual transmission of Zika. If you’re planning a pregnancy, follow the recommended wait times (2 months for women, 3 months for men) before trying to conceive.

Other infections:

If you’re considering international travel, there may be other infections to consider, such as malaria and foodborne illnesses. You might also need other vaccines, so be sure to review the current vaccine recommendations for your destination. Some vaccines can be given during pregnancy, but it’s a good idea to check with your healthcare provider or contact MotherToBaby to discuss the risks and benefits of specific vaccines as you’re deciding about travel. 

Medical concerns:

Other travel considerations include the increased chance of blood clots during travel if you’re pregnant, and where you will receive medical care in case of unexpected preterm labor or another medical emergency. Before any travel, be sure to talk with your healthcare provider about any additional considerations that are specific to you and your pregnancy.

Given all these considerations, if you’re pregnant you might decide this year is a good one to enjoy low-key holidays at home and save the travel for another time. However you decide to spend the season, we hope it’s safe, healthy, and happy!

The post COVID-19, the Flu, and Zika: Considerations for Pregnancy in the Winter Travel Season 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.

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.

**This information was current as of the time the blog was published. However, information is constantly changing. Please visit Zika Central for the latest information.**

As a teratology information specialist, I counsel women and their families on medications, chemicals, herbal remedies, and illnesses that could harm developing babies. So as the Zika Virus, a viral infection that can cause severe birth defects including microcephaly (a condition where a baby’s head is much smaller than expected, and may indicate a baby’s brain has not developed properly during pregnancy), spread from the Polynesian Islands, to South America, to the Caribbean, I made sure to educate myself on everything we know about the virus, reading article after article and keeping up to date on the Centers for Disease Control and Prevention (CDC’s) recommendations to avoid infection, knowing that eventually I would need this information to counsel a pregnant woman or her family. I never imagined I would use this information to try to prevent becoming infected myself, and that I would fail.

One week in February I opened an email from my in-laws with the subject “30th Birthday Plan.” My husband’s 30th was a few weeks away, and I was excited to see what they had planned. As I read the email detailing a week-long sailing trip in the Caribbean I felt blessed, and honestly a little scared. I rushed to the CDC’s page on Zika to look up whether the islands we were visiting had outbreaks. Sure enough-16 Caribbean islands, including the two we were visiting, had Zika outbreaks. At first I didn’t want to go, which set off an intense inner debate racked with guilt. “How could I say no to a surprise trip for my husband, especially one planned and paid for by my in-laws?” I thought, and in the next second, “But what if I get Zika? I work with pregnant women, I can’t expose them!” Finally, my Dad stepped in. “You’re too adventurous to let Zika scare you away from a vacation.” he said. “Fine,” I thought, “I’ll go, but I’m going to be careful.”

I was careful. Despite the gentle teasing from my in-laws, I insisted on sleeping indoors with the windows closed, even though it was more comfortable outside. I wore bug spray with 30% DEET when I thought mosquitos would be out. I got three or so bites at dinner one night, and three more at the end of our trip. As we headed home I mentally patted myself on the back; “Only six bites,” I thought, “pretty sure I didn’t get Zika!” I was so sure that three days after our trip when I developed a head-to-toe rash I was certain it was an allergic reaction, but after three doses of Benadryl did nothing, I googled Zika-related rashes. Dead ringer. Symptoms of the Zika Virus include rash, joint and muscle pain, red eye, fever, and headache, and boy did I have them. I rushed in to see an infectious disease doctor, who came to the same conclusion. “My money’s on Zika,” he said. Suddenly everyone wanted a piece of me; my blood was sent to the county board of health, Emory’s lab, and a lab in Washington for testing.

A call from the county board of health confirmed what my aching joints hinted at: I tested positive. My first thought was to thank my lucky stars that I have access to safe, reliable birth control. My second was to start worrying about those around me. I had brunch with a pregnant friend before I had symptoms-could I have given her Zika? Thankfully, the answer is no (more on that below)! I was amazed at how a short vacation and six bites could give me Zika. I thought about all the people going to the Caribbean for vacation. How many of them are pregnant or could become pregnant while traveling? Would they wear bug spray? Would they recognize the symptoms? How many are men who could get Zika and then unknowingly transmit it to their sexual partner? How many people are walking around not knowing they were infected? I called my friend and begged her to wear insect repellant for the rest of her pregnancy.

As of July 27, 2016, 1.658 cases of Zika, including 433 pregnant women have been confirmed in the continental United States; 4 cases of local transmission have been reported in Miami-Dade and Broward counties in Florida. There are likely far more cases since most people don’t have symptoms, so never get tested. Zika is mostly spread through mosquito bites, but can also be spread through sex, blood transfusions, or from a mother to baby during pregnancy. We don’t know how long the incubation period (the time between when you get infected and when you see symptoms) is, but it is likely a few days to weeks. For most people the virus stays in the blood for about a week, but some people still have the virus in their bodies for as long as two months. Currently, the only Zika outbreak in the continental United States is in a small area of Dade County, Florida, however,, the mosquitoes that can carry Zika are found in some areas of the US, making a Zika outbreak in the U.S. very possible. You can follow these steps to protect yourself:

1. If you are pregnant or could be pregnant (planning a pregnancy or not using birth control), don’t travel to a country with an active Zika outbreak. You can find a list of current outbreaks here.

2. If your partner has traveled to a country with an active Zika outbreak and you are pregnant, use condoms correctly every time you have sex for the rest of your pregnancy. Why, you might ask? Because Zika can stay in semen longer than in blood, but we don’t know exactly how long it stays there. To be as safe as possible, the CDC recommends using condoms for 6 months.

3. If your partner has traveled to a country with an active Zika outbreak and has symptoms of Zika (rash, fever, headache, joint pain, and conjunctivitis) use condoms correctly whenever you have sex and avoid pregnancy for at least six months. If he does not have symptoms, use condoms and avoid pregnancy for at least two months.

4. If you have traveled to a country with an active Zika outbreak and you are not pregnant, avoid pregnancy for at least two months. The Zika virus can also be transmitted from a woman to her sexual partner. Because of this, use condoms and/or a dental dam when you have sex for two months. Do not share sex toys.

5. If you are currently pregnant, avoid mosquito bites as much as possible by wearing bug spray outdoors (bug spray with at least 30% DEET is preferable; for information on the safety of DEET during pregnancy, see here), wearing long-sleeved shirts and pants, closing windows or using windows with screens, and removing any standing water from around your house. Two things to remember: the mosquitos that spread Zika are daytime biters and like to be indoors, and they can breed in pools as small as a bottle-cap.

If you have questions about the Zika virus or you have been infected or exposed and want free up-to-date information about what this could mean for a current or future pregnancy, you can contact a MotherToBaby expert by phone at (866) 626-6847 or by visiting https://mothertobaby.org//a>.

Bethany Kotlar is a teratology information specialist with MotherToBaby Georgia. She holds a Masters in Public Health specializing in Maternal and Child Health, and is a Certified Childbirth Educator. She enjoys exercising, traveling (and collecting viral illnesses), and Netflix.

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. You can also visit MotherToBaby.org to browse a library of fact sheets, email an expert or chat live.

The post How I Got the Zika Virus and How You Can Too: Protecting Yourself and Your Family appeared first on MotherToBaby.

**This information was current as of the time the blog was published. However, information is constantly changing. Please visit Zika Central for the latest information.**

When it comes to pregnancy, so much of the attention is focused on the woman: her nutrition, her health, her behavior and just about her whole world comes under scrutiny in order to promote a healthy pregnancy; but what about the man? His nutrition, health, and behavior hardly comes under that same intense scrutiny…until now. Enter Zika virus. A man who has traveled to a Zika-affected area and has a wife/girlfriend who is pregnant must play an active role in protecting his partner and baby from possible Zika infection. Even if his partner is not currently pregnant, a man must be aware of his role when it comes to preventing the spread of the Zika virus. Father’s Day starts well before you actually become one, men….here’s why:

This illness, which is spread by the bite of a mosquito, took the world by surprise last fall when an unusually high number of babies, particularly in Brazil, were born with small heads and brains, a birth defect called microcephaly. Zika is a mild illness and typical symptoms include fever, skin rashes, muscle and joint pain, headache and conjunctivitis or red eyes. These symptoms normally last for 2-7 days. Some adults do not even know that they are infected because they have no symptoms while others will recover with rest, fluids and taking over-the counter medications to control symptoms. While Zika is a mild illness for many adults, if a pregnant woman becomes infected she can pass the infection to her child and, as a result, increase the chance that her child may be born with microcephaly and other abnormalities. To complicate matters more, it became clear that Zika can be transmitted by a man to a woman through sex or intercourse. The virus can be spread before symptoms begin and after symptoms end. Also Zika virus can remain in the blood of an individual for a week (or sometimes longer), but in regards to men Zika can remain in semen even longer than in the blood. Since we still don’t know how long Zika can remain in the semen, a man has to be more proactive than reactive when it comes to protecting his partner and future baby.

And ladies, our men, especially fathers-to-be, are thinking about Zika and are making some life changing decisions to protect the welfare of their families. Take, for example, cyclist Tejay van Garderen (27 years old) who is considered a medal contender for this year’s summer Olympic Games in Rio de Janeiro, Brazil. He has decided to withdraw from consideration to be a part of the US Olympic team because his wife Jessica is pregnant and he doesn’t want to put her or the well-being of his unborn child at risk by possibly contracting Zika and passing the infection on to them. “I don’t want to take any chances. If anything were to happen, I couldn’t live with myself.” When you consider that Tejay will now have to wait 4 more years to fulfill his Olympic dreams and put all that training on hold for his wife and child, that is chivalry at its finest. (All I can hear is the song “When a Man Loves a Woman” playing in my mind right now!)

So what is a man to do?

If you have a pregnant partner and you have traveled or lived in a Zika-affected area:

The most conservative approach is to not have sex during the entire pregnancy. Although the thought of not having sex for several months might seem like the end of the world for some, the health and welfare of your child is well worth the sacrifice.

However, every couple has to do what will work for them, so if abstaining from sex is not possible then it is important to use a condom correctly and consistently while having sex for the entire time of intercourse. Condoms should be used regardless of whether you are having vaginal, anal or oral (mouth to penis) sex, even if you do not have symptoms. Remember: since Zika virus is found in semen, the idea is to make sure your partner has no contact with semen. Think, knight in shining latex armor, right? Yet another chance for chivalry, guys.

If your partner is not currently pregnant:

If you and your partner are planning or actively trying to get pregnant but you’ve recently traveled to or lived in a Zika-affected area, experts advise you to hold off on getting pregnant. The length of time you delay would depend on whether you’ve had symptoms of Zika infection: delay 6 months men, if you have had symptoms, or 8 weeks if your wife or girlfriend had symptoms.. Avoid sex or be sure to use condoms every time , as mentioned before, during this period. If neither one of you have experienced symptoms than it is advised that you wait 8 weeks before trying.

Even if you are not planning a pregnancy, it is advisable to wear condoms every time you have sex because (well, you know) accidents have been known to happen! And you can even go a step further by not having sex for 8 weeks after you return from a Zika-affected area, if you have had no symptoms or for 6 months if you do.

Other Means of Prevention

Here in the United States, we do not yet have local cases of Zika – meaning that all reported cases in the US to date are from individuals who lived in or traveled to Zika-affected areas and have traveled back to the United States. While this is reassuring, we cannot be completely at ease and need to take the proper steps to prevent infection – especially since there is no vaccine or medicine to treat Zika. The use of insect repellents is an important tool in the prevention of Zika for everyone and especially those who are traveling back to the United States from Zika infected areas. The Centers for Disease Control and Prevention has some great info about Zika prevention: http://www.cdc.gov/zika/prevention/ 

If you are uncertain about your risk of infection, you should talk to your doctor sooner than later so that they can make a proper assessment of your level of risk. Zika testing is available for people who believe they have been exposed through sex and have symptoms; however, keep in mind that testing blood, semen or urine will not tell you the level of risk for passing the infection to someone during sex. In addition, because Zika can remain longer in semen than in blood, a man could get a negative blood or urine test but still have the Zika virus in their semen.

So men, prepare for your most chivalrous self. We need you in the fight against Zika! Your partner and future child will appreciate all you do to protect them.

Patricia Cole, MPH, is the Program Coordinator for MotherToBaby Massachusetts. She obtained her Bachelor’s degree in Biology from Simmons College in Boston and her MPH in Maternal and Child Health from Boston University School of Public Health. She has been the serving the families of New England as a teratogen counselor since 2001 and provides oversight for the day-to-day functions and outreach of the program. She has also provides education to graduate students and other professionals.

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 viruses, alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text counseling 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. MotherToBaby recently released an evidence-based Zika virus fact sheet for concerned pregnant and breastfeeding women. It can be found here: https://mothertobaby.org/fact-sheets/zika-virus-pregnancy/

References:

Macur, Juliet. (2016, June 3) Fearing Zika, a Top American Will Skip the Olympics. He May Not be the Last. The New York Times (Sports of The Times). Retrieved from: http://www.nytimes.com/2016/06/04/sports/olympics/zika-cycling-tejay-van-garderen.html?_r=0

The post Father’s Day Food for Thought: Zika in a Man’s World appeared first on MotherToBaby.

**This information was current as of the time the blog was published. However, information is constantly changing. Please visit Zika Central for the latest information.**

Zika, Zika, Zika……everywhere you turn someone is talking about Zika and it’s not hard to understand why. Last fall in Brazil, the cases began coming in with unusual frequency. Health care providers noticed an increase in babies born with small heads and small brains, a birth defect called microcephaly. And the questions began pouring in as to why this could be happening? Providers noticed these women lived in or had visited areas affected by the Zika Virus; in fact, out of the first 35 case reports of microcephaly the majority of the moms reported a rash-like illness and some tested positive for Zika.

When Zika hit the news, it was understandably scary for pregnant woman. One of our most vulnerable populations – our babies– are at risk from something we can’t even see with our natural eyes: a virus carried by a mosquito. While we still have much to learn about Zika and pregnancy (including whether it is actually associated with microcephaly), the possibility that there is a risk takes away from the joy and celebration that pregnant woman normally feel and has replaced that with fear and trepidation. As a counselor with MotherToBaby, I know. I’ve heard the fear in the voices of women calling me; even through emails and text messages, the concern has been palpable. So let’s put it all into perspective.

Focusing Away From Fear: If You’re Planning A Pregnancy…
While there is so much focus on the fears of pregnant woman, there are very real concerns that the woman or couple planning for pregnancy experience as well. Just the other day, I had a conversation with a woman who contacted our service hoping to get some answers. “I am planning to go through IVF and scheduled a trip to Mexico well in advance of the news about Zika. My plan was to go to Mexico and start going thru IVF when I came back. Do I have to cancel my trip or if I go do I have to delay my plans for pregnancy, and, if so, for how long. It is hard to think of delaying pregnancy but at the same time we were so looking forward to this trip and planned it long ago!” I could hear the struggle.

We’re still learning about Zika, but for couples planning a pregnancy the current recommendation is that you talk with your physician about how your plans could be affected by travel to a Zika–affected area. Zika usually remains in the blood for a week after infection and there is currently no evidence to suggest an increased risk of birth defects if a woman becomes pregnant after the infection has passed.

If You’re Pregnant…
Zika can be spread from a pregnant woman to her baby. The link between Zika and microcephaly is still being investigated, but to be safe the US Centers for Disease Control and Prevention (CDC) currently recommends that pregnant women consider postponing travel to any area where Zika virus is spreading. If travel to an affected region cannot be avoided, you should talk to your healthcare provider before leaving, and while traveling take careful steps to prevent mosquito bites (see below). If you’ve recently completed your travel, you should still talk to your healthcare provider, even if you don’t feel sick.

Zika Can Be Transmitted Through Sexual Contact.
For men, Zika can remain in semen for a longer period of time so it is important to speak with your healthcare provider regarding risks. If a man has traveled to a Zika-affected region and has a pregnant partner, it has been recommended that he use condoms during sex (vaginal, anal, and oral) for the remainder of the pregnancy. For couples planning a pregnancy, it has been recommended that men use condoms for 28 days after traveling to Zika infected areas. For more details, see our fact sheet, Zika and Pregnancy https://mothertobaby.org/fact-sheets/zika-virus-pregnancy/.

Travel and Mosquito Bite Prevention
It is important to check travel advisories for the area you plan to visit because the status of areas can change before your trip quite rapidly. For example, prior to traveling to Florida a physician called me about the safety for his wife to use DEET during pregnancy. At the time there were no advisories for the area but shortly thereafter, the Governor of Florida issued a state of emergency for some counties that had reported cases of Zika infection that were linked to people who had traveled to Zika-affected areas. Therefore it is important to always check the CDC website for travel information (http://wwwnc.cdc.gov/travel/page/zika-travel-information) and to take the necessary precautions to protect yourself from mosquito bites. These include:

1. Wear long sleeve shirts and pants;
2. Use mosquito repellent with an EPA registered number as this means that the repellant has been proven safe and effective like DEET and picaridin; both of these agents are considered compatible for pregnancy. Make sure to read the label and follow the instructions, as you may need to reapply insect repellant every few hours. If you are using sunscreen, apply that first and then add the insect repellant. You can get more info on insect repellant use during pregnancy from our new Fact Sheet at https://mothertobaby.org/fact-sheets/insect-repellents/;
3. Stay in air-conditioned areas;
4. Stay in areas with screened doors, and sleep with mosquito netting.

Mosquito-transmitted Viruses are Nothing New
Zika is just the latest punch from these biting bullies. In fact, taking steps to avoid mosquito bites is something we should all be doing, as there are quite a few diseases they can pass on to humans. Some are more common in tropical areas but can also be found here in the United States like Dengue and West Nile Virus. Both conditions are associated with uncomfortable symptoms, dengue can pose complications for pregnancy and the effects of West Nile during pregnancy are not that well known – so protection at all times is key. Thankfully, neither are as frequent in the United States or Canada as in some other parts of the world due to the use of insect repellants and other protective measures we have. For more info, check out our West Nile Virus Fact Sheet at https://mothertobaby.org/fact-sheets/west-nile-virus-infection-pregnancy/

Remember: if you are not pregnant, Zika virus overall does not cause serious effects. It is only when a woman gets Zika during pregnancy that experts suspect (but have not yet proven) that it may increase the risk of birth defects so there is still more to learn.
It’s been said that the only thing that remains constant is change. Whether it’s Zika or the next mosquito-transmitted outbreak, fight the bite and navigate those changes. MotherToBaby is here to help.

Patricia Cole, MPH, is the Program Coordinator for MotherToBaby Massachusetts. She obtained her Bachelor’s degree in Biology from Simmons College in Boston and her MPH in Maternal and Child Health from Boston University School of Public Health. She has been the serving the families of New England as a teratogen counselor since 2001 and provides oversight for the day-to-day functions and outreach of the program. She has also provides education to graduate students and other professionals.

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 viruses, alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text counseling 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. MotherToBaby recently released an evidence-based Zika virus fact sheet for concerned pregnant and breastfeeding women. It can be found here: https://mothertobaby.org/fact-sheets/zika-virus-pregnancy/

The post Fighting The Bite: A Woman’s Guide to Avoiding Zika in Pregnancy appeared first on MotherToBaby.