News Moms Need

Today’s guest post is written by Leyla Sahin, MD, U.S. Food and Drug Administration Division of Pediatric and Maternal Health.

Thank you for inviting me to talk with you about FDA’s new prescription medicine labeling system which provides information on the benefits and risks of using medicines during pregnancy and breastfeeding.  This new system is one way that FDA works to support healthy pregnancies.

Why has the FDA decided to change their system of labeling prescription medications for use during pregnancy and breastfeeding?

FDA wants women and their health care providers to have useful and up-to-date information to help them make decisions about the benefits and risks of using prescription medicines during pregnancy and breastfeeding. The decision to change the labeling was based on several years of careful consideration and listening to healthcare providers, organizations and the general public about the pros and cons of the old system. We learned that the old system was somewhat confusing and not used consistently. The new Pregnancy & Lactation Labeling for prescription medicines will include more helpful information about a medication’s risks to pregnant women, the developing baby, and babies that are breastfed. Over-the-counter (also called, OTC) medicines that you get without a prescription are not affected by the new labeling rules.

How is the new labeling system different from the older system? What new information will I see on my prescription labels?

The biggest change for the new labeling system is that the letter categories are being phased out. The old system used five-letters (A, B, C, D and X) to categorize what is known about the risks of taking a medicine.  Instead of the letters, the new labeling will have a description of the known risks in sentence format.  The new labeling will also include information about the background risks of having a birth defect or miscarriage. Background risks  are risks that every woman starts out with, even if she does not take any medication.  Information about the risks of the medical condition on the pregnancy will be included, if known. In addition, there will be information on dose adjustments that may be needed in pregnancy.

FDA decided to eliminate the pregnancy letter categories because they were often misinterpreted as a grading system. Medications could have the same letter categories but have very different risks. People sometimes focused so much on the letters and did not focus on what the risk data actually said.

Will the new labels tell me if the medication will affect fertility?

The new labeling format includes a subsection called “Females and Males of Reproductive Potential”. This new section will include recommendations about birth control and pregnancy testing, if it’s a medication that should not be used in pregnancy because of a known or suspected risk. It will also include information about what is known about a medication’s effects on fertility if this information is available.

Some medications are more dangerous at certain times in pregnancy. Will the new labeling provide specific information for each trimester of pregnancy?

If there is information about effects in a specific trimester, it will be included in the labeling. The labeling will also include medical and disease factors that should be considered.

I’m breastfeeding. How can I find out if the medication I’m taking will be found in my breastmilk and if it will affect my baby?

The “Lactation” subsection will provide information, when it is known, about the amount of medication that is transferred into breastmilk and potential effects on the breastfeeding infant.

Will it be clear when a medication should be completely avoided during pregnancy or breastfeeding?

If a medicine should not be used during pregnancy or breastfeeding, this information will be clearly stated in the labeling.  If there are ways to minimize exposure to the breastfed infant, this information will be included as well.

When can I expect to see these changes?

The changes have already started. The new prescription labeling system went into effect on June 30, 2015.  New prescription medications approved on or after that date will immediately have the new format. For products approved on or after 2001, but prior to 2015, the changes will occur over the next several years.  Some products are not required to change to this new format but all prescription medications will be required to remove the pregnancy letter category.

The risk information included in drug labeling often comes from research. How can I participate in research?

The new labeling will include information about pregnancy exposure registries. A pregnancy exposure registry is a study that collects health information from women who take prescription medications or receive vaccines when they are pregnant. There are registries for a number of medications and vaccines. By signing up for a pregnancy exposure registry, you can help other pregnant women and prescribers find out more about the safety of medicines used during pregnancy.

If there is a pregnancy exposure registry available for a medication, you will see contact information in the medication labeling. FDA’s Office of Women’s Health keeps a web listing of registries that you can search by medication name or medical condition. Here’s the link: www.fda.gov/pregnancyregistries

In addition to the research information that will be included in the prescription medication labeling, FDA has information on the participation of women in clinical trials. FDA is also participating in a multi-Agency task force to address the participation of pregnant and lactating women in research.

There are some infections that you can get either before or during pregnancy that may cause complications for you and your baby. You can’t always prevent infections, but here are some tips that can help:

Wash your hands: Washing your hands regularly can help to reduce the spread of colds, the flu and other infections, like cytomegalovirus (CMV).

Wash your hands:

• Before preparing or eating food
• After handling raw meat, raw eggs or unwashed vegetables
• After being around pets or animals
• After changing diapers, wiping runny noses, or picking up toys

Prepare food properly: Handle foods safely whenever you wash, prepare, cook and store them. Wash knives, cutting boards and dishes used to prepare raw meat, fish or poultry before using them for other foods. Foods to avoid during pregnancy include raw meat, fish, and eggs and unpasteurized foods.

Get vaccinated: Vaccinations can help protect you and your baby from certain infections during pregnancy. Some vaccinations are safe to get during pregnancy, but others are not. Talk to your provider to make sure any vaccination you get during pregnancy is safe. Make sure your vaccinations are up to date before you get pregnant.

Protect yourself from Zika: If you get infected with the Zika virus during pregnancy, you can pass it to your baby. It causes a birth defect called microcephaly and other brain problems. Zika virus spreads through mosquito bites and through body fluids, like blood and semen.

• If you’re pregnant or trying to get pregnant, don’t visit a Zika-affected area unless absolutely necessary.
• Protect yourself from mosquito bites.
• If your male or female partner may be infected with Zika, use a barrier method (like a condom) every time you have sex or don’t have sex at all.
• If you’re pregnant and think you may have been exposed to Zika virus, see your health care provider right away.

Ask someone else to clean your cat’s litter box: If you have to do it yourself, wear gloves. Wash your hands thoroughly when you’re done emptying the litter. Dirty cat litter may contain toxoplasmosis, an infection caused by a parasite. Toxoplasmosis can cause health problems for your baby during pregnancy.

Get tested for sexually transmitted infections (STIs): STIs are infections you can get from having unprotected sex with someone who’s infected. If you’re pregnant and have an STI, it can cause serious problems for your baby, including premature birth and birth defects. Testing for STIs is a part of prenatal care. If you have an STI, getting treatment early can help protect your baby.

Talk to your health care provider: Talk to your provider about how to prevent infections, making sure that you’re up-to-date on your vaccinations before pregnancy, and what vaccinations you need during pregnancy.

Have questions? Text or email us at Askus@marchofdimes.org.

The loss of a baby is one of the most painful things that can happen to a family. If your baby died during pregnancy, in the first days of life, or even as an infant, you and your family may need support to find ways to deal with your grief and ease your pain.

October 15^th is Pregnancy and Infant Loss Remembrance Day – a time to pause and remember all angel babies.

It is important to know that parents and families are not alone in their grief. Connecting with others going through the same or a similar situation can help you process your grief. We invite all families to share and connect in our online community Share Your Story. The families in our community know what you are going through and can offer support during this devastating time and in the days ahead.

We provide resources that may help you understand what happened and how to deal with the daily pain of your loss. We encourage you to visit our website if you are looking for resources for families that have lost a baby or ways to remember your baby.

If you would like to receive our free bereavement materials, email us at AskUs@marchofdimes.org with your mailing address.

Loss affects entire families every day, in different ways. Read one heartfelt story of loss as seen through the eyes of a sibling.

The March of Dimes is so very sorry for your loss. We are here for you.

From September 15^th through October 15^th we celebrate Hispanic Heritage Month, a time where we recognize Hispanic culture, as well as achievements, and contributions Hispanics and Latinos have made to the United States.

According to the U.S. Census, there are approximately 57.5 million Hispanics in the United States– about 18% of the country’s total population and the largest ethnic or racial minority in the country. Despite this wonderful growth, there is concern over the health status of Hispanics/Latinos and their health outcomes. According to the Centers for Disease Control and Prevention (CDC), our community is at higher risk for diabetes. This is a disease that affects blood sugar. Over time diabetes can cause serious health problems and complications if not treated. Many things can increase the risk of diabetes (known as risk factors). Some factors cannot be controlled, such as family health history. But other factors, such as diet and physical activity, can be controlled. There are several things we can do to reduce the risk of this disease, live a healthy life, and celebrate our culture day by day. For example:

• Having a medical checkup every year is the key to prevention. Talk to your healthcare provider if someone in your family has diabetes (for example, your grandparents, parents, or siblings). Ask your provider about your risk factors and ask them to give you a diabetes test.
• Cook your favorite foods in a healthy way. Use vegetables and herbs to season your food. Peppers, onions, garlic, and cilantro are some of the basic and common ingredients in Latin cuisine. These ingredients provide rich flavor to any meal, and can help you cook with less salt. Instead of desserts or cookies, eat fresh fruit.
• You do not need to have a gym membership to be active. You can do things in your home or community. For example, dancing is an activity that helps you stay physically active. You can organize activities with other people who enjoy dancing, or you can dance at home with your children or with your partner.
• Avoid smoking, and second hand smoke. Do not let people smoke in your car or at home. Be careful about how much alcohol you consume or avoid it all together. All of this can cause serious health problems and cause complications if you already have diabetes.

If you and your partner want to have a baby, these recommendations can be helpful as you plan your pregnancy. Diabetes can make it harder to get pregnant; it can affect the fertility of you and your partner. Additionally, during pregnancy, diabetes can increase your risk of having a premature baby. That is why it is important to think about the health of your future baby before getting pregnant.

If you have more questions on this topic, or any others related to preconception health and pregnancy, you can email us at: askus@marchofdimes.org or preguntas@nacersano.org. Our bilingual health educators can help guide you and provide you with a list of questions you can ask your health care provider if you are at risk of getting, or have, diabetes and want to have a baby.

Depression is more than just feeling sad. It’s a medical condition that affects your thoughts, feelings, and even causes changes to your body. You may have depression if you have any of these signs that last for more than 2 weeks:

Changes in your feelings 

• Feeling sad, hopeless or overwhelmed
• Feeling restless or moody
• Crying a lot
• Feeling worthless or guilty

Changes in your everyday life 

• Eating more or less than you usually do
• Having trouble remembering things, concentrating or making decisions
• Not being able to sleep or sleeping too much
• Withdrawing from friends and family
• Losing interest in things you usually like to do

Changes in your body 

• Having no energy and feeling tired all the time
• Having headaches, stomach problems or other aches and pains that don’t go away

If you have any of these symptoms, talk to your health care provider.

Depression during pregnancy

If you’ve had depression before, you’re more likely than other women to experience depression during pregnancy. Being pregnant can make depression worse or make it come back if you’ve been treated in the past and were feeling better.

If you have depression during pregnancy and don’t get treatment, you may not feel well enough to make sure you are eating healthy foods and you may not gain the right amount of weight. You may miss prenatal care appointments or not follow medical instructions. Or you may smoke, drink alcohol, use street drugs or misuse prescription drugs. All of these things can affect your baby before he’s born.

Depression that is not treated during pregnancy can increase the risk of:

• Premature birth
• A low-birthweight baby (a baby weighing less than 5 pounds, 8 ounces)
• A baby who is more irritable, less active, less attentive and has fewer facial expressions than babies born to moms who don’t have depression during pregnancy.
• Postpartum depression.

Treatment for depression during pregnancy

It’s best if you work with a team of providers to treat your depression during pregnancy. These providers can work together to make sure you and your baby get the best care. They may include your prenatal care provider and a professional who treats your depression (such as a psychiatrist, psychologist, therapist, or counselor).

There are several treatment options available for depression during pregnancy including talk therapy, support groups and medicine, such as antidepressants. Make sure you talk to your health care provider about the best choice for you.

If you think you have depression during pregnancy, talk to your health care provider. You may need treatment to help you feel better.

Have questions? Text or email us at Askus@marchofdimes.org.

The March of Dimes recommends pregnant women receive the Tdap vaccine at 27 to 36 weeks of pregnancy. This vaccine protects against pertussis (also called whooping cough). Pertussis spreads quickly and is dangerous for your baby.

In a new study, researchers from the Centers for Disease Control and Prevention (CDC) found that receiving the Tdap vaccine in the third trimester of pregnancy prevented more than 78% of cases of whooping cough in babies younger than two months. The CDC has recommended pregnant women receive the Tdap vaccine since 2012, but these findings confirm that the vaccine is not only beneficial, but incredibly important in order to protect your baby after birth.

The study looked at babies younger than two months old from six states from 2011 through 2014. They learned that the mothers of babies who had whooping cough were less likely to have received the Tdap vaccine during their pregnancy.

Although these findings show how effective getting Tdap during pregnancy can be, researchers also found that only 49% of pregnant woman who had a baby between fall 2015 and spring 2016 received the vaccine.

Why are these results so important?

So far in 2017 there have been more than 11,000 cases of whooping cough in the U.S. Whooping cough is a serious disease that causes uncontrollable, violent coughing that can make it hard to breathe. Babies younger than one year of age are at the highest risk for severe complications, hospitalization or death.

Babies don’t receive their own whooping cough vaccine until two months of age. But if a pregnant woman gets vaccinated during the third trimester of pregnancy (between 27 and 36 weeks) she can pass her antibodies on to her baby and provide protection during these first two months. This study confirms that vaccination with the Tdap vaccine during pregnancy can prevent whooping cough in babies before they are able to receive their own vaccine.

If you’re pregnant, make sure you ask your prenatal care provider about when to schedule your Tdap vaccine so that you can protect your baby.

To see when it’s time for your baby’s whooping cough vaccine (and other immunizations), see our vaccination schedule.

Have questions? Text or email us at AskUs@marchofdimes.org.

Respiratory syncytial virus (RSV) is a common virus that infects the lungs and breathing passages. Almost all babies get it before the age of 2. Your baby can get RSV at any time of year, but it’s most common from November to April.

Symptoms of RSV

For most healthy children, the symptoms of RSV are similar to those of a cold and can last about two weeks. They can include:

• Cough
• Fever
• Irritability
• Runny nose
• Sneezing
• Sluggish or being inactive
• Trouble breathing
• Wheezing

Some babies have a high risk of getting severe RSV. This includes babies who were born premature, have lung problems, heart problems or other chronic illnesses. Severe RSV may lead to other serious infections, like:

• Bronchiolitis, an infection that causes swelling in the smallest air passages in the lungs
• Pneumonia, an infection in one or both lungs

RSV is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age.

If you notice any of these symptoms, call your baby’s health care provider right away:

• Cough that gets worse or she coughs up yellow, green or gray mucus
• High fever. High fever is a temperature greater than 100.4 F in babies younger than 2 months, 101 F in babies aged 3 to 6 months or 103 F in babies older than 6 months.
• Looks dehydrated
• Loss of appetite
• Thick nasal discharge
• Trouble breathing or mouth and fingernails look blue

Prevent the spread of RSV

You can help protect your baby from RSV by:

• Keeping her away from people who are sneezing or coughing
• Making sure everyone who touches the baby has clean hands
• Keeping your baby away from crowds of people
• Not allowing anyone to smoke near your baby

Treatment for RSV

There is no specific treatment for RSV. If your baby has RSV, you can help to relieve the symptoms by making sure she drinks lots of fluids, using a rubber suction bulb to help clear mucus from her nose, and using a cool-mist humidifier. If your baby has a fever, talk to her health provider about using acetaminophen.

Babies who are at high risk from severe RSV may benefit from medication that helps prevent RSV from becoming severe. This medication is called palivizumab. It is given in monthly injections during the fall and winter months. However, this medication does not prevent infection with RSV and it does not help cure or treat children who already have severe RSV. If your baby is a high risk for severe RSV, talk to her provider about whether palivizumab may be an option.

Have any questions? Email or text us at AskUs@marchofdimes.org.

The flu is more than just a runny nose and sore throat. It’s a serious disease that can make you very sick. The flu can be especially harmful if you get it during pregnancy or right after you’ve had your baby. Although it is only September, flu season is fast approaching. So now is the time to schedule flu shots for you and your whole family.

Who should get the flu vaccine?

Everyone 6 months and older should get an annual flu shot. It takes about two weeks after vaccination for your body to develop full protection against the flu. Getting the flu vaccine is especially important for children over 6 months, children with special needs, pregnant women and other high-risk groups.

Do you need to get a flu shot every year?

Yes! Flu viruses change every year, so just because you got a flu shot last year, doesn’t mean that you are protected this year. The flu shot is designed to protect against the flu viruses that are predicted to be the most common during the flu season. Also, immunity from vaccination decreases after a year. For these reasons, everyone needs a flu vaccine every year.

Are flu shots safe for pregnant women?

YES! All women who are pregnant should get a flu shot. It is safe to get the flu shot during pregnancy and it will protect you and your baby from serious health problems during and after pregnancy. However, remember that if you’re pregnant, the flu mist is not safe to use during pregnancy.

Why is the flu so harmful during pregnancy?

The flu can be dangerous during pregnancy because:

• Pregnancy affects your immune system. During pregnancy your immune system doesn’t respond as effectively to viruses and illnesses. This means you are more likely to catch the flu.
• You are more likely to have serious complications. Health complications from the flu, such as pneumonia and bronchitis, can be very serious and even deadly.
• Pregnant women who get the flu are more likely to have preterm labor and premature birth (before 37 weeks).

Will getting a flu shot protect your baby?

Getting the flu shot during pregnancy helps to protect your baby from the flu after he’s born. If you get the flu shot during pregnancy, you pass on your immunity to your baby. Some studies have shown that vaccinating a pregnant woman can give her baby antibodies to protect against flu for several months after birth. You baby should get his own flu vaccine at 6 months.

Where can you get a flu shot?

You can get the vaccine from your health care provider. Many pharmacies and work places also offer it each fall. You can use the HealthMap Vaccine Finder to find where the flu vaccine is available in your area.

The flu shot is the best way to protect you and your baby from the flu. You can learn more at flu.gov.

Have any questions? Email or text us at AskUs@marchofdimes.org.

Today’s post is from Nancy Hurst, director of Women’s Support Services at Texas Children’s Pavilion for Women, who will be discussing #Breastfeeding101 with us on Twitter on September 28, 2017 at 1pm EST / 12pm CST.

Here is a brief preview of the breastfeeding insight she will be providing in our #Breastfeeding101 chat.

As a board certified lactation consultant at Texas Children’s Hospital, I have heard it all! No breastfeeding experience looks the same and moms, whether it’s their first or last child, generally have many questions. Here is a look at what to expect:

The first few hours:

It’s important for new moms, when they are able, to attempt breastfeeding as quickly as possible after their baby is born. It is in this first round of feeding that babies get colostrum, a valuable, immune-boosting fluid.

While most babies are eager to latch onto their mother’s nipple, some infants need a little help the first few times. Moms, if your baby isn’t latching right away, don’t worry! It will happen.

You can help encourage latching by giving your newborn the best opportunity with extended skin-to-skin contact. This contact helps your baby relax and, eventually, you will begin to see signs that he or she is ready to feed. These signs can include: light fussing, increased alertness or changes in facial expression, rooting (opening their mouth and searching to suck on contact).

Positioning the baby is also key. Mothers should make sure to hold the baby in a position that has them facing your breast with your nipple near their mouth. Once you see a wide, open mouth, pull your baby in close and they are likely to latch on.

The first few days:

In the first few days, many moms may wonder if their baby is getting enough milk.

Remember the old saying, “What goes in, must come out?” The easiest way to figure out if your newborn is getting enough milk is to keep count of their wet and poopy diapers each day. If you have a smartphone, there are many apps that can help track this.

In the first few days of life, the number of diapers should equal about how many days old your baby is. Then, by the end of the first week, moms can expect at least six wet diapers and several poopy ones a day that are yellow and seedy.

Some moms may find themselves unable to breastfeed. In these cases, I cannot stress enough how valuable your support team is! This includes your obstetrician, pediatrician, lactation consultant, hospital staff, and your friends and family.

If a mom finds herself unable to breastfeed for any reason, there are now more resources than ever to still provide breastmilk to babies, such as pasteurized donor milk from a milk bank.

My one note of caution for moms turning to donor breast milk is to use only donor milk. Without thorough screenings of both the donor mother and the milk, you may be exposing your newborn to risks such as bacteria or viruses.

The first few weeks:

After the first few weeks, moms may begin to plan their return to work – this is where pumping comes in!

I routinely recommend that mothers wait to introduce a bottle for four to six weeks until breastfeeding is well established. Ideally, moms would have another person introduce the bottle to get baby used to food coming from someone else.

In order to get the best results, moms should aim to start pumping right after the first morning feeding.

Finally, I recommend the following three pieces of advice to breastfeeding moms:

1. Be informed. Learn about the importance of establishing milk production and the health benefits of breastfeeding for both the baby and mother.
2. Build your support network. Don’t be afraid to ask for help from any and all resources available to you.
3. Have confidence in yourself and your body! Use this time to enjoy this special relationship with your baby. Remember that it is not unusual to feel some discomfort. You can always turn to your lactation consultant for advice and to answer your questions.

Have questions? Email us at AskUs@marchofdimes.org.

Today’s guest post on the importance of recognizing Infant Mortality Awareness month is from Kweli Rashied-Henry, Director of Health Equity for the March of Dimes.

It gets me every time – the sound of a baby crying always tugs at my heartstrings. I know it is a common expectation for moms and dads to anticipate the sound of their infant calling out to them. A baby’s cry can signal many things, a need for food, touch, comfort or for someone to take the pain away. For too many parents, that sound goes unfulfilled or is cut short because their infant has passed away. September is the month that reminds us of the importance of infant mortality and the need for more support, resources, education and awareness.

In the US, babies still die before their first birthday at shockingly high rates. Although we have made great strides over the past two decades, many babies do not get a chance to fully begin their lives, let alone thrive. Infant mortality is one factor typically used in healthcare and public health to assess how well we are doing as a society. Approximately 4 million babies are born each year in the US. The 2015 infant mortality rate was 5.9 per 1,000 live births, which is one of the highest among highly developed countries. That means that over 23,000 infants died in the United States in 2015. Premature birth and birth defects are two of the major contributors to the infant mortality rate.

Infant health advocates have long promoted several strategies to decrease preterm birth rates that can ultimately reduce infant death. Care innovation, research, health education, and policy advocacy are strategies that March of Dimes and other national leaders have used to reduce preterm birth rates. However, one of the most alarming trends that has interfered with efforts to reduce premature birth and infant mortality is the persistent racial and ethnic disparities that exist in the US.

For instance in 2015, Black women had a 48% higher chance of delivering preterm than their counterparts, and were more than twice as likely to experience infant loss. Reasons behind these differences are varied and complex. Understanding the relationship between people and the impact that social factors can have on their health is important to achieve health equity — health for everyone, regardless of their income, education or racial/ethnic background. According to the March of Dimes, evidence suggests that social determinants of health, such as socioeconomic status (SES) at both individual and area/community levels (e.g., income/poverty, job status, education), as well as psychosocial factors (e.g. chronic stress, lack of social support) are associated with increased risk of adverse birth outcomes.

Our collective voices are critical to sounding the rallying cry that our babies so desperately need. Let it also include the importance of social supports that all moms and dads rely on to ensure that they are healthy in preparation for having healthy infants. September is the month to remember those babies who have passed away and to act by partnering with others to lend support for infant mortality prevention efforts. Remember a cry is a signal from a baby in need. Let our rallying cry signal the need for all babies to be born healthy, to grow and thrive.