Archive for the ‘Pregnancy’ Category

Opioids and birth defects–an update

Monday, June 26th, 2017

Prescription opioids are painkillers your health care provider may prescribe if you’ve been injured or had surgery. Prescription opioids include:pills

  • Codeine and hydrocodone (brand name Vicodin®)
  • Fentanyl (brand name Actiq®, Duragesic®, Sublimaze®)
  • Morphine (brand names Kadian®, Avinza®)
  • Oxycodone (OxyContin®, Percocet®)
  • Tramadol (brand names ConZip®, Ryzolt®, Ultram®)

Heroin also is an opioid.

Using opioids during pregnancy can cause problems for your baby, including:

  • Neonatal abstinence syndrome (also called NAS). NAS happens when a baby is exposed to a drug in the womb before birth and goes through withdrawal from the drug after birth. NAS most often is caused when a woman takes opioids during pregnancy. NAS can cause serious problems for a baby, like being born too small and having breathing problems. Even if you use an opioid exactly as your health care provider tells you to, it may cause NAS in your baby.
  • Birth defects.
  • Premature birth.
  • Preterm labor. Quitting opioids suddenly (going cold turkey) during pregnancy can cause preterm labor. Preterm labor can lead to premature birth.
  • Stillbirth.

Recently the CDC’s Treating for Two: Safer Medication Use in Pregnancy researchers reviewed a number of studies that had already been published regarding opioid use during pregnancy and birth defects. They found that the studies did show that using opioids during pregnancy may be linked to birth defects including cleft lip and cleft palate, congenital heart defects, and clubfoot. But many of the studies they looked at had problems with the way the study was done and the quality of the study.

According to the CDC, “More research is needed to understand the connections between individual types of opioids and specific birth defects. Until more is known, women of childbearing age and their healthcare providers should discuss risks and benefits when considering opioid treatment.”

If you are taking a prescription opioid, or any other medication during pregnancy remember:

  • Don’t take more medicine than your health care provider says you can take.
  • Don’t take it with alcohol or other drugs.
  • Don’t use someone else’s prescription medicine.

If you’re pregnant and need help to stop using opioids, taking drugs like methadone or buprenorphine may help you quit. These drugs can help you reduce your need for opioids in a way that’s safe for you and your baby. Talk to your health care provider to see if this kind of treatment is right for you.

If you need help to stop abusing prescription drugs, talk to your health care provider. Or contact:

Have questions? Send them to our Health Education Specialists at AskUs@marchofdimes.org.

Q and A for CMV

Friday, June 23rd, 2017

bellyYou may have heard of CMV because it’s the most common virus passed from mothers to babies during pregnancy.

Cytomegalovirus, also called CMV, is a kind of herpesvirus. There are many different kinds of herpesviruses – some of which are sexually transmitted diseases, but others can cause cold sores or infections like CMV.

Q. Who gets it?

A. Many people get CMV at some point in their lives, most often during childhood. Most people with CMV have no signs or symptoms but some may have a sore throat, a fever, swollen glands, or feel tired all the time.

Q. Is CMV dangerous?

A. It can be  – CMV can pass to your baby at any time during pregnancy, labor and delivery and even while breastfeeding. If you have CMV during pregnancy, there is a 1 in 3 chance it will pass to your baby. Eighty percent of babies born with CMV never have symptoms or problems caused by the infection. But about fifteen percent of babies develop a disability such as hearing loss, vision loss or an intellectual disability like trouble learning or communicating.

Q. Can you find out if you or your baby have CMV?

A. Yes. You can have a blood test done during pregnancy to test for CMV. And you can have prenatal tests to see if your baby has CMV. After birth, your baby’s bodily fluids like her urine and saliva can be tested for CMV. Some babies with CMV will have signs or symptoms at birth, but many will appear healthy so testing is important.

Q. Is there any treatment?

A. Yes. If your baby was born with CMV, she may be treated with antiviral medicines to kill the infection. Scientists are working to develop a vaccine for CMV.

In the meantime, remember to always wash your hands well after being in contact with body fluids, when changing diapers or wiping noses, and carefully throw diapers and tissues away. Don’t kiss young children on the mouth or cheek and don’t share food, glasses and eating utensils with children or anyone who may have CMV. These precautions can help you protect yourself and your baby.

Q. If you had CMV in a previous pregnancy, what are the chances you may get it again in another pregnancy? See this post for answers.

If you think you may have (or had) CMV, be sure to talk to your prenatal care provider. See our article to learn more about CMV including treatments.

Questions? Email AskUs@marchofdimes.org.

Preeclampsia: Impact on mom and baby

Wednesday, June 21st, 2017

May was Preeclampsia Awareness Month. We blogged about the signs, symptoms and causes of preeclampsia and how it may lead to premature birth. We also hosted a Twitter chat with Dr. Kjersti Aagaard of Texas Children’s Pavilion for Women, which generated some follow-up questions.

We’re happy to welcome back Dr. Aagaard and her colleague Dr. Martha Rac as guest bloggers. Both doctors are maternal-fetal medicine specialists at Texas Children’s. They will share some insight into who is most at risk of developing preeclampsia and how it can impact both mom and baby.

First, we must ask, who is at the highest risk for developing preeclampsia?

 Risk factors for preeclampsia include:

  • First time mothers
  • Pregnancy with a new partner than previous pregnancies – different partners may have varying genetic factors that may increase preeclampsia risk
  • Older mothers (>35 years old)
  • Black women
  • Medical problems including chronic high blood pressure, kidney disease, lupus, diabetes and heart disease
  • Pregnancies with multiples (twins, triplets, etc.)
  • Obesity
  • Preeclampsia in prior pregnancies
  • IVF pregnancies – particularly those with donor eggs. This is thought to occur as a result of genetic differences between the mother and fetus, causing the mother’s immune system to attack the “foreign” fetal tissue and cause excess inflammation.

In addition to the risk factors above, mothers with pregnancies spaced too closely together or very far apart can be at risk. Too close may be defined as 18 months or less and far apart as 4-5 years between pregnancies.

How does preeclampsia affect pregnancy?

Preeclampsia is classified as either mild or severe based on a woman’s symptoms, and how severely it affects her organs. It is a progressive disorder, which means that mild cases will eventually develop into severe preeclampsia, if not treated.

Preeclampsia can be very dangerous to both the mother and the baby. The very high blood pressure associated with preeclampsia can result in anything from seizures, stroke, liver and kidney dysfunction, bleeding problems, placental detachment and even death if left untreated.

If a mother-to-be suspects she may be experiencing preeclampsia, she should contact her doctor immediately.

How does preeclampsia impact the baby?

 This dangerous disorder can cause the baby’s growth to be restricted and increases the risk of stillbirth. In the most severe cases, preterm delivery may be required which may then expose the baby to the complications of prematurity such as under-developed organs, breathing difficulties, jaundice, anemia, a lowered immune system, etc.

In the worst cases, fetal death can occur from a sudden detachment of the placenta from the uterus.

For these reasons, women diagnosed with preeclampsia undergo additional monitoring such as: ultrasounds every 4 weeks to evaluate fetal growth, lab work to determine if there is multi-organ involvement, etc. and delivery no later than 37 weeks.

If you are worried you are at risk of developing this dangerous disorder, please be sure to consult with your doctor and discuss your concerns immediately.

Dr. Kjersti AagaardDr. Martha Rac

 

 

 

 

 

 

Many thanks to Dr. Aagaard  (left) and Dr. Rac  (right) for contributing their expertise. 

If you have questions, send them to AskUs@marchofdimes.org.

 

 

What’s one often forgotten, but very important, “must do” during pregnancy?

Monday, June 19th, 2017

teethThere are so many “do’s and don’ts” during pregnancy that it’s sometimes hard to keep track of them all. But one important “do” that sometimes gets overlooked is the need to keep up with oral care.

Somehow, brushing your teeth and going for regular dental cleanings seem to fall down on the list. But did you know that at-home and professional dental care are also important parts of a healthy pregnancy?

Pregnancy can affect dental health

During pregnancy, your changing hormones may affect the way your body reacts to plaque that builds up on your teeth. The result can be redness, swelling and bleeding gums called “pregnancy gingivitis.” In fact, nearly 70% of women experience gingivitis during pregnancy.

You also have more blood flowing through your body and more acid in your mouth when you are pregnant. All these changes mean you are more likely to have dental problems, such as loose teeth, gum disease, non-cancerous “pregnancy tumors” which form on your gums, tooth decay and even tooth loss. (See our article for more details on any of these dental issues.)

What’s the answer?

Consider oral care a “must do” on your healthy pregnancy list. Regular professional dental care as well as a good daily oral routine (brushing, flossing) are very important parts of your pregnancy.

Brushing your teeth is something that you’ve done since childhood. Even going to the dentist is something that (hopefully) you are doing regularly. Dental exams help to prevent tooth decay and gingivitis (gum inflammation), and let’s face it – your teeth look sparkly clean afterwards!

Bottom line

Take your prenatal vitamins, get plenty of rest, eat well, stay active, keep up with brushing your teeth, AND go to your prenatal and dental appointments.

Your smile and baby will thank you.

 

Have questions? Email AskUs@marchofdimes.org

Heat and pregnancy – what’s dangerous and how to cope

Wednesday, June 14th, 2017

heatIf you live in the northeast, you know we’ve been experiencing a heat wave. Just going from my car to the front door of the office seems too far to walk in this heat. If you’re pregnant, having an increased exposure to heat may cause problems for you or your baby.

Exposure to excessive heat affects people differently. When you are pregnant, your body works hard to cool you and your baby. So, if you are pregnant, you are more likely to develop a heat related illness sooner than someone who is not pregnant.

Heat illnesses occur when your body’s efforts to cool itself (eg. sweating) are no longer effective. Heat illnesses include a rash often known as “prickly heat,” cramps, fainting, heat exhaustion and heat stroke.

Heat exhaustion symptoms include a headache, nausea, dizziness, heavy sweating, weakness, thirst, being irritable, and having an increased body temperature.

Heat stroke is an emergency condition. It is when your body temperature goes above 104 degrees Fahrenheit. Symptoms include hot and dry skin or extreme sweating, a rapid pulse, throbbing head-ache, dizziness, nausea, confusion, slurred speech, loss of consciousness, and seizures. If untreated, it could result in permanent organ damage or even death. Seek medical attention or contact 911 immediately if someone you know has these symptoms.

Prevention is key

It is important that you take steps to stay cool and prevent heat related conditions, especially if you are pregnant. Here’s how:

  • Stay hydrated. Drink water frequently. Don’t wait until you’re thirsty to drink.
  • Stay in rooms with air-conditioning.
  • Avoid going outdoors during peak heat hours (11am – 3pm).
  • If you must go outdoors, stay in the shade, limit your physical activity, and stay hydrated. Use a cold or wet cloth to cool down by putting it on the inside of your wrists or forehead so you don’t get too hot.

Keep kids out of the heat, too

One more thing…each year at about this time, we hear of children being left in a hot car “for just a few minutes.” Tragic deaths from heat stroke can occur from leaving a child in an overheated closed car for a very short while.

Never leave a child unattended in a closed car – NEVER.

Children don’t have the same chemical makeup as adults, making it harder for their bodies to regulate temperature. Take steps to protect your child from heat-related illnesses by setting reminders. Here are a few tips to prevent a tragedy, from the American Academy of Pediatrics.

Have questions? Send them to AskUs@marchofdimes.org.

Get outdoors but know how to protect yourself

Friday, June 9th, 2017

Family walking outdoorsTomorrow is National Get Outdoors Day. Now that the weather has warmed up, getting outside is a welcomed change in most parts of the country.

But getting outdoors has its own set of challenges – from bug bites to sunburn. Here’s a quick rundown on how to stay safe when heading outdoors, especially if you’re pregnant.

Bugs that bite and spread diseases

Ticks – In many areas of the country, especially wooded areas or places with high grass, Lyme disease is spread by ticks. Untreated Lyme disease can have cause complications during pregnancy.

Mosquitos – If you’re traveling, be sure to check the CDC’s map to see if the Zika virus is active in the area where you are heading. The Zika virus spreads through mosquito bites and through body fluids like blood or semen. If you’re pregnant, or thinking of becoming pregnant, don’t visit a Zika-affected area. Zika virus during pregnancy can cause serious birth defects.

What should you do?

Use an insect repellant (a product that keeps insects from biting you), like bug spray or lotion, that’s registered with the Environmental Protection Agency (also called EPA). All EPA-registered bug sprays and lotions are checked to make sure they’re safe and work well.

Make sure the product contains one or more of these substances that are safe to use during pregnancy and breastfeeding: DEET, picaridin, oil of lemon eucalyptus, para-menthane-diol, IR3535 and 2-undecanone. If the product contains DEET, make sure it has at least 20 percent (20%) DEET.

Don’t put bug spray or lotion on your skin under clothes. If you use sunscreen, put it on before the spray or lotion.

If you have children: Most bug sprays and lotions are safe to use on babies 2 months and older, but don’t use products that contain oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years. Don’t put the spray or lotion on your baby’s hands or near her eyes or mouth. Don’t put the spray or lotion on cut, sore or sensitive skin.

Protect yourself from the sun

Nothing will stop your outdoor fun faster than a nasty sunburn. Sunscreen is important whenever you are outside, especially if you are pregnant. During pregnancy your skin is more sensitive to sunlight than it was before pregnancy. The sun gives off ultraviolet radiation (UV) which can increase the risk of skin cancer, give you a bad burn and increase signs of aging.

What can you do?

Before heading outside, lather up with a sunscreen that has a sun protection factor (SPF) of 30 or higher. Use only products that have UVA and UVB or Broad Spectrum protection products. Apply sunscreen at least 15 minutes before heading outdoors and reapply every 2 hours.

If you’re sensitive to sunscreens, try one with zinc oxide or titanium dioxide as they are not as irritating to the skin. You can also cover up by wearing long sleeves and pants, and a wide brimmed hat.

Don’t use products that combine bug repellant with sunscreen. It’s important to reapply sunblock every two hours. If you use a combination product, you’ll be reapplying the bug repellant chemicals as well – not good. Too much bug repellant can be toxic. So, to be on the safe side, keep these products separate, or use the combination product once, and then apply sunblock only every two hours afterward.

Don’t choose a product with retinyl palmitate, especially if you are pregnant. This type of vitamin A has been linked to an increased risk of skin cancer and is associated with birth defects.

Check the expiration date and don’t use it if it is expired. If your sunscreen does not have a date, write one on your bottle after purchasing. Sunscreens retain their original strength for three years.

Here are tips for keeping your baby safe while outdoors.

With a little planning and care, you can get outdoors and enjoy yourself tomorrow. Enjoy!

 

Too much? Too little? Or just right?

Tuesday, June 6th, 2017

pregnant-woman-on-weight-scale-shrunkWeight gain seems to always be one of the topics of conversation for pregnant women. “How much should I gain?” “How do I stay healthy?” Turns out, how much weight you gain during pregnancy is very important.

Gaining the right amount of weight during pregnancy can help protect your health and the health of your baby. And gaining too much or too little can be harmful.

So how much weight gain is recommended?

Your health care provider uses your body mass index (BMI) before pregnancy to figure out how much weight you should gain during pregnancy. BMI is your body fat based on your height and weight.

  • Underweight = BMI less than 18.5
  • Healthy weight = BMI 18.5 to 24.9
  • Overweight = BMI 25 to 29.9
  • Obese = BMI more than 30

If you’re pregnant with one baby, the recommendations are as follows:

  • If you were underweight before pregnancy, you want to gain about 28 to 40 pounds during pregnancy.
  • If you were at a healthy weight before pregnancy, you want to gain about 25 to 35 pounds during pregnancy.
  • If you were overweight before pregnancy, you want to gain about 15 to 25 pounds during pregnancy.
  • If you were obese before pregnancy, you want to gain about 11 to 20 pounds during pregnancy.

And while you don’t want to gain too much or too little weight, don’t ever try to lose weight during pregnancy. If you have questions about healthy weight gain during pregnancy, talk to your health care provider.

Preeclampsia can lead to premature birth

Friday, May 26th, 2017

woman with physicianPreeclampsia is a serious health problem for pregnant women around the world. It affects 2 to 8 percent of pregnancies worldwide and is the cause of 15 percent (about 1 in 8) of premature births in the United States. Women with preeclampsia are more likely than women who don’t have preeclampsia to have preterm labor and delivery. Even with treatment, a pregnant woman with preeclampsia may need to give birth early to avoid serious problems for her and her baby.

What is preeclampsia?

Preeclampsia is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. This condition can happen after the 20th week of pregnancy or right after birth. Preeclampsia can be a serious medical condition. Without medical treatment, preeclampsia can cause kidney, liver and brain damage. It can also cause serious bleeding problems. In rare cases, preeclampsia can become a life-threatening condition called eclampsia that includes seizures. Eclampsia sometimes can lead to coma and even death.

Know the signs and symptoms:

  • Severe headaches
  • Vision problems, like blurriness, flashing lights, or being sensitive to light
  • Pain in the upper right belly area
  • Nausea or vomiting
  • Dizziness
  • Sudden weight gain (2 to 5 pounds in a week)
  • Swelling in the legs, hands, and face

If you have any of these signs or symptoms, contact your prenatal care provider right away.

Preeclampsia can develop gradually, or have a sudden onset, flaring up in a matter of hours. You can also have mild preeclampsia without symptoms. It’s important that you go to all of your prenatal care visits so your provider will measure your blood pressure and check your urine for protein.

How is preeclampsia treated?

The cure for preeclampsia is the birth of your baby. Treatment during pregnancy depends on how severe your preeclampsia is and how far along you are in your pregnancy. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse. Treatments may include medications to lower blood pressure, corticosteroids or anticonvulsant medications to prevent a seizure.  If not treated, preeclampsia can cause complications during pregnancy and result in premature birth.

What causes preeclampsia?

We don’t know what causes preeclampsia, but you may be more likely than other women to have preeclampsia if you:

If your provider thinks you’re at high risk of having preeclampsia, he may want to treat you with low-dose aspirin to help prevent it. Talk to your provider to see if treatment with aspirin is right for you.

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

Cooking out this weekend?

Wednesday, May 24th, 2017

pregnant couple with grocery bagMemorial Day weekend is prime time for cookouts and family gatherings. And there’s one activity that can always bring people together – eating! Whether you’re hosting or preparing a side dish, be sure you take precautions in your preparations and in how your dish is served. These tips are especially important for pregnant women.

Before you begin your prep, here’s some tips to ensure your meal is a success:

  • Wash your hands. And then wash all of your fruits and vegetables and cut away any damaged sections.
  • Keep your raw meats and the tools you used to prepare them and keep them separate from the rest of your foods and supplies.
  • Make sure your meats such as hamburgers and grilled chicken are cooked thoroughly.
  • Be sure any salads and dishes with mayonnaise are kept cold and out of the sun.
  • Be sure to put leftovers away quickly – within 2 hours after eating.

Why the extra precaution?

Bacteria from foods can cause Salmonella and Listeriosis, both of which can be harmful to pregnant women.

Listeriosis is a kind of food poisoning caused by Listeria bacteria. This type of bacteria can come from hot dogs, unwashed fruits and vegetables and cold salads.

Salmonella is another kind of food poisoning caused by Salmonella bacteria. You can find this kind of bacteria in undercooked poultry, meat, fish or eggs.

If you’re pregnant, one of these types of food poisoning can cause serious problems for you and your baby, including premature birth, miscarriage and stillbirth. This is why it’s important to prepare your foods properly and serve foods that are safe. Your guests will be sure to thank you for a wonderful cookout and great company.

Have questions about a certain dish you are planning to make? Text or email us at AskUs@marchofdimes.org

Neonatal abstinence syndrome

Monday, May 22nd, 2017

infant crying“The March of Dimes has made it a priority to help and support women and infants affected by opioid use and other substance use disorders,” says Stacey D. Stewart, president of the March of Dimes. “There are few things more tragic than an infant starting out life in drug withdrawal.  We owe it to these babies to do everything in our power to ensure they are treated appropriately and can recover fully from drug exposure.”

Neonatal abstinence syndrome (NAS) happens when newborns go through drug withdrawal shortly after birth because they were exposed to drugs in the womb. In the United States, the number of babies born with NAS has been increasing. The Centers for Disease Control and Prevention (CDC) estimates that the number of babies with NAS has tripled from 1999 to 2013.

What drugs can cause NAS?

One of the most common causes of NAS is maternal use or abuse of opioids during pregnancy. Opioids are painkillers your provider may recommend if you’ve been injured or had surgery. Some common opioids that may be prescribed include:

  • Codeine and hydrocodone (Vicodin®)
  • Morphine (Kadian®, Avinza®)
  • Oxycodone (OxyContin®, Percocet®)

Heroin is also an opioid. Using it during pregnancy can cause your baby to be born with NAS.

In addition to opioids, these drugs can lead to NAS too:

  • Certain antidepressants (prescription drugs used to treat depression)
  • Benzodiazepines (sleeping pills)

What are the signs and symptoms of NAS?

Babies may exhibit different signs of NAS. Most babies will show symptoms within 3 days (72 hours) of birth, but sometimes symptoms will appear soon after birth or a few weeks later. Signs and symptoms can include:

  • Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone
  • Fussiness, excessive crying or having a high-pitched cry
  • Poor feeding, poor sucking or slow weight gain
  • Breathing very fast
  • Fever, sweating or blotchy skin
  • Trouble sleeping and lots of yawning
  • Diarrhea or throwing up
  • Stuffy nose or sneezing

NAS can last from 1 week to 6 months after birth.

How is a baby with NAS treated?

Treatment for NAS may include:

  • Taking medicines to treat or manage severe withdrawal symptoms. Your baby’s provider may give her a medicine that’s similar to the drug you used during pregnancy. This can help relieve your baby’s withdrawal symptoms. Once these symptoms are under control, your baby gets smaller doses of the medicine over time so her body can adjust to being off the medicine. Medicines used to treat severe withdrawal symptoms include morphine, methadone and buprenorphine.
  • Getting IV fluids. Babies with NAS can get very dehydrated from having diarrhea or throwing up a lot. If a baby’s dehydrated, she doesn’t have enough water in her body. Getting fluids through an IV helps keep your baby from getting dehydrated.
  • Drinking higher-calorie baby formula. Some babies with NAS need extra calories to help them grow because they have trouble feeding or aren’t growing properly. slow growth.

Most babies with NAS who get treatment get better in 5 to 30 days.

Research

The March of Dimes, together with the CDC, has awarded grants to conduct one-year of surveillance on neonatal abstinence syndrome (NAS) in three states with high rates of NAS:  Vermont, Illinois, and New Mexico. The project will enable each state to conduct enhanced identification of babies born with NAS and evaluate the health services needed by these babies through one year of age.

If you or someone you know is pregnant and struggling with drug use, please share these resources:

Have questions? Text or email AskUs@marchofdimes.org