“Spread Prevention, Not the Infection” during Pregnancy: Listeria

23
Jan
Posted by Sara

This year the theme of  National Birth Defects Prevention Month is Prevent to Protect. This week we will be posting a series of guest posts from MotherToBaby’s Kirstie Perrotta, MPH, Lorrie Harris-Sagaribay, MPH, Robert Felix and Susan Sherman of the Organization of Teratology Information Specialists (OTIS) Zika Task Force. Each day they will respond to one of the top five questions they receive about preventable infectious diseases and what you can do to prevent exposure during pregnancy.

“It’s 2018! I didn’t even know you could get syphilis nowadays!” Yes, I mentioned the stats about syphilis and other infections that can affect pregnancy to the caller who had contacted me through our free MotherToBaby helpline. I thought, this is a great time to educate her as well as others about a variety of infections. Some infections, like Zika, seem to make headlines every week, while others tend to be discussed much less frequently. January is National Birth Defects Prevention Month, and this year’s focus is on infection prevention.

I just ate unpasteurized cheese and I’m worried I have Listeria. What symptoms should I watch for? Do I need to be tested?

Eating unpasteurized cheese does put you at risk for a Listeria infection (called listeriosis). So during your pregnancy it’s important to avoid unpasteurized cheeses and other foods made with unpasteurized milk. The US Food and Drug Administration has developed additional food safety guidelines specific to pregnancy.

While listeriosis has not been found to cause birth defects, it can increase the risk for miscarriage, preterm delivery, and still birth. It also increases the risk of infection in newborns which can result in very serious long-term complications for baby.

Not everyone who is infected with Listeria will have symptoms, but some will have mild to severe symptoms that appear a few days or even weeks after eating contaminated food. Symptoms of a Listeria infection to watch for may include: diarrhea, fever, muscle aches, joint pain, headache, backache, chills, sore throat, swollen glands, and sensitivity to light.

Since not everyone has symptoms, it is important to be tested if you think you might have listeriosis. Your health care provider can order a simple blood test to confirm a Listeria infection. Treatment will reduce the risks of infection for you and your baby.

Other posts in the series:

“Spread Prevention, Not the Infection” during Pregnancy: Zika

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

About MotherToBaby 

MotherToBabyis a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.

“Spread Prevention, Not the Infection” during Pregnancy: Zika

22
Jan
Posted by Sara

This year the theme of  National Birth Defects Prevention Month is Prevent to Protect. This week we will be posting a series of guest posts from MotherToBaby’s Kirstie Perrotta, MPH, Lorrie Harris-Sagaribay, MPH, Robert Felix and Susan Sherman of the Organization of Teratology Information Specialists (OTIS) Zika Task Force. Each day they will respond to one of the top five questions they receive about preventable infectious diseases and what you can do to prevent exposure during pregnancy.

“It’s 2018! I didn’t even know you could get syphilis nowadays!” Yes, I mentioned the stats about syphilis and other infections that can affect pregnancy to the caller who had contacted me through our free MotherToBaby helpline. I thought, this is a great time to educate her as well as others about a variety of infections. Some infections, like Zika, seem to make headlines every week, while others tend to be discussed much less frequently. January is National Birth Defects Prevention Month, and this year’s focus is on infection prevention.

One of our most common Zika questions comes from couples who have just returned home after a tropical vacation: How long do we need to wait to get pregnant after returning from a country with Zika, and what should we do in the meantime to minimize risk? Can we be tested?

Many countries continue to see active transmission of Zika virus from infected mosquitoes. If a woman is infected with Zika during pregnancy, it can increase the risk of microcephaly (small head and brain) and other severe brain defects. It may also cause eye defects, hearing loss, seizures, and problems with the joints and limb movement. That’s why it’s so important for couples who are planning a pregnancy to make sure the virus is completely out of their bodies before they attempt to conceive.

So, how long do couples need to wait? The Centers for Disease Control and Prevention (CDC) recommends that women who travel to a country with Zika wait at least two months before attempting to get pregnant. If a male partner travels, the CDC recommends waiting six months. Some callers ask, “Why so long? We’re ready to get pregnant now!” Although the virus is expected to leave most people’s blood in about two weeks, this could vary depending on a number of factors including their own immunity. The CDC considers 2 months to be a long enough wait time for women. As for men? Zika has been found in the semen for up to 6 months after a man is first infected. The six-month wait time ensures that men do not pass the virus to their partners during intercourse if it is still present in their semen.

Practicing safe sex is important during these wait times! Since Zika can spread through sexual contact, using condoms or dental dams is recommended every time a couple has intercourse. Don’t want to use protection? 100% abstinence is another option. These safe sex precautions significantly reduce the risk of transferring the virus from one partner to another during these important wait times.

Couples who want to get pregnant right away will often ask, “Instead of waiting, isn’t there a way my doctor can just test me for the virus?” Unfortunately, the answer to that question is not so simple. The CDC does not recommend testing as a way to know if it’s “safe” to get pregnant. For one reason, the virus could have already left your blood, but could still be hanging out in other areas of the body (like semen). In this case, you could get a negative blood test result, but still have the virus. Second, no test is 100% accurate. There’s always a chance that your result could be a false negative, especially if you are tested too soon or too late after returning home from a country with Zika.

So, the bottom line? It’s a waiting game. Couples should follow the CDC’s official recommendations to make sure their pregnancy has the healthiest start possible. Still have questions or concerns about Zika? Check out Zika Central on MotherToBaby.org or call us at 866-626-6847 to speak with a specialist who can assess your specific exposure.

About MotherToBaby 

MotherToBabyis a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.

Worried about the flu?

19
Jan
Posted by Sara

By now you’ve probably heard that flu activity is widespread throughout the United States. If you’re pregnant or have a baby, here’s some information that may help during this flu season.

Signs and symptoms of the flu

Common signs and symptoms of the flu include:

  • Cough or sore throat
  • Feeling very tired
  • Fever, chills, or body shakes
  • Headaches
  • Muscle or body aches
  • Runny or stuffy nose
  • Not being hungry
  • Vomiting (throwing up) and diarrhea (more common in children)

Fever and most other symptoms can last a week or longer. Some people can be sick from the flu for a long time, including children, people older than 65, pregnant women and women who have recently had a baby.

Treating the flu

If you think you or anyone in your family may have the flu, call your health care provider right away. She may prescribe an antiviral medicine to prevent or treat the flu. Antivirals kill infections caused by viruses. They can make the flu milder and help you feel better faster. Antivirals also can help prevent serious flu complications, like pneumonia. For flu, antivirals work best if you take them within 2 days of having symptoms.

If you’re pregnant and have a fever, call your provider as soon as possible and take acetaminophen.

If your baby has a fever, ask her provider if you can give her infant’s or children’s acetaminophen or ibuprofen.

Protect yourself and others from the flu

When you have the flu, you can spread it to others. Here’s what you can do to help prevent it from spreading:

  • Stay home when sick and limit contact with others.
  • Don’t kiss anyone.
  • Cough or sneeze into a tissue or into your arm. Throw used tissues in the trash.
  • Try not to touch your eyes, nose or mouth.
  • Wash your hands with soap and water before touching anyone. You also can use alcohol-based hand sanitizers. Use enough hand sanitizer so that it takes at least 15 seconds for your hands to dry.
  • Use hot, soapy water or a dishwasher to wash your dishes and utensils.
  • Don’t share your dishes, glasses, utensils or toothbrush.

Is it too late to get a flu shot?

No it’s not too late! You can still get a flu shot. Getting a flu shot is safe for most pregnant women and it can help prevent you from getting the flu. The flu shot may make your symptoms milder and prevent complications if you do get sick. You can get the shot from your health care provider or pharmacies. Use the HealthMap Vaccine Finder to find out where you can get the flu vaccine.

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

Get vaccinated before you get pregnant

17
Jan
Posted by Sara

If you are planning a pregnancy, it is very important to make sure that you are up-to-date on all of your vaccinations. Vaccinations help protect you from infection and you pass this protection to your baby during pregnancy. This helps keep your baby safe during the first few months of life until he gets his own vaccinations.

Why do adults need vaccinations?

You probably got vaccinations as a child, but they don’t all protect you your whole life. Over time, some childhood vaccinations stop working, so you may need what’s called a booster shot as an adult. And there may be new vaccinations that weren’t available when you were young. Talk to your provider to make sure you’re fully protected with vaccinations.

What vaccinations do you need before pregnancy?

Before you get pregnant, you should make sure that you are up-to-date on all your routine adult vaccinations, including:

  • Flu. Get the flu vaccine once a year before flu season (October through May). There are many different flu viruses, and they’re always changing. Each year a new flu vaccine is made to protect against three or four flu viruses that are likely to make people sick during the upcoming flu season. If you come down with the flu during pregnancy, you’re more likely than other adults to have serious complications, such as pneumonia.
  • HPV. This vaccine protects against the infection that causes genital warts. The infection also may lead to cervical cancer. The CDC recommends that women up to age 26 get the HPV vaccine.
  • MMR. This vaccine protects you against the measles, mumps and rubella.
  • Varicella. Chickenpox is an infection that causes itchy skin, rash and fever. It’s easily spread and can cause birth defects if you get it during pregnancy. It’s also very dangerous to a baby. If you’re thinking about getting pregnant and you never had the chickenpox or the vaccine, tell your provider.

There are some vaccines that are not safe to get during pregnancy, so make sure you get them before you get pregnant. Once you get these vaccinations, you should wait at least one month before you try to get pregnant.

  • BCG (for tuberculosis)
  • Meningococcal
  • MMR
  • Typhoid
  • Varicella

If you’re thinking about getting pregnant, schedule a preconception checkup, so your health care provider can make sure you are up-to-date with all of your vaccinations.

And if you just had a baby, it’s a good time to get caught up on any vaccinations that you missed before or during pregnancy. This can help protect you from diseases in future pregnancies. If you’re breastfeeding, it’s safe for you to get routine adult vaccines. Ask your health care provider if you have questions.

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

Chickenpox and pregnancy – what you need to know

16
Jan
Posted by Lauren

You probably don’t need to worry about chickenpox (also called varicella) if you’ve had it before or if you’ve had the chickenpox vaccine. Both of these can help make you immune to chickenpox. Immune means being protected from an infection. If you’re immune to an infection, it means you can’t get it. About 9 out of 10 pregnant women (90 percent) are immune to chickenpox.

Usually people get chickenpox during childhood. It’s caused by a virus and you can get it by being in contact with someone else’s chickenpox rash or through the air when someone with chickenpox coughs or sneezes. An infected person can spread chickenpox starting 1 to 2 days before the rash appears and until the rash stops spreading and is covered by dry scabs. This is about 5 days after the rash starts.

Chickenpox usually isn’t dangerous in children. But if you get it during pregnancy, chickenpox can be harmful to your unborn baby or newborn. Chickenpox during pregnancy may cause some babies to get congenital varicella syndrome. This is a group of birth defects that can include problems with muscles and bones, blindness, seizures, learning problems, and microcephaly. Also, 1 to 2 out of 10 pregnant women (10-20%) who get chickenpox get a dangerous form of pneumonia (a kind of lung infection).

The good news is that if you haven’t had chickenpox already, the best way to protect yourself is to get the vaccine before getting pregnant. But if you’re already pregnant, you’ll need to wait until after you give birth to get the vaccine. So if you’re pregnant or planning to get pregnant and you’re not sure if you’ve had chickenpox or the vaccine, talk to your health care provider. You can get a blood test to find out if you’re immune to chickenpox.

If you’re pregnant and find out that you’re not immune to chickenpox, try to avoid anyone who has chickenpox or shingles. If you come into contact with someone who has it, tell your health care provider right away. Treatment is available, but it’s important to get it within 4 days after you’ve come into contact with chickenpox to help prevent the infection or make it less serious.

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

#ShowYourLove by being your healthiest self

12
Jan
Posted by Sara

January is National Birth Defects Prevention Month. Today’s guest post is from Suzanne Woodward, Communications Director at the National Preconception Health and Health Care Initiative (PCHHC), to help raise awareness on the steps women can take to be as healthy as possible before having a baby.

Love it or hate it, January is a great time to reflect, set intentions, and start fresh. The bustle around “New Year, Healthier You” is a great opportunity to let yourself be motivated by and encourage others to take steps toward your health and life goals. What did you love about 2017 that you want to keep in your life? What new experiences or attitudes would you like to welcome into this New Year? What support do you need to make this happen? Is starting a family or growing your family in the cards for 2018? This is the cornerstone theme for the #ShowYourLoveToday consumer health and wellness campaign. Have you heard of it?

Show Your Love aims to help young adults live and grow to their full health potential. For themselves, their families and/or for their future families if they choose to have one.

Why is a health and wellness campaign called “Show Your Love?”
We know that women are busy – often caring for friends, family, colleagues and others before themselves. Taking the time to invest in yourself – to give yourself the same love and respect you give to others – is important. Because by showing love to YOURSELF, you are more likely to have the energy and focus you need to work toward your goals and life plans.

How can you show love for yourself?
You “show your love” in many ways. Some ideas could be taking time to walk, take the stairs not the elevator, pray/meditate, get more sleep, get a physical “tune up” with your health care provider, add a fruit and vegetable to your meal, drink less soda, take a vitamin, learn about your family’s health history, and protect yourself against sexually transmitted infections (all called, STI), sunburn and insect bites. Maybe this is the  year that you will focus on stopping habits like tobacco and binge drinking that may help you cope with stress but don’t help you reach your goals. Take stock of the relationships in your life – do they build you up or take you down? Do you have people in your life who might want to join you in making positive changes?

If a baby is definitely NOT in your future for 2018, make sure that you are happy with your contraceptive plan whether that’s abstinence, an IUD or anything in between. If getting pregnant is on your list then you can show your love to your future baby this year too by taking care of you now.

How can you show love for others?
Some ideas could be as simple as encouraging your loved ones to make ONE healthier choice each day, asking about their goals, sharing your health and wellness tips, supporting their efforts to understand their health, telling YOUR story and influencing others (to name a few!). By showing your love for other, you show love for yourself.

Many health “resolutions” offer a two for one benefit. They are good for women AND lay the foundation for a healthy next generation too.

Whether you ARE planning to become pregnant or NOT in 2018, there are critical steps that can be taken TODAY to improve your own overall health and wellness AND increase the chance of a healthy baby. This January, the Show Your Love campaign is proud to partner with the March of Dimes to raise awareness about the 1 in 33 babies born with a birth defect. While not all birth defects are preventable, practicing self-care before becoming pregnant can reduce the risk of birth defects. Some key areas for birth defect prevention include:

You can find full health and wellness, life and/or reproductive planning checklists here. These checklists can support you with tips to get healthy before, during or after pregnancy.

Show Your Love is a virtual community of young adults striving to live healthier and encouraging each other along the way. Join our Ambassador Network (it’s free) and share your health journey/goals/messages. I will plug: it is a fun group, an easy way to connect and elevate your voice, and we have lots of cool incentives for healthy challenges. Follow and contribute to our conversation on Twitter, Instagram, Facebook using #ShowYourLoveToday.

Show Your Love is led by the National Preconception Health and Health Care Initiative (PCHHC), a public-private partnership of 90+ national organizations working to advance preconception health. PCHHC is hosting a Tweet chat with the March of Dimes and Mother to Baby on January 30, 2-3pm ET. Join us on Twitter using: #Prevent2Protect.

We can’t wait to hear from YOU!

Want more information about PCHHC or Show Your Love? Email Suzanne at Suzannew@med.unc.edu. Connect with her on Twitter and LinkedIn.

Is your baby sleeping safely?

10
Jan
Posted by Sara

Did you know that each year there are about 3,500 sleep-related deaths among babies in the U.S.? Causes include sudden infant death syndrome (SIDS), accidental suffocation, and deaths from unknown causes.

After the “Back to Sleep” safe sleep campaign was introduced in the 1990s, the number of sleep-related deaths were greatly reduced.  But since the late 1990s the decline has slowed. The Centers for Disease Control and Prevention (CDC) released a report that looked at safe sleeping practices. They found that:

  • About 1 in 5 mothers (21.6%) placed their baby on their side or stomach to sleep.
  • More than half of mothers (61.4%) reported any bed sharing with their baby.
  • 2 in 5 mothers (38.5%) reported using any soft bedding in the baby’s sleep area

How can you keep your baby safe when you put her to sleep?

The best place for your baby to sleep is in a bassinet or crib. If you have multiples (twins, triplets or more), put each baby in his own bassinet or crib. Here’s what else you can do to make sure your baby is sleeping in a safe place:

  • Place your baby on her back at all sleep times until she’s 1 year old – this includes naps and at night.
  • Use a firm sleep surface, such as a safety-approved mattress and crib.
  • Keep soft objects and loose bedding out of your baby’s sleep area. This includes blankets, pillows, bumper pads, and soft toys.
  • Share a room with your baby, but not the same bed.

And remember that while you may know about how to create a safe sleep environment for your baby, other people may not. Grandparents, babysitters, and anyone else who may take care of your baby should be made aware of the importance of safe sleep.

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

Care Women Deserve

09
Jan
Posted by Sara

Today we are happy to help launch the Care Women Deserve campaign. Care Women Deserve is a partnership of organizations concerned about women’s health. It includes the American College of Obstetricians and Gynecologists, Black Women’s Health Imperative, March of Dimes, National Women’s Law Center, Power to Decide, the campaign to prevent unplanned pregnancy, UnidosUS, and the United State of Women. The goal of the campaign is to educate people about health services that are available to women with no out-of-pocket costs.

The Affordable Care Act (also known as ACA) requires insurance plans to cover recommended preventive health services without any additional cost to you. Preventive services are those that you get when you are not sick. They try to prevent health problems or detect them early so that you can get treatment. Many women may not be aware of these benefits or believe they have been eliminated.

If you have insurance, here’s a list of services that are available to most women across the United States at no cost:

“Under the Affordable Care Act, women gained access to a host of important preventive health services without having to pay out of pocket,” states March of Dimes President Stacey D. Stewart. “We want all women to understand these benefits, so they can be as healthy as possible at every stage of life.”

To learn more visit:

Join us to help all women get the care they deserve! Follow #CareWomenDeserve and #GetTheCare.

Are you getting your daily folic acid dose? Check the label

08
Jan
Posted by Lauren

Folic acid is a B vitamin that every cell in your body needs for normal growth and development. It helps your body make red blood cells that carry oxygen from your lungs to all parts of your body. If you take folic acid before and during early pregnancy, it can help prevent birth defects of the brain and spine called neural tube defects (also called NTDs). Some studies show that it also may help prevent heart defects in a baby and birth defects in a baby’s mouth called cleft lip and palate.

How can you be sure you’re getting the right amount of folic acid?

The best way to get the right amount of folic acid is to take a daily multivitamin that has 400 mcg of folic acid. Check the back of your bottle for the label (also called supplement facts). Look for the word “folate” on the label to see how much folic acid you’re getting.

The label tells you this information:

• Serving size. This tells you how much of the product is in one serving. One multivitamin usually is one serving.

• Servings per container. This tells you how many servings are in a multivitamin bottle. For example, if two pills is one serving and the bottle has 30 multivitamins in it, that’s 15 servings.

• Nutrients, like vitamin D, folate and calcium, in each serving

• Daily value (also called DV) of one serving. DV is the amount of a nutrient in a serving. For example, if the DV of folic acid in a multivitamin is 50 percent, that multivitamin gives you 50 percent (half) of the folic acid you need each day.

What else do I need to know about the labels?

Multivitamin labels now give new information about folic acid. In the past, they just listed mcg of folic acid. Now they list “mcg DFE of folate.” For example, for folate you’ll see “400 mcg DFE.” DFE stands for dietary folate equivalent. It’s the amount of folate your body absorbs. If a serving has less than 400 mcg DFE of folate, you need more than one serving to get all the folic acid you need each day.

Can I get folic acid from food?

Some foods have folic acid added to them. Look for the word “fortified” or “enriched” on the package label on foods like:
• Bread
• Breakfast cereal
• Cornmeal
• Flour
• Pasta
• Products made from a kind of flour called corn masa, like tortillas, tortilla chips, taco shells, tamales and pupusas
• White rice

Some fruits and vegetables are good sources of folic acid. When folic acid is naturally in a food, it’s called folate. Folate is found in lentils, black beans, peanuts, leafy green veggies like romaine lettuce and spinach, citrus fruits and orange juice.

It’s hard to get all the folic acid you need from food. Even if you eat foods that have folic acid in them, take your multivitamin each day, too. Labels on food products don’t always list the amount of folic acid in the product. New food labels that list folic acid will list mcg DFE of folate, just like for multivitamins.

Read more about why folic acid is important to you and your baby.

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

Good hygiene can help prevent birth defects

05
Jan
Posted by Lauren

Now that winter has arrived, the temperatures are decreasing and the spread of germs is increasing. In an effort to stay healthy, I find myself constantly washing my hands and trying to maintain good hygiene. Hygiene refers to activities such as hand washing, bathing, and brushing your teeth, which help you stay healthy. Maintaining good hygiene is one of the best ways to help prevent the spread of infections.

Women who are pregnant or thinking about becoming pregnant can increase their chances of having a healthy baby by doing things to help reduce the risk of infection. Not all birth defects can be prevented, but by maintaining healthy hygiene, you can help prevent the spread of infection. Not sure where to start? We have tips:

Wash your hands

And wash them often. Wash them before preparing or eating food, after handling raw meat, raw eggs or unwashed vegetables. Wash them after being around pets or animals and after changing diapers or wiping runny noses.

Prepare food safely

Besides your hands, you should also wash all fruits and vegetables before preparing your food. Wash all surfaces and cuttings boards with warm soapy water after use as well. Separate raw meat and poultry from cooked or ready-to-eat foods. Be sure to cook foods at their proper temperature and never eat cooked food that has been out of the refrigerator longer than two hours. Ready to cook a meal? We have your guide from prep to storage.

Don’t share cups, foods or utensils with your children

Keep these items out of your mouth. Children’s saliva may contain cytomegalovirus or CMV, a kind of herpesvirus that women can pass to their baby during pregnancy. CMV can cause problems for some babies, including a birth defect called microcephaly. CMV is also found in urine and other bodily fluids so be sure to wash your hands every time after changing diapers, wiping runny noses, and picking up toys.

Stay away from wild or pet rodents

This includes mice, hamsters and guinea pigs. They may carry a virus called lymphocytic choriomeningitis virus (also called LCMV) that can be harmful to you and your baby. LCMV can cause severe birth defects and miscarriage. To help prevent LCMV, keep pet rodents in a separate part of your home, wash your hands after petting and caring for them. Ask your partner or a friend to care for the pet and clean its cage. If your home has wild rats or mice, use pest control.

Let someone else clean the litter box

Dirty cat litter might contain a harmful parasite called Toxoplasma gondii, which causes toxoplasmosis. If you have toxoplasmosis within 6 months of getting pregnant, you may be able to pass it to your baby during pregnancy. Toxoplasmosis can cause pregnancy complications such as preterm birth (birth before 37 weeks) and stillbirth. The earlier in pregnancy you get infected, the more serious the baby’s problems may be after birth.

So have a friend, partner or family member clean your cat’s litter box during your pregnancy. If you are changing the litter yourself, be sure to wear gloves and wash your hands well afterward. You can also come in contact with the parasite that causes toxoplasmosis through eating raw or undercooked meat, unwashed fruits and veggies, touching utensils and cutting boards used to prepare raw meat, fruits and veggies or by touching dirt or sand. So we recommend avoiding sand boxes as well.

Practicing good hygiene daily can help you stay healthy and prevent the spread of infection.  Have questions? Email us at mailto:AskUs@marchofdimes.org