Pregnancy, Childbirth, and the Newborn: The Complete Guide, 4th Ed.

CHAPTER 4 Having a Healthy Pregnancy

To have a healthy, safe, and enjoyable pregnancy, it’s important to eat well, get enough exercise and rest, and make positive lifestyle choices. It’s also essential to have regular prenatal care by a maternity caregiver and to avoid hazards and situations that can harm you or your baby during pregnancy. This chapter discusses the ways you can help prevent pregnancy problems by working with your caregiver, taking care of yourself, and limiting your exposure to potentially harmful substances and circumstances.

Ideally, you began avoiding hazards and consulting with a health care professional before you became pregnant. However, getting pregnant might have been a surprise to you. Whether you’ve planned for this pregnancy or not, you can use the information in this chapter to improve your health and increase your chances of having a healthy pregnancy and baby.

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In this chapter, you’ll learn about:

• Prenatal care to keep yourself and your baby healthy during pregnancy

• Warning signs of pregnancy complications that require medical help

• Ways to reduce stress during pregnancy

• Home remedies and other nonmedicinal ways to relieve discomforts and symptoms of minor illnesses

• Making healthy choices about prescription medications and over-the-counter drugs

• Hazards and situations that may be harmful during pregnancy and ways to minimize or prevent your exposure to them

• Safety and comfort when traveling during pregnancy

Caring for Yourself and Your Baby during Pregnancy

Having a healthy lifestyle during pregnancy can benefit not only your physical and mental condition, but also your baby’s well-being.

Here’s a list of things you can do to stay healthy throughout your pregnancy:

• Attend regular prenatal care appointments with your caregiver to monitor your health and your baby’s well-being. (See page 65.)

• Learn the warning signs of pregnancy complications to know when to get medical advice and care. (See page 70.)

• Eat nutritious foods and gain a healthy amount of weight. (See Chapter 6.)

• Maintain your general fitness to stay comfortable as your body changes. (See Chapter 5.)

• Reduce harmful stresses in your life. (See page 71.)

• To relieve symptoms of common ailments and pregnancy discomforts, use safe alternatives to medications. (For home remedies and tips to relieve common discomforts, see pages 73–74.)

• Avoid harmful substances and exposure to hazards. (See pages 76–84.)

• Treat harmful conditions and illnesses before pregnancy and those that develop during pregnancy. (See Chapter 7.)

A NOTE TO FATHERS AND PARTNERS

Your compassion, care, and encouragement are critical to your partner’s well-being during pregnancy. You can help your partner by encouraging her to have a healthy lifestyle. Support her efforts by making healthy changes to your lifestyle as well. For example, if you smoke, you can quit so your partner (and your baby) avoids the harmful effects of secondhand smoke. You can also strive to exercise regularly and avoid consuming unsafe foods and substances.

Get involved in your partner’s pregnancy. Attend some or all prenatal appointments, show an interest in prenatal tests and their results, and learn the warnings signs of pregnancy complications (See page 70). Help reduce your partner’s pregnancy discomforts by doing the laborious household chores and assisting her with comfort measures (See pages 103–107). If she’s upset or distressed, discover what’s bothering her and help alleviate anxiety. Review the stress-coping skills discussed on page 72 for ways to decrease your own stress. Because pregnancy can strain a couple’s relationship, you may need counseling to help resolve any family problems.

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Prenatal Care

When you know (or strongly suspect) you’re pregnant, schedule a visit with your caregiver. (See page 15 for information on the different types of maternity caregivers.) The wait to get an appointment with some caregivers can be several weeks, so call promptly.

Before your first prenatal visit, start making healthy lifestyle changes, such as quitting smoking, avoiding alcohol, eating nutritious foods, and taking folic acid. Consider having your partner accompany you to prenatal appointments so he or she can discuss his or her role at the birth with your caregiver. Visit our web site, http://www.PCNGuide.com, to download a work sheet to bring to appointments.

At your first or second prenatal visit, your caregiver will likely give you a complete physical examination and administer numerous tests. Your caregiver (or an office nurse) will also ask questions about your current life situation and family medical history. At each prenatal appointment, your caregiver will monitor your health and your baby’s growth. In midpregnancy, you’ll usually have an appointment scheduled for every month. Toward the end of your pregnancy, you’ll have an appointment every two weeks, then every week as your due date approaches.

Some caregivers schedule brief appointments; others schedule longer visits so you have time to build a relationship and discuss concerns and questions you may have. If you want a longer appointment than usual, request one in advance.

Toward the end of your pregnancy, schedule a long visit to talk about your birth plan with your caregiver. (See Chapter 8.) Also, if your caregiver is part of a group, try to meet the others in the practice in case one of them is on call when you’re in labor. If meeting the others isn’t possible, a written birth plan can communicate your specific birth preferences and help introduce you to unfamiliar care providers.

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PRENATAL TESTS

Throughout your pregnancy, your caregiver will offer you routine screening tests and diagnostic tests to detect possible problems with your health or your baby’s.

screening test is a quick, easy, and inexpensive way to rule out a particular condition. If the results of your test are negative, you don’t have the condition. If the results are positive, you may need further testing to confirm that you have the condition. If additional testing determines you don’t have the condition, your screening test gave a “false positive” reading. For inclusion in standard practice, screening tests must have a minimal “false negative” rate; that is, they must be unlikely to miss detecting someone who has the condition. (See pages 67–68 for a list of routine screening tests.)

diagnostic test is more specific and more reliable than a screening test in identifying women with a pregnancy complication or a baby with a problem. Diagnostic tests are often more invasive, more expensive, and usually have more side effects than routine screening tests. As a result, most caregivers use diagnostic tests only if indicated by a positive screening test or other pertinent factors. (See pages 143–145 for more information on diagnostic tests.)

What Information Should I Include in My Medical History?

Your caregiver can provide better prenatal care when he or she is aware of any of the following potentially troubling health or social problems concerning you, your partner, and your families.

• Prior surgeries or illnesses that required medical treatment

• Hereditary conditions or illnesses, including birth defects (such as heart defects), mental retardation, blindness, deafness, stillbirths, and miscarriages

• Prior or current behavioral or mental health conditions, such as depression or eating disorders

• Ethnic or cultural traditions that may affect prenatal care, birth procedures, and postpartum care

• Current prescription medications, drug allergies, and drug reactions

• Prior negative experience with a hospitalization, caregiver, or illness (All may influence your responses to care or medical procedures.)

• Prior sexual abuse, domestic violence, or any other significant mistreatment

• Heavy use of alcohol, tobacco, recreational drugs, or other harmful substances

Prenatal tests are reassuring when the results indicate a normal pregnancy or a healthy baby. But if the results are uncertain or if they indicate a problem, you may face difficult choices and considerable anxiety. When your caregiver suggests a prenatal test, ask the following key questions to help you make an informed decision about whether to have the test. These questions are particularly important if the test carries potential risks.

• What are the benefits, risks, and alternatives of the test? (See pages 67–68 and 143–145 for descriptions of prenatal tests.)

• How is the test done?

• Is it a screening test or a diagnostic test?

• How reliable or accurate are its results?

• How will the results influence my prenatal care?

• What happens if the test has a negative result? A positive result?

• How much does the test cost? Will my insurance cover it?

• What are the consequences of not having the test? Advancing medical technology is improving the ability to detect or diagnose many pregnancy complications or problems with the baby; however, medical technology hasn’t advanced the ability to treat or cure many of these problems. For example, amniocentesis can diagnose the presence of Down syndrome in the baby, but the test can’t predict how seriously the condition will affect her.

Because Down syndrome is untreatable, families who have a test that can detect it must decide how they’ll respond if test results are positive. Some families consider whether to terminate the pregnancy. Other families believe abortion isn’t an option for them, even if problems are discovered. These families may choose not to have the test (and avoid the anxiety of waiting for the results), or they may choose to have the test so they can learn what to expect and can prepare for the future.

Some prenatal tests indicate certain conditions that can improve with self-care or medical treatment. For example, glucose screening and a diagnostic glucose tolerance test indicate gestational diabetes (See page 68). To treat the condition, you can make changes to improve your diet and exercise regimen.

With good prenatal care, including screening and diagnostic tests, you’ll greatly increase your chances of having a healthy pregnancy and baby. To learn more information about prenatal testing, visit http://www.mymidwife.org/prenatal_guide.cfm and http://www.marchofdimes.com. You can also visit our web site, http://www.PCNGuide.com.

ROUTINE EXAMS AND SCREENING TESTS

Your caregiver will perform some exams and tests at just one prenatal visit and will perform others periodically throughout your pregnancy. Caregivers typically perform the following assessments at every prenatal visit:

• Urine test to detect bacteria, protein, and sugar (At first visit, a urine test may be used to confirm pregnancy.)

• Blood pressure check to screen for high blood pressure

• Weight check to monitor nutritional status and detect sudden weight gain (which can indicate preeclampsia)

• Abdominal exam to measure uterine growth or fundal height (which indicates the baby’s growth) and estimate the baby’s position

• Listening to fetal heart tones (FHT) to help confirm the baby’s well-being

Caregivers perform the following assessments only at specific visits, depending on the information gained from them.

• Pelvic exam to help confirm pregnancy, estimate the size of the mother’s pelvis, check for infection, or perform a Pap smear. In late pregnancy, a pelvic exam reveals cervical changes.

• Blood test (at first visit) to confirm pregnancy, determine blood type, test for anemia, and assess exposure to infection. For women with diabetes, caregivers check blood glucose levels periodically throughout pregnancy.

• Breast exam to help screen for breast cancer and assess breasts for conditions affecting breastfeeding For more information on routine exams and screening tests, visit our web site, http://www.PCNGuide.com.

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OTHER EXAMS AND SCREENING TESTS

Caregivers often perform the following exams and tests, but not routinely. Some caregivers don’t offer certain tests. If a specific test interests you, talk to your caregiver about your wishes and concerns.

• Dental exam (performed by dentist) to check for tooth decay and repair if needed, clean teeth, and check for gum infection, which is associated with preterm labor

Fact or Fiction?

Non-medical use of ultrasound, such as at-home Doppler heartbeat monitors and ultrasound videos or photos, are completely safe.

Fiction. Although the U.S. Food and Drug Administration (FDA) and the American Institute of Ultrasound in Medicine acknowledge that ultrasound poses no known risks to babies, it can affect the body and the long-term effects of extensive exposure are also unknown. To be safe, health care experts recommend that ultrasound be performed only by a trained provider and only when medically indicated.

• Fetal movement counts (kick counts) to help assess your baby’s well-being by detecting changes in his normal pattern of movements. This test counts the number of times your baby kicks or moves within a certain period. It’s performed by you, not your caregiver. (See page 71.)

• Ultrasound to help confirm pregnancy, estimate due date and your baby’s size, and detect or rule out complications (See below.)

• Integrated prenatal screening to assess the possible risk of Down syndrome and neural tube defects such as spina bifida. This test is a combination of first trimester screening tests (ultrasound and blood tests) and second trimester blood tests. If your test results are outside the normal range, your caregiver will perform diagnostic tests. (See pages 143–145.)

• Genetic screening to check for diseases such as cystic fibrosis, Tay-Sachs, thalassemia, and sickle cell anemia. Depending on your family’s medical history and ethnicity, your caregiver may offer carrier-screening tests. If these blood or saliva tests reveal a risk, your caregiver may recommend further diagnostic testing.

• Glucose screening to detect high glucose levels, which may indicate gestational diabetes (See page 134), between the twenty-fourth and twenty-eighth weeks of pregnancy. After you’ve had a sugary drink or snack, your blood is drawn. If your blood sugar is high, your caregiver will recommend a glucose tolerance test.

• Group B streptococcus (GBS) screening to detect the presence of GBS bacteria in secretions swabbed from the vagina and anus and cultured in a laboratory. See also page 131.

Understanding Ultrasound

Many caregivers rely heavily on ultrasound to check the baby’s heart rate, observe her development within the uterus, and make clinical decisions. Most pregnant women have at least one ultrasound at some point in their pregnancies.

There are two forms of ultrasound: Doppler ultrasound and diagnostic ultrasound scans. Doppler ultrasound (or simply Doppler), which monitors the baby’s heart rate, uses continuous transmission of sound waves to detect motion of the baby’s heart as it beats. Women receive Doppler from a hand-held device at prenatal visits. (See page 252 for more information on monitoring your baby’s heart rate.)

Diagnostic ultrasound scans, which help caregivers “see” inside the uterus, use intermittent transmission of sound waves for less than 1 percent of the time during the test. For the rest of the test, the equipment receives the echoes of the sound waves, which indicate differences in tissue density. The echoes are converted into a video image that shows the baby’s skeleton and organs, amniotic fluid, umbilical cord, placenta, and the mother’s womb. Visit our web site, http://www.PCNGuide.com, for more information on diagnostic ultrasound scans.

Studies on diagnostic ultrasound scans have found no evidence that they harm either the mother or baby, and researchers conclude that wise use of ultrasound scans outweigh their possible risks. However, because high exposure may cause unknown side effects, health care experts recommend that pregnant women not receive frequent ultrasound scans or have them for a nonmedical reason, such as to make a keepsake ultrasound video.

The accuracy of ultrasound depends on the quality of the equipment, the skill and experience of the technician and caregiver, and the purpose of the test. In addition, some tests are less reliable than others. For example, using ultrasound scans to estimate the baby’s gestational age and weight are less accurate in late pregnancy than in early pregnancy.

Despite the possible risk and inaccuracies, many expectant parents like ultrasound because it allows them to see their babies’ faces, fingers, toes, beating hearts, and wriggling bodies. This first sight of their babies inspires many parents to make an effort to have a healthy pregnancy and birth.

Fetal Movement Counting

During late pregnancy, keeping track of your baby’s movements for a short time each day helps you learn more about your baby and his health. Some caregivers ask only those women with high-risk pregnancies to count their babies’ movements (see page 71 for instructions), while others suggest that all pregnant women do so. If you’re concerned or curious about your baby’s well-being, you may decide to count his movements on your own.

Babies who are doing well in the uterus have several active, wakeful periods during the day. They also have quiet periods, when they’re sleeping. Even though healthy babies tend to move slightly less often toward the end of pregnancy (because of space restrictions within the uterus), they don’t markedly reduce their activity unless they have a problem. If your baby becomes noticeably less active, call your caregiver, who can assess your baby’s well-being and take action (for example, early delivery) if necessary.

Sample Fetal Movement Counting Chart

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Warning Signs of Pregnancy Complications

Because your prenatal visits occur only periodically, you may be the first to notice a change or new discomfort that signals a pregnancy complication. Although most pregnancies are healthy, it’s extremely important to know the following warning signs and immediately call your caregiver for an early diagnosis and prompt treatment. Your caregiver also may ask you to report other pertinent signs and any symptom or pain that concerns you. See Chapter 7 for more information on complications in pregnancy.

Warning Signs

• Vaginal bleeding (even a small amount)

• Abdominal pain

• Continuing, intermittent abdominal cramping or uterine tightening (contractions)

• Constant and severe abdominal pain and a hard abdomen, with or without vaginal bleeding

• Leaking or gushing of fluid from your vagina

• Sudden puffiness or swelling of your face, hands, or fingers

• Severe, persistent headache

• Problems with your vision (seeing spots or flashes, blurring, or blind spots)

• Severe and persistent dizziness, lightheadedness

• Noticeable reduction or change in your baby’s movement or activity after the 28th week of pregnancy

• Painful area in leg, swelling or redness over affected area, or pain in leg when standing or walking

• Severe pain in pubic area and hips, with trouble moving your legs

• Painful urination or burning sensation, with or without the urgent and frequent need to urinate

• Irritating vaginal discharge, genital sores, or vaginal itching

• Fever (temperature over 102°F or 38.9°C) when feeling sick

• Persistent nausea or vomiting

Possible Problems

• Miscarriage (see page 127); placenta previa (see page 139); placental abruption (see page 140); preterm labor (see page 136)

• Ectopic pregnancy (see page 127); miscarriage (see page 127); placental abruption (see page 140); preterm labor contractions (see page 136). May indicate a medical problem, such as appendicitis or gallbladder disease.

• Preterm labor (see page 136)

• Placental abruption (see page 140)

• Rupture of the membranes (see page 172)

• Preeclampsia (see page 140–142)

• Gestational hypertension or preeclampsia (see page 140–142)

• Preeclampsia (see page 140–142)

• Preeclampsia (see page 140-142); supine hypotension (see page 89)

• Fetal distress (see page 69 for fetal movement counting)

• Blood clot in leg or inflammation of vein (venous thrombosis—see page 130)

• Strain or separation of pubic symphysis joint or sciatica (pain in the lower back from pelvic joint stress)

• Urinary tract infection or UTI (see page 132); sexually transmitted infection or STI (see page 131)

• Vaginal infection or STI (see page 131)

• Infection (see page 130)

• Hyperemesis gravidarum (see page 129); infection (see page 130)

The Count-to-Ten Method

Any time after the twenty-eighth week of pregnancy, count your baby’s movements each day at roughly the same time when he’s normally active, such as after dinner. Don’t worry if you miss a day now and then, but try to notice if your baby moves every day.

Find a comfortable position and avoid doing anything distracting, then time how long it takes your baby to move ten times. A movement may be short (a kick or a wiggle) or long (a continuous squirming motion). Don’t count hiccups. Mark the end of a movement when it’s followed by a clear (albeit brief) pause. Record movements on a chart such as the one on page 69. Visit our web site, http://www.PCNGuide.com, to download a template of this chart.

The length of time it takes to complete ten movements varies among babies. Focus not on how your baby’s movements compare with other babies’, but on whether his activity has slowed down compared to his usual pattern.

If your baby doesn’t move at all during the chosen time, he may be asleep. Try waking him with a loud noise, or wait until you feel him move and then begin counting his movements (it may take only a few minutes if you’ve chosen a time when your baby is usually active). Call your caregiver if your baby clearly takes a longer time than usual to make ten movements or if he doesn’t move at least ten times or have an active period within the next twelve hours.

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Reducing Stress during Pregnancy

Few women go through pregnancy without experiencing occasional emotional stress. When you’re anxious or feel stressed, your body produces adrenaline and cortisol, stress hormones that signal a “fight or flight” response, causing tight muscles, constricted blood vessels, and elevated heart and breathing rates. In the short term, this response to stress doesn’t cause harm and can be beneficial. For example, it may boost your energy level or encourage you to prepare for an upcoming event.

In the long term, however, chronic (continual) stress can constrict blood vessels to the placenta and within it, reducing the amount of blood and nutrients to your growing baby. Constant severe stress may increase your chances of preterm labor or decrease your baby’s birth weight even if she’s not preterm.1 High anxiety levels during pregnancy can also affect your baby later in life by increasing her chances of developing behavioral and neurodevelopmental problems, such as attention deficit disorder/hyperactivity, anxiety disorders, and language delays.2

Stress can make you feel overwhelmed, out of control, and less productive. Typically, your caregiver can help you manage these effects. Stress, however, becomes detrimental when it makes you extremely anxious or depressed, affects your sleeping and eating schedules, or causes health problems. If you experience any of these harmful effects, contact your caregiver for help immediately. See page 337 for warning signs of postpartum mood disorders (PPMD) that can also occur during pregnancy. If diagnosed with depression or a mood disorder, you may need the care of a mental health counselor or take medications to manage your stress. You may also want to contact a counselor or an agency that’s devoted to the emotional support of pregnant women and new mothers.

In Their Own Words

During my pregnancy, I had a very demanding job as a nurse and was on my feet for most of every twelve-hour shift. I’d come home at the end of a shift, slump into my chair, and watch reruns of my favorite TV show. After my baby was born, that show’s theme song would calm her when she was fussy, just as it had calmed me when she was in utero!

Amy

WHAT CAUSES CHRONIC STRESS?

Any situation or event that upsets you can cause chronic stress if left unmanaged. Examples include a demanding job, financial worries, an unstable home life, problems with your partner, a loved one’s illness, or violence or danger in your life. (If your partner or your home environment is violent or abusive, your resources and coping skills may be limited. See page 81 for more information on abuse and domestic violence.)

Other ongoing conditions may trigger an excessive stress response to every challenging experience. For example, you may have an extreme reaction to everyday pressures because of unresolved or untreated anxiety from a previous traumatic event (including emotional, physical, or sexual abuse), a chemical imbalance that causes your brain to interpret minor stresses as major ones, or hormonal changes (such as those that occur during pregnancy) that can intensify emotional problems.

COPING WITH CHRONIC STRESS

To help cope with chronic stress, take these steps:

1. Recognize your stress response. Notice how you feel when you’re anxious or stressed; for example, you may feel overwhelmed, have trouble sleeping, or have frequent headaches or bowel problems.

2. Identify the source of your stress. Try to discover which person, situation, or experience is triggering the stress.

3. Try to eliminate that source, if possible. For example, you may decide to quit a stressful job or transfer to another work setting, or you may leave an abusive home environment.

4. Learn better ways to cope with a stressful condition when eliminating the source may be difficult or impossible. The following are steps to help reduce the tension and pressure of stressful situations:

• To minimize your stress, think of ways to modify the situation. For example, you can stay away from people who trigger a stress response.

• Take action to reduce your stress. Sometimes, simply attempting to solve the problem diminishes the stress to a manageable level and helps you control your responses to everyday challenges.

• Try to get enough sleep at night and nap during the day. If you can’t sleep, sit or lie down and rest. Remember that fatigue makes everything seem worse.

• Use the relaxation skills described on pages 216–220. Also use slow breathing (see page 224) while resting, meditating, or listening to soothing music.

• Eat nourishing foods and drink plenty of water and other fluids.

• Exercise regularly to help relieve stress, promote sleep, keep you fit, and improve your health. Walking, swimming, and yoga are great options when pregnant. If you want more vigorous exercise, first check with your caregiver to ensure your exercise regimen is appropriate during pregnancy. (See page 94.)

• Discuss your problems and worries with someone you trust, such as your partner, a friend, a relative, your caregiver, or another health care professional. Sharing your concerns at a support group also may help.

• Nurture yourself by doing something you enjoy. Have a massage, manicure, or facial. Take a walk through a park. Spend time with people who comfort you.

If these steps don’t ease your stress or you’re unable to use them, you may need to live with the stress—at least for a while. If you’re concerned the stress will harm your baby, many counselors suggest regularly talking to your baby to express your love and to reassure him that your troubles aren’t his fault. Your baby, of course, won’t understand your words, but saying them can lower your stress level and give you a chance to connect with your baby.

Treating Illness and Discomforts during Pregnancy

If you’re in discomfort or feel sick, you may be tempted to take over-the-counter or prescription medications to feel better. During pregnancy, however, talk with your caregiver before taking any medicine; use a medication only if recommended. If possible, try some of the home remedies discussed in the following sections before using medications.

HOME REMEDIES TO HELP RELIEVE COMMON DISCOMFORTS

These nonmedicinal treatments of common ailments may help you, but if discomforts persist or worsen, consult your caregiver for further treatment.

Headache

Instead of taking aspirin, acetaminophen (Tylenol), or ibuprofen to relieve a headache, try taking a warm bath, having a massage, or doing tension-reducing exercises (such as shoulder circles) and relaxation techniques. (See pages 216–220.) Heat or cold also may help relieve a headache. Try laying a hot pack across your shoulders or on the back of your neck, or try placing a cold pack on your forehead. Hunger, dehydration, and fatigue can cause headaches. Make sure to eat frequently, drink enough fluids, get more sleep, and arrange for periods of rest and relaxation in your daily routine. Report a severe, persistent headache to your caregiver; it may be a warning sign of a pregnancy complication (see page 70).

Cold, hay fever, runny nose, or cough

Safe ways to relieve these ailments include getting additional sleep and rest, using a cool-mist vaporizer, using saline nose drops (available at drugstores or made at home by mixing together 1 cup warm water, ⅛ teaspoon salt, and a small pinch of baking soda, and using a neti pot to administer the drops), drinking plenty of liquids, and swallowing a mixture of honey and lemon juice.

Nausea, vomiting, and heartburn

See page 119 for nonmedicinal treatments.

Back pain

Upper and lower back pain is common in pregnancy, but you can help prevent it by maintaining good posture, using good body mechanics, and doing exercises that strengthen your abdominal muscles and decrease the curve in your lower back. (See Chapter 5.) Treat back pain with rest, massage, warm baths, and hot or cold packs. Avoid taking aspirin, ibuprofen, and muscle relaxants unless your back pain is severe and your caregiver approves or prescribes these drugs.

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Sleeplessness

Sleeplessness is especially common in late pregnancy because of frequent trips to the bathroom, an active baby, light sleeping, or difficulty finding a comfortable sleep position. (See page 89 for sleep positions.) To help release stress and tension that may prevent sleep, try exercising or taking a brisk walk each day (but not just before bedtime). At bedtime, try taking a warm bath, drinking warm milk, having a massage, or listening to soothing music. If you awaken at night, try reading, writing your thoughts in a journal, or using the relaxation techniques described in Chapter 11. Avoid watching TV or using your computer, which tend to stimulate your brain and make you feel more awake.

MEDICATIONS

If home remedies don’t make you feel better and your symptoms are troubling, check with your caregiver about over-the-counter medications, which may relieve symptoms but don’t treat or cure an illness. If you have a chronic condition or current disease during pregnancy, your caregiver may prescribe prescription medications (such as antibiotics, insulin, antidepressants, anti-seizure drugs, and steroids) because the condition or disease is more harmful than the potential risks of the medications. See the following sections for more information on over-the-counter and prescription medications.

When deciding whether to use a medication, consider the seriousness of your symptoms or condition, the relief the medication may provide, and its possible side effects. To help you weigh a medication’s possible risks against its benefits and make an informed decision, ask the following questions:

1. What are the medication’s benefits, risks and alternatives? (See page 10 for information about these key questions.)

2. If the benefits clearly outweigh the risks and you decide to take the medication, ask your caregiver or a pharmacist the following questions:

• What dose should I take and how often should I take it?

• What’s the maximum dose in a 24-hour period?

• Should I avoid any foods or other drugs while taking it?

• How long should I take it? Should I stop taking it at any specific time in pregnancy?

3. If the benefits don’t clearly outweigh the risks, avoid taking the medication and seek a safer alternative.

Over-the-Counter (OTC) Medications

When buying any OTC medication, look at its ingredients. Many medications include more than one drug in their pills or capsules. You’ll need to learn the benefits, side effects, and possible risks for every drug in the medication. Visit our web site, http://www.PCNGuide.com, to learn current information on some common OTC medications and their effects on pregnancy. You can also find updated information by using the resources listed on page 82.

Prescription Medications

Some prescription medications are safe to use in pregnancy; others aren’t (see below). The safety of many drugs is yet unknown. Some caregivers may feel these medications are safe to take at certain times in pregnancy but dangerous at other times. They may prescribe them only if the benefits clearly outweigh the known risks. Or they may closely supervise their use in certain circumstances when the risks are unclear. When talking to your caregiver about a prescription medication whose safety isn’t completely known, discuss other available treatments and their benefits and risks.

Medications to Avoid

During pregnancy, a few medications are extremely harmful to your baby. Many are teratogens, which are substances that can cause birth defects, deformities, or even death. Some (such as thalidomide and diethylstilbestrol or DES) were prescribed for pregnant women before their severe side effects were known. Now their use has almost disappeared. Research will undoubtedly find more medications that can harm unborn babies. When considering any medication, make sure that all health care professionals working with you know that you’re pregnant.

The following are medications known to be harmful during pregnancy:

• Chemotherapy drugs (methotrexate and aminopterin)

• Oral drugs to treat severe acne, such as isotretinoin (Accutane) and vitamin A derivatives (The vitamin A in acne medications differs from the vitamin A found in vitamin pills. Vitamin A in prenatal vitamins is safe to take in pregnancy.) Note: Tretinoin, a topical drug, doesn’t appear to increase the rate of birth defects, but you may want to avoid it as well.

• Radioactive isotopes (used in imaging studies such as x-ray and MRI)

The following drugs are potentially harmful if taken during pregnancy, but their benefits may outweigh the risks:

• Some medications used to treat hyperthyroidism (such as propylthiouracil, methimazole, or iodide) unless your caregiver recommends their use

• Certain medications used to treat seizure disorders (phenytoin, valproic acid or Depakote, and others), bipolar disorder (lithium), and other conditions—unless your caregiver closely supervises their use

Warning!

Research shows that excessive drinking throughout pregnancy may cause severe harm to the baby. The more alcohol a pregnant woman drinks and the more often she drinks during her pregnancy, the more risk her baby has of having problems with growth, development, and mental ability.

Substances and Hazards to Avoid during Pregnancy

Just about everything you consume or are exposed to during pregnancy affects your baby—from common foods and beverages that contain potentially harmful substances, such as caffeinated coffee and herbal teas, to dangerous situations such as abuse and domestic violence. Also included are harmful substances such as some medications, alcohol, tobacco, recreational drugs, environmental agents, and workplace chemicals. (Some of these substances can also affect the reproductive health of men and nonpregnant women.)

With any harmful substance or situation, its effect on your baby and pregnancy depends on the amount and frequency of exposure as well as what trimester of pregnancy you’re in when exposed. For example, exposure to a hazardous substance in the first trimester can increase your risk of miscarriage or birth defects; exposure in the second and third trimesters can increase your risk of slowed growth of your baby’s body or brain (intrauterine growth restiction, or IUGR) or preterm labor.

In general, the more you’re exposed to a harmful substance or situation, the higher are your chances of serious problems for your baby or pregnancy. Harmful consequences may occur even with minimal exposure; however, don’t panic if you’ve already been exposed to an unsafe substance or condition. Babies can be remarkably resilient and some do well despite repeat exposure to harm. Consult with your caregiver for advice to manage your exposure to the following harmful substances or situations.

DRINKING, SMOKING, AND DRUG USE

When you’re pregnant, be extremely cautious about using alcohol or other drugs. Substance abuse can severely harm your baby or pregnancy.

Alcohol

Any alcohol you drink while pregnant crosses the placenta and enters your baby’s blood in the same concentration as in your blood, increasing her risk of serious birth defects and long-term problems with her development. The extent that alcohol can harm your baby depends on the amount you drink, how often you drink, and when in pregnancy you drink.3

Babies whose mothers drink heavily at any time during pregnancy are at high risk of developing severe problems. In the first trimester, when a baby’s organs are forming, excessive alcohol can cause organ defects, facial abnormalities, or miscarriage. Alcohol abuse in the second trimester can affect nerve formation in the brain, and in the third trimester it may interfere with the development of the nervous system. It may also cause preterm labor. Of the babies whose mothers drank heavily while pregnant, 4 percent develop fetal alcohol syndrome (FAS), a cluster of physical, mental, and behavioral disabilities that include growth problems, heart defects, mental retardation, facial abnormalities, and problems with muscle and nerve development.

Common Questions about Alcohol and Pregnancy

What if I drank before I knew I was pregnant?

Alcohol’s effects on your baby depend on when in pregnancy you drank and how much you drank. Talk to your caregiver to assess your risk. The important thing to do is stop drinking as soon as you learn you’re pregnant. Babies are remarkably strong and resilient. (Consider the high percentage of healthy babies born to mothers who drank alcohol, took medications, or had health problems during pregnancy.) But the earlier you stop exposing your baby to harmful substances, the greater are his chances of healthy development.

What if I drink just a little only occasionally while pregnant?

Current studies show that moderate drinking (one standard drink per day) has minimal effect on a baby’s risk of birth defects from alcohol exposure. However, research hasn’t determined a safe amount of alcohol for pregnant women, because blood alcohol levels vary depending on physical size, genetic factors, the amount of food eaten while drinking, and the amount of time between drinks. For that reason, it’s best to avoid alcohol during pregnancy.

How can I easily avoid drinking alcohol?

Pregnant women have several reasons to avoid drinking alcohol. Some develop an aversion to alcohol (and to smoking and some foods) during pregnancy. Many avoid alcohol because it’s not good for their babies.

At any occasion where alcohol is available, choose a nonalcoholic beverage such as mineral water with a lemon twist, fruit or vegetable juice, or a refreshing seltzer. If offered an alcoholic drink, request something else. You can say that you’re pregnant and want to avoid alcohol. Or if you don’t want to announce your pregnancy, you can say that you’ll be driving home and are already tired.

What’s the definition of heavy drinking? Some researchers define it as having more than four drinks a day. Other researchers define it as having two or more drinks per day or binge drinking more than three drinks on one occasion. A standard drink is ½ ounce of distilled alcohol (by itself or in a mixed drink), one can of beer, or a 4-ounce glass of wine.

Even light to moderate drinking (one standard drink per day) during pregnancy increases a baby’s risk of fetal alcohol effects (FAE), problems that are less severe than FAS but still have subtle, long-lasting neurological and behavioral consequences. When compared to a child whose mother didn’t drink any alcohol during pregnancy, a child exposed to alcohol before birth may have a slightly lower IQ, may be less agile or athletic, or may have more trouble with concentration, organizational skills, or impulse control.

Because drinking even a little alcohol may harm your baby, it’s best to avoid it during pregnancy—the earlier the better. In fact, avoiding alcohol before becoming pregnant may help you conceive; drinking, especially heavy drinking, may contribute to infertility problems. See above for suggestions on ways to avoid alcohol.

If you find it difficult to quit drinking alcohol, try to avoid occasions, locations (such as bars), and friendships that focus on drinking alcohol. Seek people who support your decision not to drink and, if necessary, consider attending Alcoholics Anonymous (AA) meetings.

Common Q & A

Q: I know I shouldn’t smoke during pregnancy, but what can I do to quit?

A: Ask your caregiver for information about quitting. He or she may also provide a list of local smoking cessation programs. In addition, you can visit http://smokefree.gov and http://www.cancer.org for helpful tips, as well as other web sites of organizations that help people stop smoking.

One thing not to do is use smoking substitutes (nicotine patch, gum, or nasal spray) during the first trimester. They can increase the risk of malformations in your baby if used when his organs and structures are forming.4

Smoking

Cigarette smoke contains numerous toxins that can harm you and directly affect the growth and development of your baby and placenta. These toxins include nicotine, tar, carbon monoxide, lead, and other substances. During pregnancy, the risks of complications from smoking and exposure to secondhand smoke increase with the amount and frequency of exposure.

When compared to pregnant nonsmokers, pregnant smokers have a greater risk of miscarriage, placental abruption, stillbirth, or infant death. If a woman has a family history of clubfoot, cleft lip, or cleft palate, she increases her baby’s risk of those deformities if she smokes during pregnancy. In addition, the more a woman smokes while pregnant, the greater is the risk that she may develop placenta previa or have an ectopic pregnancy.

Pregnant smokers often give birth to babies with low birth weight (who tend to have health problems) because of intrauterine growth restriction and not prematurity—although smokers also have a higher risk of preterm birth than do nonsmokers.

Smoking also may harm a baby after birth. If a woman smokes during pregnancy, she increases her baby’s risk of sudden infant death syndrome or SIDS (see page 391). If her baby lives with smokers, his risk of SIDS increases even more, depending on the number of smokers in the household and the amount of time he’s exposed to secondhand smoke. In addition, smoking during pregnancy and exposure to secondhand smoke after birth increases a baby’s risk of respiratory problems later in life.5

If you smoke, try to quit (or at least significantly cut back) before pregnancy or as soon as possible during pregnancy.6 The withdrawal symptoms you’ll experience (physical discomfort and psychological stress that last for several days or a few weeks) are difficult. But it takes just a day or so for your baby to benefit from a smoke-free environment. To reduce your exposure to secondhand smoke (and your baby’s exposure after birth), stay away from smoky areas and ask friends, colleagues, and relatives not to smoke near you or your baby.

Illegal Drugs and Prescription Drug Abuse

The most commonly abused drugs are illegal, and most have no accepted medical use. Illegal drugs are often sold on the street, come from unregulated sources, and lack medical supervision. Because most illegal drugs readily cross the placenta to your baby, taking these substances while pregnant can harm not only you, but also your growing baby, depending on the drug you took, how much you of it you took, when in pregnancy you took it, and how often you took it.

If you take an illegal drug in the first trimester, your baby may develop a defect or deformity or you may have a miscarriage. If you take an illegal drug in the third trimester, your baby may have intrauterine growth restriction or IUGR (that is, grow slowly) or suffer the effects of prematurity because of a preterm birth. Each drug has its own harmful effects, and taking a combination of two or more drugs may compound the damage to your baby. Visit our web site, http://www.PCNGuide.com, to learn more about illegal drugs’ harmful effects.

Instead of taking illegal drugs—or in addition to taking them—some pregnant women abuse prescription drugs by using them without medical supervision. These women mistakenly believe these substances are safer than illegal drugs and are therefore okay to use during pregnancy. But the effects of prescription drugs can be just as dangerous to babies as the effects of illegal drugs (see page 75). Try to stop using all drugs before you’re pregnant or as soon as you know you’re pregnant, to improve your baby’s chances of a healthy life.

POTENTIALLY HARMFUL SUBSTANCES AND HERBS IN FOODS

Some substances and herbs that are in several common foods and beverages may be potentially harmful to consume when pregnant. During your pregnancy, be careful about consuming the following items.

Caffeine

Caffeine is a stimulant that can raise your heart rate and blood pressure, constrict blood vessels, affect your ability to sleep, and make you jittery. It’s also a diuretic (a substance that makes you urinate more fluid, more often) and increases the amount of calcium you expel in your urine.

Coffee, tea, energy drinks, colas, and other soft drinks contain significant amounts of caffeine. Of these beverages, coffee has the most caffeine, but the amount of the drug in a serving depends on how the coffee is made and the number of ounces in a serving. For example, an 8-ounce serving of brewed coffee may have 65 to 120 milligrams of caffeine; even decaffeinated coffee has 2 to 4 milligrams in an 8-ounce serving. An 8-ounce serving of black or green tea has 20 to 90 milligrams of caffeine.7 A 12-ounce serving of some sodas has 54 milligrams of caffeine. In addition, several over-the-counter medications include caffeine, and chocolate contains a small amount of a caffeine-like chemical. To learn the amount of caffeine in packaged products, read the labels.

Although researchers haven’t found any connections between caffeine and birth defects or delayed childhood development, babies in the womb probably experience the stimulating and diuretic effects of caffeine that their mothers notice. Caffeine can elevate the baby’s heart rate and reduce the amount of fluid and calcium available for her optimal growth. The evidence on caffeine’s connection to miscarriage, intrauterine growth restriction, and stillbirth is conflicting and controversial. Numerous studies observe a connection, but others don’t. Various factors seem to influence results, such as a woman’s unique susceptibility to caffeine-related health risks, the amount of caffeine she consumed, and when in pregnancy she consumed the caffeine.

Research suggests that consuming large amounts of caffeine each day (for example, more than eight 8-ounce servings of coffee) at any time in pregnancy may harm your baby. However, consuming more than 200 milligrams of caffeine each day (for example, just two 8-ounce servings of coffee) during the first trimester may increase your risk of intrauterine growth restriction or miscarriage.8

Given the potentially harmful effects of caffeine, try to avoid it during your pregnancy or at least reduce the amount you consume.

Warning!

Just because herbs are considered “natural,” they’re not necessarily safe. Some herbal preparations and dietary supplements contain potentially harmful ingredients, and most of these can cross the placenta and affect your baby.

Herbal Tinctures, Teas, and Capsules

Traditional healers have used herbal remedies for centuries to help treat or cure various ailments. Pharmacies and specialty shops sell hundreds of herbs and dietary supplements, although little is known about their ingredients. The U.S. Food and Drug Administration (FDA) hasn’t tested or approved most of these herbs and botanicals, and their safety is often uncertain. When and how an herb was harvested and processed influence a product’s potency, which may range widely from one brand to another and even among different batches of the same brand.

Herbs and dietary supplements affect both the mother and baby during pregnancy. For the mother, caregivers sometimes recommend red raspberry leaf to tone uterine muscles. At the end of pregnancy, some caregivers may recommend herbs that can start labor (such as blue cohosh, evening primrose, and black cohosh); however, women should avoid these uterine stimulants in early pregnancy because they may cause miscarriage. Uterine stimulants can also have potentially dangerous side effects. For example, blue cohosh may cause elevated blood pressure, irritated mucous membranes, and multi-organ injury from lack of oxygen.

During pregnancy, research suggests the potential harm of herbal products on the baby’s health stems more from hormonal effects (for example, herbs containing estrogen-like substances) and drug interactions (increasing or decreasing the effect of a prescription medication) than from toxic effects. However, some Chinese herbal medicines, specifically An-Tai-Yin and huanglian, may cause congenital malformations.9

To reduce your consumption of caffeine during pregnancy, you may consider drinking herbal teas. But you may experience undesirable side effects to specific herbs. For example, if you’re allergic to ragweed and related plants, you may develop allergic symptoms after drinking chamomile tea. In addition, certain herbs have specific side effects when consumed in large amounts. For example, drinking licorice root tea can increase water retention and decrease potassium, and drinking tea with ginseng can cause swollen and painful breasts. For these reasons, be aware of the ingredients in an herbal tea before drinking it.10

Because dosages in herbal products and supplements vary and little is known about their risks and benefits, avoid them while pregnant or use them only under the guidance of a naturopathic doctor or other expert. It’s also important to consult with your caregiver about any herbal remedies or dietary supplements that you’ve taken or are considering taking.

Mercury and Other Substances in Food That May Cause Harm

For information on mercury and other substances that can cause harmful illnesses when consumed during pregnancy (such as listeriosis and toxoplasmosis), see page 121.

Environmental Hazards and Harmful Situations

The following sections discuss hazardous substances that are present in many homes and workplaces, as well as harmful situations that can affect the health of your pregnancy and baby, such as being in an abusive relationship or having workplace stress.

Abuse and Domestic Violence

Abuse and domestic violence (any combination of verbal, psychological, emotional, sexual, economic, or physical abuse) can happen to any woman regardless of her age, physical ability, lifestyle, religion, ethnicity, or socioeconomic and educational backgrounds. When you’re pregnant, abuse increases your risk of serious pregnancy problems such as high blood pressure, vaginal bleeding, severe nausea or vomiting, urinary tract infections (UTIs), preterm birth, a baby with low birth weight, or a baby who needs intensive medical care.11 In addition, your risk of being killed by an abusive partner increases during pregnancy.12

If you’re in an abusive relationship, you are not at fault. The goal of abuse is to leave you feeling confused, ashamed, powerless, hopeless, and out of control. Living with abuse is painful, confusing, and stressful. The suggestions for coping with stress on pages 72–73 may be useful. Talking with a trusted friend or relative also may help you cope. You may choose to call your caregiver for information on counselors and local agencies that offer support or resources for abused women. If you decide to leave the relationship, you may require their help. Your caregiver also may suggest further testing to detect any sexually transmitted infections (STIs) or to evaluate you for stress-related pregnancy complications. Childhood sexual, emotional, and physical abuse can also have troubling long-term effects that interfere with your joy in pregnancy. (See page 59.)

National agencies can help you as well. Memorize the phone number for the National Domestic Violence Hotline, 800-799-SAFE (7233), and call if you need to talk to someone or need resources, including help making an escape plan. See also page 362 for more information on abuse and domestic violence.

Insecticides, Herbicides, and Pesticides

During pregnancy, avoid frequent, sustained exposure to chemicals that kill insects (insecticides), weeds (herbicides), or unwanted insects, bugs, or animals (pesticides). The presence of these chemicals in the air and on food may cause miscarriage, poor growth in the baby, birth defects, and childhood neurobehavioral problems. Because some of these chemicals haven’t been tested for their effects on pregnant women and young children, their safety is unknown; however, many governments have banned the use of chemicals that have been proven harmful such as DDT.

To avoid exposure to these chemicals, wash fruits and vegetables well to help remove pesticides and other chemicals. If you need to use a pesticide to remove household pests, plan on leaving your home for at least a day to allow the chemicals to dissipate from the air. Before using the pesticide, close all drawers, cupboards, and other doors to food-storage areas. When you return home, wash counters, tables, and food-preparation surfaces thoroughly.

Occupational Hazards

Some occupations and workplaces may be more hazardous than others during pregnancy. Studies have shown the potential harm of some workplace chemicals, including anesthetic agents, benzene, cancer treatment (cytotoxic) drugs, carbon monoxide, ethylene oxide, ethylene glycol ethers, formaldehyde, ionizing radiation (x-ray), lead, methyl mercury, organic solvents, polybrominated biphenyls (PBBs), and polychlorinated biphenyls (PCBs). These chemicals can cause severe problems such as miscarriage, birth defects, low birth weight, preterm birth, developmental delays, and childhood cancers. In addition, if you work with any of the medications described on page 75, avoid them as well.

Internet Resources about Hazards in Pregnancy

U.S. Food and Drug Administration (FDA)

http://www.fda.gov

March of Dimes

http://www.marchofdimes.com

U.S. Environmental Protection Agency (EPA)

http://www.epa.gov/epahome/hotline.htm

Environmental Working Group (EWG)

http://www.ewg.org

U.S. Centers for Disease Control and Prevention (CDC)

http://www.cdc.gov

The National Institute for Occupational Safety and Health (NIOSH)

http://www.cdc.gov/niosh

U.S. Occupational Safety & Health Administration (OSHA)

http://www.osha.gov

People who may encounter these chemicals include health care workers (including dental and veterinary offices), pharmacists, battery makers, solderers, welders, radiator repairers, industrial painters, home remodelers, and atomic and electronic workers.12 In addition, farm workers may be exposed to pesticides.

Researchers are constantly revising the list of substances that are harmful in pregnancy, so ask your caregiver about potentially dangerous chemicals. If you work with any dangerous chemicals, talk with your employer about limiting your exposure to them. Also talk with your employer about limiting your exposure to workplace stress (see page 71 to learn about the harmful effects of chronic stress). Visit the web sites at left for information about occupational hazards.

Chemicals Used for Hobbies

Many people enjoy hands-on hobbies such as arts-and-crafts projects, furniture refinishing, and auto repair. Several of these hobbies aren’t risky during pregnancy, but some require products that may contain dangerous chemicals. If you plan to continue a hobby that uses a potentially toxic product, learn about risks of exposure during pregnancy by contacting the manufacturer or a poison control center, or by getting the product’s Material Safety Data Sheets (MSDS) from a store that sells it.

House Paint

Many people prepare for parenthood by repairing or renovating their homes, which often includes painting. Caregivers generally discourage pregnant women from spray painting (because they can inhale the paint particles), but rolling or brushing house paint onto surfaces is probably safe during pregnancy. However, many brands of paint contain potentially dangerous chemicals (such as ethylene glycol ethers, mercury, formaldehyde, and hydrocarbon solvents) that you may inhale or absorb through touch. Try to avoid using paints that have these chemicals; instead, use low-VOC or no-VOC paints, which contain fewer (or no) harmful volatile organic compounds than standard paint.

When painting, wear gloves and make sure there’s ample ventilation. (Better yet, have someone else do the painting!)

If your home contains lead-based paint (which is often found in older homes), don’t try to remove it or paint over it yourself. A professional painter can safely handle the toxic paint chips and dust without harm to you or your family.

Hair Treatments

Women who have their hair colored or chemically treated may worry whether these treatments will harm their babies during pregnancy. Although some studies show a link between chemical hair dyes and an increased risk of childhood brain tumors, the results aren’t statistically significant. Other studies find no evidence that dyes cause birth defects. In addition, no direct evidence exists that suggests permanent wave solutions or hair relaxers are harmful in pregnancy.

Most caregivers don’t discourage pregnant women from getting chemical hair treatments, but if you have any concerns about their safety, you may choose to wait until after the birth to have your hair treated.

Saunas, Hot Tubs, and Heat Wraps

During pregnancy, exposure to the extreme heat of saunas, hot tubs, and heat wraps may raise your baby’s temperature along with your own. Once overheated, your baby takes much longer than you to cool down. In early pregnancy, high temperatures can cause birth defects or even miscarriage if the exposure is frequent and prolonged, or if it occurs at a critical point in your baby’s development. Later in pregnancy, raising your body temperature can produce a fever in your baby and may cause him to develop neurological disorders such as seizures.

To keep your baby safe, avoid using saunas and heat wraps during pregnancy. If you find soaking in a hot tub relaxing, keep your temperature below 102.2°F (39°C). If monitoring your temperature is difficult, keep the water temperature below 99°F (37.2°C) and limit use to ten minutes or less. Keep your shoulders and arms out of the water to promote heat loss and help maintain a safe body temperature. As a safer alternative to using a hot tub, consider taking a warm bath, where your body can maintain a safe temperature because less of it is submerged in warm water.

Electric Blankets

As with all other electric household appliances, electric blankets emit low-frequency electromagnetic energy, which may harm your pregnancy if exposure is prolonged and close to your body. Although manufacturers have produced low-emission electric blankets that reduce magnetic field exposure, the safety of electric blankets is inconclusive. The few studies on the harmful effects of electric blankets suggest that if health problems occur, they may stem from the heat the blankets generate. Because it’s unknown what temperature is too hot for your baby during pregnancy, consider using a down comforter or wool blankets instead of an electric blanket to keep warm.

Ionizing Radiation (X-rays)

Depending on the dose, radiation may harm your baby during pregnancy. X-rays for medical and dental diagnoses use much less radiation than does radiotherapy for cancer treatment. Because the risk of birth defects from one diagnostic x-ray (about 1 radiation absorbed dose, or rad) during the first four months of pregnancy is tiny, many health care professionals don’t consider it dangerous. (See page 144 for more information on diagnostic x-rays.) However, avoid exposure to high radiation levels at work and try to avoid x-rays in the first trimester, when radiation may interfere with your baby’s organ development.

Infectious Diseases

Several infectious diseases may harm your baby before and after birth. Examples include toxoplasmosis, Lyme disease, rubella (German measles), chicken pox, fifth disease (parvovirus B19), listeriosis, hepatitis, and sexually transmitted infections (STIs). See pages 132–133 for more information on infectious diseases.

THE FATHER’S EXPOSURE TO HAZARDS AND DRUGS

Although little is known about the effects of drugs, environmental and occupational hazards, and other potential dangers on male reproductive health, increasing evidence suggests that a man’s exposure to certain hazards during the months before conception may increase the risk of miscarriage, childhood brain tumors, and other problems.13 Exposure to hazards also may affect a man’s fertility (although research results differ about the effects of smoking on male fertility). To increase the chances of producing a healthy baby, men should limit their exposure to the same hazards that are harmful to women in pregnancy.

In addition, fathers and partners can create an environment that supports a healthy pregnancy by controlling their alcohol, tobacco, or drug use. Before and during pregnancy, a woman is more likely to control her use of alcohol, tobacco, or drugs if her partner (male or female) does so as well.

Traveling during Pregnancy

Being pregnant doesn’t mean you can’t take a trip, but you may have some restrictions depending on when, where, and how you’ll be traveling. Traveling during pregnancy may be more enjoyable if you follow some common precautions and safety tips.

When planning a trip, consult with your caregiver for travel suggestions and any precautions specific to your pregnancy. If you have pregnancy complications, your caregiver may recommend against travel. In the last month of pregnancy, your caregiver may suggest staying within an hour’s travel time from home. Even if your pregnancy is healthy, get a copy of your medical history to take with you while traveling.

If you’re planning to fly, especially in late pregnancy, find out if your airline has restrictions for pregnant passengers. Some airlines limit travel on domestic flights in the week before a due date, and many have restrictions for international trips. Throughout pregnancy, avoid flying at altitudes above 7,000 feet in small planes without pressurized cabins; the oxygen available to your baby may be reduced.

If you’re planning to take a cruise, be aware that some cruise-ship companies also have restrictions for passengers in late pregnancy.

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If planning a trip to an international destination, check for any special health concerns or travel warnings. If certain vaccinations are recommended before entering a country, check with your caregiver to learn if you can receive them when pregnant. (Only a few vaccines are considered safe in pregnancy.) For more information on health precautions or recommended vaccinations, contact the U.S. Centers for Disease Control’s international travel line at 877-394-8747 or visit http://www.cdc.gov/travel. For information about travel warnings, contact the U.S. Department of State at 202-647-5225 or visit http://www.travel.state.gov.

During pregnancy, long trips by car, bus, plane, or train may limit your movement, which can affect your circulation, increase swelling in your legs, and thereby increase your risk of developing a blood clot in a leg vein. Walking every hour or so and stretching as much as possible can eliminate or minimize this risk. In an airplane, try to sit in an aisle seat or one at the bulkhead to allow for more legroom and an easy exit. Do simple exercises while in your seat to help increase circulation to your legs and arms. (See Chapter 5.) If you have varicose veins, consider wearing support stockings (available at medical supply stores).

In vehicles and airplanes, always wear your seat belt to protect you and your baby in a collision. Fasten the belt low on your hip and below your belly. Use the shoulder strap if available; don’t tuck it behind you. If an accident occurs, the seat belt will keep you in your seat, while your muscles and pelvic bones protect your uterus and the amniotic fluid cushions your baby.

Pregnancy discomforts may seem worse while traveling. The constant motion may aggravate morning sickness or nausea. Hours of sightseeing or long business meetings may increase fatigue. Back pain may become more noticeable when your usual comfort measures aren’t available. The change in routine may disrupt when you eat, as well as what you eat. Air travel, hot climates, and places with forced air ventilation may increase dehydration if your availability to fluids is limited.

To help minimize pregnancy discomforts when traveling, try to drink lots of fluids, eat well, walk around, and get plenty of rest. Try to use your typical comfort measures as best as you can, or adapt them if possible.

Key Points to Remember

• Throughout your pregnancy, you’ll have opportunities to improve your health. By learning about healthy lifestyle choices, knowing potential pregnancy hazards to avoid, and recognizing the warning signs of pregnancy problems, you can make the best choices for you and your baby.

• You can improve your chances of having a healthy, safe, and enjoyable pregnancy by actively participating in your prenatal care. Ask key questions about prenatal tests or procedures so you can make informed decisions about whether to have them.

• Eliminating or reducing your exposure to harmful substances and situations will increase your chances of having a healthy pregnancy and baby. Although your risk of severe problems is small, use caution when considering exposure to environmental hazards or potentially harmful medications, substances, or situations.