Fetal development

Mamas on Bedrest: Decongestants and Birth Defects

January 31st, 2014


Hello Mamas!  With cold and flu season upon us, I wanted to take a moment and go over important information about taking medications for symptoms.

Being sick while you are pregnant is a bear because you are very limited in what you can take. So many medications are not good for your baby’s development that most healthcare providers advise mamas not to take anything. A recent article in the American Journal of Epidemiology noted that the use some nasal and oral decongestants during the first trimester can cause birth defects. In this study, Dr. Wai-Ping Yau at the Sloan Epidemiology Center in Boston looked at data from a birth defects study conducted from January 1993-January 2010. Studying 12,734 infants with birth defects and 7606 control infants (infants without birth defects) the researchers looked at those who had birth defects and then contacted the mothers regarding the use of medications during pregnancy.

Pseudophedrine has long been used by mamas during pregnancy and has been touted as being safe. However, there has been some question of suspected limb shortening when used in the first trimester. These researchers wanted to know if pseudophedrine and other decongestants did in fact cause any sort of birth defects and if so, what types. Dr. Yau and his colleagues found that phenylephrine use was associated with endocardial (heart) cushion defect (4 exposed cases), phenylpropanolamine was associated with ear defects ( 4 exposed cases), and phenylpropanolamine was associated with pyloric stenosis (narrowing and hardening of the passage from the stomach to the small intestine) (6 exposed cases). They also found elevated risks of 2 malformations with the use of intranasal decongestants (nasal sprays): pyloric stenosis and tracheo-esophageal fistula. In addition, renal collecting system anomalies potentially could be associated with second-trimester exposure to oxymetazoline.

The authors reiterated the fact that the numbers of infants affected were very small, for each products used birth defects occurred in less than 10/1000 births. Yet they suggested that further studies be done to make a definitive cause/effect statement for the medications. They also made specific note that most of the associations were the result of mamas using medications during the first trimester, so they suggested that health care providers reiterate to their patients the importance of not using any medications during that critical developmental time.

What is a mama to do if she becomes ill while pregnant? Well, after looking at this study, if she is in the first trimester, it looks as if she is going to have to tough it out. Since such a large amount of fetal development occurs in the first 12-16 weeks, refraining from the use of any medication during that time-except in cases of absolute necessity-appears to be the best course of action. How would mama know if treating her illness is an absolute necessity? She must consult with her health care provider.

Sometimes when mama is ill, the risk treating her illness is outweighed by the potential harm to her baby if she does not receive treatment. Case in point, when I was pregnant with my son, my asthma flared. I hadn’t had an asthma attack in year! But the change in my immune system with the pregnancy triggered something and there I was wheezing. I called my OB and was told to use my rescue inhaler and immediately scheduled to see a pulmonologist the next day. The pulmonologist started me on daily inhaled corticosteroids for the remainder of my pregnancy (about 4 months). His rationale was that if I was not getting enough oxygen neither was my baby. It was more important to keep my airways clear by eliminating inflammation and sensitivity with the inhaled steroid than for me to have low oxygen levels and potentially subject my baby to the same.

If you have questions about what medications (or even herbal/”natural” medicinal preparations) are safe to take if you are sick, please call and talk to your health care provider before you take anything. As Dr. Yau and his colleagues noted in the aforementioned study,

“It is not known whether any of the oral decongestants (pseudoephedrine, phenylephrine, and phenylpropanolamine) cross the placenta to exert any direct effect on the fetus.”

With that being the case, Mamas, if you become ill and feel that you need to take something for your symptoms (including home remedies!!), Please consult with your health care provider first!



Wai-Ping Yau, Allen A. Mitchell, Kueiyu Joshua Lin, Martha M. Werler, Sonia Hernández-Díaz. Use of Decongestants During Pregnancy and the Risk of Birth Defects American Journal of Epidemiology. 2013;178(2):198-208.

MedScape OB/GYN Women’s Health

Mamas on Bedrest: Get Your Babies off to a Healthy Start!

August 24th, 2011

When I was pregnant with my son, my then 3 year old daughter used to come up to my belly and scream, “Hi baby! How are you? It’s your big sister!” In response to her voice, my son would roll around in my belly and reposition himself (typically away from her voice) comfortably.  So it’s really no surprise to me now, 5 1/2 years later, that my son often tunes his big sister out. “Do this. Do that. You’re not listening to my words…” He’s heard it all before, loud and clear, and has reached the conclusion that he’d really rather place his energy elsewhere.

Mamas on Bedrest, our relationships with our children begin long before they are born.  Some research even suggests that from the moment we become pregnant, our words, thoughts and deeds are influencing the growth and development of our babies and will exert this same influence into adulthood and into the aging process. Mark Hanson, a professor at the University of Southampton in England conducts research into the relationship between prenatal health and care and infant and child development.

According to Hanson, a pregnant mother’s body and the body of her developing baby have an intricate and constant dialogue going on for the duration of the pregnancy-from conception until delivery. Everything that the mother does from eating a nutritiously balanced diet, to exercising, taking a good prenatal vitamin and getting enough rest sends signals to the developing baby how to prepare and how to adapt to the external environment. This ability to accept these cues, integrate them and adapt makes infants more adaptable and as a result, better able to weather complications that may arise not only during the pregnancy, labor and delivery but also later in life.

Research into the “developmental origins of adult disease” suggests that a mother’s healthy living prenatally may help her child avoid problems such as cancer, heart disease, depression and diabetes not just in childhood, but 50 years from now. According to Peter Gluckman at the University of Auckland in New Zealand, even though adults must eat well, exercise and reduce stress to help avoid disease, research is indicating that how mothers take care of themselves during the prenatal course may also have profound impact on whether or not their children develop chronic diseases as a result. Many of these cues come to the fetus via the amniotic fluid and maternal blood.

Here is the explanation.

Prior to birth, environmental cues help program a person’s DNA. This programming is called epigenetics. Through epigenetics, chemical groups attach to DNA. Although they don’t change the order of the genes, the chemical groups can switch those genes on or off. Chemicals, stress and other environmental influences can thus profoundly alter how a person’s DNA manifests.

For example, babies exposed in the womb to synthetic hormones may begin responding abnormally to the natural hormones later made by their own bodies. In the same way babies and children exposed to prenatal stress can also learn abnormal reactions to stress.

So in a nutshell, if a fetus “gets the message” from its mother that there is not enough good, healthy food available (because she is not eating healthy foods or enough food) the baby may hoard its calories. Studies done on pregnant women during famines show that the babies born to them actually developed an extra layer of abdominal fat in preparation for famine. A problem arises when a mother is not in a famine, but perhaps of low income or just eats poorly. If her baby develops the extra layer of abdominal fat, when food is plentiful, that child is at risk for becoming obese and at risk for heart disease and Type 2 diabetes as an adult.

What can Mamas on Bedrest do to get their babies off to a healthy start? First and foremost, relax. I can hear many of you gasping and berating yourselves, thinking you’ve done something wrong and that it’s all your fault that you are on bed rest.

Stop that stinkin’ thinkin’!

Every year some 750,000 women are prescribed bed rest for a portion of their pregnancies. You most likely didn’t do a thing wrong, but are a consequence of the law of averages.

Keep stress to a minimum. The more stressed you are, the more stress your baby will experience and adapt to. Epigenetics is real. Let’s help your baby learn a healthy adaptation to stress instead of a heightened stress reaction.

Rest. Yup, you heard me, get some rest. I know that it can be hard to rest while on bed rest; the boredom, the body aches, the worry… but try. Believe me, once your baby gets here, you’ll wish you had taken more naps!

Eat well. This is one of the most important factors to come from the research findings. Eat enough of a nutritious diet so that your baby learns to expect nutritious foods and in adequate quantities. If you need help, please don’t be afraid to ask. There are many resources available at the local, state and federal levels that will ensure that you and your baby are well nourished. Please make the call if necessary. Your health and the health of your baby depend on it.

Ask for help and support. That statement, “It takes a village to raise a child” is true. You may be thinking, sure, once the baby is born, but as these researchers and studies show, help and support of mamas is needed from the very beginning. If you are on bed rest, you need even more help and support. Enlist the help of family, friends and neighbors. Don’t be too proud or ashamed to seek out the support of churches and civic groups. And when all else fails, contact us, info@mamasonbedrest or visit www.mamasonbedrest.com and let us help you out!

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Aging well starts in womb, as mom’s choices affect whole life USAToday Article, June 30, 2009

Jack P. Shonkoff, MD, W. Thomas Boyce, MDBruce S. McEwen, PhD  “Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention” JAMA 2009;301[21]:2252-2259

Mamas on Bedrest: Fishing out the Facts

May 4th, 2011

When I was pregnant with each of my kids, I recall being warned to watch my fish consumption. In particular, I was advised to avoid eating shark, swordfish, king mackerel, tile fish and tuna steaks because regular consumption of these fish can lead to mercury accumulation in mama and baby. A huge tuna fish fan,  (I love it in salads!) I was also advised to avoid eating too much canned tuna for the same reasons (although canned tuna is reported to have less mercury than the tuna steaks!).

However, fish is a wonderful source lean protein and of Omega (healthy) Fatty Acids and should not be completely avoided during pregnancy.  The omega fatty acids are  key ingredients in healthy brain development of the growing fetus. So what fish is safe and what should mamas (Mamas on Bedrest in particular) know?

As was previously stated, fish contain essential fats that aid in fetal brain development. Since we’ve talked about the fish to avoid, what fish are safe for pregnant mamas to eat? According to the US FDA, it is safe for a pregnant woman to consume up to 12 ounces of fish per week. She should make her selections from commercially caught fish (which is usually lower in contaminants), such as wild salmon, sole, tilapia and trout. Mamas can also choose cold water fish such as haddock, cod, pollack,  and flounder. The “small fish” are also recommended such as anchovies, sardines and herrings. And if a mama has no aversions, other forms of seafood (such as scallops, clams, crabmeat, etc…) are good for her to eat as well.

So why am I trying to “hook” you on fish (okay, that was pretty bad!)? Because a recent study found that moderate fish intake may lower the risk for repeat preterm birth. There, do I have your attention now??

Fish Consumption, Erythrocyte Fatty Acids, and Preterm Birth

Dr. Mark Klebanoff, MD, MPH and his colleagues at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU) sought to estimate the association between fish intake and red blood cell omega-3 long-chain polyunsaturated fatty acids with preterm birth in a cohort of women at high risk because of at least 1 previous spontaneous preterm delivery. Participants completed a questionnaire regarding dietary fish consumption. Red Blood Cell fatty acids were measured at enrollment at 16 to 21 completed weeks of gestation. Linear and quadratic terms were used to model the association between fish intake and preterm delivery.

The Findings

“Eating fish has been associated with reductions in preterm birth, increased duration of pregnancy, or both reductions in preterm birth and increased duration of pregnancy in some but not in all studies; most studies have been conducted in unselected or low-risk women,” writes Klebanoff. “Several reports have found the association between fish consumption and pregnancy outcome to be nonlinear.”

In Klebanoff’s study, among women eating fish less than once per month, the probability of preterm birth was 48.6% vs 35.9% among women who reported more frequent fish consumption. For moderately frequent fish intake, defined as 3 servings per week, the adjusted odds ratio (OR) for preterm birth was 0.60. Women who ate more than 3 servings of fish per week had no further reduction in the risk for preterm birth.

Mamas, Eat Fish!

In this study, moderate fish intake (up to three meals per week) before 22 weeks of gestation was associated with a reduction in repeat preterm birth.  Eating fish more than 3 times per week did not seem to provide any additional benefit. These results support the recommendations of the U.S. Food and Drug Administration [FDA] and the American Congress of Obstetricians and Gynecologists [ACOG] for fish consumption during pregnancy.

Read the original article (hyperlinked in the first section title), or a summary from MedScape