Fetal Health

Mamas on Bedrest: Decongestants and Birth Defects

January 31st, 2014

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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!

 

References:

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: Not all C-Sections are bad

January 24th, 2014

Mamas,

Vanessas-birth

My daughter at birth

Having a c-section is not the worst thing that can happen to you. I say this from the perspective of having had 2. While chatting with mamas in this community, one mama stated how she is terrified at the thought of having a c-section. I realized that c-sections have become demonized in the birth world and this is not a good thing.

On this blog, all over the web there and in numerous chats there are articles and points of view touting “normal”  and “natural” (meaning vaginal) delivery. I’ll admit that I am a proponent of minimal intervention. Having went through what I went through to have my children, I know the potential pitfalls of too much intervention. Intervention must be balanced with “watch and wait” and not overdone. Even though labor and delivery is a marathon process, there are many physiologic benefits for mamas and babies who endure the process and emerge victorious on the other side. So for women who can, I most certainly advocate for “natural, vaginal birth”  whenever possible.

Well, the sad truth is that this isnt always possible. Many years ago, many women (and babies) died as a result of being unable to deliver “naturally” and doctors and midwives of the day not having the skills or technique of cesarean section. Thankfully (for me and my daughter at least) clinicians have those skills and expertise and many mamas and babies are alive today. But what is a very viable and useful method of delivery and one that saves lives in critical situations has become an overused, overdone process. Cesarean sections are the second most performed surgery in the US second only to Hysterectoies. And while they are a critical tool in the obstetrical arsenal, their overuse has contributed to many mamas and babies are not faring so well during the childbirth process.

Currently cesarean sections account for a full one third of all births in the United States. According to the CDC, rates of C-section deliveries-especially first time c-section deliveries-have leveled off and are declining. This is good news because a first c-section is often an indication for subsequent c-sections. C-sections are often scheduled for the following reasons and these indications are responsible for 85% of all cesarean deliveries:

  • “large babies”
  • uterine/placental/vaginal issues,
  • fetal distress or shoulder dystocia
  • breech presentation
  • The leading indication for cesarean delivery is previous cesarean delivery

I doubt anyone would argue the necessity of a cesarean section for a mama and/or baby in distress; i.e. mama’s blood pressure skyrocketing and not responding to medication, a decrease in fetal heart rate, decreased fetal movement which may indicate a problem, or other complication. But in this country, c-section has (or had) become the norm for twins, mamas who have gone beyond 39 weeks (as late as 42 weeks is still considered full term!), induction (a whole other topic for a blog in and of itself!), “big baby” and several other “nebulous” reasons. C-sections became a way to “control” birth and to be able to dictate specifically when a baby would be born and who would be attending.

That is where we here in the US fell into problems. Birth is a wild and unpredictable process. Because we can never be exactly sure when conception and implantation occur (except in cases of assisted reproductive technology), clinicians really are guessing the age and developmental status of an infant in utero. Granted, we have some very sophisticated technology that we can use now and get a pretty accurate “guestimate”. But we are still guessing, and sometimes the guesses are off way more that expected. there also seems to be this need to control the process. Birth should not be controlled. It is as it is for a reason; so that mama’s and baby’s physiologies can interplay and together navigate the birth process. That process, that delicate physiologic communication is disrupted when clinicians intervene. Again, sometimes intervention is waranted. But historically in the US, the interventions are often more disruptive than beneficial.

So what should a mama do? How does she decide? Mamas, always have frank and open discussions about your care with your health care providers. Ask them what they hope to accomplish by performing a cesarean section and why they believe it is the best course of action in your particular case. Get as much information as you can; read, get second opinions if you feel uneasy. Make sure that in the end, whatever route of delivery you choose, you are comfortable with the decisions made and the procedures being performed.

Not all c-sections are bad. Many are lifesaving (as was the case with me and my daughter!). Just be sure that you are fully informed and fully at peace with your decision for the procedure before you signed the “informed consent”.  Remorse and regret following a birth that has not gone well can haunt a mama for years. It can have lifelong (negative) implications for the baby. And sadly, it cab alter the interaction between mama and child if not just initially, for many years to come.

What are your thoughts of C-section? Share your thoughts in the comments sections below.

Mamas on Bedrest: Is Echinacea Safe To Take During Pregnancy

January 10th, 2014

Hello Mamas,

I love getting your e-mails and Facebook questions. I love how you are taking charge of your health and your pregnancies and doing all that you can to make the best health care choices for you and your baby. I recently received this question from a mama and decided to share my take on herbs and supplements during pregnancy.

Q: Is Echinacea safe to take during pregnancy?

echinaceaFirst I want to start off by saying that I AM NOT an herbalist or expert in herbal medicine. While I am comfortable suggesting information on nutrition and nutritional supplements because I have training and experience in this area,  It is not my habit to recommend or advise people to take herbs because I don’t feel that I am qualified to make such recommendations. That being said, for this mama’s question, I did a bit of research.

Echinacea is one of the most commonly used herbs in North America. Most people use Echinacea to treat upper respiratory infections such as colds. In a November 2000 study published in The Archives of Internal Medicine, Researchers in Canada evaluated 200 pregnant women who had contacted MotherRisk, a program that assesses risk during pregnancy. These women had either knowingly taken echinacea in pregnancy or taken it unaware that they were pregnant. The women were matched with 200 pregnant women who had not taken echinacea. Following delivery, the researchers assessed the rates of complications, live births, miscarriages and major and minor birth defects and malformations and found no statistical difference in outcomes between pregnant women who had taken echinacea during pregnancy and those who had not. They concluded that echinacea is safe to take in pregnancy.

The caveat to this study and one the researchers themselves admitted is that because there is very little study done on herbs, its tough to say whether or not they are safe. Many people assume that because herbs are “natural” they are okay. One must always keep in mind that herbs are taken for their medicinal properties, and yes, they do act on our physiologic systems. For example, I was not that echinacea can promote bleeding, so if a person has a bleeding disorder taking echinacea could negatively affect their bleeding patterns. These people especially should consult with their health care provider-and/or a really knowledgeable herbalist about the safety of echinacea for them and may need to refrain from taking echinacea.

When I have a mama or other women’s health client who wants to know about herbs, I refer them to one of my colleagues who has extensive knowledge in herbal medicine. Additionally, once they have consulted with an herbalist, I suggest that they take what they have learned and discuss it with their health care provider so that the provider can compare the notes on the herbs with the health history of the patient. I know it sounds cumbersome and like I am being a Nervous Nelly. However, like I said, I was unaware that echinacea affects bleeding. If mama had been taking aspirin or another anticoagulant, this could have been a problem. The uterus is a highly vascularized organ meaning it has TONS of blood vessels feeding it. It a woman is prone to post partum hemorrhage, perhaps taking echinacea is not a good idea for her. Ultimately the decision is up to mama, but this is critical information she needs to make her decision.

As my highschool chemistry teacher used to say, “When in doubt, check it out!” Find out as much as you can before you introduce anything into your system while you are pregnant.

What’s your take on herbs during pregnancy? Share your experience in our comments section.

I love your questions and am happy to find the answers you need. Keep them coming! E-mail me at info@mamasonbedrest.com.

 

References:

Gallo M, Sarkar M, Au W, Pietrzak K, Comas B, Smith M, Jaeger TV, Einarson A, Koren G.  Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Archives of Internal Medicine 2000 Nov 13;160(20):3141-3.

Gallo M, Koren G. Can herbal products be used safely during pregnancy? Focus on echinacea. Canadian Family Physician. 2001 Sep;47:1727-8.

WebMD Health News: Study Shows Echinacea Safe During Pregnancy. November 28, 2000

Echinacea. Mayo Clinic Natural Standard® Patient Monograph, Copyright © 2013