Illness in pregnancy

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: 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

Mamas on Bedrest: Use Medications in Pregnancy with Caution and Supervision

March 16th, 2011

Asthma Flare During Pregnancy

When I was pregnant with my son my asthma flared up. I hadn’t had an attack in years but there I was, about 5 1/2 months pregnant and suddenly I couldn’t breathe. I had a Proventil (albuterol) inhaler, but I was reluctant to take it. I called my OB service (of course this happened on the weekend) and her nurse called me back and instructed me to use the inhaler. They also referred me to a pulmonologist to make sure that my asthma was controlled throughout the remainder of my pregnancy.

The pulmonologist was a really wonderful man and took a long time with me assessing my medical history and my current asthma situation. He prescribed Pulmicort, an inhaled steroid, to be taken twice daily for the remainder of my pregnancy. Evidently I had developed some sort of inflammatory response in my respiratory system. It wasn’t clear if it was due to the pregnancy hormones or some sort of viral illness, but I was inflammed none the less. I was very hesitant to take the steroid inhaler. But the pulmonologist reassured me that it was safe during pregnancy and would not cause any adverse complications with my baby. Furthermore, he reminded me that if I wasn’t breathing well, I would not be getting enough oxygen. If I wasn’t getting enough oxygen for my body, then I certainly couldn’t give adequate oxygen to my baby. I was sold.

A pregnant woman’s body undergoes so many changes that often she develops illnesses and ailments that she’s never had before-and may well never have again-but which can be quite problematic during pregnancy. Treating illness during pregnancy can be a real challenge because many medications have not been adequately tested in pregnant women and their exact effects on the pregnant woman and her baby are unknown. However there are many situations, my asthma being one such case, where treating the ailment outweighs the potential harm of the medication. At the very least, the untreated condition is as hazardous to the mother and baby as the treatment. So what should a pregnant woman do if she becomes ill or if she is on regular medication for a chronic condition? Let’s address the chronic condition first.

Chronic Conditions and Pregnancy

Many women with chronic medical conditions such as asthma, epilepsy, colitis, depression and others may take medication regularly to manage symptoms and keep flares or attacks at bay. However, many of the medications used to treat these conditions may be harmful to a developing fetus. Very little pharmaceutical testing is done on pregnant women due to the potential harm to both mother and baby. So if a woman has a chronic medical condition and is contemplating pregnancy-or has already become pregnant, her is what she should do:

  • Notify her obstetrician or midwife immediately that she is on medication for a chronic condition
  • If she has a specialist who is monitoring her chronic condition, notify them immediately of her pregnancy
  • DO NOT STOP YOUR MEDICATION! This could have serious medical effects for you and your baby. Consult with the provider who prescribed your medication and discuss whether or not to continue the medication, to change medications, or to taper off the medication entirely. Medication changes should always be supervised.
  • Notify your providers of any and all medications that you are taking, especially if you have to change medications due to your pregnancy, so that you can avoid potential interactions and side effects.

Transient illnesses and Pregnancy

Pregnancy depresses a woman’s immune system, leaving her susceptible to many viruses and illnesses she would otherwise be able to easily fend off. So many women contract colds, allergies and other maladies and can’t seem to shake them. When this occurs, check with your OB or midwife to determine which over the counter (OTC) medications are safe for you to take.

A word of caution: Don’t assume that “natural” or “herbal” preparations are safe to take during pregnancy. So many people assume that if something is “natural” it is not harmful. Nothing could be further from the truth! Many pharmaceuticals are actually derived from herbs or plants. Penicillin for example, was originally derived from mold yet is a potent antibiotic. Herbs and “natural” preparations work because plants have bioactivity, i.e. they are able to change your biology.  This is how all medications work-they act on your body to either suppress a symptom or to enhance your body so that it can fight whatever is ailing it. However, because a woman’s body changes so much during pregnancy, what is normally harmless (at least to her) may in fact be harmful (if not to her, potentially to her baby). Always check with your OB or midwife before taking any medication while you are pregnant.

There is no doubt about it, pregnancy is wonderful and yet hard on a woman’s body. But with proper daily care and professional expertise as needed, most pregnant women cruise peacefully through pregnancy and have healthy babies.

Photo:  I was about 6 months pregnant with my son in this photo. My then 3 yo daughter is trying to move me.