IN THIS CHAPTER
Finding a healthcare practitioner who meets your needs
Walking through a typical prenatal visit
Considering medications you may be taking
Recognizing the consequences of alcohol and drugs
Finding the right practitioner to care for you — and your baby — is a decision you shouldn’t take lightly. Your healthcare is always important, but your new and sometimes overwhelming condition means you want a practitioner who’s in sync with your approach to pregnancy. This person should be someone you trust and feel safe with. If you’ve had a previous child, you may already have a practitioner. If not, there’s no need to feel overwhelmed. This chapter helps you make that important decision and takes you through a typical prenatal visit.
Maintaining good health throughout your pregnancy is a critical step in delivering a healthy baby, so this chapter also includes information on risks and benefits associated with certain medicines and vaccinations, along with the consequences of alcohol and drugs.
Selecting the Right Practitioner for You
Many kinds of professionals can help you through pregnancy and delivery. Be sure to choose a practitioner with whom you feel comfortable. Review this list of the basic five:
· Obstetrician/gynecologist: After completing medical school, this physician receives another four years of special training in pregnancy, delivery, and women’s health. She should be board certified (or be in the process of becoming board certified) by the American Board of Obstetrics and Gynecology (or an equivalent program if you’re from a country other than the United States).
· Maternal-fetal medicine specialist: Also known as a perinatologist or high-risk obstetrician, this type of doctor has completed a two- to three-year fellowship in the care of high-risk pregnancies, in addition to the standard obstetrics residency, to become board certified in maternal-fetal medicine. Some maternal-fetal medicine specialists act only as consultants; some also deliver babies. You might seek the care of or even a consultation with a high-risk specialist if you’ve had a history of problem pregnancies (prior preterm delivery, history of preeclampsia, or multiple miscarriages), if you have underlying medical problems (like diabetes or chronic hypertension), or if your fetus has been diagnosed with a disorder.
· Family practice physician: This doctor provides general medical care for families — men, women, and children. She is board certified in family practice medicine. This kind of doctor is likely to refer you to an obstetrician or maternal-fetal medicine specialist if complications arise during your pregnancy.
· Certified nurse-midwife: A certified nurse-midwife is a registered nurse who has completed additional training to obtain a master’s degree in nursing and is also licensed to perform deliveries. A certified nurse-midwife typically practices in a setting where there is a physician available and refers patients when complications occur.
· Certified registered nurse practitioner: A certified registered nurse practitioner is a registered nurse who has completed additional training to obtain a master’s degree in nursing and is trained to provide routine prenatal care, but she typically doesn’t perform deliveries. She usually practices in conjunction with a physician; whether you see the nurse practitioner or the physician for your prenatal visits depends on the individual practice and where you are in your pregnancy. (Whether a certified registered nurse practitioner is allowed by law to deliver differs state to state.)
Before you make a decision, you want to be thorough in your search. Make sure you know what you want out of the experience. When you’re deciding on a practitioner, ask yourself the following key questions:
· Am I comfortable with and do I have confidence in this person? You should trust and feel at ease not only with your practitioner but also with the whole constellation of people who work in the practice. Would you feel free to ask questions or express your anxieties to them? Another point to keep in mind is how your general personality fits in with the practice’s philosophy. For example, some women prefer a low-key, low-tech approach to prenatal care, while others want to have every possible diagnostic test under the sun. Does this practitioner deliver in a setting where you feel most comfortable having your baby? Your past medical and obstetrical history can also influence the approach you take to your pregnancy and the provider you choose.
· How many practitioners are involved in the practice? You may end up choosing between a practitioner who works with one or more partners and one who is in solo practice. Many group practices rotate you through appointments with each of the doctors, enabling you to get to know them all so you’ll feel comfortable having any of them deliver your baby. Some practices utilize nurse practitioners to help render prenatal care. Practically speaking, you’re likely to bond more with one or two people in the practice than with others, which is natural, given that practitioners have varied personalities. A provider who practices alone should tell you who handles deliveries when she is ill, off duty, or out of town.
Ask your practitioner about her policy for after-hours problems or emergencies — including questions you may need to ask by telephone during evening or weekend hours.
· Where do I want to deliver? If your pregnancy is uncomplicated, any good hospital or birthing center will work just fine. Some women may even choose a home birth. If you’re at risk for some complications, however, you should consider a hospital delivery and ask whether the hospital you’ll be delivering in has a labor and delivery suite and a nursery equipped to handle any problems that may arise if, for example, the baby is born early. You may also want to ask the following questions:
· Is an anesthesiologist on-site 24 hours a day, or can your doctor call in an anesthesiologist quickly in case of an emergency?
· Can the hospital provide you with epidural anesthesia (a form of pain control during labor)? If epidural anesthesia isn’t readily available or you’re not interested in it, find out what other options are available for pain management.
· Are you allowed to room in — that is, keep the baby in your room as much as possible — after delivery? Also, are accommodations available for your partner to stay with you during your postpartum hospitalization?
· Can this practitioner refer me to a nearby specialist if needed? Consider whether you may need the services of a maternal-fetal medicine specialist or a neonatologist, a physician who specializes in the care of infants who are born early or who have other medical problems. Ideally, your practitioner can refer you to someone quickly if anything comes up.
· Will my insurance plan cover this practitioner? Now that managed care has become an important part of the health insurance industry, check to see whether your plan covers your practitioner of choice. Some places allow you to select an out-of-network physician if you pay part of the cost yourself.
DETERMINING WHETHER YOU’RE AT HIGH RISK
The question of whether you and your pregnancy are at high risk has no black-and-white answer, especially at the beginning. But it helps to be aware of the kinds of conditions that can put a pregnancy at high risk:
· Diabetes
· High blood pressure
· Lupus
· Blood disorders
· Heart, kidney, or liver disorders
· Twins, triplets, or other multiple fetuses
· A premature delivery in a prior pregnancy
· A previous child with birth defects
· A history of miscarriage
· An abnormally shaped uterus
· Epilepsy
· Some infections
· Bleeding
· Advanced maternal age (35 or older by the due date)
Remember that midwives and most family practice physicians are not equipped to handle high-risk pregnancies. If you have or develop any of these conditions, consult an obstetrician or a maternal-fetal medicine specialist.
Planning Prenatal Visits
Your positive pregnancy test marks a new beginning. The time has come to start thinking about what lies ahead. After you decide who your practitioner will be, give the office a call to find out how to proceed. Some practices want you to come in for a visit with the office nurse to give a medical history and to confirm your good news with either a blood or urine test, whereas others schedule a first visit with the practitioner. How soon your first visit will be scheduled depends in part on your history.
If you didn’t have a preconception visit and you haven’t been on prenatal vitamins or other vitamins containing folic acid, let the office know. A prescription for prenatal vitamins can be called in, so you can start taking them even before your first prenatal visit. All over-the-counter adult multivitamins and prenatal vitamins should have the correct dose of folic acid (400 micrograms), so the typical patient doesn’t need a prescription for them, but ask the pharmacist if you’re not sure. Also, some insurance companies may cover prescription vitamins but not over-the-counter ones, and some women just simply prefer one particular type of vitamin.
Some things are consistent from trimester to trimester — like checking your blood pressure and urine and checking the baby’s heartbeat — so these topics are covered in this chapter. In Chapters 1, 2, and 3 in Book 2, you can find specifics on what happens during prenatal visits for each trimester. See Table 2-1 for an overview of a typical schedule for prenatal visits.
Table 2-1 Typical Prenatal Visit Schedule
|
Stage of Pregnancy |
Frequency of Doctor Visits |
|
First visit to 28 weeks |
Every four weeks |
|
28 to 36 weeks |
Every two to three weeks |
|
36 weeks to delivery |
Weekly |
If you develop problems during pregnancy or if your pregnancy is considered high risk (see the risk factors described in Book 6, Chapter 1), your practitioner may suggest that you come in more frequently.
This schedule of prenatal visits isn’t set in stone. If you’re planning a vacation or need to miss a prenatal visit, tell your practitioner and reschedule your appointment. If your pregnancy is going smoothly, rescheduling usually isn’t a big deal. However, because some prenatal tests have to be performed at specific times during pregnancy (see Book 1, Chapter 1 for details), just make sure that missing an appointment won’t affect any of these tests.
Prenatal visits vary a bit according to each woman’s personal needs and each practitioner’s style. Some women need particular laboratory tests or physical examinations. However, the following procedures are standard during your prenatal visits:
· A nurse checks your weight and blood pressure. For more information on how much weight you should be gaining and when, see Book 1, Chapter 3; for details on healthy ways to manage your weight gain, head to Book 3, Chapter 1.
· You give a urine sample (usually an easy job for most pregnant women!). Your practitioner checks for the presence of protein, which may indicate preeclampsia, or glucose, which may be a sign of diabetes (see Book 6 for information on dealing with special conditions during pregnancy). Some urine tests also enable your doctor to look for any indications of a urinary tract infection.
· Starting sometime after 14 to 16 weeks, a nurse or doctor measures your fundal height. The practitioner uses either a tape measure or her hands to measure your uterus. This gives her a rough idea of how the baby is growing and whether you have an adequate amount of amniotic fluid (see Figure 2-1).
The nurse or doctor is measuring the fundal height, the distance from the top of the pubic bone to the top of the uterus (the fundus). By 20 weeks, the fundus usually reaches the level of the navel. After 20 weeks, the height in centimeters roughly equals the number of weeks pregnant you are. (Being above or below by 2 centimeters is usually within acceptable norms as long as you’re consistent from visit to visit.)
Note: The fundal height measurement may not be useful in women who are expecting two or more babies or in women who have large fibroids (in both cases, the uterus is much bigger than normal) or in women who are very obese (because it can be difficult to feel the top of the uterus).
· A nurse or doctor listens for and counts the baby’s heartbeats. Typically, the heartbeat ranges between 120 and 160 beats per minute. Most offices use an electronic Doppler device to check the baby’s heartbeat. With this method, the baby’s heartbeat sounds sort of like horses galloping inside the womb. Sometimes, you can hear the heartbeat as early as 8 or 9 weeks using this method, but often the heartbeat isn’t clearly discernible until 10 to 12 weeks. Prior to the availability of Doppler, a special stethoscope called a fetoscope was used to hear the baby’s heartbeat. Using this method, the doctor can hear the heartbeat around 20 weeks. A third way of checking the baby’s heartbeat is by seeing it on ultrasound. The heart beating away can frequently be seen at around 6 weeks.
Illustration by Kathryn Born, MA
FIGURE 2-1: Your practitioner may measure your fundal height to ensure that your baby is growing properly.
In some practices, a medical assistant or nurse performs tasks such as checking your blood pressure; in other practices, a doctor may perform this task. No matter who performs the technical components of the prenatal visit, you should always have the opportunity to ask a practitioner questions before leaving the office.
Keeping Your Medicines and Vaccinations in Check
During your pregnancy, you’ll probably experience at least a headache or two and an occasional case of heartburn. The question of whether you can safely take pain relievers, antacids, and other over-the-counter medicines is bound to come up. Many women are afraid to take any medicine at all, for fear of somehow harming their babies. But most nonprescription drugs — and even many prescription drugs — are safe during pregnancy. During your first prenatal visit, go over with your practitioner what medications are okay to take during pregnancy — both over-the-counter medications and medications prescribed to you by another physician. If another physician is treating you for a medical condition, let her know that you’re pregnant, in case any adjustments need to be made.
Reviewing your medications
Many medicines — both over-the-counter and prescription — are safe to take during pregnancy. If you’re taking medications essential for your health, discuss them with your physician prior to stopping them or changing your dose or regimen. But a few medications can cause problems for the baby’s development, so let your doctor know about all the medications you take. If one of them is problematic, you can probably switch to something safer. Keep in mind that adjusting dosages and checking for side effects may take time.
Exposure to the drugs and chemicals listed in Table 2-2 is considered to be safe during pregnancy.
Table 2-2 Medications Generally Considered Safe during Pregnancy
|
Type of Medication |
Example |
|
Pain relievers |
Acetaminophen |
|
Antiviral medications |
Acyclovir |
|
Antiemetics/antinausea medications |
Phenothiazines, trimethobenzamide, and Diclegis, a combination of doxylamine and vitamin B6, which has been approved by the Food and Drug Administration for morning sickness and is in the safest drug classification for pregnancy (category A) |
|
Antihistamines |
Doxylamine |
|
Low-dose aspirin |
Often used to decrease risk for preeclampsia in patients at risk |
|
Minor tranquilizers and some antidepressants |
Meprobamate, chlordiazepoxide, and fluoxetine |
|
Antibiotics |
Penicillin, cephalexin, trimethoprim-sulfamethoxazole, and erythromycin |
|
Antiviral agent used in patients with HIV |
Zidovudine |
Medications to ask your doctor about
The following are some of the common medications that women should ask about before they get pregnant:
· Birth control pills: Women sometimes get pregnant while they’re on the Pill (because they missed or were late taking a couple of pills during the month) and then worry that their babies will have birth defects. But oral contraceptives haven’t been shown to have any ill effects on a baby. Two to three percent of all babies are born with birth defects, and babies born to women on oral contraceptives are at no higher risk.
· Ibuprofen (Motrin, Advil): Occasional use of these and other nonsteroidal anti-inflammatory agents during pregnancy (for pain or inflammation) is okay and hasn’t been associated with problems in infants. However, avoid chronic or persistent use of these medications during pregnancy (especially during the last trimester) because they have the potential to affect platelet function and blood vessels in the baby’s circulatory system — and because your baby’s kidneys process them just like your own kidneys do.
· Vitamin A: This vitamin and some of its derivatives can cause miscarriage or serious birth defects if too much is present in your bloodstream when you get pregnant. The situation is complicated by the fact that vitamin A can remain in your body for several months after you consume it. Discontinuing any drugs that contain vitamin A derivatives — the most common is the anti-acne drug Accutane — at least one month before trying to conceive is important. Scientists don’t know whether topical creams containing vitamin A derivatives — anti-aging creams like Retin A and Renova, for example — are as problematic as drugs that you swallow, so consult your physician.
Some women take vitamin A supplements because they’re vegetarians and don’t get enough from their diet or because they suffer from vitamin A deficiency. The maximum safe dose during pregnancy is 5,000 international units (IU) daily. (You need to take twice that amount to reach the danger zone.) Multiple vitamins, including prenatal vitamins, typically contain 5,000 IU of vitamin A or less. Check the label on your vitamin bottle to be sure.
If you’re worried that your prenatal vitamin plus your diet will put you into that danger zone of 10,000 IU per day, rest assured that it would be extremely difficult to get that much vitamin A in your diet.
· Blood thinners: Women who are prone to developing blood clots or who have artificial heart valves need to take blood-thinning agents every day. One type of blood thinner, Coumadin (warfarin), or its derivatives, if taken during pregnancy, can trigger miscarriage, impair the baby’s growth, or cause the baby to develop bleeding problems or structural abnormalities. Women who take this medicine and are thinking of getting pregnant should switch to a different blood thinner. Ask your practitioner for more information. Do not simply stop taking your medications; discuss your options with your provider first.
· Drugs for high blood pressure: Many of these medications are considered safe to take during pregnancy. However, because a few can be problematic, you should discuss any medications to treat high blood pressure with your doctor (see Book 6, Chapter 3).
· Antiseizure drugs: Some of the medicines used to prevent epileptic seizures are safer than others for use during pregnancy. If you’re taking any of these drugs, discuss them with your doctor. Don’t simply stop taking any antiseizure medicine, because seizures may be worse for you — and the baby — than the medications themselves (see Book 6, Chapter 3).
· Tetracycline: If you take this antibiotic during the last several months of pregnancy, it may, much later on, cause your baby’s teeth to be yellow.
· Antidepressants: Many antidepressants (like Prozac and Zoloft) have been studied extensively and are considered safe during pregnancy. Recent studies on selective serotonin reuptake inhibitors (SSRIs) showed a small increase in certain birth defects, particularly with paroxetine, while other studies showed no increased risk. Most doctors believe that the absolute risk is very small. Although most data doesn’t show an increase in prematurity or low birth weight, some data suggests a possible small increase in the chance of miscarriage in the first trimester. Some reports also show a very small risk (0.6 to 1.2 percent) of a newborn condition called persistent pulmonary hypertension with exposure in the latter half of pregnancy.
Some of the newer antidepressants like Cymbalta, Celexa, Lexapro, and Effexor appear to be safe in pregnancy, but because they are new, data is limited. If you need to start an antidepressant during pregnancy, many doctors feel that sertraline (Zoloft) is the best first-line drug. But if you’re already taking an antidepressant, ask your doctor whether you’ll be able to keep taking the medication while you’re pregnant or need to switch to something safer.
· Bupropion: Bupropion is an antidepressant, but it’s also prescribed to help people stop smoking (for example, Wellbutrin or Zyban). Very little info exists on its use during pregnancy, but the available data doesn’t suggest any significant problems with fetal development. Although you shouldn’t use it as a first line for depression, its use for smoking cessation may be beneficial.
· Fluconazole: Fluconazole is an oral medication used to treat yeast or other fungal infections. A recent study showed that oral fluconazole used during the first trimester was not associated with an increased risk of birth defects overall, but it may be associated, at higher doses, with an increased risk of a specific heart defect known as Tetralogy of Fallot.
· Decongestants: A mounting body of recent evidence suggests that decongestants like phenylephrine and phenylpropanolamine, when used during the first trimester, may be associated with an increased risk of birth defects. If possible, avoid taking these medications until you’ve completed your first trimester; however, if you inadvertently took some before you found out that you were pregnant, the likelihood of a resulting birth defect is still very low.
· Lithium: Lithium is used occasionally to treat bipolar disorder. It’s thought that taking this medication during pregnancy increases your risk of having a child with a specific cardiac abnormality known as Ebstein’s anomaly. If possible, an alternative medication should be chosen for the first trimester, but if you inadvertently take lithium during the first trimester, the risk is still quite low. Women taking lithium during early pregnancy should have a fetal echocardiogram at around 20 weeks. This is a special type of ultrasound done to diagnose cardiac abnormalities, including Ebstein’s anomaly.
Some drugs are known to have a teratogenic effect, which means they have the potential to cause birth defects or problems with growth and development. If you took any teratogenic medications before you knew you were pregnant — or before you knew that the drugs could pose a problem — don’t panic. In many cases, the drugs do no harm, depending on when during pregnancy you took them and in what quantities. Some medications can cause problems in the first trimester but are totally safe in the third trimester, and vice versa. In fact, relatively few substances are proven to be teratogenic to humans, and even those that are don’t cause birth defects every time. Discuss with your practitioner the medications you’ve been taking and what tests are available to check on your baby’s growth and development.
Continuing medications until you talk to your doctor
Many medications are labeled “Don’t take during pregnancy” because they haven’t been adequately studied in pregnant women. However, this warning label doesn’t necessarily mean that adverse effects have been reported or that you can’t use these medications.
Whenever you have a question about a particular medication, ask your practitioner for advice. Don’t be surprised if opinions vary among practitioners, especially between nonobstetric providers and obstetricians. Many nonobstetricians are hesitant to prescribe many medications because they’re uncertain, whereas your obstetric practitioner may be more secure.
Certain medical problems, such as high blood pressure, pose more risk to the growing fetus than the medication you’d take to treat it does. Even a common headache, if it’s bad enough to cause you to miss a traffic signal when you’re behind the wheel, can be more dangerous than a little acetaminophen (Tylenol), which actually isn’t dangerous at all when taken in therapeutic doses. Many pregnant women suffer needlessly with common symptoms that could be treated with medications that are safe for the baby.
Don’t stop taking a prescription medication or change the dosage without talking to your doctor first.
Recognizing the importance of vaccinations and immunity
People are immune to all kinds of infections for one of two reasons:
· They’ve suffered through the disease. Most people are immune to chickenpox, for example, because they had it when they were kids, causing their immune systems to make antibodies to the chickenpox virus.
· They’ve been vaccinated. That is, they’ve been given a shot of something that causes the body to develop antibodies.
Many vaccines are safe, and in fact recommended, while you’re pregnant. (See Table 2-3 for information on several vaccines.) Here’s some further information on some common vaccinations:
· Rubella: Your practitioner tests to see whether you’re immune to rubella (also known as German measles) by drawing a sample of blood and checking to see whether it contains antibodies to the rubella virus. (Antibodies are immune system agents that protect you against infections.) If you aren’t immune to rubella, your practitioner is likely to recommend that you be vaccinated against rubella at least three months before becoming pregnant. Getting pregnant before the three months are over is highly unlikely to be a problem. No cases have been reported of babies born with problems due to the mother having received the rubella vaccine in early pregnancy. If you’re already pregnant when you discover that you aren’t immune to rubella, your practitioner will recommend that you get the vaccine after you deliver your baby, just before you go home from the hospital.
· Flu: The influenza vaccine is safe and recommended during pregnancy. Pregnant women who get the flu are at an increased risk of complications, including maternal morbidity and mortality. The vaccine poses no harm to your developing baby.
· Tetanus, diphtheria, and pertussis: It’s recommended that women get an adult tetanus, diphtheria, and pertussis (Tdap) vaccine during each pregnancy, ideally between weeks 27 and 36 of pregnancy. The pertussis vaccine also protects your baby from whooping cough after birth.
· Measles, mumps, and poliomyelitis: Most people are immune to measles, mumps, and poliomyelitis, and your practitioner is unlikely to check your immunity to all these illnesses. Besides, these illnesses aren’t usually associated with significant adverse effects for the baby.
· Chickenpox: There’s a small risk that the baby will contract a chickenpox infection from her mother. If you’ve never had chickenpox, tell your practitioner so you can discuss possible vaccination before you get pregnant or, if you’re already pregnant, after delivery before you go home.
· Human papilloma virus: Vaccines are available for the human papilloma virus (HPV), which is associated with some kinds of abnormal pap smears, genital warts, and cervical cancer. Studies suggest the HPV vaccine is similar to other vaccinations that are safe in pregnancy; however, it’s still recommended that pregnant women skip this vaccination. If you inadvertently got vaccinated before realizing that you were pregnant, the risk to your developing baby is very low, but you shouldn’t get subsequent doses until after delivery.
Table 2-3 Safe and Unsafe Vaccines before or during Pregnancy
|
Disease |
Risk of Vaccine to Baby during Pregnancy |
Immunization Recommendations |
Comments |
|
Cholera |
None confirmed |
Same as in nonpregnant women |
|
|
Hepatitis A (inactivated) |
None confirmed |
Okay if at high risk for infection or for prevention due to recent exposure |
|
|
Hepatitis B |
None confirmed |
Okay if at high risk for infection |
Used with immunoglobulins for acute exposure; newborns need vaccine |
|
Human papilloma virus |
None confirmed, but little data |
If found to be pregnant after initiating series, give remaining doses postpartum |
|
|
Influenza (inactivated) |
None confirmed |
Recommended |
|
|
Measles |
None confirmed |
No |
Vaccinate postpartum |
|
Mumps |
None confirmed |
No |
Vaccinate postpartum |
|
Plague |
None confirmed |
Selected vaccination if exposed |
|
|
Pneumococcus |
None confirmed |
Okay if high risk |
|
|
Poliomyelitis |
None confirmed |
Only if exposed or if traveling to endemic area |
|
|
Rabies |
Unknown |
Indication same as for nonpregnant women |
Consider each case separately |
|
Rubella |
None confirmed |
No |
Vaccinate postpartum |
|
Smallpox |
Possible miscarriage |
No, unless emergency situation arises or fetal infection |
|
|
Tetanus, diphtheria, and pertussis (Tdap) |
None confirmed |
Recommended for each pregnancy between 27 and 36 weeks |
|
|
Typhoid |
None confirmed |
Only for close, continued exposure or travel to endemic area |
|
|
Varicella (chickenpox) |
None confirmed |
Immunoglobulins recommended in exposed nonimmune women; should be given to newborn if around time of delivery |
If nonimmune, vaccinate postpartum (second dose 4–8 weeks later) |
|
Yellow fever |
Unknown |
No, unless exposure is unavoidable |
Understanding the Effects of Alcohol and Other Drugs on Your Baby
Alcohol and recreational/illicit drugs can cross the placenta and get into your baby’s circulatory system. Some medications can also cross the placenta. Some are completely harmless, whereas others can cause problems. The following sections outline which substances you can safely use and which you should avoid — information that’s crucial to your baby’s health.
Smoking
Unless you’ve been living on Mars for the past 30 years, you no doubt are aware that smoking is a health risk for you. When you smoke, you run the risk of developing lung cancer, emphysema, and heart disease, among other illnesses. During pregnancy, however, smoking poses risks to your baby as well.
The carbon monoxide in cigarette smoke decreases the amount of oxygen that your growing baby receives, and nicotine cuts back on blood flow to the fetus. Consequently, women who smoke stand an increased chance of delivering babies with low birth weight, which may mean more medical problems for the baby. In fact, babies born to smokers are expected to weigh a half pound less, on average, than those born to nonsmokers. The exact difference in birth weight depends on how much the mother smokes. Secondhand smoke is also a risk.
In addition to low birth weight, smoking during pregnancy is associated with a greater risk of preterm delivery, miscarriage, placenta previa (see Book 6, Chapter 2), placental abruption (also in Book 6, Chapter 2), preterm rupture of the amniotic membranes, and even sudden infant death syndrome (SIDS) after the baby is born.
Quitting smoking can be extremely difficult. But keep in mind that even cutting back on the number of cigarettes you smoke is beneficial to your baby (and yourself).
If you quit smoking during the first three months you’re pregnant, give yourself a pat on the back and be reassured that your baby is likely to be born at a normal weight and have fewer health issues.
Some women use nicotine patches, gum, lozenges, or inhalers to help them kick the habit. The nicotine from these products is still absorbed into the bloodstream and can still reach the fetus, but at least the carbon monoxide and other toxins in cigarette smoke are eliminated. The American Congress of Obstetricians and Gynecologists recommends that nicotine replacements such as these may be used when nonpharmacologic treatments have failed. The total amount of nicotine absorbed from the intermittent use of the gum or inhalers may be less than the amount from the patch, which is used continuously. It’s very important that you not smoke cigarettes while also using nicotine replacement, and if you relapse, discontinue the nicotine replacement.
The effects on fetal development with the use of bupropion (Zyban or Wellbutrin; see the earlier section “Medications to ask your doctor about”) haven’t been extensively studied, but one well-designed study showed that pregnant smokers receiving bupropion were much more likely to quit than those not taking the medication.
Drinking alcohol
Clearly, pregnant women who use alcohol put their babies at risk of fetal alcohol syndrome, which encompasses a wide variety of birth defects (including growth problems, heart defects, mental retardation, or abnormalities of the face or limbs). The controversy arises because medical science hasn’t defined an absolute safe level of alcohol intake during pregnancy.
Scientific data shows that daily drinking and heavy binge drinking can lead to serious complications, although little information is available about occasional drinking. Two recent studies from Britain, however, demonstrated that light or moderate drinking had little effect on either neurodevelopmental outcomes or balance. In one study, up to two drinks per week was not linked with developmental problems with children. A separate study of 7,000 10-year-olds whose mothers had light (one glass per week) or moderate (three to seven glasses per week) alcohol consumption during pregnancy found that the children had no difference in balance compared to those whose mothers did not drink at all during pregnancy. The authors of the studies still say, however, that abstaining from alcohol during pregnancy is the best choice. Similarly, both the American Congress of Obstetricians and Gynecologists and the Food and Drug Administration (FDA) recommend avoiding any amount of alcohol during pregnancy.
If you think you may have a drinking problem, don’t feel uncomfortable talking to your practitioner about it. Special questionnaires are available to help your doctor identify whether your drinking is excessive enough to pose a risk to you and the fetus. If you think you may have a problem, discussing this questionnaire with your practitioner is crucial to your baby’s health — and to yours.
EXPECTANT MOTHERS ASK …
Questions about alcohol consumption during pregnancy are very common, so here are the answers to some of the most frequently asked questions:
Q: “On my Caribbean vacation, I enjoyed some piña coladas on the beach. I didn’t find out I was pregnant until a few weeks later. Will my baby have birth defects?”
A: No evidence suggests that a single episode of drinking has any increased risk of adverse effects on pregnancy. Now that you know you’re pregnant, avoid alcohol.
Q: “Is hard liquor worse for the baby than wine or beer?”
A: They’re all considered the same risk. A can of beer, a glass of wine, and a mixed drink with 1 ounce of hard liquor contain roughly the same amounts of alcohol.
Q: “My doctor suggested I have a glass of wine on the evening after my amniocentesis. Is this okay?”
A: While the party line is that avoiding alcohol entirely is best, occasional use is probably okay, especially under these circumstances. Alcohol is a tocolytic, which basically means that it relaxes the uterus. After amniocentesis, many women feel a little uterine cramping. The alcohol in a glass of wine minimizes that discomfort without hurting the baby.
Using recreational/illicit drugs
Many studies have evaluated the effects of drug use during pregnancy. But the studies can be confusing because they tend to lump all kinds of drug users together, regardless of which drugs they use and how much they use. The mother’s lifestyle also influences the degree of risk to the baby, which complicates the information even more. For example, women who abuse drugs are more likely to be malnourished than other women, they’re typically of lower socioeconomic status, and they suffer a higher incidence of sexually transmitted diseases. All these factors, independent of and added to drug use, can cause problems for your pregnancy and for your baby.