Almost as soon as you see that little pink line on the pregnancy test, the worry seems to set in. You start thinking about the two cups of coffee you had at work yesterday, the glass of wine you sipped at dinner last week, the tuna steak you devoured for lunch 2 weeks ago.
No doubt about it, pregnancy can be one of the most thrilling and most worrisome times in a woman's life. Of course, when you're pregnant, what you don't put into your body (or expose it to) can be almost as important as what you do. The official, scary-sounding word for something that may cause birth defects or harm to a fetus is teratogen, and can include drugs, medications, infections, chemicals, etc.
But stressing out about every little thing you come into contact with can make for a long and taxing three trimesters. And beating yourself up about things you did before you knew you were pregnant or before you found out they could be hazardous won't do you or your baby any good.
Questions abound regarding what you can and can't do during pregnancy. But the answers may not always come from the most reliable sources, so you might worry unnecessarily. Some warnings from friends and other well-wishers are worth listening to; others are popular but unproven rumors.
Knowing what could truly be harmful to your baby and what's not a real concern is the key to keeping your sanity during these 40 weeks.
You should be particularly mindful of a handful of things during your pregnancy, some of which are more harmful than others. Your doctor (or other health care provider) will talk to you about those that should be avoided altogether, dramatically reduced, and/or carefully considered during pregnancy.
Should I avoid it? Yes! Although it may seem harmless to have a glass of wine at dinner or a mug of beer out with friends, no one has determined what is a "safe amount" of alcohol to drink during pregnancy. Fetal alcohol syndrome (FAS) is caused by the consumption of a large amount of alcohol during pregnancy. What that amount is versus a safe amount is really not known. Because of the uncertainty, it's always wise to err on the side of caution and not drink any alcohol at all while you're pregnant.
What are the risks to my baby? One of the most common known causes of mental and physical birth defects, alcohol produces more severe abnormalities in a developing fetus than heroin, cocaine, or marijuana.
Alcohol is easily passed along to the baby, who is less able to eliminate alcohol than the mother. That means an unborn baby tends to develop a high concentration of alcohol, which stays in the baby's system for longer periods than it would in the mother's. And moderate alcohol intake, as well as periodic binge drinking, can possibly damage a baby's developing nervous system.
What can I do about it? If you had a drink or two before you even knew you were pregnant (as many women do), don't worry too much about it. But your best bet is to not drink any more alcohol for the rest of your pregnancy.
If you're an alcoholic or think you may have a drinking problem, be sure to talk to your doctor about it. He or she needs to know how much alcohol you've consumed and when during your pregnancy to get a better idea of how your unborn baby may have been affected. Your doctor may also be able to start you on a path to getting the help you need to stop drinking — for your sake and your baby's.
Should I avoid and/or limit it? Yes. It's wise to cut down or eliminate caffeine intake. Studies indicate that caffeine consumption of more than 200-300 milligrams a day (about 2-3 cups of coffee, depending on the portion size, brewing method, and brand) might put a pregnancy at risk. Less than that amount is probably safe.
What are the risks to my baby? High caffeine consumption has been linked to an increased risk of miscarriage and, possibly, other pregnancy complications.
What can I do about it? If you're having a hard time cutting out coffee cold turkey, here's how you can start:
And remember that caffeine is not limited to coffee. Green and black tea, cola, and other soft drinks contain caffeine. Try switching to decaffeinated products (which may still have some caffeine, but in much smaller amounts) or caffeine-free alternatives.
If you're wondering whether chocolate, which also contains caffeine, is a concern, the good news is that you can have some of the scrumptious treat in moderation. Whereas a cup of brewed coffee has 95-135 milligrams of caffeine, the average chocolate bar has between 5-30 milligrams. So, small amounts of chocolate are fine.
Are there some I should avoid? Yes. Foods that are more likely to be contaminated with bacteria or heavy metals are ones to try to avoid or limit your exposure to. Those you should steer clear of altogether during pregnancy include:
Also, although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), you should avoid eating certain kinds due to high levels of mercury, which can damage the brain of a developing fetus.
Fish to avoid:
What are the risks to my baby? Although it's important to eat plenty of healthy foods during pregnancy, you also need to avoid food-borne illnesses, such as listeriosis, toxoplasmosis, and salmonella, which are caused by the bacteria that can be found in certain foods. These infections can be life threatening to an unborn baby and may cause birth defects or miscarriage.
What can I do about it? Be sure to thoroughly wash all fruits and vegetables, which can carry bacteria or be coated with pesticide residue. And be mindful of what you're buying at the grocery store or when dining out.
When you choose seafood, eat a variety of fish and shellfish and limit the amount to about 12 ounces per week — that's about two meals. Common fish and shellfish that are low in mercury include: canned light tuna, catfish, pollock, salmon, and shrimp. But because albacore (or white) tuna has more mercury than canned light tuna, it's best to eat no more than 6 ounces (or one meal) of albacore tuna a week.
You may have to forego a few things during pregnancy that you normally enjoy. But just think how delicious they'll taste after waiting 9 months!
Should I avoid it? Yes. Pregnancy is the prime time to get out of cleaning kitty's litter box. But that doesn't mean that you have to keep away from Fluffy!
What are the risks to my baby? An infection called toxoplasmosis can be spread through soiled cat litter boxes and can cause serious problems in a fetus, including prematurity, poor growth, and severe eye and brain damage. A pregnant woman who becomes infected often has no symptoms but can still pass the infection on to her developing baby.
What can I do about it? Have someone else change the litter box, making sure to clean it thoroughly and regularly, then wash his or her hands well afterward.
Should I avoid them? Some — yes; others — no. There are many medications you should steer clear of during pregnancy. Be sure to talk to your doctor about which prescription and over-the-counter (OTC) drugs you can and can't take, even if they seem like no big deal.
What are the risks to my baby? Even common OTC medications that are generally safe may be considered off-limits during pregnancy because of their potential effects on the baby. Certain prescription medications may also cause damage to the developing fetus. (The type of harm and extent of possible damage depends on the kind of medication.)
Also, although they may seem harmless, herbal remedies and supplements are not regulated by the U.S. Food and Drug Administration (FDA). That means that they don't have to follow any safety standards and, therefore, could be harmful to your baby.
What can I do about it? To make sure you don't take anything that could put your baby at risk talk to your doctor about:
Also, be sure to let all of your health care providers know that you're pregnant so that they'll keep that in mind when recommending or prescribing any medications. If you were prescribed a medication before you became pregnant for an illness, disease, or condition you still have, your doctor can help you weigh the potential benefits and risks of continuing your prescription.
If you become sick (e.g., with a cold) or have symptoms that are causing you discomfort or pain (e.g., a headache or backache), talk to your doctor about medications you can take and alternative ways to help you feel better without medication.
Should I avoid them? Yes!
What are the risks to my baby? Pregnant women who use drugs may be placing their unborn babies at risk for:
And their babies could also be born addicted to those drugs.
What can I do about it? If you've used any drugs at any time during your pregnancy, it's important to inform your doctor. Even if you've quit, your unborn child could still be at risk for health problems. If you're still using drugs, talk to your doctor for help on how to quit. Health clinics such as Planned Parenthood also can recommend health care providers, at little or no cost, who can help you quit your habit and have a healthier pregnancy.
Should I avoid it? Yes! You wouldn't light a cigarette, put it in your baby's mouth, and encourage your little one to puff away. As ridiculous as this sounds, pregnant women who continue to smoke are allowing their fetus to smoke too. The smoking mother passes nicotine and carbon monoxide to her growing baby.
Likewise, you should steer clear of people who are smoking, whether they're coworkers, friends, family members, or other diners at a restaurant (if your state still allows smoking in public places).
What are the risks to my baby? If a pregnant woman smokes, it could cause:
And the risks to a fetus from regular exposure to secondhand smoke include low birth weight and slowed growth.
What can I do about it? If you smoke, having a baby may be the motivation you need to quit. Talk to your doctor about options for kicking the habit.
If you spend time with people who smoke, ask them nicely to do it outside — and away from you if you're outside as well. And, of course, request the nonsmoking area whenever you dine out.
Whether you read it on an online pregnancy chat board, heard it from your best friend's coworker's cousin, or aren't sure where that nagging doubt came from, worries about what's OK during pregnancy abound. Here's the lowdown on some common ones that many expectant women wonder about.
Should I avoid them? Although some are OK, one in particular isn't so clear-cut.
Aspartame, sucralose, stevioside, and acesulfame-K have been found to be safe to use in moderation during pregnancy. However, you should avoid aspartame if you or your partner has a rare hereditary disease called phenylketonuria (PKU), in which the body can't break down the compound phenylalanine, which is found in aspartame. In that case, you should avoid aspartame altogether since your baby may also be born with the disease.
But the jury still seems to be out on whether saccharin, which is found in some foods and in the little pink packets, is safe to use during pregnancy or not — it can cross the placenta and could stay in the fetus' tissue. (Also, a sweetener called cyclamate was banned in the United States because of concern about cancer.)
What are the risks, if any, to my baby? Although some people have alleged that the artificial sweetener aspartame is linked with birth defects and illnesses ranging from multiple sclerosis to Parkinson's disease, government authorities and medical groups throughout the world have evaluated aspartame and approved it as safe for human consumption, including during pregnancy.
Research done during the 1970s suggested that saccharin caused bladder cancer in lab rats when given in large quantities. Since then, though, those studies have often been called into question. Also, a warning saying that it could cause cancer was removed from all saccharin-containing products' labels in 2000.
What can I do about it? With aspartame, sucralose, stevioside, and acesulfame-K, moderation is the key. It's OK to have an occasional diet soda or sugar-free food with these sweeteners here and there. But if you're really craving something sweet, it's probably better to have the real thing, as long as it's in moderation.
If you've already consumed something with saccharin in it during your pregnancy, don't obsess about it. It's highly unlikely that small amounts could do any harm to your baby.
Still, it's wise to check product labels and try to avoid — or at least limit — anything with artificial sweeteners (especially saccharin), just to be safe. After all, this is one time in your life when you have a good reason to avoid diet foods! And the more naturally flavored whole foods you eat during pregnancy, the better.
Should I avoid them? No. There is no evidence that computer monitors (also called video display terminals, or VDTs) cause any problems in unborn babies.
What are the risks, if any, to my baby? There's been speculation since the 1980s that VDTs are unsafe for pregnant women because of low levels of radiation (electromagnetic fields). But according to the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), computer monitors have not been found to cause low birth weight or preterm births.
What can I do about it? You don't need to do anything. Before you quit your office job or sit 10 feet away from the screen using a pool stick to type, rest assured that computer monitors are OK.
Should I avoid it? No, not unless your due date is near or your doctor tells you that you or your baby has a medical condition that warrants keeping you near home. Women with certain health conditions — like high blood pressure (hypertension) or blood clots, a history of miscarriage, premature labor, ectopic pregnancy, or other prenatal complications — are encouraged not to fly.
Otherwise, most healthy pregnant women can fly up to 4 weeks before their due date. After that, it's best to stay close to home in case you deliver.
Note: it is recommended that pregnant women not fly to areas with high altitudes, regions with disease outbreaks, or where certain vaccines are recommended for travelers beforehand.
What are the risks, if any, to my baby? For women with healthy pregnancies, there are no significant risks. However, women who have difficult pregnancies, especially involving their cardiovascular system, could be compromised by air flight and should discuss any flying plans with their doctor.
What can I do about it? Discuss any plans for lengthy or distant travel with your doctor during your last trimester, just in case. If he or she says it's OK, check with the airlines to find out what their policies are regarding flying during pregnancy. (Most airlines will allow pregnant women to fly up until week 37.)
To make sure your flight is as comfortable as possible, you may want to:
Should I avoid them? No. According to the American College of Obstetricians and Gynecologists (ACOG), because very little dye is absorbed through the skin, dying your hair is "most likely safe" during pregnancy, despite what doctors in years past may have advised. That's good news for many expectant women — coloring your hair can be a great little confidence boost when everything else going on in your body feels so out of your control.
Having said that, though, very few studies have closely examined the many different kinds of hair treatments and their potential effects on a fetus. What we do know indicates that hair treatments are most likely safe.
What are the risks, if any, to my baby? None that are currently known.
What can I do about it? If you're still concerned, ask your doctor about natural, non-chemical dyes that could give you the little makeover you may need without the added worry. Also, having your hair highlighted (rather than dyed) uses far less chemicals.
Should I avoid it? Yes. For most pregnant women, low-impact exercise is a great way to feel better, look better, and help prepare the body for labor. Low-impact exercise increases your heart rate and intake of oxygen while helping you avoid sudden or jarring actions that can stress your joints, bones, and muscles. Unless your doctor tells you otherwise, stick to low-impact exercise.
How much is enough? Well, the U.S. Department of Health and Human Services recommends at least 150 minutes (that's 2 hours and 30 minutes) of moderate-intensity aerobic activity each week for healthy women who are not already highly active or used to doing vigorous-intensity activity. If you were very active or did intense aerobic activities before getting pregnant you may be able to continue your exercise regimen, as long as your doctor says it's safe for you and your baby.
It's wise to avoid some exercises and activities, such as:
What are the risks, if any, to my baby? High-impact exercise can cause increased pressure on the structures within the uterus that could lead to problems such as premature labor or bleeding.
What can I do about it? Some of the healthy ways pregnant women can stay fit include walking, swimming, water aerobics, yoga, and Pilates. But be sure to talk to your doctor before starting — or continuing — any exercise routine during pregnancy.
Should I avoid them? Some — yes; others — no. While chemicals like ammonia and chlorine may make you nauseated because of the smell, they're not toxic, says the March of Dimes. But others, such as some paints, paint thinners, oven cleaners, varnish removers, air fresheners, aerosols, carpet cleaners, etc., may be.
What are the risks, if any, to my baby? It depends on the product. Some household chemicals may have no effect, while others in high doses could potentially be harmful.
What can I do about it? Here a few tips to help keep household chemicals in perspective during your pregnancy:
Should I avoid them? Yes. They're considered poisons and pregnant women should stay away from them as much as possible.
What are the risks, if any, to my baby? Although there's no evidence that the typical occasional household use of insecticides does any damage to a baby, it's best to err on the side of caution. High levels of exposure may cause:
As for insect repellents (which may contain DEET, or diethyltoluamide), the risks aren't fully known. So, it's best to either not use them at all during pregnancy or to wear gloves to place a small amount on socks, shoes, and outer clothing instead of putting repellents directly on your skin.
What can I do about it? If you have a real problem with pesky bugs around your home, the March of Dimes suggests the following:
Should I avoid it? Yes. However, exposure to high lead levels is rare for women in the United States.
What are the risks, if any, to my baby? Exposure to high levels of lead can cause:
But even low levels of lead can cause subtle problems with behavior and learning in children.
What can I do about it? If your home was built before 1978, it could have lead-based paint. But it only becomes a problem if the paint is chipping, peeling, or being removed. Some homes also may have lead pipes or copper piping with lead solder that can allow lead to enter the tap water.
If you have an older home or think that you may have lead piping or soldering and are concerned about lead exposure, you can have a professional come out to test your water, the dust in your home, the soil outside, and/or the paint around your home for lead.
Make sure that anyone who removes any potentially lead-based paint from your home:
To help reduce potential lead levels in your tap water, you can run the water for 30 seconds before using it and/or buy a water filter that specifically says on the packaging that it removes lead.
Should I avoid them? No. Nuke away! After all, for pregnant women on the go, especially those with other kids, microwaves are usually a must.
What are the risks, if any, to my baby? There are no medically proven risks. Microwaves don't leak radiation, and any that did would emit extremely small amounts that are virtually undetectable.
What can I do about it? If you're still concerned, you might want to make sure your microwave is working properly and isn't leaking or damaged. Researchers have determined that if a microwave does leak any radiation, it diminishes exponentially with distance from the microwave. In other words, if you have any concerns, stand a few feet away instead of immediately in front of the oven.
Should I avoid or limit it? Yes. You should limit activities that would raise your core temperature above 102ºF (38.9ºC). They include:
What are the risks, if any, to my baby? If your body temperature goes above 102ºF (38.9ºC) for more than 10 minutes, the elevated heat can cause problems with the fetus. Overheating in the first trimester can lead to neural tube defects and miscarriage. Later in the pregnancy, it can lead to dehydration in the mother.
What can I do about it? Instead of hot tubs or saunas, take a dip in a cool pool. And it's probably a good idea to stick to warm or slightly hot baths and showers. If you have a fever during your pregnancy, talk to your doctor about ways to lower it. And follow your body's cues that you're getting overheated when exercising or enjoying the great outdoors in the warmer months.
But if you've already become overheated during your pregnancy, don't worry too much about it. Chances are, you removed yourself from the uncomfortable situation before any damage was done.
Should I avoid them? Maybe. Although there's no proof that self-tanners are harmful to an unborn baby, there haven't been many studies done on their effects to a fetus.
What are the risks, if any, to my baby? No risks specific to tanning have been documented.
What can I do about it? For a summer glow, skip the self-tanner and apply some bronzer to your face, neck, shoulders, and chest. And if you do decide to try a self-tanner, that's far safer than lying out in the sun and becoming potentially overheated. Overheating in the first trimester, as discussed above, can lead to significant problems for the baby; later in the pregnancy, it could lead to dehydration in the mother. Still, ask your doctor before applying any "tan in a bottle."
Should I avoid it? No. Most pregnant women having a "normal" pregnancy can continue having sex — it's perfectly safe for both mom and the baby, even up until the delivery. Of course, you'll probably need to modify positions for your own comfort as your belly gets bigger.
However, your doctor may advise against sexual intercourse if he or she anticipates or detects certain significant complications with your pregnancy, including:
What are the risks, if any, to my baby? You should not have sex with a partner whose sexual history is unknown to you or who may have a sexually transmitted disease, such as herpes, genital warts, chlamydia, or HIV. If you become infected, the disease may be transmitted to your baby, with potentially dangerous consequences.
What can I do about it? Talk to your doctor about any discomfort you experience during or after sex or any other concerns.
Should I avoid it? Not necessarily. Before you go out and buy a 9-month supply of bottled water, tell your doctor where you live and whether you have public water or well water.
It's also important to note that just because water is bottled doesn't necessarily mean it's safer. Although bottled water (which is regulated by the FDA) may often taste better or just different, tap water meets the same Environmental Protection Agency (EPA) standards.
What are the risks, if any, to my baby? Different studies show different things, according to the March of Dimes. Some have found that the chlorine used to treat public water can turn into chloroform when it mixes with other materials in the water, which can increase the risk of miscarriage and poor fetal growth. But other studies have found no such links. Also of concern to some is the potential for the water to be contaminated by things like lead and pesticides. If you have well water you should probably have it checked regularly, such as once a year, whether you're pregnant or not.
What can I do about it? If you're concerned, contact your local water supplier to get a copy of the annual water quality report. If you're still concerned and/or have private well water, have your water tested by a state-certified laboratory. This can cost anywhere from $15 to hundreds, depending on the number of contaminants you want to have your water tested for.
To help ease your mind, you could also buy a water filtration system to help reduce the levels of lead, some bacteria and viruses, and chemicals such as chlorine. But be sure to read the product's label thoroughly, as some do more than others.
Countertop pitcher and faucet-mounted units are fairly inexpensive (some for under $50), whereas systems used to treat your entire home's water supply are much pricier (up to thousands of dollars). You can also have refillable water coolers delivered to your home, often through wholesale — or bulk items — stores.
Should I avoid them? Maybe. As with self-tanners, no good studies have been done on teeth whiteners that definitively say whether they're safe to use if you're expecting. And some makers of whitening products do caution against using them during pregnancy. Some dentists encourage waiting until after pregnancy to get your teeth whitened and others say that the procedures are safe. The concern is primarily about the chemicals used in teeth whitening products that could be swallowed and the potential effect on a fetus.
What are the risks, if any, to my baby? There's currently no evidence that teeth whitening can harm a fetus.
What can I do about it? Talk to your doctor before plunking down the cash on whitening products. If you'd rather wait until after your pregnancy to try to make your teeth pearly white, simply brush regularly with whitening toothpaste, which may give a little extra kick to your smile.
Should I avoid them? Many — yes; others — no. It's best to wait until after your pregnancy for most vaccines, but a few are considered safe. Your doctor may say it's OK to get a vaccine if:
The flu shot fits the criteria above and is recommended by the CDC during any stage of pregnancy. But note: only the shot made with the inactivated virus is safe for moms-to-be. This vaccine can curb flu-related problems for expectant moms, who are at higher risk of complications from the illness. And, the vaccine is safe — studies show "no adverse fetal effects and no adverse effects during infancy or early childhood," according to the CDC.
Women who are given the flu shot during pregnancy may also reduce their infants' risk of getting the flu by more than 60% in the first half of the babies' first year — when little ones are at the greatest risk of flu complications and hospitalizations. Plus, the shot fends off more than a third of fever-inducing respiratory illnesses in both mothers and their babies.
The Tdap vaccine (against tetanus, diphtheria, and pertussis) is now recommended for all pregnant women in the second half of each pregnancy, regardless of whether or not they had the vaccine before, or when it was last given. This new recommendation was made in response to a rise in pertussis (whooping cough) infections, which can be fatal in newborns who have not yet received their routine vaccinations.
In addition to the flu shot and Tdap vaccine, other vaccines the CDC considers safe during pregnancy, only if truly necessary, are:
What are the risks, if any, to my baby? Live-virus vaccines — those containing a live organism — aren't recommended for pregnant women because of the risk that the actual infection or disease the vaccine is meant to prevent may be passed along to the unborn baby. However, this depends on the circumstances and whether the vaccine would ultimately be safer to receive than being exposed to the actual disease. For example, the chickenpox vaccine may be safer to your unborn baby than getting the infection. So, it's important to speak to your doctor if you believe that you may have been exposed to a disease.
For the most part, though, researchers don't know what the risks of some vaccines may be to a fetus. So, it's wise to just wait to be vaccinated unless your doctor tells you otherwise.
What can I do about it? Be sure to talk to your doctor before getting any vaccination during pregnancy. It's also a good idea to inform your doctor if you became pregnant within 4 weeks of having a vaccine. And if your workplace requires certain vaccines, be sure to let them know you're pregnant before agreeing to be immunized.
Should I avoid them? Yes and no. If your doctor thinks it's truly necessary — for your own well-being or your baby's — to get one during your pregnancy, then it's highly unlikely that low levels of X-ray radiation will be harmful. However, if you can safely wait to get an X-ray until after your baby is born, then that's probably the best way to go.
What are the risks, if any, to my baby? According to the American Academy of Family Physicians (AAFP), X-rays are most likely safe during pregnancy. Most diagnostic X-rays emit much less than 5 rads, which is the limit of what the FDA suggests a pregnant woman should be exposed to.
Different imaging studies emit different amounts of radiation and the direction of the X-ray beam also affects the possible exposure to the fetus. Dental X-rays, for example, aren't cause for much concern because the X-ray area is far from your uterus. However, researchers believe that a fetus is more susceptible to damage by radiation because of the rapid rate with which their cells are dividing.
What can I do about it? First, make sure that all of your health care providers (including your dentist and the X-ray technician) know about your pregnancy before you get an X-ray. Also make sure that your stomach is covered with a lead apron.
If you're concerned and would rather not get an X-ray at all during pregnancy, your doctor may be able to use an MRI (magnetic resonance imaging) test during the first trimester or an ultrasound anytime.
Although some things are certainly considered unsafe during pregnancy, try not to spend too much time wondering and worrying. When in doubt, just use common sense — if it seems like a bad idea, doesn't need to be done right now, or might be risky, hold off at least until you've had a conversation with your doctor about it. He or she can likely help ease your mind and may even give you license to do something you never expected to be able to do until after your special delivery.
Above all, make sure to follow the most important healthy pregnancy habits — eat right; get plenty of rest; steer clear of drugs, alcohol, and tobacco — and you'll be well on your way to keeping both you and your baby healthy.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: March 2013
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