By Chris Colón, Certified Genetic Counselor at MotherToBaby Arizona

During pregnancy, many women make changes in their lives in order to have the best chance to have a healthy baby. I know I did during both of my pregnancies. These changes can involve their diet, exercise habits and other lifestyle factors. After birth, new moms may consider adding back some of the things they cut out over the last 9 months, including drinking alcohol. But is adding it back in that simple? During September’s Fetal Alcohol Spectrum Disorders (FASD) Awareness month, I thought I’d examine the topic of alcohol in breastmilk a little more closely for you. It’s a question I get frequently from the women who contact our service. As you probably know, for years, experts have been saying there is no known safe amount of alcohol use during pregnancy, but does alcohol affect a breastfeeding baby?

Before you raise your glass of favorite vino, here’s what research says…

Studies have shown that alcohol passes into the breast milk. The concentration of alcohol in the breast milk is close to the concentration of alcohol in the woman’s bloodstream. Alcohol can pass back and forth from the bloodstream into the breast milk. It’s a common myth that pumping and discarding breast milk will remove the alcohol from breast milk. Even if you discard pumped breast milk after drinking, alcohol still remains in your blood for a period of time, depending on how much you had to drink. The only way to get rid of alcohol from your system is to wait for your body to break it down and get rid of it. It takes about 2 to 2.5 hours for each standard drink to clear from breast milk. (A standard serving is considered to be 12 ounces of beer, 4-5 ounces of wine, or 1.5 ounces of hard liquor.) For each additional drink, a woman must wait another 2-2.5 hours per drink. Pumping and discarding, drinking water, taking caffeine, or exercising do not help your body get rid of the alcohol faster, because only time can reduce the amount of alcohol in the breast milk.

More misconceptions…

Another common misconception is that drinking during breastfeeding is recommended to help produce more breast milk. It used to be believed that beer raised levels of prolactin, a hormone in the body that plays a role in making breast milk. However, alcohol may actually reduce the amount of milk you produce. It is now known that alcohol lowers the release of another hormone called oxytocin. Lower oxytocin levels can affect the amount of milk that is released from the breast, meaning a baby may get less milk.

Alcohol’s known effect on baby

Many people wonder if alcohol affects a growing baby. Effects on infants from alcohol in breast milk are not well studied. There are some reports that babies whose mothers drink alcohol while breastfeeding may eat less and/or experience changes in their sleeping patterns. One study suggested problems with motor development following exposure to alcohol in breast milk, but other studies did not show the same results. There are many factors that can play a role in how alcohol can possibly affect a developing baby. Differences in genetics and metabolism of alcohol by both the mother and the baby may result in a wide range of risk. The risk may be different even in different babies from the same mother. At this time, it’s not clear how alcohol in breast milk can affect a developing baby.

Depending on the amount of alcohol you drink and the frequency with which you drink, you may not need to stop breastfeeding if you drink alcohol. You can speak with your health care provider as well as the baby’s pediatrician about how much alcohol you are drinking as well as all your choices for breastfeeding. You can also contact a MotherToBaby counselor at (866) 626-6847 to talk about alcohol and other exposures during breastfeeding.

Chris Colón is a certified genetic counselor based in Tucson, Arizona and proud mother of two. She currently works for The University of Arizona as a Teratogen Information Specialist at MotherToBaby Arizona, formerly known as the Arizona Pregnancy Riskline. Her counseling experience includes prenatal and cardiac genetics, and she has served as MotherToBaby’s Education Committee Co-chair since 2012.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847. You can also visit MotherToBaby.org to browse a library of fact sheets.

By Elizabeth Salas, MPH, Teratology Information Specialist, MotherToBaby California

“Do women really eat their placenta after delivery?” I was asked many years ago when a coworker mentioned a famous celebrity had talked about it during an interview. I had never heard of the practice before. As I await the birth of my first child, I got to thinking about this question again. I mean, the placenta-eating crowd has really created some demand over the last couple of years! Today, you can easily find services that will encapsulate your placenta, countless articles on the web, and even websites that offer placenta recipes. What’s next? Seeing it on a menu? Imagine hearing at your favorite dine, “I’d like a burger, fries and a placenta pop, please!” Bottom line, women are talking about it, asking about it, and yes, eating their placenta.¹

The human placenta is an amazing organ, but what exactly does it do?

The placenta is a temporary organ that develops during pregnancy to connect mom and her developing baby. The placenta provides oxygen and nutrients, removes substances or waste that could be harmful, and protects the baby from mom’s immune system.² The placenta also produces hormones that play an important role in pregnancy and the baby’s development.³ When there are problems with the placenta, this can cause serious complications for mom and baby. Furthermore, as our knowledge of the placenta continues to grow, research suggests that problems with the placenta may give us clues or even cause future disease in mom or baby.⁴

What do we know about placentophagy?

The term placentophagy refers to the consumption of the placenta. Among mammal species, animals commonly eat raw placenta immediately after the delivery of their offspring. It has been theorized that animals instinctively consume the placenta for its nutritional benefit to the mother animal, or to prevent predators from being attracted to the location of their newly born offspring.⁵ Human placentophagy however, does not consist of eating the raw placenta immediately after delivery. Typically the placenta is processed and consumed in small quantities in the weeks or months after delivery. Some cultures practice consumption of the placenta, but according to studies of cultures around the world this is a rare practice.⁶

Are there benefits to consuming the placenta after delivery?

Supporters of placenta consumption point to several possible benefits for mom. Iron is an essential element needed by our bodies for blood production.⁷ When a woman delivers, it is normal to expect some blood loss. Since the placenta is rich in iron, consuming placenta may replace some of the iron lost during birth. The placenta also produces a substance called placental opioid-enhancing factor (POEF) which may aid in pain relief after delivery. Placenta consumption has also been suggested to improve milk production and decrease the chance of postpartum depression. The placenta contains a hormone called placental lactogen which can stimulate milk production. It also contains the hormones progesterone and corticotropin-releasing hormone (CRH). Women with low levels of these hormones may be more likely to develop postpartum depression. Therefore, it is thought that consuming placenta containing these hormones could possibly decrease the risk of depression.⁸

While the practice of consuming placenta has gained popularity and the possible benefits may be worth investigating, the practice is mainly supported by individual cases or personal stories. Well controlled studies have not been conducted to investigate the safety of placentophagy or its efficacy in aiding with pain management, milk production, or reducing postpartum depression.⁹ Most of the studies published on placentophagy have focused on surveying both men and women regarding the practice and their attitudes towards it.

Have any concerns been raised regarding placenta consumption?

There is currently no regulation of the processing or consumption of human placenta. If the placenta is prepared by an outside party, how can a new mom be assured of sanitary practices and handling? How does she know she has received her own placenta back? Since the placenta is a blood product and tissue, there are concerns that consumption can transmit infectious diseases. There is also a possibility of contamination that may occur in the hospital or during the process of storage, preservation, or preparation.⁸

Some commentators suggest that due to the processing of the placenta which may include preservation, cooking, drying, or freezing of the tissue, there would be little or no nutritional health benefits. Individuals or companies that process the placenta may add herbal products which consumers should be aware of in case there is a sensitivity or allergy to these products. Some have also suggested that because the placenta acts as a filter of some environmental toxins, eating the placenta could expose mom to higher levels of harmful substances. Finally healthcare providers have also expressed concerns that women experiencing postpartum depression may not seek help or may refuse treatment with medications proven to be effective because they are self-treating at home with placenta.⁹

What can I do if I’m concerned about postpartum depression or milk production?

If you are concerned about developing postpartum depression or think you may be experiencing symptoms, contact your doctor right away. Postpartum depression has serious consequences for both mom and baby, but help is available and symptoms should never be ignored. To learn more about Depression During and After Pregnancy, check out the following fact sheet: http://www.womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.pdf

You can also learn more by visiting the following links:

http://www.postpartum.net/learn-more/pregnancy-postpartum-mental-health/

https://www.womenshealth.gov/mental-health/illnesses/postpartum-depression.html#pubs

If you have recently delivered or are getting close to delivery, and have concerns about producing enough milk, talk to your pediatrician, a lactation consultant, or attend a breastfeeding support group. Making small modifications during breastfeeding can make a big difference. To learn more about solutions to common challenges that come up when breastfeeding visit the following womenshealth.gov page: http://www.womenshealth.gov/breastfeeding/common-breastfeeding-challenges.html

For more information on breastfeeding support, information, and resources visit the following links: http://www.womenshealth.gov/breastfeeding/finding-breastfeeding-support.html

http://www.womenshealth.gov/breastfeeding/breastfeeding-resources.html

Is it safe to breast feed while consuming placenta?

No studies have been published to accurately evaluate safety of consuming placenta during breastfeeding. Among the things a mom consumes in her diet or the medications she takes, some substances pass more easily into breast milk and can reach the breastfed infant. Because every woman’s placenta is slightly different, some placentas may contain substances that others do not or they may contain very different levels of a particular substance compared to another placenta. Without testing individual placentas, it would be difficult to evaluate how they differ and how safe mom’s consumption might be for babies who are breastfed.

Where can I get more information about the safety of exposures during breastfeeding?

MotherToBaby experts are ready to answer all of your questions on exposures during breastfeeding. We also answer questions about exposures in pregnancy for women who are currently pregnant or planning a pregnancy, as well as their healthcare providers. You can speak with a MotherToBaby counselor through our free and confidential service. Call us toll free at (866) 626-6847.

Elizabeth Salas, MPH is the Lead Teratology Information Specialist for MotherToBaby California, a non-profit that provides information to healthcare providers and the general public about medications and more during pregnancy and breastfeeding. She is based at the University of California, San Diego, and is passionate about the work MotherToBaby is doing to promote healthy moms, healthy pregnancies and healthy babies.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or call the Pregnancy Studies team directly at 877-311-8972. You can also visit MotherToBaby.org to browse a library of fact sheets, as well as pregnancy studies.

References:

1. Storrs, C. (2015, June 5). Eating Placenta: Trendy, but benefits are fuzzy. CNN.com. Retrieved from http://www.cnn.com/2015/06/04/health/eating-placenta/
2. Donnelly L, Campling G. Functions of the placenta. Anesthesia and Intensive Care Medicine. 2011 March; 12 (3):111-5.
3. Hsiao EY, Patterson PH. Placental regulation of maternal-fetal interactions and brain development. Developmental Neurobiology. 2012 Oct; 72(10):1317-26.
4. Barker DJ, Thornburg KL. Placental programming of chronic diseases, cancer and lifespan: a review. Placenta. 2013 Oct; 34(10):841-5.
5. Odent, M. Placentophagy. Midwifery Today With International Midwife. 2014 Spring; (109):17-8.
6. Cremers GE, Low KG. Attitudes toward placentophagy: a brief report. Health Care Women Int. 2014 Feb; 35(2):113-9.
7. Regents of the University of California. (2002-2015). Hemoglobin and Functions of Iron. UCSF Medical Center, Conditions and Treatments, Patient Education. Retrieved from http://www.ucsfhealth.org/education/hemoglobin_and_functions_of_iron/
8. Schwartz S. Maternal placentophagy as an alternative medicinal practice in the postpartum period. Midwifery Today With International Midwife. 2014 Summer; (110):28-9.
9. Coyle CW, Hulse KE, Wisner KL, Driscoll KE, Clark CT. Placentopagy: therapeutic miracle or myth? Archives of Women’s Mental Health. 2015 Jun 4. [Epub ahead of print] PubMed PMID: 26043976.

By Robert Felix, President, MotherToBaby

Gardens are blooming, kids are out of school, beaches and parks are crowded, and the sun is shining. Ahhh….Summer is here again! With more skin showing during these warm summer months, it’s important to protect our skin from the sun by wearing sunscreen. But what do we know about the safety of sunscreen products during pregnancy? Should pregnant moms avoid sunscreen? What if the day is overcast and cloudy? These are questions I’m getting often these days as a teratogen information specialist at MotherToBaby. So let me share with you what I tell women who contact our service…

First, there’s a misunderstanding that when the sun is not directly shining, like when it’s overcast, we are protected from the harmful effects of the sun’s ultraviolet rays (UV-A and UV-B). So let me shine a light on the issue (no pun intended). Because the sun’s ultraviolet rays penetrate clouds, everyone – including children and pregnant women – is vulnerable to sunburns, even on cloudy days. Damage to our skin that is caused by the sun can lead to long-term issues, including premature aging as well as skin cancer.. Prevention is key. Seeking shade, wearing protective clothing and using sunscreen are all important in reducing the risk of sunburns and skin cancer.

So what about sunscreen safety during pregnancy?

Sunscreen alone is not fully protective. However, it certainly can provide added protection for the skin and reduce the risk from sunburn. In fact, the American Academy of Dermatology (AAD) recommends everyone use sunscreen. Pregnant or not, choose a sunscreen that protects against both UVA and UVB rays. Water resistant with a high sun protection factor (SPF) really helps, too; the AAD recommends using a sunscreen with a SPF of at least 30, which blocks 97% of the sun’s rays.1

The ingredients in sunscreen products in the U.S. have to go through a specific approval process. They must be reviewed by the U.S. Food and Drug Administration (FDA) for their safety before they hit shelves. Unfortunately, there is not one preferred choice for pregnant women. However, it is reassuring that to date there is no published information suggesting that sunscreens cause an effect to the developing fetus/unborn baby. Additionally, sunscreen use can help prevent blistering sunburns, which can become easily infected and lead to other complications for a pregnant woman.

So what do our counselors at MotherToBaby recommend that pregnant women do? Before you head out the door, cover up with cool, breathable long sleeve clothing; wear a hat to protect your head and face; apply sunscreen on any areas of your skin that are exposed; and try to stay under shaded areas, when possible. Our last bit of advice? Enjoy your summer!

Robert Felix is a teratogen information specialist at MotherToBaby California, a non-profit affiliate of the international Organization of Teratology Information Specialists (OTIS). Robert is the current president of MotherToBaby and is based at UC San Diego’s Center for Better Beginnings. MotherToBaby CA answers questions over the phone as well as via live chat and email through www.MotherToBabyCA.org.

MotherToBaby is a service of the international non-profit Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies, including the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration’s (FDA) Office of Women’s Health. If you have questions about medications, diseases, vaccines or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit www.MotherToBaby.org to browse a library of fact sheets and to find your nearest affiliate.

References:

1. American Academy of Dermatology. Suncreen FAQs. Available from, https://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreen-faqs Accessed July 6, 2015.

As it turns out, I’m not crazy nor am I a hypochondriac! After decades – and I mean more than 30 years – of bouts of severe constipation and diarrhea, fatigue, joint pain, migraines, skin rashes and infertility, I finally received the news that I have celiac disease. Oddly enough, it was only after adopting a sickly cocker spaniel named “Peanut” from the Humane Society that the mystery of my symptoms was solved. When our vet suggested that Peanut eat gluten-free food, I bought her some gluten-free pretzels as a treat. After eating some myself, I noticed fewer tummy issues; that feeling of the “kink” in my intestine and the bloating pain didn’t happen!

I contacted my physician, whose first response was, “You don’t have celiac disease, you would have already known it by this time.” She tested me anyway and, when the blood test for transglutaminase antibodies (tTG-IgA) was positive, she sent me to a gastroenterologist for an endoscopy (a scope of the intestines), which also indicated celiac disease. It had taken countless trips to countless physicians, but at the age of 55, my health took a turn for the better after starting a diet without gluten.

In my case, it was unfortunate that the diagnosis took so long because for years I struggled to have children. I feel lucky to have gotten pregnant five times and was able to carry two pregnancies to term. My boys are now wonderful adult men and I feel blessed to have them in my life! I’ll never know if my undiagnosed celiac disease contributed to my pregnancy losses or my harder time in getting pregnant, but as an information specialist with the MotherToBaby Utah program and over 20 years’ experience talking to mothers and health care providers, here’s what I do know from reviewing the published information about celiac disease…

What is Celiac Disease?

Celiac disease is inherited, meaning it runs in families. When people with this auto-immune disease have contact with gluten, it causes inflammation or swelling and can damage the small intestine. Over time, the damage to the intestine causes serious health concerns, including an increased risk of colon cancer and lymphomas (cancer of the lymphatic system, such as Hodgkin’s). It is estimated that 1 in 100 people worldwide have celiac disease. Many are never diagnosed.

With celiac disease, food that is eaten is quickly released from the body with little time for nutrients to be absorbed by the body. That’s because the finger-like tubes in the small intestine, called villi, are flattened from the swelling.

Celiac Disease and Pregnancy

For women who want to get pregnant or who are pregnant with celiac disease, it can be a nutritional nightmare and may lead to anemia (low iron) and other vitamin deficiencies, lactose intolerance (unable to eat dairy), and osteoporosis (weak and brittle bones). It is rare that people have only one autoimmune problem and, for many people with celiac, thyroid disorders and diabetes go hand-in-hand. A recently published study looking at 24 articles on ‘reproductive’ issues found women with celiac disease have a harder time getting pregnant, as well as a higher risk for miscarriage, prematurity, babies born small for their age and with low birth weight. With other autoimmune disorders, such as rheumatoid arthritis, multiple sclerosis, and Lupus, we see the same types of negative pregnancy outcomes. More studies are needed to confirm if celiac disease increases any risks.

Hope

The good news is that studies also show that when moms stay on their gluten free diets, the problems almost always go away! So, to my ‘Celiac Sisters’ there is hope! Here are a few suggestions to have a healthy pregnancy:

• Avoid gluten, of course! Not only is gluten in foods, but gluten hides in make-up (be extra careful with lipsticks), hair products, soap and even in sheetrock. Never lick an envelope or a stamp, because there is gluten in glues!
• Take your Multivitamin Before, During and after Pregnancy. A multivitamin will help balance nutritional deficiencies from celiac disease. Make sure your vitamin has at least 400mcg of folic acid.
• Control the Other Maladies that Come with Celiac Disease. Rarely will someone just have celiac disease. If you have thyroid problems, diabetes or hypertension, it is important to stay on your medications and control these issues before you try to have a baby.

Ultimately, if you control the symptoms from celiac disease, you can be healthy during your pregnancy. It takes some work to avoid gluten, but I promise you will feel better! In retrospect, the veterinarian really saved two lives that day…Peanut is also doing great on a gluten-free diet!

Julia Robertson, CPM, is the program manager for MotherToBaby’s Utah affiliate, a program with the Utah Department of Health and University of Utah that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering questions from women and health providers regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline (866-626-6847) and email counseling service, Julia has authored several peer-reviewed publications focusing on maternal medication consumption and the effect on the developing fetus.

MotherToBaby is a service of the international non-profit Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies, including the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration’s (FDA) Office of Women’s Health. If you have questions about medications, diseases, vaccines or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit www.MotherToBaby.org to browse a library of fact sheets and to find your nearest affiliate.

References:

1. Mahadoy S, Green P. Celiac Disease: A Challenge for All Physicians Gastroenterol Hepatol (N Y). 2011 Aug; 7(8): 554–556
2. Tersigni C, Castellani R, de Waure C et al. Celiac disease and reproductive disorders: Meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Human Reproduction Update. 2014 Vol.20, No.4; 582–593.

*May is Maternal Mental Health Awareness Month*

By Elizabeth Salas, MPH, Teratology Information Specialist, MotherToBaby California

If you are feeling anxious during your pregnancy, you’re not alone. It seems every year there are more articles and news stories on the latest health hazards. Whether you read it online or in a medical journal, hear it on the news or from friends and family, there’s no shortage of information on health concerns. This seems especially true during pregnancy.

 Having Questions Vs. Having Anxiety

 It’s normal to have questions and concerns during pregnancy. Every woman has them. Every woman also deserves to have her questions answered and concerns addressed. Beyond having questions about what’s safe to eat, products to use, or medications to take, pregnant women must balance their normal activities and responsibilities with scheduling prenatal appointments and preparing for their baby’s arrival. With so much to think about, it’s not unusual for pregnant women to feel a little bit anxious. So what’s the difference between having questions and having anxiety? How much anxiety is too much during pregnancy?

The month of May is Maternal Mental Health Awareness Month, and a great time to tackle these questions, raise awareness, and talk about mental health.

What Are Anxiety Disorders?

 While stressful events in our lives can cause anxiety that is mild and temporary, anxiety disorders are different in that the fear and anxiety can be excessive and/or persistent over time and can interfere with a person’s ability to function in their daily life. It is estimated that 13-18% of American adults or up to 40 million people each year experience an anxiety disorder.^{1, 6} Anxiety disorders include generalized anxiety disorder (GAD), panic disorder, post-traumatic stress disorder (PTSD), social phobia, and other phobias. These conditions can cause individuals to experience a great deal of worry or fearfulness. Anxiety disorders can cause physical symptoms such as difficulty sleeping, fatigue, headaches, muscle aches, irritability, lightheadedness, dizziness, trembling, hot flashes, feeling out of breath, and nausea among other symptoms.⁶

 Anxiety Disorders And Pregnancy

While more attention has been given to the study of anxiety disorders during pregnancy in the last decade, information is limited. Screening tools for anxiety disorders during pregnancy, such as those used to screen for depression during pregnancy and postpartum, have not been well studied and are not used regularly in obstetric clinics.² Without screening being part of routine prenatal care, it is up to pregnant women to express their concerns about anxiety to their healthcare providers. It also means that some women might not get the help they need.

Anxiety disorders during pregnancy are estimated to affect from 4%-39% of women.³ While some studies suggest that pregnant women are more likely to have anxiety disorders than non-pregnant women, other studies found that pregnant women are just as likely than non-pregnant women to have an anxiety disorder.⁴ How many women develop anxiety disorders during pregnancy is not well understood. A woman with a preexisting anxiety disorder may find that her condition is worse during pregnancy, but for others symptoms may stay the same. While gaps in our knowledge remain about anxiety disorders in pregnancy, the importance of maternal mental health is receiving more attention.⁵

What If I’m Having Problems With Anxiety?

Whether starting a new job, dealing with financial stressors, or struggling with a relationship or health complications, we have all experienced anxiety at some point in our lives. If your anxiety is affecting you more than usual or if you’re concerned you may be experiencing an anxiety disorder, talk to your healthcare provider right away. Your provider will ask about your symptoms and may give you a screening questionnaire to fill out. If you are having symptoms they will talk to you about your options and may refer you to a mental health provider. Depending on a woman’s diagnosis and the severity of her condition, she and her providers may decide to treat her condition with talk therapy, behavior modification, medications, or a combination of these. Many pregnant women take medications for anxiety during pregnancy and delivery healthy full-term babies.

Since anxiety disorders can cause significant physical symptoms and stress in a person’s life, these conditions require attention and treatment just like any other medical condition during pregnancy. Every woman and every pregnancy is different. Working together with your provider to keep you healthy during pregnancy isn’t just important for your health; it’s important for the health of your developing baby too.

WHERE CAN I GET MORE INFORMATION?

California Maternal Mental Health Collaborative

 To learn more about maternal mental health disorders, access a self-quiz, and obtain a list of resources that can help, visit the California Maternal Mental Health Collaborative website.

http://www.2020mom.org/mmh-disorders/

http://www.2020mom.org/get-help/

 National Institute of Mental Health

 To learn more about anxiety disorders, check the National Institute of Mental Health website and their Anxiety Disorders information booklet.

http://www.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml?rf=53414

http://www.nimh.nih.gov/health/publications/anxiety-disorders/nimhanxiety_34436.pdf

 MotherToBaby

At MotherToBaby, we answer questions about exposures during pregnancy and breastfeeding. We receive questions on everything from hair dye to medications used to treat anxiety and depression and much more. Our service is free, confidential, and provides information that is evidence-based. Most importantly, our service is available to you and your healthcare providers. To speak to a MotherToBaby expert, you can call toll free at (866) 626-6847 or visit us online.  https://mothertobaby.org/

Elizabeth Salas is the Lead Teratology Information Specialist for MotherToBaby California, a non-profit that provides information to healthcare providers and the general public about medications and more during pregnancy and breastfeeding. She is based at the University of California, San Diego, and is passionate about the work MotherToBaby is doing to promote healthy moms, healthy pregnancies and healthy babies.

 MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or call the Pregnancy Studies team directly at 877-311-8972. You can also visit MotherToBaby.org to browse a library of fact sheets, as well as visit our website for MotherToBaby Pregnancy Studies, www.PregnancyStudies.org.

References:

1. Combs H, Markman J. Anxiety disorders in primary care. Med Clin North Am. 2014 Sep; 98 (5):1007-23. doi: 10.1016/j.mcna.2014.06.003. Epub 2014 Jul 11. PubMed PMID: 25134870.
2. Evans K, Spiby H, Morrell CJ. A psychometric systematic review of self-report instruments to identify anxiety in pregnancy. J Adv Nurs. 2015 Mar 26. doi: 10.1111/jan.12649. PubMed PMID: 25818179.
3. Goodman JH, Chenausky KL, Freeman MP. Anxiety disorders during pregnancy: a systematic review. J Clin Psychiatry. 2014 Oct;75(10):e1153-84. doi: 10.4088/JCP.14r09035. PubMed PMID: 25373126.
4. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014 Nov 15;384(9956):1775-88. doi: 10.1016/S0140-6736(14)61276-9. Epub 2014 Nov 14. PubMed PMID: 25455248.
5. Howard LM, Piot P, Stein A. No health without perinatal mental health. Lancet. 2014 Nov 15;384(9956):1723-4. doi: 10.1016/S0140-6736(14)62040-7. Epub 2014 Nov 14. PubMed PMID: 25455235.
6. National Institute of Mental Health. 2009. Anxiety Disorders. NIH Publication No. 09 3879. Retrieved from http://www.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml