The air we breathe matters and often we do not have control over what is in it. For many, the Spring season brings beautiful flowers and a most welcome warming of temperatures, as well as spending more time outside. It also marks the explosion of pollen, which can irritate both those with allergies and people with asthma. Being outside to engage in outdoor activities also means we are exposed to any air pollution that may be present.

Pregnancy is a sensitive time for both the parent and the developing baby. Preventing issues related to allergies, asthma and air pollution is important for a few reasons. If you do have issues with asthma and it affects your breathing, the amount of oxygen in your blood can drop; this can create problems for baby as you are their source of oxygen while pregnant. The baby may have trouble growing as much as they should or may be born at a low birth weight. This can put the baby at higher risk for several health issues.

There has been increasing research on the possible effects of air pollution on pregnancies. Some studies suggest that higher amounts of pollution in the air are related to babies being born too small or too early. Air pollution also can make asthma symptoms worse. There are some ways to lower the amount of air pollution you are exposed to, and this may be even more important for those that live near highways or high traffic areas, or near landfills. Some clear ideas from the American Pregnancy Association include:

• Buying an air purifier to use in your home
• Checking the air quality before planning outdoor activities to see if it is dangerous for groups sensitive to air pollution or pollen. Simply visit this website and enter your zip code: https://www.airnow.gov/
• Choosing to spend more time indoors when air quality is low
• Buying some plants to have in your home that are known to improve air quality. Some common household plants known to help with this include Peace Lilies, Snake plants, Philodendrons, Spider plants, or Rubber Trees

Other important things to consider are checking in with your healthcare provider about any types of medications you may use to treat your asthma or allergies. Quitting your medications as soon as you become pregnant is often not the best choice for you or baby and managing your symptoms is important for the reasons discussed above. MotherToBaby has a landing page on asthma that includes resources: https://mothertobaby.org/pregnancy-breastfeeding-exposures/asthma/ and one about allergies: https://mothertobaby.org/pregnancy-breastfeeding-exposures/allergies/  These pages have links to fact sheets on many medications that are used to treat symptoms related to both topics. 

As you move through the Spring months into Summer, try to appreciate the seasons while also being aware of how air quality can affect your health. As the saying goes, when you are pregnant you are “breathing for two.” As a reminder, our fact sheets also have breastfeeding information near the bottom of them that you can check out. We also encourage you to remember air quality can affect young children as well – especially ones with asthma.  Finding a healthcare provider you and your family can see routinely to manage asthma related issues is important in order to avoid emergency room visits.

Take a deep breath and remember, whatever your concerns are, experts at MotherToBaby will do our best to give you useful information based on research, or to point you in the right direction if we are unable to help.

There are a variety of uses for botulinum toxin, marketed as Botox, that include both cosmetic procedures and treatment for some medical conditions. The experts at MotherToBaby get questions about the safety of being injected with Botox during pregnancy and breastfeeding. While more studies are  still needed, we can answer some of your questions with helpful information as you decide whether or not you feel comfortable using it.

What is Botox?

Botox and Botox Cosmetic are used by healthcare providers. Both include botulinum toxin, though each are used differently depending on what issue is being addressed. You may also see it called OnabotulinumtoxinA or botulinum toxin type A. This toxin works by paralyzing muscles at the site where it is injected, causing the muscles to relax.

There is an illness called botulism, which you may have heard of, and it is caused by the bacteria that make the botulinum toxin. According to the CDC, botulism is a rare but serious illness and can cause people to have vision or breathing issues, paralyzes muscles causing them to feel weak, and can cause death in some cases. It is often caused by bacteria associated with improperly canned or preserved foods and symptoms are likely to present 18-36 hours after eating the contaminated food. You can read more about the different types of botulism here.

What is Botox used for?

When used for cosmetic reasons, the botulinum toxin is injected into specific areas, like the face or neck, in order to smooth out wrinkles or lines in the skin.

There are also individuals who get Botox to help with medical conditions. Examples include treating chronic migraines, urinary incontinence (or issues with the bladder), and spastic muscle movements in parts of the body. Some people also get Botox injections to help stop excessive sweating in certain areas of their body. There are several uses for Botox, and some are incredibly important for improving quality of life and function for people.

What is known about being exposed to Botox during pregnancy or breastfeeding?

The short answer is not a lot. There have been no well-controlled research studies in either pregnant or breastfeeding people. Botox is expected to be contained to the area of the body where it is administered to and not to circulate throughout a person’s system. Because it is not known to enter your system, or bloodstream, it is unlikely it could cross the placenta to reach a developing baby or to enter breast milk. However, because we do not know for sure, many providers suggest avoiding using Botox during pregnancy and lactation. It is also thought to stay in your body from four to six months, so avoiding using it while planning a pregnancy if possible may also be advised. 

There are some risks that come with Botox use. It is possible to get an infection in the area where you are injected, and the toxin could spread beyond where it is injected. This can cause people to experience issues breathing and/or swallowing issues and seeking immediate medical care if needed is important.

Speaking with your healthcare provider is always recommended by the experts at MotherToBaby. If you are routinely receiving some form of Botox therapy, it may be worth discussing this with your healthcare provider before you become pregnant. Weighing the pros and cons of your therapy can help you make the best choice for yourself and your baby. If you are receiving Botox for purely cosmetic reasons, putting a pause on your injections may be well worth the wait if you want to take the least risk possible.

To read more from the Centers for Disease about botulism visit: https://www.cdc.gov/botulism/index.html

FDA Botox Drug Label: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf

Sometimes we have anxiety about…well, having anxiety. Kristen contacted MotherToBaby and was asking about ways to manage her already extremely high anxiety around pregnancy and birth during the pandemic. Should I even try to get pregnant right now? How will I deal with my anxiety and stress if I do become pregnant? What if almost no one in my family can even come to the hospital when I go into labor? How can I deal with my anxiety during labor and birth? I could tell she had a tremendous amount on her mind.

It is completely normal to feel stressed and anxious, and Kristen is not alone. Many people, regardless of whether they are pregnant during the time of COVID-19 or not, are experiencing higher levels of anxiety. The important thing is to address the anxious feelings and learn ways to manage them. I have some ideas on how to do just that! But one thing I need to emphasize: if your anxiety is excessive, ongoing, difficult to control, and interferes with your daily living, this may be a sign of generalized anxiety disorder and I encourage you to talk to your doctor or a mental health professional.

Managing Anxiety

There are ways to manage anxiety and stress that may be commonly shared, but in case you haven’t heard them before below are some tips you can try at home:

• Exercise, even if it is going for a brief walk outside
• Call a friend just to catch up
• Volunteer or donate to a cause you care about – often doing things to help others actually can make you feel good
• Try to eat healthy, nourishing foods
• Journal as a way to express what you are feeling
• Take a break from your screen time on phones, tablets and TV – especially before bed
• If you feel like nothing really helps to address your feelings of anxiety and stress, or if you are feeling really down, make an appointment to talk to your healthcare provider and be honest about how you’re feeling

If you do feel like you need to talk to your healthcare provider, how do you do it? Remind yourself that healthcare providers are not only trained to talk about mental health topics with their patients, but that they likely talk to multiple people every day or week about them. Sometimes pregnancy increases anxiety that is already present, and for others it may be that they are experiencing it for the first time. Being pregnant does not mean that you are immune from or that you cannot be treated for mental health issues.

Before you go to see your healthcare provider, you can write down some notes on what you hope to say. Try to be as honest as possible and ask about the variety of options you have to address your anxiety or symptoms, including what you can try at home, who you may be able to see for some form of talk therapy, and if necessary, what medications the provider may recommend trying. Remember, just because you bring up anxiety or mental health, it does not mean you will be put on a medication. Equally as important, if you need to take a medication to help you manage better, there are several options you can take during your pregnancy.

Working on dealing with your anxiety before becoming pregnant is always a great idea, but you can address it at any point during pregnancy or in the postpartum period. There is never a bad time to improve your mental health (doing so is not only good for you, but also good for your baby) and it is never too late. In addition, I have had women express that admitting they need help makes them feel weak or selfish. In truth, it is the opposite – it takes courage to ask for support when we need it!

COVID-19, Labor and Delivery

The other piece of Kristen’s worry was having support in the delivery room. Due to COVID-19 many hospitals and birthing centers may be reducing the number of support people someone can have present during delivery. In addition, no one may be allowed in nearby waiting rooms. Giving birth can be one of the most challenging events for a person and having support during labor and delivery is incredibly important for getting through it with both a healthy mom and a healthy baby. First, you should speak with your planned delivery hospital/center to learn what their most current rules are for time of delivery and ask about any extra precautions they are taking due to COVID-19. Once you have that information, you can figure out what your game plan is. Other things to consider include:

• Does the hospital offer doulas? Would you want to hire your own? If you hire one and s/he is not allowed in the delivery room, can she call in and be there via facetime and text? Can she spend extra time going over pain management techniques with you and your support partner in advance if she is unable to be there herself?
• You can also consider programs like Hypnobirthing or Lamaze classes that really work with women to be confident in managing their experience during labor and delivery. Sometimes the type of prenatal education you choose to receive can help you feel more prepared and aware of what to expect, which alone may help reduce fear of the unknown.

In short, try not to panic with all of the questions you may have about dealing with anxiety. Write down your questions and make sure to ask your healthcare provider and the place you plan to deliver all of them. Prepare for what you can, take care of yourself, ask for help when you need it and trust that you have the strength to get through anything – because you do.