By Beth Conover, APRN, CGC MotherToBaby Nebraska, UNMC

“There are so many risks to the baby if I go for dental work, right?” “What about x-rays?” “I don’t like going to the dentist anyway, so I’ll probably just wait until my baby is born. That should be fine, right?” Worries, excuses, we’ve heard it all at MotherToBaby when it comes to dental procedures during pregnancy. We often receive questions from women wondering whether dental care is safe. In short, the answer is….yes! What better time to talk about the reasons why it’s ok than during June – typically the month the American Dental Association dubs as “Oral Health Month.”

Routine dental care is low risk, and most emergency procedures can be done as well.
Good oral health improves your overall health, and increases your chances of a good pregnancy outcome. However, when you are scheduling a dental appointment and are pregnant (or trying to get pregnant), let the office know so that they can be prepared to make decisions about which procedures are safe for your baby. In some cases, you or your dentist may want to wait until after delivery for elective (non-necessary) procedures.

Here are some commonly asked questions we get from pregnant women:

• When I brush my teeth, my gums have started to bleed. Is this normal? What should I do?

Bleeding gums is a common problem during pregnancy. Pregnant women have hormonal changes that can increase their chances of getting gum problems such as gingivitis (puffy and tender red gums that bleed easily). Your dentist will want to monitor this so that it does not progress to a more serious gum disease. Periodontal disease is a bacterial infection of the gums and jaw bones that support the teeth, and can increase your chances of having a smaller baby, delivering early, and having other pregnancy complications. Dentists recommend that you floss daily, and get your teeth cleaned on a regular basis during pregnancy (consider having it done more frequently, if you are having pregnancy gingivitis).

• It seems like pregnancy is causing me to get more cavities in my teeth…am I right?

Pregnancy can contribute to women having more cavities. This is in part due to changes in diet such as frequent snacks including sugary foods. To prevent cavities, eat a healthy diet and brush your teeth after eating sweets. In addition, if you have morning sickness, the acid from your stomach can affect your tooth enamel and make cavities more likely. Rinse your mouth with water or mouthwash after morning sickness episodes. If your toothpaste is making your morning sickness worse, ask your dentist for the name of a bland-tasting toothpaste.

• What if I need to get a cavity filled or a tooth pulled? Can I have a local anesthetic?

Agents like lidocaine which are injected into your gums are low risk for your baby. In one study, researchers compared pregnant women who received lidocaine injections as part of dental treatment with women who did not, and found no significant increase in risk for miscarriage, prematurity, or birth defects. If you need a pain medication, your dentist will take into account where you are in your pregnancy so as to make a choice that is safest for your baby.

• Are dental x-rays safe in pregnancy?

You may choose to have routine X-rays done prior to pregnancy, or to delay them until after you deliver – talk to your dentist about the best options for you. However, if you have a dental emergency and need to have them done, don’t hesitate. Advances in technology have made dental X-rays safer, and they do not involve as much radiation or may not involve radiation at all. Your dental office will cover your neck and abdomen with a lead apron, which lessens the exposure to your baby even more.

• What else can I do to ensure dental health?

Schedule a visit to your dentist before you are pregnant. Get teeth cleaned, gums examined, and any dental issues addressed prior to pregnancy.

Brush your teeth at least twice a day and floss once a day. This helps reduce plaque, the sticky film that covers your teeth and can make gums inflamed and increase your risk for periodontal disease.

I hope I’ve given you a few good tips to chew on – Your teeth and baby will thank you. Have a healthy pregnancy!

Beth Conover, APRN, CGC, is a genetic counselor and pediatric nurse practitioner. She established the Nebraska Teratogen Information Service in 1986, also known as MotherToBaby Nebraska. She was also a founding board member of the Organization of Teratology Information Specialists (OTIS). In her clinical practice, Beth sees patients in Pharmacogenetics Clinic and Genetics Clinic at the University of Nebraska Medical Center. Beth has provided consultation to the FDA and CDC.

About MotherToBaby
MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.

My baby sister was 35 years old and pregnant with her first child. As a family, we were ecstatic. The family was expanding, and I was about to be an aunt for the third time. She was in her 3^rd trimester and very pregnant, but she was up there in the choir singing and dancing her heart out at a memorial concert.  I, along with many others, was shocked at how energetic and agile she was that far into pregnancy. However, when the concert was over, I looked at her feet and they were very, very swollen. I was concerned and told her to speak with her doctor immediately.  Three days later, she got a call from her doctor to check in to the hospital, 6 days before her actual due date.  Unbeknownst to me, she had dropped off a urine sample the day before the concert. Test results revealed that she had preeclampsia (a type of high blood pressure that is specific to pregnancy) and they needed to deliver the baby.  Left untreated, preeclampsia can be very dangerous for mom and baby. My sister scrambled to get everything together and rushed to the hospital, and baby Jordan, my nephew, was born. My sister is a strong, educated, physically fit African American woman, and thank God her story ended well. However, that is not always the case. It could have gone a very different way.

Hypertensive disorders of pregnancy (HDP) are a group of medical conditions that involve high blood pressure during pregnancy. High blood pressure, also known as hypertension, is a condition where the force of the blood against the walls of the arteries is too high.  This can damage the arteries and increase the risk of heart attack, stroke, and other serious health problems. Hypertensive disorders of pregnancy are a leading cause of maternal death and can put both mother and baby at risk for serious complications during pregnancy.

There are four main types of hypertensive disorders of pregnancy:

• Chronic hypertension: High blood pressure that occurs before pregnancy or before 20 weeks of gestation, or that persists longer than 12 weeks after delivery.
• Gestational hypertension: High blood pressure that develops after 20 weeks of gestation, without signs of organ damage or protein in the urine.
• Preeclampsia: High blood pressure that develops after 20 weeks of gestation, with signs of organ damage or protein in the urine.
• Preeclampsia superimposed on chronic hypertension: Chronic hypertension that worsens or causes organ damage or protein in the urine during pregnancy. This means that you have two problems with your blood pressure.

Chronic hypertension affects approximately 85,000 births (2.3%) in the United States each year. Unfortunately, the number of pregnant women diagnosed with HDP is increasing and more maternal deaths are occurring due to complications from these conditions in pregnancy. On top of that, the rates between white people and other racial groups are widening, especially among black pregnant women during pregnancy.  According to a Centers for Disease Control and Prevention (CDC) report, HDP affected at least 1 in 7 delivery hospitalizations in the United States from 2017 to 2019, and about a third of those who died during hospital delivery had some form of HDP.  Some of the other key findings of the report were that:

• HDP affected more than 1 in 5 delivery hospitalizations of Black women and about 1 in 6 delivery hospitalizations of American Indian and Alaska Native women, compared to 1 in 8 delivery hospitalizations of White women.
• Black women had higher odds of entering pregnancy with chronic hypertension and developing severe preeclampsia.
• Black women and American Indian and Alaska Native women had higher rates of maternal death due to HDP than White women.

The causes of hypertensive disorders of pregnancy are not fully understood, but some risk factors include obesity, diabetes, kidney disease, family history, multiple pregnancies, and advanced maternal age (over age 35) and the rates are higher among communities of color compared to white people. In general, more than 50% of black women have hypertension, compared to 39% of non-Hispanic white women and 38% of Hispanic women.  The symptoms of hypertensive disorders of pregnancy may vary depending on the type and severity, but some common ones are headaches, swelling, blurred vision, stomach pain, and reduced amounts of urine than usual.

HDP can be dangerous for both you and your baby, but it can be prevented and treated with proper care and attention. To reduce the chance of HDP, pregnant women and those planning for pregnancy can take the following steps:

• Get early and regular prenatal care. They can check your blood pressure and screen for any signs of HDP¹.
• Take your blood pressure medication to lower your blood pressure and prevent complications. They may also advise you to take a low-dose daily aspirin after 12 weeks of pregnancy to reduce the risk of preeclampsia².
• Maintain a healthy weight and lifestyle. Try to lose weight before you conceive and gain weight gradually during pregnancy according to your doctor’s guidelines. Exercise regularly, eat a balanced diet, avoid smoking, limit alcohol and salt intake, and manage stress²³.
• Monitor your blood pressure at home. Your doctor may suggest that you use a home blood pressure monitor to keep track of your blood pressure between visits.

MotherToBaby has helpful fact sheets on smoking, alcohol, stress and exercise, and low-dose aspirin.  You can also contact us for information on medications that may be recommended by your healthcare provider for treatment. We are a free service that is available for everyone.  The heart of the matter is that you do what is best for you and your baby and we are here to help you through all stages of pregnancy from the time you hear a heartbeat on a monitor and until the time your baby captures your heart.

Resources:

American Heart Association. (2023, February 27. Black women of childbearing age more likely to have high blood pressure, raising pregnancy risks. Accessed February 7, 2024 Read More

Ford, N. D., et al., (2022). Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization – United States, 2017-2019. MMWR. Morbidity and mortality weekly report, 71(17), 585–591.

Hoover, C., (2023, August 30). Addressing Hypertension Is Critical for Lowering the Black Maternal Mortality Rate. The Century Foundation . Read More

Kalinowski, J., et al., (2021). Stress interventions and hypertension in Black women. Women’s health (London, England), 17, 17455065211009751.

Leonard, S. A., et al., (2023). Chronic Hypertension in Pregnancy and Racial-Ethnic Disparities in Complications. Obstetrics and gynecology, 142(4), 862–871.

Margerison, C. E., et al., (2019). Pregnancy as a Window to Racial Disparities in Hypertension. Journal of women’s health (2002), 28(2), 152–161.

Sharma, G., et al., (2022). Social Determinants of Suboptimal Cardiovascular Health Among Pregnant Women in the United States. Journal of the American Heart Association, 11(2), e022837.

Dealing with constipation can be challenging, and the struggle intensifies during pregnancy. The struggle is real, and I know it firsthand! I have struggled with constipation ever since I was a teenager. But once I started college, the stress of my day-to-day life intensified my symptoms which led me to suffer from chronic constipation. Once I found out I was pregnant, I knew it was only a matter of time until I experienced the discomfort, pain, and bloating all over again. But I knew that, while this might be disheartening, I was not alone. Up to 38% of pregnant individuals experience constipation in the first trimester (Trottier et al., 2012).

This common issue has even earned its own ICD-10 code (used for medical billing), emphasizing the need for attention and solutions. Let’s explore the reasons behind pregnancy-related constipation and discover effective ways to manage and alleviate it. Our Constipation Resource Hub is a great way to access all the information that MotherToBaby experts have for you related to this topic, but let’s go over some specifics first!

Understanding the Causes of Constipation in Pregnancy:

Constipation during pregnancy can be attributed to various factors, including an unbalanced diet, insufficient fiber intake, inadequate hydration, and a lack of physical activity. Hormonal changes, particularly an increase in progesterone, also play a significant role. Additionally, medications used to combat nausea and vomiting in pregnancy (NVP) and supplements like iron and calcium may contribute to constipation.

Navigating Treatment Options during Pregnancy:

While constipation is common during pregnancy, suffering needlessly is not acceptable. Explore different treatment options, but keep in mind that there is no one-size-fits-all approach. Understanding the complexities of your individual situation is crucial.

Nutrition Adjustments:

• Incorporate 4-5 cups of fresh fruits and vegetables daily.
  • Aim for 25-30 grams of fiber daily.
  • Stay hydrated by drinking plenty of water.

  • Engage in 150 minutes of moderate exercise per week (consult your healthcare provider before starting any new exercise routine during pregnancy).

Medication Considerations:

• Laxatives can be an option, they are medications used to soften stool or stimulate the bowel, but it’s essential to be informed. Explore our fact sheet on laxatives here https://mothertobaby.org/fact-sheets/laxatives/. Here’s a brief run-down of some of these options:

• Bulk-forming laxatives (fiber supplements) like psyllium
  • Osmotic laxatives
  • Stool softener laxatives

  • Stimulants, and lubricants

Prescription medications

• Prucalopride (Motegrity®) for the treatment of functional constipation, also known as chronic idiopathic constipation. Read our fact sheet here.

Managing Underlying Conditions that May Make Constipation during Pregnancy Worse:

Some individuals may face constipation due to underlying conditions such as Irritable Bowel Syndrome (IBS-C) or Functional Constipation (FC). Consult your healthcare provider for a proper diagnosis and follow their recommendations. Explore our informative fact sheet on Functional Constipation here. https://mothertobaby.org/fact-sheets/functional-constipation/ .

Stress can exacerbate constipation, especially for those with IBS-C. Be kind to yourself and explore stress management techniques. Learn more about stress during pregnancy in our fact sheet here https://mothertobaby.org/fact-sheets/stress-pregnancy/ .

For those with Gestational Diabetes or a predisposition to Type 2 Diabetes Mellitus, regulating blood glucose levels is crucial. Explore our blog on diabetes during pregnancy here https://mothertobaby.org/baby-blog/diabetes-and-pregnancy-the-not-so-sweet-story/ .

In conclusion, constipation during pregnancy is a shared experience, but it shouldn’t be endured without seeking relief. I certainly looked for options that helped me during my pregnancy, just like I did, so can you! Open a conversation with your healthcare provider to explore solutions. By making dietary adjustments, staying active, and managing stress, you can navigate constipation more comfortably during this transformative time. For personalized information about medications or conditions, or to volunteer for the study on constipation (https://mothertobaby.org/ongoing-study/constipation/) in pregnancy, reach out to our experts at MotherToBaby—they’re here to answer your questions and provide support throughout your pregnancy journey.

We want to enroll all individuals who took Motegrity® at any point in their current pregnancy or while breastfeeding. If you, or someone you know has been exposed to this medication, please report use to our team.

Participating in the largest, long-term study of early brain and child development in the United States

I recently came across a patient named Jamie when she asked some interesting questions about a new study she had heard about on child development. Jamie is pregnant with her second baby and got a flyer from the Healthy Brain and Child Development study (HBCD). The HBCD is a national study being carried out at 27 sites in different parts of the country, with two sites at MotherToBaby locations including Emory University and UC San Diego. At first, she was undecided if she wanted to volunteer. It is a large-scale, long-term project with the goal to better understand how child development is affected by exposure to social and environmental experiences and conditions. She would be one of the 7,000 mother/infant pairs contributing their time and effort to this project.

Here were some questions that she was thinking about before deciding to join the research project. With so many research sites across the nation, you may be asking yourself these questions, too:

What is the HBCD goal and where is this study?

Most of the HBCD sites are at universities and hospitals that have a history of working with pregnant women and their babies.  The study was developed by the National Institutes on Health, part of the US public health service.   The goal is to understand children’s brain development. HBCD aims to recruit 7000 pregnant women. Researchers will follow them, as well as their babies, over the first 10 years of life. They’ll keep track to gather more information on how prebirth and after birth events affect the development of children’s brain, more specifically, their cognitive and emotional functioning. The information that is collected (data) and will be stored at NIH. The data is made available to scientists who will use this information to improve our understanding of children’s growth and adjustment.  All information will be “deidentified”.  That means, to protect confidentiality, there will be NO information that could identify individual mothers or children in the stored data.  

Who can participate?

HBCD will include pregnant women across the United States from both rural and metropolitan areas.  Recruitment takes place during pregnancy with the first visit in the second trimester.  HBCD enrolls women, 18 years and older, from different ethnic and racial groups based on the population of the sites where recruitment is taking place.  They are able to include Spanish speakers by having staff who are bilingual.  The study is interested in mother’s health and exposures during pregnancy, as well as the caregiving environment that can predict how well children grow. As a result, they are looking for all kinds of women to participate, from the general population as well as those who use alcohol, tobacco, stimulants and opioids.

What will participation involve?

Parents will answer a series of questions through surveys and interviews. Mothers and babies will also provide urine and blood samples.  In addition, HBCD is monitoring babies’ sleep in the newborn period and taking “pictures” of children’s brains as they develop using MRI and electroencephalograms (EEG) periodically over time.   As they get older, babies’ development and behavior will be tested to monitor how they are progressing. 

There are several study visits in the first  year after the baby arrives and then once a year until they are 10 years old.   Families will be reimbursed  for their time and travel expenses.

Jamie went to the HBCD website to answer some of her questions (Home – UCSD – Healthy Brain and Child Development (hbcdstudy.org)) and she also got in touch with the Project Coordinator at our HBCD site to ask more about the schedule and the MRI.  She was satisfied with the answers and decided that she would like to make a contribution to children’s futures by participating  in HBCD.  She has already completed her first visit and is looking forward to seeing us again when her son in born. Jamie shared with us that she wants to be part of HBCD because she understands how important understanding brain development and behavior is for both children and their families.

MotherToBaby experts know how important research is and supports the efforts of the HBCD study. You can learn more about MotherToBaby’s own studies to consider as well here.

I can’t begin to describe how organized I was during the holiday season when I was pregnant with my first child. Since I was pretty far along (5 months), I wanted to make sure each gift was chosen way ahead of time, I knew how long it would take me to get the food trimmings just right and whether I should emphasize red or green in my decorating scheme. All of this had to be done before that “pregnancy brain” I had heard so much about set-in. Little did I know, the most important items on my holiday to-do list weren’t sitting on store shelves or mixed in with the tinsel and mistletoe.

Years later, as a teratogen information specialist for MotherToBaby, I realized some of the best gifts for a healthy pregnancy didn’t come with ribbons and bows, but from awareness and education! For example, did you know the holiday buffet table could include foods that could potentially cause harm to a developing baby? Or, if not careful, decorating could put a pregnant woman in a dangerous situation? Today I encourage pregnant women to master must-know safety tips long before putting together must-have gift lists this season. Here are a few of my tips:

Tip 1. Importance of Getting Vaccinated

It is recommended that pregnant women have a flu vaccine in every pregnancy and be current on Tdap vaccine and Covid 19 vaccines.  Women who are 32-36 weeks pregnant are currently eligible for the RSV vaccine https://mothertobaby.org/fact-sheets/rsv-vaccine/. This vaccine can pass protection to the developing baby, helping lower the chance of severe RSV infection once the baby is born.  

Not only should a pregnant woman be up-to-date on vaccines, but anyone older than 6 months of age who will be around a newborn should be vaccinated.

Tip 2. Choose Wisely at the Buffet Table

Drinks like eggnog and spiced cider may contain alcohol https://mothertobaby.org/fact-sheets/alcohol-pregnancy. If you’re not sure what’s s in a beverage, ask the host. Also, avoid soft cheeses made from unpasteurized milk, as they may contain bacteria that can cause a serious illness for a developing baby called Listeria https://mothertobaby.org/fact-sheets/listeriosis-pregnancy, as well as increased risk of miscarriage, uterine infection, or premature labor. Meats like cocktail franks and pâté can also contain bacteria. Meats need to be thoroughly cooked so that bacteria are killed.

Tip 3. CMV (cytomegalovirus) May Be Lurking

CMV is a common virus that often has no symptoms. If a pregnant woman gets CMV https://mothertobaby.org/fact-sheets/cytomegalovirus-cmv-pregnancy, the baby could be at increased risk for hearing loss, developmental delays, or birth defects. To prevent infection, pregnant women should wash hands after changing diapers, feeding children, wiping children’s noses, or handling children’s toys. Also, avoid sharing food, eating utensils, toothbrushes, and pacifiers with children.

Tip 4. Holiday Decoration Safety

Some artificial trees, strings of lights, and ornaments may contain lead. Use gloves or wash hands after handling decorations to reduce exposure. Because of changes in their center of gravity, pregnant women should stay off ladders and let others decorate the hard-to-reach places.

Tip 5. Manage Anxiety and Depression

Having a ‘happy holiday’ can mean lots of stress, especially when pregnant.  Anxiety https://mothertobaby.org/fact-sheets/anxiety-fact to have that perfect holiday is real. Depression https://mothertobaby.org/fact-sheets/depression-pregnancy can be triggered this time of year as well.  Don’t hesitate to ask for help if you are feeling overwhelmed with all the gift giving and holiday activities.  Stay in-touch with your healthcare providers because…. help is available!

I hope these tips are helpful. While my son did end up turning out to be just fine, I think I would have caused myself less stress and worry had I known these tips during my pregnancy. If you have questions, don’t hesitate to reach out to MotherToBaby by phone, text, chat or email.

On behalf of all of us at MotherToBaby, here’s to wishing you a happy and healthy holiday!