Being pregnant can be stressful enough without worrying all the time about things like “can I bake with poppy seeds?” Or “can I drink tea with peppermint?” Recently I had a caller tell me that “it seems like every time I turn around, there is something else that either I should not cook with or drink in a tea during pregnancy. What about when I am breastfeeding? Help!” As a specialist who answers questions about exposures during pregnancy and breastfeeding, I hear these kinds of questions all the time.

Spices vs. Herbs

Let’s explore some of the spices and herbs that are not recommended for frequent use during pregnancy and breastfeeding. Many of these items can be used in different ways, such as in baking, to flavor candy, as spices in foods, toppings on salads, or as part of herbal teas. To clarify, the difference between a spice and an herb is that herbs have to have a green leafy part and are mainly used for flavoring. They are also used as a garnish in cooking or salads. Spices, on the other hand, come from a variety of things such as dried roots, nuts, dried fruits and vegetables, or even from bark. Some spices are used for flavoring, while others are used as food preservatives or to give food color. If you use these herbs and spices once in a while as flavoring in your food and drinks, that is OK. The concern is when you consume these items every day or most days.

Poppy Seeds

Poppy seeds come from the poppy plant and are often used in foods such as bagels, pastries, cakes, and salad dressings. The seeds are washed and processed before use and eating small amounts now and then as part of a food dish or baked item is not known to be a risk during pregnancy or breastfeeding. However, the outer surface of the poppy seed does contain small amounts of morphine and other opiates such as codeine. When poppy seeds are used to make tea, the drugs can seep into the water when the seeds are soaked. Poppy seed tea should be avoided during pregnancy and breastfeeding for this reason.

Nutmeg

Who hasn’t had nutmeg floating on top of a latte or a cup of hot apple cider on a cold day in the winter? Nutmeg is a ground spice that comes from the seed of a dark-leaved evergreen tree. Nutmeg is also used in many different baked goods and with vegetables, specifically going well with squash dishes. Eating a little nutmeg as a spice in food does not have a known increased risk during pregnancy or breastfeeding. But high levels of nutmeg can also be used as a recreational drug as it contains myristicin, which has mind altering hallucinogenic effects. The myristicin isolated from nutmeg oil can be used to produce synthetic amphetamines. Also, in the past, nutmeg was used in folk medicine to induce abortion. Because of this, high level exposure should be avoided in pregnancy and breastfeeding.

Peppermint

Peppermint use is a common question during pregnancy and breastfeeding. Peppermint is a popular herb used as flavoring in candy, chewing gum, desserts, and tea. Peppermint oil is also made from the leaves of the peppermint plant. The oil is widely used topically on the skin to treat headaches, muscle, and joint aches and pain, and in aromatherapy to treat coughs and colds. Peppermint oil can also be diluted with water and sprinkled around your house as an insect repellent too. So is this popular herbal product a risk during pregnancy? High levels of peppermint exposure during pregnancy can be a risk since it can relax the muscles of the uterus and increase the risk for miscarriage. For that reason, frequent use of peppermint oil on your skin (see our blog on essential oils) or drinking lots of peppermint tea is not advised during pregnancy.

Rosemary

One of my favorite herbs is rosemary! It is easy to grow and widely used as a seasoning in soups, salads, vegetable dishes, and with chicken and fish. Rosemary grows as a large evergreen shrub. The small evergreen “needles” are used in cooking, while the oil is used in folk medicine for digestive problems and to treat headaches. The concern comes when ingesting large amounts of rosemary, which can stimulate menstruation and increase the risk for miscarriage. Due to this reason, using rosemary for medicinal reasons or frequently on your skin is not advised during pregnancy. Rosemary also contains camphor. When taken orally in high amounts, camphor can act as a poison.

Garlic

Lastly, I want to talk about garlic, a favorite for many people. Is it an herb or a spice? Even though garlic is widely used as both an herb and a spice, it is really a root vegetable. I still want to include it in this blog due to its widespread use as a spice. Garlic is popular in pasta dishes, in garlic butter and on garlic toast, and in many dishes such as stews and soups! Additionally, garlic is high in vitamins B6 and C and is also high in calcium, so it’s often taken as an oral supplement. Yet taking high levels of garlic can increase the risk for bleeding as garlic contains alliin, which acts as a blood thinner in our bodies. During pregnancy, this can lead to an increased risk for miscarriage. Avoiding high levels of garlic during pregnancy is advised. Even topical use of garlic on your skin is not advised as it can cause dermatitis and burns. When breastfeeding, eating garlic can change the taste of the milk and babies may not like it. Garlic use can also increase the chance for gas and colic in some babies.

Hopefully this blog has helped you make heads and tails out of using/eating/drinking these spices and herbs during pregnancy and breastfeeding. In general, with many spices and herbs, using a little bit to flavor your food usually does not have any known increased risks during pregnancy or breastfeeding. However, using the product in a tea or as an oral supplement is often not advised. We have a helpful fact sheet on herbal supplements that explains how little pregnancy safety data there is on most herbal supplements. Plus, these products are not regulated by the Food and Drug Administration (FDA) for safe use during pregnancy and breastfeeding. Any time you have questions or concerns about using spices and herbs during pregnancy, please contact us! One of our specialists will be happy to help you.

Morgan called late Friday afternoon with a question about COVID-19 booster shots. She shared that she was 37 weeks along and had received both shots of the Pfizer COVID-19 vaccine back in February, at the very beginning of her pregnancy. Morgan wanted to do what was best to protect her baby, and asked if she qualified for the booster shot that was now available.

As a Teratogen Information Specialist at MotherToBaby California, COVID-19 vaccine questions are my number one inquiry right now. With the guidance continuing to evolve as the pandemic rages on, it can be hard for pregnant women to keep up! Luckily, that’s what we are here to help with. I shared with Morgan that although the vaccines are still working well to prevent severe illness, hospitalization, and death, overall effectiveness has been shown to decrease over time (called waning immunity). Because of this decreased protection, the Centers for Disease Control and Prevention (CDC) have recommended booster shots for some people over the age of 18, including:

• Certain groups – including those who are pregnant or recently pregnant – who got both doses of an mRNA vaccine (Pfizer or Moderna) at least 6 months ago, and
• Everyone who got the Johnson & Johnson vaccine at least 2 months ago.  

So, what does this mean for my pregnant caller Morgan? Women who are pregnant and recently pregnant (up to 42 days after delivery) may be more likely to get severely ill from COVID-19. We know that there are higher risks of ICU admission, need for a ventilator, and death when a woman gets COVID-19 while pregnant, so protection of this group through vaccination is extremely important. I shared with Morgan that since it has been more than 6 months since she received her first two doses of the Pfizer vaccine, and since she is currently pregnant, she may choose to get a booster shot. The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) have both recommended the booster at any time in pregnancy once you’re eligible for it.

Morgan and I went on to review the latest pregnancy data on the COVID-19 vaccines, which now includes thousands of women who have received mRNA vaccines (Pfizer or Moderna). Reassuringly, the available data does not suggest a risk for pregnancy complications (including miscarriage, preterm birth, stillbirth, effects on the baby’s growth, or infant death). Although COVID-19 booster shots have not been specifically studied in pregnancy, the Pfizer and J&J boosters are the same dose and contain the same ingredients as the initial doses, and the Moderna booster contains just half of the original dose. Most experts agree that the components of the COVID vaccines only stay in our bodies for a short time, and are not expected to cross the placenta to reach the baby.

Morgan was happy to hear that she qualified for the booster shot. Her three-year-old was in preschool, and although he wore his mask every day, she was still worried about him bringing home COVID and infecting her. She also visited her grandparents often, and wanted to keep them safe. For her, the benefits of protecting herself and her unborn baby definitely outweighed any potential risks.

Before we disconnected, Morgan asked about her sister-in-law who received the Moderna vaccine three months ago and was now pregnant. “Would she be able to get a booster?” Looking at the latest CDC guidelines, I informed Morgan that her sister-in-law would need to wait until 6 months after her second dose of Moderna before she became eligible for the booster. However, I also reminded her that her sister-in-law still has good protection against becoming very sick or hospitalized from COVID-19 from her initial vaccination. Like everyone who is pregnant, she should continue to take other precautions, such as wearing a mask and avoiding crowded indoor gatherings.

If you are unsure whether or not you qualify for a booster or you have other vaccine-related questions, please reach out to a MotherToBaby Specialist. And for anyone who has not yet received their initial COVID-19 vaccine, please know that it is strongly recommended before or during pregnancy by many organizations focused on maternal and child health, including the CDC, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. If you would like to go over the latest pregnancy information for the COVID-19 vaccines, COVID-19 boosters, or any other exposures, please give us a call.

I recently received a phone call from Molly.  Molly told me that she had just found out that she was pregnant; this was a surprise, but a welcome one.  However, Molly confessed that she smokes a pack of cigarettes per day and her doctor recommends that she quit smoking since cigarettes can present a number of hazards for her pregnancy and baby.  Molly’s friend told her that e-cigarettes were safe in pregnancy and would help Molly with her efforts to reduce use of traditional cigarettes.  Molly wanted to be sure.  “Don’t both cigarettes and e-cigarettes both contain nicotine,” she asked?  

What are e-cigarettes? 

‘E-cigarettes’ is short for electronic nicotine delivery system, sometimes also referred to as vapes, e-hookah, or other slang names.  E-cigarettes utilize a device that heats up nicotine-containing fluid from a cartridge, which can then be inhaled as a vapor.  Using an e-cigarette does have the potential to avoid some of the hazardous compounds found in traditional cigarettes such as tar and cadmium.  However, e-cigarettes are a relatively new product and not very well regulated.  Some e-cigarette fluids contain a lot of nicotine while others very little.  They often have other substances added to them including preservatives and flavorings. Many of these agents have not been studied regarding their safety in pregnant women.   

All of this makes it difficult to draw accurate conclusions about what risk e-cigarettes might present to a pregnant woman and her baby.  What we do know is that traditional cigarettes and nicotine (the chemical which is in both tobacco and e-cigarettes) do present a risk for a wide number of issues including birth defects (cleft lip and palate), miscarriage, and poor growth in the developing baby.  In addition, substituting e-cigarettes for traditional cigarettes is not a proven way to quit smoking, and in some cases, people continue to smoke conventional cigarettes as well as e-cigarettes which makes the exposure to the baby even larger.  Scientists are still learning about this, and most public health agencies recommend behavioral approaches as the safest strategy for pregnant women who are trying to quit smoking.

Molly is smart to ask about the safety of e-cigarettes before she uses them.  She also shows how much she cares about herself and her baby by trying to decrease smoking as much as possible!  I suggested she speak with her healthcare provider about strategies for quitting.  I also told her about free services like the CDC’s Smoker’s Quitline (1-800-784-8669).

MotherToBaby has fact sheets on e-cigarettes, cigarette smoke and vaping...

… and people can call (866-626-6847), text (855-999-3525), email, or chat to speak with a specialist on exposures in pregnancy.

“What products can I use on my skin during pregnancy and breastfeeding?” As a MotherToBaby information specialist answering our texting service, every day I get questions about any type of product you can think of that can be applied to your skin! Anything from itching and antibiotic creams, vitamin C products, essential oils, homeopathic creams and gels, acne products, to cosmetics and skin care products. Pregnancy and breastfeeding can be stressful times, and since we always want what is best for the baby, we all worry that a product we are using on our skin may get to the baby and be a problem. But is it true? What should you worry about and what can you use (as directed) without concerns?

Your Skin

First, lets talk about your skin and how topical products (things you put on your skin) get into your system. Your skin is a large, dynamic living tissue that is made up of different layers. We need to understand the absorption process in order to evaluate the safety of cosmetic, medicinal, and chemical products that come into contact with our skin. When a substance is put on your skin, it first has to go through the outer layer of the skin called the stratum corneum, which is made up of dead cells. Then come the living layers of our skin, the epidermis (waterproof barrier), dermis (connective tissue, hair follicles and sweat glands), hypodermis (fat and connective tissue) and the vascular network.

How Much is Absorbed?

Different factors affect skin absorption, including how much is applied, the physical state of the product (is it a liquid, powder, gel, etc.), where on the body it is applied, how large of an area the product is applied to, the person’s age, and whether the skin is wet or dry at the time the product is applied. Often, only 1 or 2% of an applied dose is absorbed into your system. But sometimes, more is absorbed, especially if your skin has open wounds, cracks etc. or if you have a skin condition such as eczema. In fact, how “complete” your skin is can be the most important factor in determining how effective a barrier it can be to topical products.

It can be hard to get good safety information on every type of topical product. The FDA (Food and Drug Administration) does require cosmetic products to be “safe,” which is based on their specific labeling and use. Yet cosmetic products do not need FDA approval to be sold on the market, and often the companies make claims that have not been studied and cannot be proven. So it is always a good idea to check with our MotherToBaby information specialists and let us research the product and its ingredients for you.

Many times during pregnancy and breastfeeding, people worry about the use of retinoids (a class of chemical compounds contained in treatments for acne, psoriasis, wrinkles, and other skin conditions), high dose salicylic acid (a common ingredient in topical acne treatments), formaldehyde (often used as a preservative in cosmetic products), hydroquinone (a skin-lightening agent that can be used to treat age spots and sun spots), and chemical sunscreens to name a few. These products do have some concerns and should be used with caution when pregnant and nursing.

Other products that are applied to your skin have less concerns in most instances. These include over-the-counter antibiotic creams, corticosteroid creams (used to reduce skin inflammation and irritation from things insect bites or poison oak/ivy, but also in treatments for eczema and psoriasis), essential oils, menthol and lidocaine type products (used in products to cool or numb the skin), hydrogen peroxide (used in treatments for acne, sun spots, and age spots), fluoride and dental products, homeopathic creams and gels, vitamin C products (used in treatments to reduce fine lines and as an antioxidant to protect the skin), and things that you put on your hair and nails.  

So that is the skinny on skin care! You might be able to use more products on your skin than you thought you could during pregnancy and breastfeeding. Even with a product that is considered low risk, you may want to check with your healthcare provider or with us if you have any concerns before using. We have a number of fact sheets and blogs that can answer some of your questions about topical products, and our information specialists are always happy to answer your questions by phone, text, email, or chat.

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