By Lori Wolfe, Certified Genetic Counselor at MotherToBaby North Texas

Did you know that the month of March is green tea month? Green tea has been said to have many health benefits, including: preventing memory loss, promoting bone health, decreasing risk of cancer, increasing dental health, reducing the chance of getting type 2 diabetes, and helping us lose weight. Green tea is loaded with nutrients and antioxidants, and has been said to be “the healthiest beverage on the planet.” So, given all of this wonderful news, who wouldn’t want to join Lucky the Leprechaun in the month of March and enjoy a cup of green tea?

As an information specialist with MotherToBaby, I recently had a pregnant mom named Lynn text me, asking: “Can you drink green tea if you take your prenatal vitamin later? How much does green tea impact folic acid absorption? I am in my first trimester and have had some green tea throughout pregnancy, and I am now worried about it impacting my folic acid absorption.” Wow, I thought, that is a great question! As the MotherToBaby specialist on the other side of the text, I started researching her questions so that I could give her the most up-to-date information out there.

First, let’s talk about folic acid: what is it and why is it important to pregnant women?
We all need folic acid every day in our bodies to help make new cells. Folic acid is a synthetic form of Vitamin B9, also known as folate. It is very important to take enough folic acid just before and during pregnancy. Many studies have shown that taking the recommended daily allowance of 400 micrograms per day during pregnancy reduces the chance that the baby will have serious birth defects of the spine and brain, called neural tube defects (NTD).

So what’s the connection between drinking green tea, folic acid, and pregnancy?
Green tea contains something called catechins, which have been shown to partially prevent the cells in the intestines from absorbing folic acid. Studies have shown that when women are drinking a lot of green tea, they have lower levels of folate in their system. That means there is less folic acid that can cross the placenta and get to the baby, and the baby can thus be at a higher risk for having a NTD. This can occur when a pregnant woman is drinking more than three cups of tea per day. Green tea and some forms of black tea such as Oolong tea can be high in catechins. Taking a daily prenatal vitamin has been shown to reduce this possible risk in heavy tea drinkers.

Another concern with drinking green tea during pregnancy is the caffeine content.
The good news is that green tea contains less caffeine than coffee (about 20 to 50 mg of caffeine per cup in green tea verses an average of 100 mg of caffeine per cup in coffee). Moderate levels of caffeine (about 200 mg/day) have not been shown to increase any risks in pregnancy. See our MotherToBaby fact sheet for more information on caffeine and pregnancy at https://mothertobaby.org/fact-sheets/caffeine-pregnancy/. Women may want to limit their tea consumption during the first trimester when the baby’s neural tube is developing to avoid the chance of decreasing absorption of folic acid. After this point, drinking one cup of green tea per day has not been shown to increase any risks for the baby.

I counseled Lynn that she can enjoy a cup of green tea now and then, as occasionally drinking green or black tea has not been shown to increase the risk for any problems during pregnancy. So, raise that cup of green tea along with Lucky the Leprechaun and enjoy “going green” in the month of March!

If you have questions about exposures during pregnancy or breastfeeding, contact an expert at MotherToBaby. You can reach us by phone at 866-626-6847 or by text at 855-999-3525. You can also email or live chat with us by visiting https://MotherToBaby.org.

Lori Wolfe, CGC, is a board certified Genetic Counselor and the Director of MotherToBaby’s North Texas affiliate. MotherToBaby aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free number, text line and by email, Wolfe also teaches at the University of North Texas, provides educational talks regarding pregnancy health in community clinics and high schools.

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.

References:
Gunners, Kris, https://www.healthline.com, 1/17/18.

“Folic Acid, Key Points,” www.marchofdimes.org, 2/18.

Rongwei, Ye et al, “Tea Drinking as a Risk Factor for Neural Tube Defects in Northern China, Epidemiology, Volk 22, No 4, July 2011. Yazdy, Mahsa et al,
“Maternal Tea Consumption during Early Pregnancy and the Risk of Spina Bifida”, Birth Defects Research (Part A), Clinical and Molecular Teratology 94:56-76, 2012.

“Why to go Easy on the Green Tea During Pregnancy,” Neifeild, Rachel, RD. CDN, www.babymed.com, 2/23/18.

By Ginger Nichols, Licensed Certified Genetic Counselor at MotherToBaby Connecticut

The New Year often brings thoughts of finding a new job. Even those happy in their current occupations often use the New Year to jump start career advancements. If you are thinking about a pregnancy, or you are already pregnant or breastfeeding, chances are you have also started to think more about potential exposures that might be of concern.

As a prenatal genetic counselor, I have noticed a common trend among working women. Many women do not worry very much about potential work hazards when first starting their careers. However, once they start to plan a pregnancy or find out that they are pregnant, many women call to ask about job safety. With a new life is on their minds, many women start to view their environment more critically.

For those of you planning a pregnancy, now is a great time to ask your questions about workplace safety with your healthcare providers or to contact a MotherToBaby specialist. Researching possible occupational exposures prior to pregnancy can allow time to decide if extra safety measures should be considered. Don’t forget to think about occupational exposures that your partner might be facing.

Occupational hazards can include:

• chemicals,
• metals,
• anesthetic gases,
• ionizing radiation,
• loud noise,
• extreme heat or extreme cold,
• strenuous physical exertion,
• repetitive movements,
• whole body vibration,
• infectious agents (viruses, diseases),
• injury,
• emotional stress and
• changing shift rotations.

In general, exposures can happen through: inhaling substances (e.g., breathing a gas, powder, dust or vapor into your lungs), absorption through skin, or ingestion (i.e., eating or drinking).

Sometimes, workers carry hazardous substances (dust, powder, chemicals, metal flakes) home on their shoes or clothing. This is one of the reasons that it is also important talk to your partner or other adults living in your home about their workplace.

While the list of potential hazards looks long, we should remember that just because we work around a potential hazard, it does not mean that we are actually exposed to the hazard. More importantly, employment has generally been considered beneficial for maternal health and birth outcomes. This is due to the financial and social benefits of working, and some call it the “healthy worker effect”. Most of the health problems that have been associated with workplace exposures do not affect our ability to get pregnant or to carry a healthy pregnancy to term.

The United States Department of Labor’s Occupational Safety and Health Administration (OSHA) requires employers (your bosses) to make the workplace safe for their workers. But, workplace safety measures were mainly created with adults (men and non-pregnant women) in mind; not a developing baby. In addition, workplace hazards that might affect a pregnancy are difficult to research. Therefore, your healthcare providers might not always know how a true exposure could affect a pregnancy. However, by following proper safety procedures, workplace exposures will likely be kept below levels that would affect your health or a pregnancy.

What should I be ready to discuss if I am worried about possible exposures at my workplace?

1. Employer/Job title
2. How long you’ve been working there
3. Description of job tasks, during and prior to pregnancy
4. Exposures that you are worried about
5. Personal protective equipment used (such as gloves, gowns, masks, or eyewear)
6. Ventilation at the work site (e.g., are there Hoods? Air Handlers? Fans? Windows that can open?)
7. Eating or drinking at the work site (e.g., do you store your food in an area that is designated only for that purpose?)
8. Any health symptoms in you or coworkers
9. Any reports available, such as blood lead levels, air quality reports, or water report.
   1. Sometimes an industrial hygienist will come to a work site to visually look at the work place or to take test samples (air, water, surfaces) for contamination.
10. For those who work around chemicals, they may ask about Safety Data Sheets (more on these below).
11. Other jobs/hobbies during pregnancy

What are Safety Data Sheets?

The best way to find out what chemicals are in the product(s) you use at work, or products that are used around you, is to get a copy of the Safety Data Sheets (SDS) (previously called Material Safety Data Sheets, or MSDS). SDS are prepared by chemical manufacturers and outline information on the product. Your workplace is required to have the SDS readily available to workers for all hazardous chemicals used at a worksite. Most SDS / MSDS can also be downloaded from the internet.

Along with listing hazardous ingredients, the SDS will talk about how to handle and store the product. The sheet should also talk about any specific recommendations for PPE and how to clean a spill or how to apply immediate first aid in case of accidental exposure.

Sometimes, a hazardous ingredient may be listed as “trade secret” or “proprietary formulation”. One can try to learn more about the chemicals in the proprietary formulation by contacting the manufacturer at the address or telephone number listed on the SDS. If a product contains no hazardous ingredients, it will be listed as such.

Along with a list of ingredients considered hazardous, the SDS may also discuss allowable levels of exposure. You may have heard of these limits by the terms: the Threshold Limit Value (TLV) or Permissible Exposure Limit (PEL). TLVs and PELs are limits for the maximum exposure allowed in the workplace. Industrial hygienists can perform workplace assessments to determine if there are exposures that are above allowable levels. These limits are designed to minimize health effects in nonpregnant workers. So it cannot be assumed that exposure levels below the TLV or PEL will be safe for a pregnant woman and/or her fetus.

What kind of safety protection can be used?

All work places should provide the proper personal protective equipment (PPE) for handling and working around hazardous situations. Some examples of PPE include gloves, shoes, aprons, gowns, ear protection, masks, and/or ventilation such as hoods and air filters.

• Use the PPE that is recommended for your job.
• Use PPE at all times, not just when pregnant.
• Keep your training on how to properly use the PPE up to date.
• Make sure hoods, respirators, and other equipment are working properly.
• If you wear PPE (such as a respirator), be sure it fits correctly. And keep in mind: as a woman’s body changes during pregnancy, PPE may need to be re-fitted.
• If you wear a respirator, remember that respirators are not a substitute for appropriate permanent exhaust ventilation (such as fume hoods, exhaust ducts and/or exhaust fans). Respirators are designed to be used only for a short period of time.
• If the right PPE is not currently at your worksite, ask your employer about getting it.

Consider talking with an occupational health specialist or industrial hygienist who may be able to provide information that is specific to your workplace.

How can I learn more about ways to reduce my exposure to potential hazards in my workplace?

MotherToBaby has a fact sheet that discusses general tips on working safely called Reproductive Hazards of the Workplace. There are some other fact sheets on specific occupational exposures, such as infectious diseases, lead, paint, and pesticides. There are also specific workplace sheets that look at working in a veterinary setting, in a nail salon, and for those who work with x-ray machines. Our entire library of fact sheets can be accessed by visiting https://mothertobaby.org/fact-sheets-parent/.

You can also contact an industrial hygienist or occupational medicine specialist. Try looking for them at a local medical university or through the American Industrial Hygiene Association: https://www.aiha.org/about-ih/Pages/Find-an-Industrial-Hygienist.aspx. Industrial hygienists should be able to provide an independent assessment on ways to improve the safety of your job, if needed, and may be able to give advice on how to work with employers in implementing these changes. The National Institute for Occupational Safety and Health (NIOSH) has a free service called Health Hazard Evaluation (HHE), which can provide you or your employer advice about health hazards that might be in your workplace and can offer tips on how to make your workplace safer. To learn more, visit the NIOSH website at: https://www.cdc.gov/niosh/hhe/.

Happy New Year, New Job, and New Baby.

Ginger Nichols is a licensed certified genetic counselor based in Farmington, Connecticut. She currently works for MotherToBaby CT, which is housed at UCONN Health in the Division of Human Genetics, Department of Genetics and Genome Sciences. She obtained her Bachelor of Science degree in Biology and Sociology from Juniata College and her Master’s Degree in Medical Genetics from the University of Cincinnati. She has a special interest in occupational and environmental exposures.

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.

Selected References:

Feinberg JS & Kelley CR (1998) Pregnant Workers: A Physician’s Guide to Assessing Safe Employment; West J Med; 168(2): 86-92.

Frazier L & Hage M (1998) Reproductive Hazards of the Workplace. New York: Van Nostrand Reinhold.

Frazier L, Jones T (2000) Managing Patients with Concerns About Workplace Reproductive Hazards. JAMWA 55(2): 80-84.

The American College of Obstetrics and Gynecology (ACOG). 2017. Committee Opinion Number 313. The Importance of Preconception Care in the Continuum of Women’s Health Care. Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/The-Importance-of-Preconception-Care-in-the-Continuum-of-Womens-Health-Care

The Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH). REPRODUCTIVE HEALTH AND THE WORKPLACE. https://www.cdc.gov/niosh/topics/repro/healthcare.html

The United States Department of Labor’s Occupational Safety and Health Administration (OSHA). Employer Responsibilities. Available at: https://www.osha.gov/as/opa/worker/employer-responsibility.html

The United States Department of Labor’s Occupational Safety and Health Administration (OSHA). Hazard Communication Safety Data Sheets: https://www.osha.gov/Publications/HazComm_QuickCard_SafetyData.html

By MotherToBaby’s Kirstie Perrotta, MPH, Lorrie Harris-Sagaribay, MPH, Robert Felix and Susan Sherman of the Organization of Teratology Information Specialists (OTIS) Zika Task Force

“It’s 2018! I didn’t even know you could get syphilis nowadays!” Yes, I mentioned the stats about syphilis and other infections that can affect pregnancy to the caller who had contacted me through our free MotherToBaby helpline. I thought, this is a great time to educate her as well as others about a variety of infections. Some infections, like Zika, seem to make headlines every week, while others tend to be discussed much less frequently. January is National Birth Defects Prevention Month, and this year’s focus is on infection prevention.

In keeping with the theme Prevent to Protect: Prevent Infections for Baby’s Protection, read on to learn more about the top five preventable infectious diseases that we get questions about here at MotherToBaby, and what you can do to prevent exposure during pregnancy.

#1: Zika Virus
One of our most common Zika questions comes from couples who have just returned home after a tropical vacation: How long do we need to wait to get pregnant after returning from a country with Zika, and what should we do in the meantime to minimize risk? Can we be tested?

Many countries continue to see active transmission of Zika virus from infected mosquitoes. If a woman is infected with Zika during pregnancy, it can increase the risk of microcephaly (small head and brain) and other severe brain defects. It may also cause eye defects, hearing loss, seizures, and problems with the joints and limb movement. That’s why it’s so important for couples who are planning a pregnancy to make sure the virus is completely out of their bodies before they attempt to conceive.

So, how long do couples need to wait? The Centers for Disease Control and Prevention (CDC) recommends that women who travel to a country with Zika wait at least two months before attempting to get pregnant. If a male partner travels, the CDC recommends waiting six months. Some callers ask, “Why so long? We’re ready to get pregnant now!” Although the virus is expected to leave most people’s blood in about two weeks, this could vary depending on a number of factors including their own immunity. The CDC considers 2 months to be a long enough wait time for women. As for men? Zika has been found in the semen for up to 6 months after a man is first infected. The six-month wait time ensures that men do not pass the virus to their partners during intercourse if it is still present in their semen.

Practicing safe sex is important during these wait times! Since Zika can spread through sexual contact, using condoms or dental dams is recommended every time a couple has intercourse. Don’t want to use protection? 100% abstinence is another option. These safe sex precautions significantly reduce the risk of transferring the virus from one partner to another during these important wait times.

Couples who want to get pregnant right away will often ask, “Instead of waiting, isn’t there a way my doctor can just test me for the virus?” Unfortunately, the answer to that question is not so simple. The CDC does not recommend testing as a way to know if it’s “safe” to get pregnant. For one reason, the virus could have already left your blood, but could still be hanging out in other areas of the body (like semen). In this case, you could get a negative blood test result, but still have the virus. Second, no test is 100% accurate. There’s always a chance that your result could be a false negative, especially if you are tested too soon or too late after returning home from a country with Zika.

So, the bottom line? It’s a waiting game. Couples should follow the CDC’s official recommendations to make sure their pregnancy has the healthiest start possible. Still have questions or concerns about Zika? Check out Zika Central on MotherToBaby.org or call us at 866-626-6847 to speak with a specialist who can assess your specific exposure.

#2 Listeria
I just ate unpasteurized cheese and I’m worried I have Listeria. What symptoms should I watch for? Do I need to be tested?

Eating unpasteurized cheese does put you at risk for a Listeria infection (called listeriosis). So during your pregnancy it’s important to avoid unpasteurized cheeses and other foods made with unpasteurized milk. The US Food and Drug Administration has developed additional food safety guidelines specific to pregnancy.

While listeriosis has not been found to cause birth defects, it can increase the risk for miscarriage, preterm delivery, and still birth. It also increases the risk of infection in newborns which can result in very serious long-term complications for baby.

Not everyone who is infected with Listeria will have symptoms, but some will have mild to severe symptoms that appear a few days or even weeks after eating contaminated food. Symptoms of a Listeria infection to watch for may include: diarrhea, fever, muscle aches, joint pain, headache, backache, chills, sore throat, swollen glands, and sensitivity to light.

Since not everyone has symptoms, it is important to be tested if you think you might have listeriosis. Your health care provider can order a simple blood test to confirm a Listeria infection. Treatment will reduce the risks of infection for you and your baby.

#3: Toxoplasmosis
I didn’t find out I was pregnant until 12 weeks, and I’ve been changing my cat’s litter box this whole time. Am I at risk for toxoplasmosis?

Toxoplasmosis infection is caused by the parasite Toxoplasma gondii. You can get it from handling cat feces or soil, or eating undercooked, infected meat that contains the parasite. Eating raw eggs or drinking unpasteurized milk are also possible sources.

Most adults with toxoplasmosis don’t have symptoms, but some have symptoms similar to the flu or mononucleosis, with swelling of the lymph nodes, fever, headache or muscle pain. In most cases, once a person gets toxoplasmosis, they cannot get it again. If a woman has an active toxoplasmosis infection during pregnancy, it can pass to the developing baby (called congenital toxoplasmosis infection). Not every infected baby will have problems, but the infection could cause a variety of developmental problems for the infant.

Up to 85% of pregnant women in the U.S. are at risk for toxoplasmosis infection. Generally, women who have recently acquired a cat or care for an outdoor cat may be at an increased risk for toxoplasmosis. Ask yourself: Have you ever been diagnosed with toxoplasmosis? How long have you had your cat? Is your cat indoor only, outdoor only, or both? Do you feed the cat raw meat? Talk to your healthcare provider if you have concerns and want to learn more about a blood test that can determine if you have ever had toxoplasmosis.

To avoid future infection, here are some precautions you can take: (1) wash your hands carefully after handling raw meat fruit, vegetables, and soil; (2) do not touch cat feces, or else wear gloves and immediately wash your hands afterwards if you must change the cat litter; (3) wash all fruits and vegetables; peeling fruits and vegetables can also help reduce risk of exposure; (4) cook meat until it is no longer pink and the juices run clear; and (5) do not feed your cat raw meat.

#4 Syphilis
I just found out I have syphilis and my doctor recommended medication to treat it, but I’m worried the medication will hurt the baby. What should I do?

Syphilis is a sexually transmitted infection (STI) caused by bacteria that can be treated and cured with antibiotics. Learning that you have syphilis when you are pregnant is frightening, but the earlier you treat the infection, the better the outcome for you and your baby.

The syphilis bacteria can spread to the baby during pregnancy (called congenital syphilis or CS). CS can cause stillbirth, prematurity, or other pregnancy problems, including birth defects of the bones, the brain and other body systems. If you are diagnosed with syphilis during pregnancy, be sure to talk with your baby’s pediatrician since a baby might develop symptoms of CS even after being born.

The medications that are used to treat syphilis have been around for many years and are well studied. While there is always the possibility of side effects with any medication, the antibiotics used to treat syphilis during pregnancy are very well tolerated by most women.

The MotherToBaby website contains fact sheets on many of the medications doctors prescribe during pregnancy. If you still have concerns about the medication your doctor has prescribed to treat your syphilis, you can review the fact sheet and contact a MotherToBaby specialist at 866-626-6847.

#5 CMV (Cytomegalovirus)
I’m pregnant, and my 3-year-old came home from daycare with symptoms of CMV. Should I be worried? What can I do to prevent getting CMV from her?

CMV is a common virus that spreads through urine, saliva and other body fluids. In pregnancy, CMV can pass from mom to the developing baby (called congenital CMV infection). This could happen if you already had CMV before you got pregnant or if you got a new strain of CMV from your daughter, but it might be more likely to happen if you get a first-time CMV infection from your daughter while you’re pregnant.

Reassuringly, most babies born with congenital CMV infection don’t get sick or have health problems. But about 1 out of every 5 babies with congenital CMV infection has health problems at birth or complications that develop later in childhood. These include developmental disability, vision problems, and hearing loss, even in babies with no signs of congenital CMV infection at birth.

So, how can you prevent getting CMV from your daughter? There is no surefire way to guarantee that you won’t get it, but the best prevention is the easiest one: wash your hands often. Especially after any contact with your daughter’s urine or saliva. Kissing her on the cheek or the top of the head instead of the mouth or the hands is another way to prevent contact with her saliva. And if you are still concerned, talk to your health care provider about blood tests to detect a current or past CMV infection. For more information, check out our Baby Blog about this topic.

If you have more questions about infections during pregnancy, contact a MotherToBaby expert by phone, email, text message or chat. During National Birth Defects Prevention Month and every day, moms-to-be have the opportunity to #prevent2protect, ensuring the healthiest start to life for their new additions!

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.

By MotherToBaby, a service of the Organization of Teratology Information Specialists (OTIS)

Why should pregnant women care about influenza? Isn’t Zika a bigger deal?

The second you get pregnant, the advice starts coming in from everyone. No eating unpasteurized cheese (Listeria!), don’t change the cat litter (Toxoplasmosis!), and definitely don’t travel to South America (Zika!). While these are all valid concerns, influenza tends to get forgotten, and dismissed as “just the flu.” The Influenza virus may not make sensational headlines, but it’s a serious problem every year, and pregnant women are especially vulnerable to this infection.

In 2009/2010, the United States (U.S.) experienced a flu pandemic. The flu hit the public hard, and many pregnant women were hospitalized. The U.S. saw higher rates of admission to intensive care units for pregnant women, and 109 pregnant women died from confirmed or suspected flu infection. In comparison, Zika virus, which received much media attention and continues to be a source of great concern for many pregnant women, rarely results in hospitalization and has not resulted in any maternal deaths.

5 Quick Flu Facts:

1. The flu is a risk year-round, and is not limited to a particular area of the country.
2. Changes with the immune system, heart, and lungs put pregnant women at an increased risk of developing serious complications from the flu, such as respiratory distress. Pregnant women who get the flu are also much more likely to be hospitalized, and can even die from influenza complications.
3. Fever is a common flu symptom. Research shows that an untreated high fever early in pregnancy can result in an increased risk for a certain class of birth defects known as neural tube defects (spina bifida is one example).
4. Being very sick from the flu can increase the risk of pregnancy complications such as miscarriage and preterm delivery.
5. For pregnant women looking to ensure the healthiest start to life for their little one, influenza is an important infection to be aware of, and to try to prevent.

Is it too late to get a flu shot? It’s January, isn’t flu season over?

It’s never too late to get a flu shot! Flu season can start as early as October, and runs as late as May some years. However, research shows that the highest number of flu cases each year usually occurs in February. While vaccine effectiveness can vary from season to season, the flu vaccine is thought to reduce the risk of illness by about 50% to 60% when the flu viruses that end up circulating in the community closely match the viruses included in that year’s vaccine. Even during years when the flu vaccine is not a good match, it is still thought to provide some protection against the flu. If you haven’t received this year’s flu vaccine yet, talk to your health care provider as soon as possible.

10 Quick Flu Vaccine Facts:

1. The best way to avoid getting the flu virus is to receive the flu vaccine.
2. Women who are planning a pregnancy and women who are currently pregnant are strongly encouraged to get the seasonal flu shot as early as possible during the flu season.
3. There is no known risk from getting the flu shot during pregnancy. The seasonal flu shot is an inactivated virus vaccine, which means that it won’t cause you to get sick with the flu.
4. Pregnant women are asked to avoid the live attenuated flu vaccine (also called the nasal spray vaccine) as it contains a tiny amount of weakened live virus.
5. There is no trimester during pregnancy when the flu shot has to be avoided.
6. Studies of thousands of women who have received the flu shot just before or during pregnancy have found no increased risk for birth defects.
7. Studies have found that when pregnant women get the flu shot, their baby is born with protection against the flu for anywhere from 2 to 6 months after birth.
8. Most women who receive the flu shot will not experience any problems.
9. A small number of individuals who receive the flu vaccine may experience soreness/redness/swelling at the injection site, headache, fever, nausea and/or muscle aches. Reassuringly, these symptoms are usually mild and go away on their own within a few days.
10. Anyone with a severe, life-threatening allergy to any of the vaccine ingredients should talk with their health care provider before getting the flu vaccine.

Is there anything else I can do to avoid the flu?

In addition to getting vaccinated, healthy habits can further reduce your risk of getting the flu. Avoid close contact with other individuals who are sick. If you’re caring for someone with the flu (like a partner or a child), make sure to clean and disinfect common surfaces that may be contaminated with germs. Wash your hands frequently with soap and water. Cover your mouth and nose while coughing or sneezing, and practice good health habits like staying well hydrated and eating nutritious food.

If you develop symptoms of the flu, you should contact your health care provider as soon as possible. When indicated, antiviral medications may be prescribed (ideally within 48 hours) to lessen flu symptoms and reduce the risk of serious illness.

MotherToBaby is a suggested resource by many federal agencies including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration’s (FDA) Office of Women’s Health, and HRSA, and provides the most up-to-date information. More than 100,000 women and their health care providers seek information about birth defects prevention from MotherToBaby every year. Additionally, MotherToBaby conducts observational research studies in order to contribute more information to the published literature about a variety of exposures. To be connected with a MotherToBaby expert, please call (866) 626-6847, text questions to (855) 999-3525 (standard messaging rates might apply) or visit www.MotherToBaby.org.

REFERENCES:

Flu Shot Effectiveness: https://www.cdc.gov/flu/about/qa/vaccineeffect.htm
Flu Prevention: https://www.cdc.gov/flu/protect/habits.htm
Peaks In February: https://www.cdc.gov/flu/about/season/flu-season.htm
MTB Flu Shot Fact Sheet: https://mothertobaby.org/fact-sheets/seasonal-influenza-vaccine-flu-shot-pregnancy/
MTB Flu Fact Sheet: https://mothertobaby.org/fact-sheets/seasonal-influenza-the-flu-pregnancy/
MTB Antiviral Fact Sheet: https://mothertobaby.org/fact-sheets/antiviral-medications-treatprevent-influenza-the-flu-pregnancy/
Flu Shot Side Effects: https://www.cdc.gov/flu/protect/vaccine/general.htm
Flu Shot Protects Baby: https://www.cdc.gov/features/pregnancyandflu/index.html
CDC Illness/Death Stats: https://www.cdc.gov/flu/about/disease/burden.htm
https://immunizationforwomen.org/uploads/Pregnancy_Related_Mortality_Resulting_From%206.pdf

By Ginger Nichols, Licensed Certified Genetic Counselor at MotherToBaby Connecticut

I was pregnant in 2004 when the Food and Drug Administration (FDA) and the U.S. Environmental Protection Agency (EPA) released guidelines on limiting fish consumption in pregnancy because of methylmercury. That pregnancy was definitely the most amazing time of my life; however, it was also stressful. It was the 5th time I had been pregnant, but due to miscarriages and the death of a son who was born very prematurely, I had yet to bring a baby home from the hospital. I became hyper-vigilant about anything that might be a possible exposure of concern for a pregnancy. I freely admit that my frame of mind for that pregnancy could not be called logical. Therefore, with the new and somewhat scary information about fish and methylmercury, fish was quickly added to my list of “don’t eat that.” I also admit that I don’t eat the recommended amount of fish anyway, so it was not that big of a leap to stop eating all fish.

It turns out that I wasn’t the only ‘fish out of water.’ According to a FDA study of the dietary habits of over 1,000 pregnant women in the U.S., around 21% of the women said that within the past month they had eaten zero fish. For the women who said that they did eat fish, most were eating less than the recommended dietary guidelines. However, fish is healthy for you! You don’t want to stop eating fish altogether, so instead of avoiding fish, let’s learn the facts.

By now, you may be asking: “What is methylmercury and why is it in fish?” As a Genetic Counselor and MotherToBaby specialist, I often talk to women about eating fish during pregnancy, so let me explain…. Methylmercury is an organic form of mercury. Mercury occurs naturally in the environment and it is also released into the air as a by-product of some industrial processes. When mercury gets into the soil and the water (including lakes, rivers, and the ocean), bacteria and fungi found in soil and water change mercury into methylmercury. Since methylmercury is in our water, it is found in different levels in pretty much all fish and shellfish. In general, larger fish with long life spans that eat other fish are typically going to have higher levels of methylmercury than smaller, younger fish. If you are interested, there are lists of average mercury levels in fish available online, such as this FDA web site: https://www.fda.gov/food/foodborneillnesscontaminants/metals/ucm115644.htm

Methylmercury is found in all tissues of the fish, so cleaning or cooking the fish will not reduce the levels of mercury. People who eat a lot of fish with high levels of methylmercury can also accumulate methylmercury in their bodies. Our bodies easily absorb methylmercury from our gastrointestinal (GI) tract and it takes a long time for our bodies to get rid of it.

“So why should I be concerned about eating too much seafood with high levels of methylmercury?” We know that even if you are not pregnant, methylmercury is toxic to our nervous system and organs. The effects of methylmercury poisoning have been known since the 1950s. People who became sick from methylmercury poisoning had many symptoms that included numbness in the hands and the feet, muscle weakness, tremors (shaking), and personality changes (irritable, shy, nervous). Now before you panic, be aware that these people had been exposed to fish with levels of methylmercury far higher than even the most contaminated fish in your grocery store!

We know that methylmercury can cross the placenta in pregnancy. With very high exposures, babies have been born with small head size and brain damage that can lead to seizures, developmental delay, blindness, and muscle weakness. Since methylmercury can affect the baby’s developing brain, high exposure is a concern at any stage of pregnancy. For more info, visit the MotherToBaby fact sheet on methylmercury in pregnancy and breastfeeding at https://mothertobaby.org/fact-sheets/methylmercury-pregnancy/.

By now you may feel like you just need to stay away from eating fish in pregnancy, when in fact studies are showing that women who eat fish during pregnancy have better pregnancy outcomes than women who do not eat fish. Recent studies have also looked at how nutrients in fish, including Omega-3 fatty acids, might have positive effects for baby’s development and actually may help to protect against any possible harm that might occur from prenatal methylmercury exposure. And what’s more, women in the U.S. generally do not depend upon fish as their only protein intake, so are unlikely to eat enough fish to cause harmful effects in a pregnancy. So, to reap the full health benefits of fish consumption for you and baby, the key is to eat a variety of fish that are low in methylmercury. This is where the FDA’s updated 2017 guidelines can provide some assistance.

“What are the current FDA guidelines?” The FDA’s recently revised advice is designed to encourage women who are pregnant and/or breastfeeding to consume up to 12 ounces of fish that are low in methylmercury each week, and provides guidance on which fish are the best options by breaking the fish into categories of Best Choices, Good Choices, and Choices to Avoid. The easy-to-read guide can be found here: https://www.fda.gov/downloads/Food/ResourcesForYou/Consumers/UCM536321.pdf. You’ll notice that on the FDA’s guide, different types (species) of tuna and tilefish are listed under different categories – so take note of which type you are buying so you know which list it is on.

Following current recommendations, if you are planning to become pregnant, currently pregnant, or currently breastfeeding:

• A typical serving of fish is 4 to 6 ounces, measured before cooking.
• Each week, you may eat up to 2-3 servings of a variety of fish from the Best Choices list; there are over 35 different types of fish on this list!
• If choosing a fish from the Good Choices list, limit yourself to just the one serving of that fish for the week.
• Avoid the following fish, as they are highest in methylmercury: shark, swordfish, mackerel, marlin, orange roughy, bigeye tuna, and tilefish from the Gulf of Mexico.
• If you are eating fish caught by family or friends, check for local fish advisories. The EPA has a search option to check for fish/shellfish advisories based on where you live: https://fishadvisoryonline.epa.gov/General.aspx. You can also check in with your state Department of Public Health. If there isn’t an advisory, limit yourself to just one serving of that fish and do not eat any other fish that week.

So now that we’ve got you on the hook and reeled you in, what’s the takeaway? With around 60 fish listed as Best and Good Choices on the FDA’s 2017 fish guidelines, ‘there are plenty of fish in the sea’ for pregnant and breastfeeding moms!

Ginger Nichols is a licensed certified genetic counselor based in Farmington, Connecticut. She currently works for MotherToBaby CT, which is housed at UCONN Health in the division of Human Genetics, Department of Genetics and Genome Sciences. She obtained her Bachelor of Science degree in Biology and Sociology from Juniata College and her Master’s Degree in Medical Genetics from the University of Cincinnati. She has a special interest in occupational and environmental exposures.

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, like medications or diseases 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.