By Robert Felix, President, MotherToBaby

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

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

So what about sunscreen safety during pregnancy?

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

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

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

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

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

References:

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

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

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

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

What is Celiac Disease?

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

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

Celiac Disease and Pregnancy

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

Hope

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

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

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

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

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

References:

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

*May is Maternal Mental Health Awareness Month*

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

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

 Having Questions Vs. Having Anxiety

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

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

What Are Anxiety Disorders?

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

 Anxiety Disorders And Pregnancy

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

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

What If I’m Having Problems With Anxiety?

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

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

WHERE CAN I GET MORE INFORMATION?

California Maternal Mental Health Collaborative

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

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

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

 National Institute of Mental Health

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

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

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

 MotherToBaby

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

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

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

References:

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

By Patricia Olney, MS, CGC, Genetic Counselor & Teratogen Information Specialist, MotherToBaby Georgia

Emily’s call to MotherToBaby came in late at night. Her voicemail message sounded a bit garbled, almost as if she had been crying. I returned her call the next day and heard her anxious voice say, “My psoriasis flared up last week…it’s been several years. I’m really worried because I just found out I’m pregnant.” I replied calmly, “Emily, I’m glad you called MotherToBaby for information. We care about you and your baby!”

How did Emily find me? I’m a pregnancy risk specialist at MotherToBaby, which is a service of the Organization of Teratology Information Specialists (OTIS). MotherToBaby provides FREE, up-to-date, evidence-based information about exposures during pregnancy and breastfeeding. Exposures may include prescription or over-the-counter medications, chemicals in the environment, alcohol, illicit drugs, and viral or maternal illnesses, like psoriasis and psoriatic arthritis. After spending a lot of time searching the Internet for answers to her questions, a frustrated Emily found our website and our toll-free phone number and I was able to provide her with the information she needed.

Psoriasis is a life-long skin disease, but symptoms can come and go. The most common is chronic plaque psoriasis, the type Emily was diagnosed with at the age of 14. Emily described her life since being diagnosed as an emotional rollercoaster. As a teenager, she was self-conscience about how she looked, and often felt depressed. In college she studied by herself and avoided social gatherings. It wasn’t until she met her future husband that she began feeling more in control of her life. He helped her find a specialist in dermatology with experience in treating psoriasis. After trying a variety of treatments, a combination of topical corticosteroids, moisturizers, and medications helped to control her symptoms. Compared with other family members, she described the severity of her psoriasis as mild to moderate. In her late twenties, she had several flare ups which often required medication or UVB phototherapy.

During Emily’s first pregnancy, she told me her psoriasis improved, and she was hoping for the same during her next pregnancy. But the week before calling me, Emily had worked long hours on a project with a tight deadline. She came home late in the evenings, feeling stressed and discouraged. By the end of the week, she noticed the all too familiar red, scaly plaques on her elbows, knees and scalp.

The evening Emily called, she had taken a home pregnancy test. She and her husband planned to have another child, but were surprised how easy it was to conceive. This time, however, she was not prepared to face the possibility of a psoriasis flare up during the first few weeks of pregnancy. I reassured her that she was not alone, and many women face the same uncertainty with pregnancy.

So what can a woman with psoriasis and/or psoriatic arthritis do to prepare for a healthy pregnancy?
Every woman who is planning pregnancy should avoid drinking alcohol and smoking cigarettes, reduce stress, exercise, eat a healthy diet, and take prenatal vitamins with folic acid. In some woman with psoriasis, alcohol, cigarettes or stress may trigger a flare up or aggravate her disease.

Approximately 30% of individuals with psoriasis will develop psoriatic arthritis, characterized by pain and swelling in the joints. Psoriatic arthritis can be a side effect of psoriasis that’s triggered by an interaction of genetic and environmental factors. Medications similar to those that treat psoriasis can improve psoriatic arthritis as well (1).

Women who require medication to treat their psoriasis/psoriatic arthritis should discuss pregnancy planning with their healthcare provider. Some treatments may require a period of time to clear from the body before conception, and certain medications should be avoided during pregnancy.

Will psoriasis and/or psoriatic arthritis go into remission during pregnancy?
This can be hard to predict, and it varies from person to person and even from pregnancy to pregnancy. In approximately two-thirds of pregnant women who have psoriasis, their psoriasis symptoms spontaneously improved during pregnancy due to the increase of estrogen hormones. Others, however, reported that their symptoms got worse during pregnancy. In addition, inflammatory flare-ups can occur 1-2 weeks after delivery (2). If your psoriasis symptoms get worse during your pregnancy or after you deliver, be sure to talk with your doctor. In 2012, the National Psoriasis Foundation published guidelines for treating psoriasis during pregnancy and lactation (3). For example, caution is advised when applying topical steroids to the breast to avoid passing the medication to the baby while nursing.

How can MotherToBaby help?
MotherToBaby counselors are here to help answer any questions or concerns about exposures in pregnancy or while nursing. If you have questions or concerns about psoriasis/psoriatic arthritis – and the medications used to treat these conditions – during pregnancy, call us toll-free at (866) 626-6847. Our service is FREE and confidential. MotherToBaby also conducts research on psoriasis/psoriatic arthritis during pregnancy. This research is observational, meaning participants are not asked to take any medications or to change their daily routine. To learn more about our research program, please contact one of our MotherToBaby Pregnancy Studies experts at (877) 311-8972.

After our call, Emily felt a lot more confident that she was on the right track to having a healthy pregnancy. However, her fear over how a psoriasis flare could affect her pregnancy was quickly followed by questions about how her psoriasis could be safely treated during pregnancy.
————————————————————————-
Online resources for individuals with psoriasis/psoriatic arthritis:
National Psoriasis Foundation (http://www.psoriasis.org)
TalkPsoriasis Support Community (http://www.inspire.com/groups/talk-psoriasis/)
Talk Health Partnership (http://www.talkhealthpartnership.com/talkpsoriasis/)
Patricia Olney, MS, is a certified genetic counselor and pregnancy risk specialist at MotherToBaby Georgia, Emory University. She received her masters degree at the University of California, Berkeley and has practiced genetic counseling for more than 25 years.

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

References:
(1) Liu J-T, Yeh H-M, Liu S-Y, Chen K-T. Psoriatic arthritis: Epidemiology, diagnosis, and treatment. World Journal of Orthopedics 2014;5(4):537-543.
(2) Babalola, O. and Strober, BE. Management of psoriasis in pregnancy. Dermatologic Therapy 2013;26:285-292.
(3) Hsu S, Papp KA, Lebwohl MG, Bagel J, Blauvelt A, Duffin KC…National Psoriasis Foundation Medical Board. Consensus guidelines for the management of plaque psoriasis. Arch Dermatol. 2012;148(1):95-102.

By Lori Wolfe, Certified Genetic Counselor and Teratogen Information Specialist, MotherToBaby North Texas
It’s pretty much a fact – ALL pregnant women worry…about what they eat, what they do, what they breathe. Basically, they worry about everything. That’s simply because every expectant mother wants to do the very best she can for her developing baby. As a genetic counselor who runs the North Texas affiliate of MotherToBaby, I get calls every day from pregnant woman who want to know what to do and what not to do in order to have the best chance of having a heathy baby without birth defects.

Recently I was having lunch with my friend, Amber, who is expecting her first babies…Yes… plural! In seven short months, she’ll become the mother of twins! As a first time mom-to-be, Amber is always full of questions when we get together. Nothing like having a friend who is an expert in the pregnancy exposure field, right?! “Lori, is it true that since I eat lots of dark green veggies, and breads and cereals, that my babies will not have spina bifida? I remember hearing something about how good folic acid is for developing babies. Is that true?” asked Amber. “Yes!” I enthusiastically replied. “Having enough folic acid in the first two months of your pregnancy is very important to help prevent birth defects in your developing babies. In fact, studies have shown that if you are getting at least 400 mcg of folic acid during your early pregnancy through the foods you eat, as well as your prenatal vitamin, then your babies have up to a 70% less chance of having a spinal cord defect such as spina bifida.” The look on her face was priceless…pure shock! “70%? Really?! Wow, I had no idea it could be so effective,” Amber answered. “Yes, I have been taking a daily prenatal vitamin since before I became pregnant. I am always careful to take one every day. So what else can I do to help my babies be born without birth defects?”

Let me break it down for all of the “Ambers” out there. What’s thought to be the most common preventable cause of mental retardation in a baby? The answer – drinking alcohol during pregnancy. “And what is so crazy is that women do not need to drink alcohol when they are trying to become pregnant, and definitely not once they have a confirmed pregnancy,” I explained. About one in every 100 babies born in America is affected by prenatal alcohol exposure and it is totally preventable by simply avoiding alcohol during pregnancy. “Amazing!” replied Amber. “I never realized so many kids were affected by their moms’ drinking alcohol during pregnancy. That is sad. But I am good on this count as I have not had any alcohol at all during the last few months,” Amber said.

“So is there anything else I can or can’t eat or drink, or something else I can avoid that could make a difference in my babies not having birth defects?” she went on to say. “You are about eight weeks pregnant now, right Amber?” I asked her. “Yes. I am now about eight and one half weeks. Why?” she asked. “Well, another thing we worry about is hyperthermia,” I told her. “Hyperthermia means increasing your internal or core body temperature up to 102 degrees Fahrenheit or more. When you become that hot, the baby inside of you becomes hot too. When the baby’s temperature becomes too hot, especially in weeks five and six of a pregnancy, there is an increased chance that the spinal cord will not close, and your baby can be born with an open spinal cord defect like spina bifida. So we always caution pregnant women not to sit in hot tubs that are heated over 100 degrees, or to be careful to watch their temperature if they become ill with a fever during early pregnancy,” I said.
“All of this is really good to know,” Amber answered, as we wrapped up lunch. “I’m lucky I have you as a friend!”

I love making sure women have someone to turn to for answers when they have questions about exposures while pregnant or breastfeeding. In fact, during March when the world will commemorate the first-ever World Birth Defects Awareness Day, my lunch with Amber serves as a great reminder that my colleagues and I are there for all pregnant and breastfeeding women across North America.
If you have a question during pregnancy and breastfeeding about something you ate, drank or medication you took, call MotherToBaby at 866-626-6847. I may not be able to meet you for lunch, but a main course of free expertise over the phone, followed by a huge helping of cutting edge research to support that expertise, will certainly be exactly what you ordered in your search for answers. And who knows? Your kids might even thank you for having such an appetite for knowledge one day!

Lori Wolfe 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 and by email, Wolfe also teaches at the University of North Texas, provides educational talks regarding pregnancy health in community clinics and high schools, and counsels adoptive parents.
MotherToBaby is a service of the international non-profit Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies includingthe Centers for Disease Control and Prevention (CDC). If you have questions about vaccines, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate