Pediatrics

Supporting Pediatricians in Managing Pregnancy and Lactation Exposure Risks

As a pediatrician, you are on the front lines of questions that anxious parents may ask about the impact of pre- and postnatal environmental exposures on infant and child health and development. Examples of such exposures could include but are not limited to medications that a person who is pregnant or breastfeeding may need to take, foods or beverages they consume, infections they may contract, or vaccines they may need to receive. MotherToBaby is dedicated to evaluating the safety/risk of these exposures during pregnancy and lactation, and our experts are at your disposal.  

We specialize in evaluating teratogenic risks associated with maternal, household, and environmental exposures, including but not limited to medications, vaccines, substances of use, maternal health conditions and infections, workplace exposures, and much more. We provide no-cost, evidence-based information in a patient-friendly manner that will help you and your patient make informed decisions for the health of both parent and baby during pregnancy or lactation.

Although clinicians who care for [people who are pregnant] play a very important role in the effort to prevent congenital malformations, pediatricians also can contribute to the preventive effort and counseling of families in their practices who have a child born with a congenital malformation.

Brent, 2011

Explore how we can help you and your pregnant and breastfeeding patients by providing no-cost exposure risk assessments, patient education materials, observational studies to monitor pregnancy outcomes, and more.


Pediatrics

Helping You Educate Your Pregnant and Lactating Patients about Exposure Risks

MotherToBaby supports family practice physicians in their treatment and management of pregnant or breastfeeding patients by providing you with patient education materials and access to our experts who can answer questions about environmental exposure risks during pregnancy and lactation. We provide you and your patients with up-to-date, evidence-based information on the safety/risk of prescription and over-the-counter medications, vaccines, maternal health conditions or infections, drugs and substance use, herbal products, cosmetic treatments, workplace exposures, foods and beverages, and much more.

We understand the challenges that you face when deciding on treatment courses for your patients during preconception planning, during pregnancy, and while breastfeeding. We also know that your pregnant or lactating patients may have a litany of questions about whether certain exposures may pose a risk to their pregnancy or their developing baby. Our resources will help you and your patient weigh the risks and benefits of an exposure for both your patient who is pregnant and their baby, providing you with the information that you need to make informed decisions that minimize maternal and fetal/infant risk. 

After identifying the risks and benefits of treatments, family physicians can engage in shared decision making with their pregnant patients.

Gregory et al., 2018

Explore how we can help you and your pregnant and breastfeeding patients by providing no-cost exposure risk assessments, patient education materials, observational studies to monitor pregnancy outcomes, and more.


Pediatrics

By Lindsey Morse, MS, CGC, MotherToBaby New York

It’s officially summer! Time for pool parties, cook-outs, and beach-side picnics. Bring on the hamburgers and hotdogs, potato and pasta salads, fish fry, and barbecue chicken.

You may be wondering if it is safe to eat that food that has been sitting in the sun? Also, didn’t I hear somewhere that pregnant women shouldn’t eat fish or undercooked meat during pregnancy? Is it safe to swim in lake water or at the beach? How can I protect my baby during my pregnancy while still enjoying summertime fun and food with my family and friends?

Easy! There are just a few simple tips to keep in mind.

Tip 1 – Thoroughly cook all meat and seafood
Food safety is important whether you are pregnant or not. But some food-borne illnesses can be more of a concern if you are pregnant. Safe handling, preparation, and storage of foods reduces the chance that you could be exposed to little organisms that could make you feel bad in a big way.

One of the most common questions about food during pregnancy is about eating meat, especially deli sandwich meat, or undercooked meat (like that medium-rare steak). There are all these warnings about what to eat and what not to eat. So, how do you know what is a concern and what can you do about it?

Well, there are several microorganisms (bacteria and parasites) that can be found in meat before it’s cooked, if it’s only partially cooked, or if it has been cooked and then frozen or refrigerated to be eaten later. These include things like Escherichia coli (E. coli), Salmonella, Listeria, and Vibrio. (See MotherToBaby.org for more info in our fact sheets.) Some types, or strains, of these microorganisms are not harmful and are actually good for us, helping with digestion for example. But others can make you sick causing stomach cramps, diarrhea, vomiting, joint and muscle pain, and fever. Symptoms may last only a few hours with some infections or up to a week with others. In women who are pregnant, exposure to some microorganisms might make you sick, but are unlikely to directly affect the baby’s development. Other microorganisms may increase the chance for miscarriage or other pregnancy complications, like early delivery.

You may have heard that women who are pregnant should not clean out their cat’s litter box due to a risk of toxoplasmosis, but did you know that this same parasite, Toxoplasma gondii, is also found in undercooked meats? When moms are infected during pregnancy, there is a chance for congenital toxoplasmosis in their babies. This can cause liver, spleen, heart, brain, and eye problems including blindness, deafness, seizures, and cognitive delays. This is usually only a risk with a new infection during pregnancy, not if you have had toxoplasmosis in the past.

Cooking meat and seafood until the center reaches a safe minimum temperature or reheating meat destroys the bacteria or parasite, thereby preventing illness. While great chefs will tell you all sorts of tips and tricks for determining how done your steak is, invest in a meat thermometer! They are easy to find in most grocery stores and really take the guess work out of not only your next backyard party but also your weeknight dinners. Below is a table with the recommended temperatures for different meats. You can find our fact sheet on meat and seafood at https://mothertobaby.org/fact-sheets/eating-raw-undercooked-or-cold-meats-and-seafood/.

Meat/Seafood Safe Minimum Internal Temperature
Fish and Shellfish 145 °F (63°C)
Pork 145 °F (63°C)
Beef (steaks, chops, and roasts) 145 °F (63°C)
Beef and Pork (ground) 160 °F (71°C)
Wild game 165 °F (74°C)
Poultry 165 °F (74°C)
Cold lunchmeat and deli meat Cook until steaming

Tip 2 – Safe food preparation and handling are also important
Some of the same bacteria and parasites can also be found on fruits and vegetables, or in unpasteurized dairy products like milk, cheese, and eggs. Washing your fruits and vegetables thoroughly and eating only pasteurized dairy products are the best ways to prevent exposure. And don’t forget to wash your hands, cutting boards, and utensils thoroughly after handling uncooked meat, as well as unwashed fruits and veggies to avoid contaminating other foods.

Oh, and that grilled chicken that has been sitting in the sun for three hours – forget it! Once cooked, meat and seafood should be eaten right away. Leftovers of all types (including those pasta and potato salads, and anything with mayo or salad dressings) should be refrigerated at or below 40o F (4oC) as soon as possible and then meats thoroughly reheated before they are eaten.

Tip 3 – It is good to eat fish during pregnancy, but some are better than others
Another frequent question is about eating fish during pregnancy. Many fish contain a substance called methylmercury. Some fish have higher levels of this type of mercury than other types of fish – this usually depends upon the size of the fish, how long it lives, and where it lives prior to making it to your table.

But fish and seafood are actually a good source of protein and other vitamins that are good not only for adults but also for developing babies. The key is to eat the right types of fish and seafood in the right amounts. See our fact sheet athttps://mothertobaby.org/fact-sheets/methylmercury-pregnancy/pdf/ for more information. The Food and Drug Administration (FDA) also has a quick guide which can be helpful to determine which are the best options for you: https://www.fda.gov/downloads/Food/ResourcesForYou/Consumers/UCM536321.pdf%20

Tip 4 – Do some research before going swimming
Some of the bacteria mentioned earlier in this blog can be found in water, like your local lake or warm coastal waters. In addition to bacteria, lakes and rivers can contain things like protozoa and worms which cause diarrhea, abdominal cramps, and fever. Besides eating contaminated food, these organisms can get into your body if you swim in infected water especially when you have an open wound, even a small scrape, if you swallow any water, or if water goes up your nose. Risks are often highest during and after a storm as this increases rain water runoff and pollution from the surrounding area.

There also can be certain types of algae in the water that may be harmful in high amounts. I recently received a call from a pregnant mom on vacation in Florida concerned about a red tide warning in her area. Red tides are caused by a high concentration of algae (an algal bloom) and happen mainly in Florida but can occur along the Gulf Coast or as far north as Delaware. Many algal blooms are not harmful, but others can cause low oxygen levels in the water harming marine animals and causing a build-up of toxins (called brevotoxins) in the water.

Pay attention to the warnings in your area because it is not a good idea to swim in areas where you know that there is an algal bloom or high bacteria counts, particularly if you have an open wound. Check out the Environmental Protection Agency’s website https://www.epa.gov/beaches to find info about freshwater and saltwater beaches in your area. Also, look around the area that you plan to swim for obvious signs of pollution like a neighboring farm, trash in the water, or even dead fish floating in the water.

It is also important not to eat locally, recreationally caught shellfish during a red tide – shellfish in grocery stores and restaurants are regulated and are not caught during an algae bloom so they aren’t contaminated but recreationally harvested shellfish could be. The brevetoxins which are found in red-tides are not destroyed by cooking.

Bottomline, planning is key! While often the risks associated with food-borne illnesses are bigger for you than for your baby, a few simple precautions can help you have a healthy pregnancy and still enjoy your favorite foods and summertime activities. Just remember to pick up a meat thermometer, give those veggies a good wash before you make that salad, avoid foods that have been sitting out in the sun, and know your lakes and beaches!

Lindsey Morse, MS, CGC, is a senior genetic counselor for Ferre Genetics, a program of the Ferre Institute based in Binghamton NY. Lindsey is also a teratogen information specialist with Pregnancy Risk Network, also known as MotherToBaby New York, and has served as co-director of the program since 2015. Lindsey counsels patients in all areas of genetics from prenatal to adult genetics. She also lectures on a variety of genetic issues to community organizations including high school, university, and medical students, physicians, and community health programs.

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.


Pediatrics

By Patricia Markland Cole, MPH, MotherToBaby Massachusetts

November is Diabetes Awareness Month and both of my parents in recent years have been diagnosed with Type 2 diabetes (a preventable form of diabetes where the body can no longer control the amount of sugar in the blood), so it’s a particularly relatable month for me. Because “the apple does not fall far from the tree” the discussion with my doctor has started to change – Now I am at risk., Therefore, if I become pregnant, a family history of diabetes would put me at increased risk of developing diabetes during pregnancy (called gestational diabetes mellitus, or GDM). I have to think more about living a healthy lifestyle to lower my risk.

Here’s what we know about GDM:

  • GDM is still a common public health problem and could impact 1 in 10 women. It has been considered a national health priority.
  • GDM poses an elevated chance for pregnancy complications such as:
    • Preeclampsia (high blood pressure, swelling and protein in the urine)
    • Preterm birth (birth before 37 weeks of pregnancy)
    • C-sections
    • Development of Type 2 Diabetes (35-70% of women who had GDM will develop Type 2 Diabetes 10 to 15 years after pregnancy; 15-25% will develop it within 1 to 2 years after pregnancy)
    • Renal disease (problems with kidney function)
    • Cardiovascular Disease (problem with the heart and blood flow)
  • GDM also poses increased short- and long-term risks for the infant, including:
    • Increasing the chance of complications at birth
    • Difficulty breathing
    • Large in birth size and weight (over 10 pounds)
    • Increased chance of developing Type 2 diabetes
    • Childhood Obesity

There are quite a few risk factors for GDM that cannot be changed such as age, family history of diabetes, and race; those over age 35, those with a family history of diabetes, and non-whites are at higher risk. However, some risk factors are changeable like weight, diet and exercise. The funny or peculiar thing about diabetes and pregnancy is that while there are many reports of how beneficial diet, exercise and maintaining a healthy weight are in reducing general health risks, the studies that specifically examined the effectiveness of reducing the rate of GDM during pregnancy through lifestyle changes versus routine or standard care have been mixed. Sometimes the results showed that it did reduce the rate of GDM, but other times it did not. Surprising, right? Here are some of those mixed results:

For women who did not have the typical risk factors, researchers studying diet and exercise interventions did not always find a difference in the rate of GDM between comparison groups. It has been stated that the risk of GDM was four to eight times higher in women who were overweight or obese. However, methods to reduce excessive weight gain during pregnancy found no significant change in GDM and increased physical activity had only a small effect. However not all of the results were mixed; some studies actually had strong results for other health benefits. For example, one study showed a 50% reduction in the rate of Type 2 diabetes diagnosis for women who had been previously diagnosed with GDM when lifestyle changes were introduced, while another study found a 95% reduced risk for gestational hypertension and a 90% reduction in preeclampsia for pregnant women with obesity. Why such mixed results? Some fault study design flaws. For example, the studies were different in the methods used to screen and diagnose GDM, the duration and time the study was conducted and the differences among the women that participated, just to name a few.

SO…Can gestational diabetes be prevented?
According to the author of one research article I read: “The answer remains optimistic.” Do not let the mixed results give you a reason to not be the healthiest you can before going into pregnancy. There is overwhelming proof that a healthy weight, physical activity and a healthy diet are important to one’s overall health and can reduce your chance of developing sickness and disease. The earlier that one starts living a healthy lifestyle, the more there can be an impact in reducing the rates for GDM and its associated risks for childhood obesity and Type 2 diabetes. Surprisingly, many women in the studies were not asked about their diets during pregnancy. It will take a multi-level approach and better study designs to come to some better conclusions. I am sure that once research designs and methods are tweaked, we’ll have a much better idea of how GDM can be prevented or reduced because there will be more proof in the pudding … and how sweet that will be!

References:
Kennelly MA, McAuliffe FM. 2016. Prediction and preventon of Gestational Diabetes: an update of recent literature. Eur J Obstet Gynecol Reprod Biol. Jul;202:92-8.

Phelan S.. 2016. Windows of Opportunity for Lifestyle Interventions to Prevent Gestational Diabetes Mellitius. Am J Perinatol. Nov;33(13):1291-1299.

Rochan A, et al. 2016. Gestational diabetes mellitus: does an effective prevention strategy exist? Nat Rev Endocrinol. Sep;12(9):533-46.

Zhang C, et al. 2016. Risk factors for gestational diabetes: is prevention possible? Diabetologia. Jul;59(7):1385-90.

Patricia Cole, MPH, is the Program Coordinator for MotherToBaby Massachusetts. She obtained her Bachelor’s degree in Biology from Simmons College in Boston and her MPH in Maternal and Child Health from Boston University School of Public Health. She has been the serving the families of New England as a teratogen counselor since 2001 and provides oversight for the day-to-day functions and outreach of the program. She has also provides education to graduate students and other professionals.

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.


Pediatrics

Reporters, Engage a MotherToBaby Expert for Your Next News Story

MotherToBaby specialists are available for media requests. Our experts will lend their expertise to members of the news media who are writing stories about pregnancy and breastfeeding exposures. If you’re a journalist who’d like to connect with a MotherToBaby expert for a story you’re writing, please contact our Media Liaison Nicole Chavez at 619.368.3259 or nchavez@mothertobaby.org.


Event Organizers, Find a MotherToBaby Expert to Speak at Your Next Event

Our experts frequently present in educational and professional development webinars, meetings, and conferences. If you’re organizing an event at which you’d like a MotherToBaby expert to speak, please contact our Administrative Office at 615.649.3082 or ContactUs@mothertobaby.org.


Our Speakers’ Expertise

How common are birth defects?

Every year in the United States, birth defects affect 1 in every 33 babies born; this means nearly 120,000 babies are affected by birth defects each year. Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Our expertise focuses on educating people and health providers about exposures or environmental agents that may (or may not) further increase the risk for birth defects above the background risk.

What can cause birth defects?

Some birth defects are caused be defects in specific genes (the information we inherited from our biological parents when we were conceived). Others, like Down syndrome, are caused by abnormalities in chromosomes that occur either when the egg or the sperm is formed or during the early development of the fetus after conception.

A person who is pregnant and/or breastfeeding’s exposures, including their health, diet, and level of exposure to toxins and environmental pollutants, are another potential cause of birth defects. Educating people about these exposures is our focus at MotherToBaby. Examples of exposures that are known to cause birth defects include:

  • dietary deficiency of folate (folic acid, or vitamin B9)
  • drinking alcohol
  • smoking
  • certain infections, like Zika virus, rubella/German measles, and cytomegalovirus/CMV
  • certain health conditions, like obesity and poorly controlled diabetes
  • certain medications, like isotretinoin (a medication used to treat severe acne); mycophenolate (a drug used to treat certain autoimmune diseases like rheumatoid arthritis and lupus, and is also used after organ transplant to prevent the body from rejecting the organ); and valproic acid (a medication used to treat epilepsy, bipolar disorder, and migraines).

Finally, some birth defects are caused by a complex mix of genes and environmental exposures. Unfortunately, we still don’t know the cause for ~50% of birth defects. This is why research on this topic is so very important.

Can you provide insight and real-life implications of an exposure found to increase the chance for birth defects or other adverse pregnancy effects?

Yes, we can. MotherToBaby has an international team of information specialists that are dedicated to the field of teratology, which is the study of agents that may cause birth defects when a baby is exposed during pregnancy. Our experts come from a variety of professional backgrounds, including obstetrics and gynecology, maternal-fetal medicine, genetics and genetic counseling, pediatrics, public health, pharmacy, and more. Our focus is to provide up-to-date, evidence-based information to people, health providers, and the general public about exposures (medications, infections, chemicals, workplace hazards, etc.) during pregnancy or breastfeeding that may impact a pregnancy or a baby’s growth or development.

“In a day and age where reliable information about the risks of medications, alcohol, chemicals, beauty products and other exposures during pregnancy or while breastfeeding is hard to find, especially online, we realized how important it is to make sure the public has access to accurate information. MotherToBaby experts are the leaders in the field of teratology, and are up-to-date on the most cutting edge research on exposures that may impact developing babies.”

– Kenneth Lyons Jones, MD, Medical Director, MotherToBaby California
Pediatric Dysmorphologist and Division Chief, UC San Diego Department of Pediatrics

Kenneth Lyons Media Request Expert