The holiday season was in full swing when Katie found out she was pregnant. She called me and wanted to know if she could continue to take Zoloft (or sertraline), the medication she was prescribed to treat her depression. The idea of coming off of the medication scared Katie, just as much as the idea of taking something that could affect her baby did. Katie also had been feeling a bit more exhausted and down than usual, possibly due to both her pregnancy and to a case of the holiday blues. ‘Tis may be the season to be jolly – but it is also a time when emotions (and stress levels) can run high.

Reasons for the Holiday Blues

Some of the most common reasons that people feel extra stress during the holidays include money, family, traveling, over-committing to attending events, and for some, the inability to spend time with their loved ones. Being pregnant can add another layer of anxiety to an already hectic time. Though the season is always presented as a time filled with joy, it can certainly take a toll on people’s mental health. It is important to note that when depression is left untreated during pregnancy, there may be increased risks for miscarriage, preeclampsia, preterm delivery, low birth weight, and a number of other harmful effects on mom and baby. See our fact sheet on depression and pregnancy. It’s also important during pregnancy to not stop (or start) taking any medications without first talking with your health provider. Whether or not a woman continues to take a medication throughout her pregnancy will depend on the benefits of taking the medication versus any possible risks associated with the medication. For that reason, I suggested to Katie that she should speak with her healthcare provider about whether or not continuing to take sertraline is in her best interest given her particular health history and pregnancy.

Mental Health & SSRIs

I then reviewed with Katie everything that we know about sertraline use during pregnancy. Sertraline has been one of our most viewed fact sheets on MotherToBaby.org in recent months, and is in a class of medications called SSRI’s, or selective serotonin reuptake inhibitors. A small number of studies have found associations between sertraline use during pregnancy and particular birth defects, such as heart defects. However, the majority of the studies looking at over 10,000 pregnant women, have found that women taking sertraline during pregnancy are not more likely to have a baby with a birth defect than women not taking the medication. Overall, the available information does not suggest that sertraline increases the chance for birth defects above the 3-5% background risk that is there for every pregnancy. We have a wonderful fact sheet on this medication that you can view here. We also have a mental health web page where you can see links to fact sheets on other SSRI’s and commonly prescribed medications for people dealing with depression and anxiety, as well as Baby Blogs on related topics. All of our fact sheets also address breastfeeding, so if you are in the postpartum period please also take a look or reach out to us with questions.

If you’re feeling blue this holiday season, remember that it is just as important to take care of yourself as it is to care for those around you. The holidays can also be a wonderful time of year to take stock of what it is in life that you’re thankful for. If you do find that you are feeling down or depressed and have been feeling this way for quite some time, seeing your healthcare provider may be a good step to take. If you are pregnant and dealing with feelings of sadness and depression, do not assume you cannot take a medication to help with your symptoms. If you are pregnant and already taking a medication for depression, don’t stop taking it without talking to your healthcare provider. Always check with your health care provider before starting or stopping any medication.

The experts at MotherToBaby are always here to offer the latest information on medications in order to help you and your healthcare provider make the best care plan possible for you and baby. If you’re feeling blue, make sure to reach out to a friend or family member that can remind you you’re not alone, and that you are cared for. To all women and their families, here’s to a healthy, happy holiday season!

By Nevena Krstić, Genetic Counselor, MotherToBaby Florida

When I was 17 weeks pregnant, my husband and I got in a car accident. The guy going in the opposite direction swerved into our lane and hit our car head on. Airbags deployed. The car was totaled.

Moments after the impact happened, I remember looking over at my husband to see that he was ok, unbuckling my seat belt which had left burn marks all over my pregnant belly, getting out of the car, and lying down on the sidewalk. And, as the adrenaline slowly went down, the immense fear overtook my whole body. I was alive, but what will happen to the baby?

The doctors scheduled me for an ultrasound. I was so nervous to get the ultrasound; the anxiety was almost unbearable. Ultrasounds are supposed to be fun, right? They always look so fun on TV. The couples are either joyously smiling or shedding happy tears as the doctor shows them images of their baby. Most of the time it is when they find out if they are having a boy or a girl. That is how I imagined my ultrasounds too. I was looking forward to the experience I imagined. I was not looking forward to the experience I was facing. I was dreading my ultrasound.

Thankfully the baby was alive and appeared to be developing as expected. The accident did not appear to have harmed the baby directly. However, it did cause a small tear in my placenta causing it to bleed. The tear was small, but if it got bigger it could cause real problems including miscarriage. And the doctors had no way of predicting what would happen or when. All they could offer me was more ultrasounds.

What is the Purpose of an Ultrasound?

Ultrasounds are medical tests. They are mainly used as either a routine scan at around 18-22 weeks of pregnancy to look at the baby’s developing body or the anatomy. This scan is therefore often referred to as the “anatomy scan.” Ultrasounds are also used to look at the baby when there is a suspected problem or if there is a specific concern, such as bleeding during pregnancy, elevated risk on some routine blood testing, use of medication, or, as in my case, car accidents.

What Can Ultrasound Tell Me about My Baby?

Doctors are able to find out a lot of medical information during ultrasound. Ultrasound, also called sonogram, is a type of medical imaging that uses high-frequency sound waves to produce images which help doctors examine the baby’s anatomy from head to toe, including images of the baby’s brain, heart, spine, kidneys, and other organs.

Most women who have this ultrasound done will have a normal anatomy scan and are reassured that their baby is developing as expected. For some women, however, the ultrasound will show a change in the baby’s size, the shape, size, or function of one of his/her organs, the amount of amniotic fluid around the baby, or changes to the placenta itself. A baby may be diagnosed with a specific birth defect (like a heart defect or a spine defect) on an anatomy scan. Some of these birth defects can be very serious. We know that every pregnancy has a 3-5% chance of having a birth defect. The ultrasound may also show a finding that may raise concern for another pregnancy complication, and more ultrasounds or testing may be recommended.

Ultrasound, however, is not perfect. Ultrasound is good at ruling out problems, but is not perfect at finding every birth defect before baby is born. Therefore, a normal anatomy ultrasound does not guarantee that the baby won’t have a birth defect or a complication. Sometimes the ultrasound may raise concern that there is a birth defect or complication when there really is not one seen on follow-up tests or after birth. There is no test that can be done before baby is born that can guarantee a perfectly healthy baby.

Are Ultrasounds Safe?

Typically, women will have two ultrasounds in pregnancy, one in the first trimester to confirm the pregnancy, and one anatomy scan in the second trimester. Some women, however, may need to have ultrasounds more often, especially if there are complications in pregnancy.

For me, in order to track the bleeding in my placenta and the growth of my baby, the doctors did one ultrasound every month of pregnancy… And every month I would walk into the ultrasound room filled with angst and anticipation of bad news. Thankfully bad news never came, the placental tear did not get bigger, and baby continued to grow. And by the last couple of ultrasounds, dare I say, I even looked forward to seeing my baby’s squished little face. But it did make me wonder if exposing my baby to so many ultrasounds was safe?

All things considered, ultrasounds are generally ok. However, just like with every medical procedure, ultrasounds should only be performed if medically necessary and recommended by the doctor to avoid exposing baby to heat produced by the sound waves of ultrasound. Therefore, while moms-to-be may be tempted to get that 3D or 4D ultrasound, or buy your own fetal home monitor (and believe me I was), it may be best to avoid these additional ultrasounds and stick to the ones recommended by the doctor.

I went on to deliver a healthy baby girl, who is now a mobile little one-year-old. I thank my lucky stars for her every day. But in my pregnancy with her I realized a very important thing that I want to share. Ultrasounds can be fun and joyous events. For most pregnant moms they will be fun. They will reassure them that their babies are healthy and developing and may confirm for them the sex of the baby. Having that said, we should not take for granted that ultrasounds are very powerful medical tests that have the ability to tell moms a lot more information about the health of their baby. So supporting anxious moms as they enter their ultrasound appointments is key.

Nevena Krstić is a certified genetic counselor based in Tampa, Florida. She currently works for MotherToBaby Florida, which is housed at the University of South Florida Health in the Department of Obstetrics and Gynecology.

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. Also, make sure to subscribe to The MotherToBaby Podcast available on iTunes, Google Play Music, Spotify and podcatchers everywhere.

 

• My fear and anxiety over my soon-to-arrive first child is overwhelming on a daily basis…I’m angry some days, sad some days, and panicked other days.
• My anxiety and depression levels has been higher than normal
• I’m scared when I go anywhere or see anyone, even when I’m maintaining social distancing.
• We planned on having an amazing support team and the rug was pulled from under us.
• I realize this is uncharted territory, but I have not felt supported as a first-time mother.¹

These were the sentiments of pregnant individuals going through the pandemic.  It was an unprecedented event and as MotherToBaby Specialists we were challenged with dealing with the anxiety of expectant parents as they tried to get reliable information and deal with their fears, anxiety, and frustrations. Fortunately, as time went on, the infection did not appear to increase the chance of birth defects but now there is a question of the emotional toil it put on pregnant women.

Post-traumatic stress disorder (PTSD) is a condition of persistent mental and emotional stress that occurs after suffering a stressful or extremely traumatic event. Unlike post-traumatic stress that lessens over time, the symptoms of PTSD do not fade. Symptoms of PTSD fall into the following four categories and can vary in severity:

1. Intrusion: may include intrusive thoughts or distressing memories, flashbacks, nightmares
2. Avoidance: may include avoiding thinking or talking about the event or their feelings; avoiding things that remind them of the event (people, places, activities).
3. Negative changes in thinking or mood: may include lack of memory on details about the event; negative thoughts and feelings about themselves or others; feeling numb or detached from others; loss of interest in activities.
4. Changes in physical and emotional reactions (arousal): may include being irritable and having angry outbursts; self-destructive behavior; having problems concentrating or sleeping.

In general, PTSD occurs more often in women than in men and in the pregnant population more than non-pregnant individuals.  According to some studies, 3% to 19% of pregnant women experience PTSD.² When it comes to psychiatric disorders during pregnancy, PTSD after childbirth or postpartum PTSD is considered the third most common mental health disorder after depression and nicotine dependence.³

If left untreated or poorly treated, PTSD can have long lasting effects not only for the pregnant woman but also in her relationships with other people, especially family, and interfere in bonding with their child and breastfeeding that can have long-lasting impact on the child.   Pregnant women with untreated PTSD have a higher chance of experiencing negative birth outcomes including gestational diabetes (diabetes that develops during pregnancy), preeclampsia (severe high blood pressure), low birthweight (weight at birth of < 2500 grams,5.5 pounds), and preterm birth (before 37 weeks pregnancy).  Also, quite alarming, PTSD is closely linked to attempting or committing suicide and substance abuse, two leading causes of maternal death in the United States.³

We know that the pandemic was a stressful situation for the entire country and especially pregnant women, but what were the long-term effects, particularly in regard to PTSD.  In general, risk factors for postpartum PTSD include, but are not limited to, the fear of childbirth, prenatal health concerns (preeclampsia, birth defects), the lack of emotional/social support, depression and anxiety. During the pandemic the primary concern was the risk of infection for themselves and for their child before birth and after.  Also, birth plans had to be changed due to hospital restrictions. They did not have the social support that they expected or planned with their doulas, partners, family or friends.  The lack of social support was not only an issue during childbirth but remained after birth due to stay-at-home orders.  Furthermore, expectant parents may have had to face other problems amplified by the pandemic like unemployment and the loss of a loved one. The sense of security and community was greatly affected during the pandemic and then expectant parents had to navigate a new world while just becoming parents, as expressed by pregnant women above.  All of these factors can create a traumatic experience of childbirth and raise the chance for PTSD.

There have been multiple studies investigating the effects of the COVID-19 pandemic during pregnancy. While studies may have differed in their approach to review this topic, the results generally showed that giving birth during the pandemic had many effects on the pregnant population and that PTSD was quite common. Also, rates of PTSD were higher among Black and Latinx pregnant women than whites and lower socio-economic status (i.e., less educational and income).  

Recommendations:

There is a call for PTSD to be screened during pregnancy and after to make sure that no one falls through the cracks. It is suggested that providers who had patients deliver in the early part of the pandemic, follow-up with them to make sure they are coping well.  Not everyone who experiences PTSD will need counseling, but pregnant women should know about their options.

“Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering,” said Peter Levine, PhD, trauma specialist. For pregnant individuals, if your symptoms are interfering with your quality of life, please speak with your healthcare professional so that you can get the assistance that you need. As MotherToBaby information specialists we can connect you  to the resources that can promote your health and well-being. We provide information about medications used to treat PTSD as well as exposure to anxiety, depression, and stress on pregnancy and breastfeeding. We are just one important resource that new and expecting parents can rely on for confidential information. Contact us today or visit our Resource Hub on Mental Health during pregnancy and breastfeeding.

There are resources available to help you.

Postpartum Support International: https://www.postpartum.net/learn-more/postpartum-post-traumatic-stress-disorder/

National Maternal Mental Health Hotline: 1-833-943-5746 (1-833-9-HELP4MOMS)

https://mchb.hrsa.gov/national-maternal-mental-health-hotline

References:

1. Kinser PA, Jallo N, Amstadter AB, et al. 2021. Depression, Anxiety, Resilience, and Coping: The Experience of Pregnant and New Mothers During the First Few Months of the COVID-19 Pandemic. J Womens Health (Larchmt). May;30(5):654-664. 
2. Padin AC, Stevens NR, Che ML, et al. 2022. Screening for PTSD during pregnancy: a missed opportunity. BMC Pregnancy Childbirth. Jun 14;22(1):487.
3. Khsim IEF, Rodríguez MM, et al. 2022. Risk Factors for Post-Traumatic Stress Disorder after Childbirth: A Systematic Review. Diagnostics (Basel). Oct 26;12(11):2598.
4. Sharpe, Rachel. “100+ PTSD Quotes to Help Survivors Cope with Trauma”. Declutter the Mind, 27 February 2021. https://declutterthemind.com/blog/ptsd-quotes/. Accessed 22 April 2023
5. Shuman CJ, Morgan ME, et al. 2022. Associations Among Postpartum Posttraumatic Stress Disorder Symptoms and COVID-19 Pandemic-Related Stressors. J Midwifery Womens Health. Sep;67(5):626-634.
6. Benzakour L, Gayet-Ageron A, et al. 2022. Traumatic Childbirth and Birth-Related Post-Traumatic Stress Disorder in the Time of the COVID-19 Pandemic: A Prospective Cohort Study. Int J Environ Res Public Health. Oct 31;19(21):14246. 

MotherToBaby, Teratology Society, DNTS Come Together June 22 – 25 in San Diego and Host Facebook Live Event for the Public

SAN DIEGO, CA – “It’s an incomparable gathering of experts,” said Christina Chambers, PhD, MPH, MotherToBaby President, Teratology Society Past President and Professor of Pediatrics at UC San Diego in reference to the 32^nd Annual Meeting of the Organization of Teratology Information Specialists (OTIS), the non-profit behind the no-cost MotherToBaby service. MotherToBaby provides evidence-based information about exposures during pregnancy and breastfeeding. The OTIS Annual Meeting will take place at the Sheraton San Diego Hotel and Marina June 22 – 25 and be held jointly with other leading organizations in the field of birth defects research.

Dr. Chambers, who recently made headlines with her groundbreaking study showing that certain marijuana compounds linger much longer in breast milk than previously thought, described the Annual Meeting as “critical to future generations.” “New information will be shared at this meeting on hot topics, such as cigarette smoking and marijuana in pregnancy, as well as advancements in understanding birth defects, like congenital heart defects,” she said. “It’s this kind of information that can lead to better treatment for expectant and nursing moms.”

The OTIS Annual Meeting will be held simultaneously and on-location with the Teratology Society (TS) and the Developmental Neurotoxicology Society (DNTS), whose meetings extend until June 26. Other hot topics to be discussed at the various meetings include:

• Environmental Influences on Child Health Outcomes (ECHO): A National Research Program (joint with OTIS-TS-DNTS)
• Congenital Heart Defects Research: Finding the Hidden Crossroads between Genetics and Environment (joint with OTIS-TS)
• A Smoking Gun that Faced Opposition: The Causal Agent of Fetal Alcohol Spectrum Disorders (joint with OTIS-TS)
• Cigarette Smoking and Development (OTIS)
• The Scientific Evidence for Short and Long-term Risks of Gestational Marijuana Use and Marijuana Use during Breastfeeding (OTIS)
• Ocean-Borne Risks to Pregnant Women and Their Babies (joint with TS-DNTS)
• Maternal Morbidity and Mortality: Causes, Disparities and Solutions (TS)
• What Do We Need to Know about Climate Change and Effects on Maternal-Fetal Health? (TS)

Scientists and healthcare providers in Southern California are encouraged to attend as day passes are still available for all meetings. To register, visit OTIS’ and the Teratology Society’s registration pages.

In addition, a Facebook Live event will be held Saturday, June 22 at 5p during which MotherToBaby’s Facebook followers can ask questions about “what’s ok” during pregnancy and breastfeeding. The event is aimed at the pregnant or breastfeeding mother as well as healthcare providers. To be alerted of the event, follow @MotherToBaby on Facebook. “Our Facebook followers will be able to get the latest research-based answers directly from world-renowned experts attending the Annual Meeting about everything from marijuana to medications and their known effects on a pregnancy or while breastfeeding,” described Chris Stallman, a certified genetic counselor and host of the Facebook Live event. Stallman is also host of The MotherToBaby Podcast, available on iTunes, Google Play, Spotify, Stitcher and podcatcher services everywhere. “No topic will be off-limits and we hope the public will take advantage of this rare opportunity to get a behind-the-scenes look at the scientists providing the MotherToBaby service.”

More about OTIS and MotherToBaby

The Organization of Teratology Information Specialists (OTIS) is a professional scientific society made up of individuals engaged in assessing and evaluating risks to pregnancy and breastfeeding from environmental exposures. Members include, but are not limited to, specialists in the fields of: obstetrics and gynecology, pediatrics, genetics, dysmorphology, perinatal epidemiology, teratology, behavioral teratology, pharmacy, genetic counseling, nursing, midwifery, maternal and child health, public health, and includes experts that provide MotherToBaby services and researchers that conduct MotherToBaby Pregnancy Studies. MotherToBaby is a suggested resource by many federal agencies including the Centers for Disease Control and Prevention (CDC). To be connected with a MotherToBaby expert, please call (866) 626-6847, text questions to (855) 999-3525 (standard messaging rates might apply, check with your carrier) or visit www.MotherToBaby.org.

About the Teratology Society

The Teratology Society is an international and multidisciplinary group of scientists including researchers, clinicians, epidemiologists, and public health professionals from academia, government and industry who study birth defects, reproduction, and disorders of developmental origin.  The Teratology Society is made up of nearly 700 members worldwide specializing in a variety of disciplines, including developmental biology and toxicology, reproduction and endocrinology, epidemiology, cell and molecular biology, nutritional biochemistry, and genetics as well as the clinical disciplines of prenatal medicine, pediatrics, obstetrics, neonatology, medical genetics, and teratogen risk counseling. Scientists interested in membership in the Teratology Society are encouraged to visit www.teratology.org. The society’s official journal, Birth Defects Research, is published by John Wiley & Sons in partnership with the Teratology Society.

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Media Contact: Nicole Chavez, 619-368-3259, nchavez@MotherToBaby.org.

Birth Defects Experts, Colorado Chief Medical Officer to Present at OTIS, Teratology Society, DNTS Annual Meeting

DENVER, COLORADO—“From exposure during pregnancy to a child’s neurological development, it is an understatement to say the legalization of marijuana has the potential to impact Colorado’s children and families,” said Larry Wolk, MD, Chief Medical Officer for the Colorado Department of Public Health and Environment. That “potential impact” is why Dr. Wolk will join top international researchers for a meeting never before held in Denver that brings together world-renowned experts presenting the science behind birth defects research.

The meeting, which is held jointly with the Organization of Teratology Information Specialists (OTIS), the Teratology Society and the Developmental Neurotoxicology Society this week at the Grand Hyatt Denver, will have a special focus on the effects of marijuana exposure during pregnancy. Dr. Wolk will serve as the Keynote Speaker Monday, June 26 at 8am. Then, a “Marijuana and Child Development Symposium,” which features scientists from the University of Colorado at Denver, University of California at San Diego, Yale University and the National Institute on Drug Abuse, takes place Tuesday, June 27 at 3:05pm.

According to MotherToBaby, a service of OTIS that offers information to the public about exposures during pregnancy and breastfeeding through traditional and digital avenues, the growing rate of marijuana use during pregnancy is “deeply concerning.” A federal survey published late last year indicated that almost 4 percent of expecting mothers said they had used marijuana in the past 30 days. This rate is almost twice that for other illicit drugs used in the previous month by pregnant women.
The survey was conducted in 2014. In a survey just 12 years prior, only 2.4 percent had said they used marijuana in the past month.

“As scientists specializing in the effects exposures can have during pregnancy, this trend is extremely worrisome and we’re here to work together to find answers,” said Stephen Braddock, MD, OTIS/MotherToBaby’s president and a professor of Pediatrics at Saint Louis University. “At MotherToBaby, we are frequently contacted by women who want to know if marijuana is safe in pregnancy. New information that will be shared at this meeting will help us to gain a better idea of what the risks are, so that we can better educate expectant and nursing moms as well as healthcare providers.”

“While data are somewhat limited, we know there are risks associated with marijuana use in pregnancy, but we also need to be thinking about the potential impact of cannabis on the adolescent brain,” added Diana Dow-Edwards, PhD, President-elect of the Developmental Neurotoxicology Society, marijuana symposium co-chair, and professor at SUNY Downstate Medical Center. “New and breakthrough science will be presented by some of our speakers and we hope the knowledge stimulates discussion among concerned Denver-area health care providers and the general public alike,” noted Susan Makris, PhD, Teratology Society Public Affairs Committee chair, marijuana symposium co-chair and a U.S. Environmental Protection Agency scientist.

Additional scientific information presented during the meeting includes e-cigarette use in pregnancy and the latest Zika virus findings. More information and the full annual meeting program may be found on the 57th Annual Meeting website. One day registration is available for any local scientists and health care providers interested in attending.

About OTIS/MotherToBaby
MotherToBaby, a service of the Organization of Teratology Information Specialists (OTIS), is 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. OTIS was established in 1987 as a way of connecting world-renowned experts in the field of birth defects research to the general public. Today, MotherToBaby affiliates around the world provide the most cutting-edge and up-to-date information about the risks of medications, chemicals, herbal products, illicit drugs, diseases and much more during pregnancy and while breastfeeding. More than 100,000 women and their health care providers seek information about birth defects prevention from MotherToBaby every year. MotherToBaby has been able to embark on new outreach efforts to reach underserved populations and launch new communication technologies through a cooperative agreement with the U.S. Health Resources and Services Administration, as well as through the generous donations made by the public. To learn more about MotherToBaby, the ways to contact its network of experts via app, text, live chat, email and phone line, or how to support its services, please visit www.MotherToBaby.org.

About the Teratology Society
The Teratology Society is made up of nearly 700 members worldwide specializing in a variety of disciplines, including developmental biology and toxicology, reproduction and endocrinology, epidemiology, cell and molecular biology, nutritional biochemistry, and genetics as well as the clinical disciplines of prenatal medicine, pediatrics, obstetrics, neonatology, medical genetics, and teratogen risk counseling. Scientists interested in membership in the Teratology Society are encouraged to visit www.teratology.org. The society’s official journal, Birth Defects Research, is published by John Wiley & Sons in partnership with the Teratology Society.

About DNTS
The Developmental Neurotoxicology Society (DNTS) is focused on studies of the origins of neurodevelopmental disorders and the long-term effects of chemicals and drugs on health and well-being. We promote scientific research on the developmental origins of brain disorders at all life stages. For more information, please visit us at www.dntshome.org. The society’s official journal, Neurotoxicology and Teratology, is published by Elsevier in partnership with DNTS.
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Media Contact: Nicole Chavez, 619-368-3259, nchavez@mothertobaby.org