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.

By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA

Unless you don’t own a television and never listen to the radio, you know that marijuana has been in the news a lot lately and for marijuana users who have had to smoke in illegally, it appears societal attitudes about pot smoking may be changing. Twenty states have laws legalizing some form of marijuana use. Two states, Colorado and Washington, have legalized its recreational use. In an interview, the NFL Commissioner seemed to leave open the possibility that medicinal use could be considered for NFL players if there was scientific evidence that it was helpful to treat injuries and pain. Even President Obama has said that he doesn’t believe marijuana is any more dangerous than alcohol. Marijuana is currently listed as a Schedule I drug. Other Schedule I drugs include heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy).

What The Research Shows Us

According to studies, pregnant women who use illicit substances are more likely to use marijuana compared to other drugs. This is often due to the belief that marijuana is less harmful to the developing embryo and fetus, compared to other drugs such as cocaine or heroin.

Marijuana is Cannabis. The delta-9-tetrahydrocannabinol (THC) in the Cannabis plant produces the psychoactive effect or “high.” Marijuana can be smoked in a joint, inhaled through a bong or vaporizer, eaten in food and teas/beverages, used in tinctures, and topical balms. Smoking and ingestion exposes the user to THC, producing the high. When smoked in a joint, the user is exposed to carbon monoxide from the burning of the leaf as well as tar, which can stay behind in the lungs.

Marijuana use during pregnancy has been studied since the 1960’s. Like all studies, there are weaknesses that have been pointed out. For example, asking women about past drug use may not be the most accurate way to make a connection between the dose of the drug and the adverse effects because the women may have forgotten. Also asking women to volunteer information about drug use, which they may fear disclosing even in a confidential setting, may make it difficult to know how frequently pregnant women use drugs overall. Still, a number of experts have reviewed hundreds of reports in humans and animals. At least to this point, the studies do not support an association between marijuana smoking and birth defects. One large study of 12,825 interviews done after delivery, did not find a statistical association between marijuana use and birth defects.

However, the studies also show that marijuana is not risk free. Studies have reported associations between marijuana smoking and growth restriction and lower birth weight, particularly in women who keep smoking through delivery or late in pregnancy. An Australian study of almost 420,000 live births reported a higher risk for neonatal intensive care admission for newborns exposed prenatally to pot. Also, there are reports of abnormal responses or behaviors in the newborn period and this suggests a toxicity or withdrawal. The symptoms include exaggerated and prolonged startle reflexes (sleep cycle disturbances with high-pitched crying.) In a Brazilian study, exposed newborns were “more irritable and less responsive to calming, cried more during the examination, and exhibited more jitteriness and startles than the non-exposed neonates.” Pregnant women who smoke daily and/or through delivery, have a higher risk for complications in their pregnancy compared to women who quit in the first trimester.

Researchers have attempted to assess the long-term effects of prenatal marijuana exposure. Studies of 3, 10 and 14-year old prenatally exposed children suggest that the prenatal exposure to high doses of marijuana may make it harder for children to learn and may affect their emotions (increased aggression) and increase depression symptoms. Studies are needed to assess which prenatally exposed children are most at risk. Its important to note that the children in these studies often have had prenatal exposure to other drugs as well, struggles with poverty and other life challenges, making it difficult to know that the findings are due to a single drug exposure.

So Where Does Marijuana Rank Compared To Other Drugs?

Alcohol: Specific to use during pregnancy, marijuana is not alcohol. Alcohol is still the drug with the highest risk and the widest range of birth defects, including physical, mental and behavioral. Alcohol is a drug with the highest use throughout the world, easy legal access, and social acceptance.

Cocaine: Cocaine, by comparison, is associated with a small risk for birth defects, and a higher risk for admission to newborn intensive care for withdrawal and toxicity. Additionally, cocaine is associated with prenatal growth retardation, lower birth weight, shorter length, and smaller head circumference. Studies suggest the effects on height extend into childhood.

Heroin: Heroin has not been associated with an increased risk for birth defects, however, is associated with a higher risk for withdrawal and admission to newborn intensive care and sudden infant death syndrome.

Bottomline: Snuff Out Smoking It

Clearly, marijuana use in pregnancy is not preferable, nor less risky, compared to most other drugs when a side-by-side comparison is made. Changing societal attitudes doesn’t change the fact that the developing embryo (and fetus) is dependent on the mother for oxygen, nutrients and a balance of hormones, chemicals and other substances to grow normally. Disrupting the normal fetal environment, through the introduction of marijuana or other recreational drugs, puts the pregnancy at risk in the short-term and possibly the long term as well.

Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that 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 hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

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 beauty products, 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.

Brentwood, TN – A recent study that is getting a lot of attention about antidepressants (AD) and a possible link to Autism Spectrum Disorders (ASD), may be bringing about worry and confusion among moms-to-be, according to MotherToBaby experts who study a variety of medications during pregnancy and breastfeeding.

“Questions are coming in to us, so we really wanted to reassure moms that this study doesn’t prove anything. It’s not the whole story,” said Robert Felix, MotherToBaby President. The study, Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children, has suggested a link between taking antidepressants during the second or third trimester of pregnancy and an increased risk of having a child with autism spectrum disorder.

“It’s important to remember that this is one study, and there are still a lot of unanswered questions,” said Felix. “While it adds to the information on the use of these medications in pregnancy, it’s not proof that use of antidepressants will lead to ASD.” Felix points out other recent studies which have not found a link to ASD. While a mother’s mental illness may play a role, it is very important to treat her illness. Untreated mental illness may cause problems for the mom, the pregnancy and the developing baby.

“What we do know for sure is that a pregnant woman should not change her medication without talking to her health care provider first,” he added.

If you have heard about or read the new study on antidepressants and autism and are concerned, please contact MotherToBaby at 1-866-626-6847. You can also text questions to us at 855-999-3525 or read our evidence-based information fact sheets on SSRI medications.

Mental health conditions are real health issues that deserve appropriate and individualized medical care. Making informed healthcare decisions requires that women and their healthcare providers be aware of the available safety information for each specific medication they might be considering. We encourage pregnant women and those planning a pregnancy to have open conversations with their healthcare providers to carefully weigh any potential increased risks of medications, as well as the risks of untreated or undertreated mental health conditions.

SSRIs – including commonly prescribed medications such as Zoloft (sertraline), Lexapro (escitalopram), Prozac (fluoxetine), Paxil (paroxetine), and others – are among the most well-studied medications used in pregnancy. Decades of research have shown that SSRIs, when used appropriately and under the care of a healthcare provider, can be part of an effective treatment plan for managing mental health conditions before, during, and after pregnancy, and can contribute to better outcomes for women and their babies.

As always, MotherToBaby and the Organization of Teratology Information Specialists (OTIS) stand with women and their healthcare teams by providing up-to-date, evidence-based information on the use of medications and other exposures during pregnancy and while breastfeeding.

MotherToBaby offers free, expert-reviewed fact sheets on SSRIs and other medications, as well as on conditions such as depression, anxiety, and stress. You can find many of our mental health resources here: https://mothertobaby.org/pregnancy-breastfeeding-exposures/mental-health/. Individuals can also reach out to a MotherToBaby specialist via phone, live chat, text, or email to receive personalized, confidential support.

By Kirstie Perrotta, MPH and Sonia Alvarado, MotherToBaby California

With wildfires seemingly becoming a year-round problem, pregnant women have more questions than ever before about exposure to smoke and lingering poor air quality. Understanding the possible risks from a fire during pregnancy or while breastfeeding can help people make informed decisions when the unthinkable happens. Here are some commonly asked questions we receive at MotherToBaby about wildfires.

Q. What is in the air from the fires?
A wildfire produces particulate matter (a combination of dirt, soil dust, pollens, molds, ashes, and soot), in addition to other chemicals. The particulate matter can be different sizes. Particles less than 10 micrometers in diameter pose the greatest problems, because they can get deep into your lungs, and some may even enter your bloodstream. Contents of the smoke can vary based on what is being burned. In some instances, wildfire smoke can contain heavy metals such as lead. Wildfire smoke also contains carbon monoxide.

Q. I’m pregnant. How does the particulate matter affect my pregnancy? What about the carbon monoxide?
Experts tell us that the smaller the particulate matter, the worse the effects on health, including difficulty breathing, aggravated asthma, and increased risk of heart attack and death due to respiratory and cardiovascular problems. Although we do not know enough about how exposure to particulates can impact a pregnancy, it makes sense for all individuals to take extra precautions to reduce their exposure to wildfire smoke.

Carbon monoxide is a gas that enters into the lungs and blood and displaces oxygen to both mom and baby. The greater the exposure and the longer the exposure, the higher the risk. Studies suggest that there may be a higher chance of birth defects when a woman is exposed to carbon monoxide in the first trimester, but more studies are needed. Other studies have found that exposure to wildfire smoke can increase the risk for preterm delivery and low birth weight. However, this finding may be more related to the stress a woman experiences during a fire, or a combination of factors, than the actual smoke exposure. Again, more research is needed.

Q. I have asthma and I’m pregnant. Do I have added risks?
Yes. Studies in non-pregnant women tell us that exposure to particulate matter of 10 micrometers in diameter or less can make asthma symptoms worse. Pregnancy would not protect you and it may even put you at higher risk of having an asthma attack depending on how far along you are. See our fact sheet on asthma here.

Depending on your proximity to the fire zone, it may be difficult to get help if your symptoms worsen. First responders may be busy fighting the fires and evacuating residents and may not get to you as quickly as you need. Emergency rooms may be overrun. For this reason, it is very important to always have your asthma medication with you so that if the smoke exacerbates your symptoms you can start to treat yourself. You also want to be in contact with your doctor and move away from the source of the wildfires as soon as possible.

Q. I’m pregnant and work outdoors. Do I need a mask?
The U.S. Environmental Protection Agency (EPA) has recommendations about what masks to use to protect against particulate matter entering the lungs. The goal is to prevent or reduce exposure as much as possible. If you work indoors, for the most part you are protected. If you work outdoors, you may want to consider using a mask that fits correctly and has two head straps to hold it in place. It should be labeled “particulate respirator” and it should have been tested or approved by the National Institute for Occupational Safety and Health (NIOSH). Learn more here. Since pregnancy can alter your lung function, pregnant women may have a harder time breathing to begin with. For that reason, it’s important to check in with your healthcare provider before using a particulate respirator.

If you are concerned about your work conditions, NIOSH offers a program called The Health Hazard Evaluation Program. This program helps employees learn whether health hazards are present at their workplace and recommends ways to reduce hazards and prevent work-related illness. Learn more here.

Q. I live about 50 miles from the wildfires. Do I still have to be concerned about being outdoors?
Depending on where you live and the direction of the wind, the air quality in your area may be poor due to the wildfire, even if the fire isn’t that close to you. Listen to the local health and environmental officials, and avoid exercising outdoors, gardening, or performing other activities that may cause you to exert yourself and inhale more of the particulates in the air. If you have any doubts, wait until the wildfires have been extinguished and the air quality is back to normal.

Q: Can fires cause other problems for pregnant women?
Depending on weather conditions, wildfires can spread rapidly. The stress of having to make life and death choices, or the decision to leave your home and decide what items to take with very short notice, all produce tremendous stress. It is absolutely normal to feel sad, stressed, anxious, or scared. In pregnancy, depending on how long the stress is present and the level of stress, it is possible that there could be impacts on the developing baby, so anything you can do to try to reduce stress is always a good idea. Take a look at our fact sheet on stress for more information:

Q: I’m pregnant. What if I have to evacuate?
The best thing that you can do is have a plan in place ahead of time. Make a checklist of items to take with you should you need to evacuate your home. Assemble an emergency supply kit and store it in a location where you can easily get to it, and create a family communication plan.

When the time comes to evacuate, stay calm. Be sure to bring any medications that you take on a daily basis (including your prenatal vitamins). Stay well hydrated, continue to eat, and rest as much as you can. If you have to check into a shelter, tell the staff there that you are pregnant so they can make any necessary accommodations.

While making it to your prenatal check-up is probably the last thing on your mind in the midst of an evacuation, it’s important that you continue to be seen by your OB/GYN or midwife. Some individuals may be displaced from their homes for an extended period of time, however, it’s important to keep attending your prenatal care visits to make sure that baby is growing and developing properly.

If you’re close to your due date, check to make sure your hospital or birthing center is not in the mandatory evacuation zone. If it is located close to the fires, the staff and patients there may be asked to evacuate, and you may need to deliver at a different hospital. Knowing this information before you go into labor will reduce any unnecessary stress.

Q: What other steps can I take to minimize my exposure to smoke from a fire?
Stay indoors when possible, and keep your windows and doors closed. If available, an air purifier can help with indoor air quality. If you have to drive somewhere, keep your windows rolled up and use the air conditioner to stay cool. If your car has a button that recirculates air internally, make sure it is turned on. Pregnant women who must venture outdoors may also consider wearing a mask. Although any protection is helpful, a N95 particulate respirator works best to filter out harmful particulate matter.

Q. I’m breastfeeding and I’m concerned about the wildfires in my area
Breastfeeding moms can also face challenges of their own when they have to evacuate their homes. When possible, follow the steps outlined above to reduce exposure to the wildfire smoke for both you and baby.

The benefits of breastfeeding are well known, and in most cases individuals are encouraged to continue to breastfeed their babies even when faced with an emergency like a fire. Women who are nursing should focus on staying well hydrated and continue to feed baby on demand.

For moms that choose to pump breast milk, extra batteries may be something worth packing in your emergency supply kit in case the power goes out. For babies that are formula fed, it’s important to bring bottled water.

Q: Where can I learn more about fires currently happening and about air quality where I live?

The U.S. Department of Agriculture (USDA) Forest Service reports on large fires nationally. The EPA also has a website where you can check the air quality index in your local area. Pregnant women should follow instructions laid out for “sensitive individuals.” Lastly, the Centers for Disease Control and Prevention (CDC) has more helpful information about wildfire exposure during pregnancy here.