BRENTWOOD, TN – January 28, 2015

Approximately 50% Of Women Report Taking At Least One Medication During Pregnancy
As January’s National Birth Defects Prevention Month comes to a close, the United States’ Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA) opens the door for expanded access to pregnancy health education resources by funding the world’s leading organization of experts in the field of teratology (the study of exposures that cause birth defects) – the Organization of Teratology Information Specialists (OTIS) MotherToBaby network.

OTIS, an international non-profit, has been awarded a two-year, $2.4 million cooperative agreement from HRSA, establishing a nationwide reproductive and environmental health network. The MotherToBaby network, which consists of 14 affiliate OTIS sites housed at universities and hospitals across the country, provides FREE, evidence-based, personalized risk assessments, education and counseling regarding the effects of exposures like prescription and over-the-counter drugs, alcohol, smoking, illicit substances, vaccines, beauty products, herbal supplements, chemicals and more during pregnancy and while breastfeeding.

“Approximately 50% of women report taking at least one medication during pregnancy and may be doing so before they even realize they’re pregnant,” said Kenneth Lyons Jones, MD, MotherToBaby past president. “Instead of having to scour unreliable online message boards and websites for information about a medication’s risk to a developing baby, they can talk directly to an expert in this topic who will have the most up-to-date research available to them,” he explained.

More than 100,000 women and their health care providers seek information about birth defect prevention from MotherToBaby every year already. The new federal support is expected to help increase awareness of the expertise MotherToBaby has to offer among women and health care providers in more hard-to-reach populations.

“Not only is this is a huge step forward for women and children’s health, but also the general public’s, since it’ll allow us to staff increased calls, answer more questions and, ultimately, prevent birth defects, leading to a healthier society,” said Jones, who is also one of two doctors who discovered Fetal Alcohol Syndrome (FAS) in 1973. “With a broader presence, we’ll also be able to better educate new audiences about dangerous behaviors like drinking alcohol during pregnancy.”

Partner organizations, such as Help Me Grow Utah, have applauded HRSA’s move to provide funding to the MotherToBaby network. “At Help Me Grow Utah, an affiliate of the Help Me Grow National Network, we understand the challenge of funding. Through a new cooperative agreement with HRSA, all women have been provided access to the MotherToBaby’s hotline, with the latest information about risk exposures during pregnancy and breastfeeding. The result is improved health for moms and their babies, which helps put infants on track for reaching optimal development, a goal we wholeheartedly support,” said Barbara Leavitt, Program Director of Help Me Grow Utah.

The public can be connected with bilingual (English/Spanish) teratogen information specialists at MotherToBaby and receive personalized risk assessments, education and counseling by calling toll-free 1-866-626-6847. The MotherToBaby website also houses a library of fact sheets on medications and other exposures during pregnancy and while breastfeeding located at https://mothertobaby.org//a>.

Media Contact: Nicole Chavez, 619-368-3259, nchavez@mothertobaby.org. Interviews in Spanish can also be arranged.

BRENTWOOD, TN – Experts at MotherToBaby, a service of the international non-profit Organization of Teratology Information Specialists (OTIS), call the recent New York Times article suggesting use of antidepressants during pregnancy is more harmful than previously thought “incomplete” and “weak.” The story takes a strong stance suggesting depression treatments during pregnancy may lead to more birth defects. “This kind of information can scare women into taking drastic measures, like stopping her medication suddenly,” said Julia Robertson, teratogen information specialist and MotherToBaby/OTIS Board of Director member. “The article fails to include the overwhelming research that supports treating mental illness during pregnancy, which may be a contributor to healthier pregnancy outcomes, compared with women who stop their treatment cold turkey,” she added.

The MotherToBaby/OTIS BOD strongly supports two responses to the NY Times article:

http://womensmentalhealth.org/posts/response-new-york-times-article-ssris-pregnancy-moving-toward-balanced-view-risk

http://www.huffingtonpost.com/seleni-institute/the-new-york-times-irresp_b_5761090.html

In addition, the MotherToBaby issued the following statement Monday to mothers and those planning pregnancies, in which the article has caused unnecessary anxiety:

To Concerned Moms,

Each day members of the Organization of Teratology Information Specialists (OTIS), experts behind the MotherToBaby service, review the new information on medications that are used in pregnancy and while breastfeeding. When we look at the research studies we look at how well each study was done and we note the strengths and weaknesses. Many studies are done well, but many are not. The recent article on antidepressant use in pregnancy from the New York Times did not give a careful and a complete review of all the available studies. In looking at all the studies that have been completed in the last 30 years with more than 100,000 pregnancies in which the mother used an antidepressant, we conclude that if there is a risk for a birth defect, the risk is very low.

The experts at MotherToBaby are here to talk with you about the medications you are taking and to provide you with the most up-to-date information and research. Hundreds of women and their health care providers seek information about birth defect prevention from OTIS and MotherToBaby every year. Our personalized, FREE counseling service is just a phone call away at 1-866-626-6847.

You can also view our Fact Sheets,(under the Resources button) which summarize information about antidepressant use in pregnancy and breastfeeding.

Sincerely,

OTIS Board of Directors along with the OTIS Website and Public Affairs Committees.

MotherToBaby’s expertise is suggested by many agencies including the Centers for Disease Control and Prevention (CDC).

Considerations for Patients with Psychiatric Conditions during Pregnancy and Lactation

 MotherToBaby supports psychiatrists in managing mental health conditions during pregnancy and while breastfeeding. We understand the challenges that you face when deciding how to best treat mood, anxiety, psychotic, and other disorders when your patients are pregnant or breastfeeding. Our resources will help you weigh the risks and benefits to both your patient and their baby as you determine a treatment plan that maximizes disease management and minimizes maternal and fetal/infant risk.  

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

LactRx App

Download our LactRx app for on-the-go access to the Library of Medicine’s LactMed database for current information on psychiatry medications as well as other drugs and vaccinations to which breastfeeding mothers may be exposed.

Partners

• MyHealthTeams
• National Maternal Mental Health Hotline
• Patient Education Genius
• PatientsLikeMe
• Postpartum Support International
• Society for Maternal-Fetal Medicine
• Society for Birth Defects Research & Prevention
• The Mighty

By Kurt Martinuzzi, MD, Asst. Professor in the Dept of Ob/Gyn at Emory University and Claire D. Coles, PhD, MotherToBaby Georgia Director

Aryan* and Shanaya had been married for two years and very much wanted to start a family. When they were not successful at getting pregnant, they were tested for fertility (all tests came back as normal) and months of expensive medical treatments were tried without success. Emotionally and financially spent, the couple sought the counsel of friends and family. A childhood friend from India recommended an over-the-counter herbal fertility supplement called vasantha kusumakaram. The product is described as being “100% natural” so she was certain that it must be safe. Shanaya took this daily for 5 months and hoped for a baby.

In India, the traditional approach to medical care is referred to as ayurvedic medicine. In this 2000-year-old tradition, naturally occurring herbs are mixed with other substances and are prescribed for a range of symptoms. Vasantha kusumakaram is reported to be a treatment for many illnesses and problems including diabetes, lung, heart and kidney diseases as well as heavy periods, impotence and tuberculosis. It is also felt by some to be an aphrodisiac!

During the months that Shanaya took the herbal treatment she did not become pregnant. Eventually, her husband suggested checking in again with her primary health care provider because she had started to suffer from abdominal pain, constipation, fatigue and loss of appetite. At that return visit, her blood pressure was surprisingly elevated and her blood count was low (anemia)….the combination of symptoms was a dead ringer for lead poisoning.

After recognizing the symptoms of lead poisoning, her doctor took a detailed history.

• Renovating a home that was built prior to 1978 can expose occupants to high lead levels from old paint, but Aryan and Shanaya’s apartment had been built in 2002.
• Some occupations such as construction, plumbing, and auto refinishing cause exposure to lead, but Aryan was an engineer and Shanaya was an accountant.
• Hobbies such as pottery, target shooting and working with stained glass involve lead, but Aryan and Shanaya mostly spent their free time hiking with their dog and watching movies on Netflix.
• Her doctor knew that 1 out of 5 ayurvedic medicines purchased over the internet contain heavy metals such as lead, mercury, and arsenic suggesting that the vasantha kusumakaram might be responsible.

Lead Shouldn’t Be In Your Body At All
Lead levels greater than 5 micrograms/deciliter (ugm/dl) are considered harmful. Shanaya’s level was 114 ugm/dl! Unfortunately, the lead in her body had become incorporated into her bones where it would be released over the next decade.

At Shanaya’s next visit she reported that she had missed a period and had a positive home pregnancy test result. She and Aryan had thought that they would never be able to have children and now they had gotten pregnant on their own!

Lead + Babies = Not Good. Now what?
Lead is not good for babies. During pregnancy, calcium is released from bones to help form the baby’s bones… bringing any lead along with it. Thankfully, prior to Shanaya’s surprise pregnancy, she underwent chelation treatment in order to get lead out of her bones more quickly. This is a process in which a medication is given that sticks to the lead and allows the body to excrete it. The chelation worked and her lead levels came down to 70 and then 22 ugm/dl over 6 months of treatment.

After discovering her pregnancy, a repeat lead level showed a slight climb in lead levels to 30 ugm/dl. While Shanaya and Aryan’s developing baby was at an increased risk for problems such as miscarriage, brain and kidney development issues, and the potential for learning and behavior issues and decreased IQ, chelation was not an option to reduce lead levels. It is potentially harmful in pregnancy and unless lead levels climb above 45 ugm/dl, it is not recommended.

Essential Supplements Are Musts
As her OBGYN, I saw Shanaya and Aryan at 7 weeks along in their pregnancy. We were all relieved to see a healthy fetus with a normal heart rate! I made recommendations to improve chances for a healthy baby, including taking in 2,000 mg of calcium through diet and supplements to provide the calcium that the baby’s bones would need. Green leafy vegetables, almonds and dairy products are excellent sources of calcium. Because of her anemia, we had her start to take iron twice a day. Vitamin D is also involved with bone development so this was the final supplement that we added. At 7 weeks into her pregnancy, her lead level was 17 ugm/dl and by the second part of pregnancy it was stable at 13 ugm/dl.

We performed an ultrasound scan at 20 weeks and their healthy daughter is developing perfectly with no signs of birth defects. While it appears that all will turn out well for this couple, they are already investigating ways to enrich their daughter’s early years to make up for any possible small decrease in IQ as a result of the lead exposure.

Avoiding Lead Exposure
Lead is a metal that doesn’t belong in any of us, but especially in pregnant women. Sadly, though, the only two states that require pregnant women to have lead levels checked are New York and Minnesota. Here’s what you can do to avoid lead:

• Avoid natural or herbal supplements unless your doctor tells you that they are 100% safe.
• Don’t be misled by advertisements that are designed to sell products that haven’t been evaluated for safety and quality.
• Doctors should consider screening all women (not just those who are pregnant) exposed to lead through work or hobbies, who are recent immigrants, live in homes built before 1978, or who have cravings to eat non-food items (pica).

For more information, visit MotherToBaby’s Lead Fact Sheet, or contact a MotherToBaby expert via phone, text, live chat, or email. In addition, MotherToBaby has a whole section dedicated to lead exposure education including videos and brochures here.

*The names and some of the details of this couple have been changed to protect their identity.

About the Authors

Kurt Martinuzzi, MD, is an assistant professor and specialist in Obstetrics and Gynecology at Emory University in Atlanta, Georgia. His interests include resident and medical student education, recurrent pregnancy loss, premature ovarian failure and polycystic ovary syndrome. He has been an active member of the Region 4 Pediatric Environmental Health Specialty Unit since 2015. Over his 25 plus year career he has been awarded multiple teaching awards and presented at many national and regional Ob/Gyn meetings.

Claire D. Coles, PhD, is Professor of Psychiatry and Behavioral Sciences and Pediatrics at Emory University, Director of the Maternal Substance Abuse and Child Development Laboratory, and Director of MotherToBaby Georgia. Her expertise is in the developmental and behavioral effects of prenatal exposure to drugs and alcohol and the interaction of these effects with the postnatal environment. She was among the first to describe the behavioral effects of prenatal alcohol exposure and to investigate the effects of cocaine exposure on child development. Dr. Coles established the only multidisciplinary clinic in the Southeastern United States that provides specialized services to individuals prenatally exposed to drugs and alcohol. Her team also designed interventions for those affected, including the Math Interactive Learning Experience and the GoFAR intervention.

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 lead, during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.

References

Saper RB, Russell SP, Sehgal AS et al. Lead, Mercury, and Arsenic in US- and Indian-manufactured Medicines Sold via the Internet. JAMA 2008; 300(8):915-923.

Guidelines for the identification and management of lead exposure in pregnant and lactating women. https://www.cdc.gov/nceh/lead/publications/leadandpregnancy2010.pdf

Tdap Vaccine During Pregnancy Provides Some Protection To Newborns.

The health alert comes after officials declare pertussis, otherwise known as “whooping cough,” cases in Texas have reached epidemic levels on track to be the highest in 50 years. At least two infant deaths associated with the outbreak have been reported.

“Infants are the most at risk when it comes to pertussis,” said Lori Wolfe, MS, CGC, MotherToBaby North TX program director. “However, receiving the vaccine during pregnancy could offer some protection to newborns too young to get the vaccine themselves,” she added. Infants don’t begin the Tdap vaccination series until two months of age.

In general, vaccines that cannot give a person the disease, like Tdap, are not considered contraindicated for pregnancy, according to Wolfe. Tdap is a combination vaccine against pertussis, diphtheria, and tetanus. The Texas Department of State Health Services recommends pregnant women get a dose of pertussis vaccine during every pregnancy, preferably between 27 and 36 weeks of pregnancy.

Pertussis has not been established to cause pregnancy problems, although it is not well studied, says Wolfe. “What’s important to point out, however, is that severe disease does have a potential concern for pregnancy. Pertussis tends to be less severe in adults than children, but can still result in adult hospitalization,” she noted.

Some symptoms of whooping cough include runny nose and coughing, which can worsen to rapid fits of coughing that create a high-pitched whooping sound.

Wolfe points out that each pregnancy is different. She recommends women consult with their doctor before receiving the vaccine as well as receive an individualized risk assessment from an expert resource, like MotherToBaby. All Texans can be connected with an expert to receive free information regarding the risks associated with vaccines, medications and other exposures during pregnancy and breastfeeding through the toll-free counseling service (866) 626-6847 or online at MotherToBabyNorthTX.org.

MotherToBaby North TX is a one-stop-shop for evidence-based free counseling available to women, health care providers, and the general public. It is a service of the international non-profit Organization of Teratology Information Specialists (OTIS). OTIS and its information service, MotherToBaby, are suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC).

Media Contact: Lori Wolfe, 940-565-3892, lwolfe@unt.edu. Interviews in Spanish can also be arranged.