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

BRENTWOOD, TN – Sonja Rasmussen, MD, MS, current member of the Organization of Teratology Information Specialists (OTIS), the professional society which provides the MotherToBaby service, published a new commentary in the New England Journal of Medicine highlighting the risks pregnant women face if not vaccinated against the flu. She recently sat down with the CDC for a Medscape Q & A article to address common questions about the flu, as well as the vaccine to prevent it, during pregnancy. For the full article click here, or scroll below to read her interview, courtesy of Medscape.

If you have questions about specific vaccines, like the flu shot, during pregnancy or breastfeeding call MotherToBaby toll-FREE at 866-626-6847. You can also read our Fact Sheet on Influenza Vaccine In Pregnancy/Breastfeeding here. MotherToBaby Pregnancy Studies, conducted by OTIS, is also currently following up with women who’ve recently received the influenza vaccine during pregnancy. To learn more and volunteer for the study, click here.

Vaccination, Early Flu Treatment Critical for Pregnant Women

Editor’s note: What have we learned since the 2009 flu pandemic? That’s the focus of a new commentary from CDC experts Sonja Rasmussen, MD, MS, and Denise J. Jamieson, MD, MPH, published October 9th in the New England Journal of Medicine. In the commentary, “2009 H1N1 Influenza and Pregnancy – 5 Years Later,” the authors note that during the 2009 pandemic, pregnant women were at substantially higher risk for hospitalization than the general population, and they accounted for approximately 5% of flu-related deaths reported to the CDC.[1]

Dr. Rasmussen, acting director of CDC’s Office of Public Health Preparedness and Response, recently spoke with Doug Jordan, MS, CDC Health Communications specialist, about what clinicians can do now to keep pregnant women safe from influenza.

Mr. Jordan: What was your motivation for doing this commentary, and what should pregnant women know about the dangers posed by influenza?

Dr. Rasmussen: Since the 2009 H1N1 pandemic, we have learned a lot about influenza and pregnancy. The results of many studies have provided evidence on the impact of influenza on pregnant women, the benefits of treatment with oseltamivir, the safety of the influenza vaccine, and the steps clinicians can take to increase vaccination rates among pregnant women. We know much more now than we did 5 years ago about how to keep women and their infants safe from influenza. Yet, last year, we heard reports of severe illness, hospitalization, and death among pregnant women, sadly reminiscent of calls we received during the 2009 H1N1 pandemic. The idea for this commentary was in response to those reports. My coauthor, Dr Denise Jamieson, and I wanted to take what we now know about flu and pregnant women and make sure that information was in the hands of the clinicians who care for these women.

Mr. Jordan: What are the most common misconceptions that pregnant women might have about the influenza vaccine?

Dr. Rasmussen: We find that pregnant women do not always know that they are at higher risk of developing influenza-related complications. In fact, changes in the immune system, heart, and lungs during pregnancy make pregnant women more prone to severe illness, hospitalization, and even death from influenza. Infants born to women severely ill with influenza also have an increased risk for adverse birth outcomes, including preterm birth and small size for gestational age.

We also find that pregnant women often are unaware of the benefits of influenza vaccination for their baby. Flu shots during pregnancy protect not only the pregnant woman, but also her unborn baby and even her infant during the first 6 months of life. Studies have also shown that vaccinating the mother during pregnancy may reduce the occurrence of adverse outcomes like small size for gestational age and preterm birth in infants.

Mr. Jordan: What do you anticipate this season in terms of flu activity and severity?

Dr. Rasmussen: We can’t predict what kind of influenza season we will experience in the United States this year. Every flu season is different, and influenza infection can affect people differently. Similarly, we cannot know which viruses will circulate over the season. Influenza viruses can change from one season to the next or they can even change within the course of the same season. But we know that influenza vaccination during pregnancy can reduce the risk for influenza in the mother and her baby. And we know that pregnant women suspected of having influenza should receive prompt antiviral treatment, regardless of risk factors, severity of illness, history, or diagnostic testing.

Mr. Jordan: Which flu viruses does this season’s vaccine protect against?

Dr. Rasmussen: For the 2014-2015 flu season, trivalent influenza vaccines are made to protect against three influenza viruses: two influenza A viruses (H1N1 and H3N2) and an influenza B virus. In addition, the quadrivalent influenza vaccines, which are made to protect against four flu viruses, protect against the same viruses, and an additional B virus, as the trivalent vaccine. Yearly seasonal influenza vaccination is the best way to prevent influenza.

Mr. Jordan: What are the current influenza vaccine recommendations during pregnancy?

Dr. Rasmussen: CDC recommends that everyone 6 months of age or older get vaccinated against influenza each year. Getting an influenza vaccination is the best way to prevent influenza infection. Inactivated influenza vaccine is safe for pregnant women and can be administered during any trimester. Live attenuated influenza vaccine (LAIV) is not recommended for use during pregnancy. Postpartum women can receive either LAIV or inactivated flu vaccine.

Mr. Jordan: What are some important points to remember when educating pregnant women about influenza vaccine safety?

Dr. Rasmussen: Recommendations from healthcare providers are a critical motivator for pregnant women to be vaccinated. Clinicians should remind pregnant women of their increased risk of developing influenza-related complications, and emphasize that influenza vaccination is safe for pregnant women and has been recommended for many years by both the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists. Influenza vaccination is the best way to prevent influenza and influenza-related complications like hospitalization and death in pregnant women and their babies.

Mr. Jordan: What is the best way to raise influenza vaccination rates among pregnant patients?

Dr. Rasmussen: Influenza vaccination benefits the pregnant mother, the unborn child, and even the baby after birth, and we know that pregnant women are motivated to do what they can to ensure the health of their baby. When they learn that influenza vaccination can benefit their child before and after birth, they are more likely to get vaccinated. Clinicians play a vital role in sharing this information.

We also know that the best way to increase influenza vaccination rates in pregnant women is by recommending the influenza vaccine and offering it in your office. Women who reported that their doctor recommended and offered the vaccine were much more likely to get vaccinated than women whose doctors recommended the vaccine but did not offer the vaccine in their office.

Mr. Jordan: What treatment options are available for pregnant women with confirmed influenza?

Dr. Rasmussen: Pregnant women with confirmed or suspected influenza should be treated with oseltamivir as soon as possible, and they can be treated during any trimester. Your decision to treat should be based on clinical evaluation rather than on diagnostic testing because of the limited sensitivity of rapid influenza diagnostic tests and the time required to complete more definitive testing. If a pregnant patient is exhibiting the signs and symptoms of influenza, treatment should be started. Ideally, influenza antiviral treatment should begin less than 48 hours after onset of symptoms. However, there is still clinical benefit when treatment is started in a pregnant woman who is ill with influenza, even if 48 hours have already passed. There is no “48-hour rule” that prohibits later treatment.

Mr. Jordan: What else can pregnant women do to protect themselves and their families from flu?

Dr. Rasmussen: In addition to getting vaccinated, pregnant women should take everyday preventive actions against influenza, like avoiding close contact with sick people, staying home if they are sick, and washing their hands often with soap and water.

It is also important to emphasize that family members and caregivers should get vaccinated. Infants can benefit from added protection when everyone who cares for them gets an influenza vaccine. This includes all members of the household, relatives, and childcare providers.

Again, clinicians play a critical role in ensuring that pregnant women and their babies are protected from influenza. By educating women about vaccine safety and the benefits of influenza vaccine, and by offering the influenza vaccine in your office, you can help to ensure that your patients and their loved ones stay safe from influenza this season.

Kombucha: fizzy, fermented, and full of probiotics. Some people drink kombucha for its fun effervescence and wide range of fruity flavors. Others, for its alleged health benefits ranging from improved digestion to lowered blood sugar. The increasing popularity of kombucha has not surprisingly led to an increased number of inquiries to MotherToBaby about the safety of drinking it during pregnancy. Carly, a recent visitor to our online chat service, explained that she had been drinking kombucha for years, but now that she was trying to get pregnant was it okay to keep drinking it? Great question! I’ll share here what I talked about with Carly.

But first, what is kombucha? Kombucha is a sweetened green or black tea fermented with a symbiotic colony of bacteria and yeast, otherwise known as a SCOBY. Symbiotic means that the bacteria and yeast work together in balance. If you’ve never seen a scoby, let me give you a visual: a pale, rubbery, gelatinous disk vaguely resembling some sort of extraterrestrial organ. Not something most people would find appetizing from the get-go! But once the scoby is added to sweetened tea and left to ferment for a period of weeks, the result is a tangy, bubbly beverage that is slightly alcoholic, which brings me to the first consideration I discussed with Carly about drinking kombucha in pregnancy.

Kombucha and Pregnancy

Alcohol

Kombucha contains alcohol as a natural by-product of the fermentation process. In the United States, beverages containing 0.5% or more alcohol by volume (ABV) are required to have a label that includes a health warning for pregnant women. Varieties with lower alcohol content (less than 0.5 % ABV) are not required to have the label. Nevertheless, the non-labeled varieties still contain alcohol. For non-pregnant women, these small amounts of alcohol do not have a known risk; but in pregnancy, the advice of major medical organizations is to avoid alcohol altogether. Especially since the alcohol content of kombucha is not always clear-cut.

Most of the time, the manufacturing process can stabilize kombucha after it is bottled. However, kombucha has been pulled from shelves in the past after it was discovered that fermentation in the bottle did not stop, increasing the alcohol content above the amount that would require the pregnancy-warning label. And determining the alcohol content of homebrewed kombucha is difficult. Homebrews can reach as high as 3% or more depending on the type of yeast used in the scoby, how long and at what temperature the tea ferments, and other factors.

The best way to avoid unnecessary alcohol exposure in pregnancy is to not drink kombucha for those 9 months. And what about during breastfeeding? If you do enjoy an “alcohol-free” kombucha from time to time, the small amount of alcohol it might contain is unlikely to have a negative effect on your infant. Yet waiting a couple of hours after drinking the kombucha before nursing again will allow time for your body to metabolize the alcohol from your blood and breast milk.

Bacteria

Another concern about drinking kombucha in pregnancy is the possibility of bacterial contamination. Using proper sterile techniques can reduce harmful bacteria in the product, but the best way to eliminate any bacteria that might grow during the long fermentation process is to pasteurize the beverage with a quick heat treatment before bottling. Kombucha purists may argue that pasteurization destroys the probiotics responsible for the health benefits that kombucha may provide. However, unpasteurized products are not recommended in pregnancy due to an increased chance of foodborne bacteria such as listeria and salmonella, which can cause pregnancy complications. Unpasteurized products to avoid include certain milk and dairy products, and yes, fermented foods and beverages such as kombucha.

Homemade fermented foods carry an even greater risk of growing foodborne bacteria since the sterilization methods used at commercial facilities are not available in one’s own kitchen. So when it comes to fermented products in pregnancy, store-bought selections that are pasteurized are the safest way to go. This means avoiding “raw” or unpasteurized kombucha, as well as homebrewed varieties.

Caffeine

A final consideration I discussed with Carly was caffeine. The general recommendation in pregnancy is to limit caffeine to about 200 milligrams (mg) per day. The caffeine content of kombucha can vary based on the type of tea used to brew it, and may fall somewhere in the 15-130 mg range. When calculating how much caffeine you’re taking in, consider all potential sources including coffee, tea, soft drinks, and chocolate. The MotherToBaby fact sheet on caffeine lists the amounts found in some common products, and can be helpful for tallying up your daily intake (be sure to also check your product labels). For example, if you already drink a cup or two of regular coffee in the morning, a bottle of kombucha might put you over the recommended amount of caffeine for the day.

If breastfeeding, keep in mind that caffeine passes into the breast milk and can cause some babies to be irritable or have trouble sleeping. While you might not need to avoid caffeine altogether while breastfeeding, limiting the amount you take in can up the chances of a good night’s sleep for both you and baby.

In the end, Carly decided that foregoing her beloved brew for the duration of her future pregnancy would be in the best interest of her developing baby. In the meantime, she’ll opt instead for water to stay well-hydrated, and for carbonated fruit spritzers and juices when she gets a craving for the uplifting fizz that kombucha provides. Cheers to that, Carly!

Growing a baby is hard work, and it often comes with a side of extra hunger as your body fuels the little one inside. While the idea of “eating for two” is a common myth, changes in hunger levels, digestion, and food tolerance are very real. For example, you might sit down to enjoy a meal you’ve eaten countless times before, only to experience sudden heartburn that just won’t quit. Or you may plan a short outing and unexpectedly find yourself searching for the nearest restroom due to an upset stomach. These common experiences can be both frustrating and surprising. Symptoms such as heartburn, indigestion, upset stomach, and diarrhea can disrupt daily routines, interfere with sleep, and make even simple moments feel uncomfortable during pregnancy.

Comfort plays a vital role in promoting both physical and emotional health. This includes maintaining balanced nutrition, staying hydrated, being physically active (safely) and trying to get enough quality rest. Comfort is not a luxury; it is an important part of staying healthy for both you and your baby. However, it’s important to remember to check your usual remedies to make sure they can also be used during pregnancy.

Bismuth subsalicylate is an over-the-counter medicine often used to treat symptoms such as nausea, heartburn, indigestion, upset stomach, and diarrhea. Once bismuth subsalicylate reaches your stomach and intestines, it separates into salicylic acid (which the body can absorb) and bismuth compounds that are mostly not absorbed. Bismuth subsalicylate is related to aspirin, as they are both in a group of mediations called salicylates. Products that include this ingredient are Pepto-Bismol®, Bismatrol®, Diotame®, Kaopectate®, and Kao-Tin®.

Can Products Containing Bismuth Subsalicylate Be Used During Pregnancy?

In general, products that contain bismuth subsalicylate are not recommended for use during pregnancy, especially during the second and third trimesters. Here is why:

• Bismuth subsalicylate is related to aspirin, which is a non-steroidal anti-inflammatory (NSAID) medication. NSAIDs can increase the chance of certain risks in pregnancy, such as bleeding complications.
• There are concerns about the effects on the fetal kidneys and lower levels of amniotic fluid (the fluid that surrounds the fetus during pregnancy).
• There are concerns about effects on the fetal heart and blood vessels if taken in the later stages of pregnancy. This can cause high blood pressure in the fetal lungs (pulmonary hypertension).

Luckily, there are other ways to help manage those annoying tummy troubles. Note: Be sure to use medications and other treatments as directed on the label or by your healthcare provider.

• For heartburn and indigestion: Antacids like calcium carbonate (Tums®)  can be used as directed in pregnancy. Using them may also help with your calcium intake.  
• For nausea: Vitamin B6 supplements, doxylamine (an antihistamine), or ginger have been recommended by healthcare providers. Your provider may also suggest prescription medications if needed.
• For diarrhea: It is important to stay hydrated. Your provider may recommend medication depending on the cause and severity of your condition.
• MotherToBaby has fact sheets on these exposures:

  • Regular Strength Aspirin
  • Calcium carbonate
  • Doxylamine succinate-pyridoxine hydrochloride
  • Ginger

Always check with your healthcare provider before taking any medication during pregnancy, even if it is over the counter. They can talk with you about your symptoms and what treatment is best for you.

What If I Already Took Pepto-Bismol?

First, do not panic. One dose is unlikely to cause harm. But it is still a good idea to mention it to your healthcare provider, especially if you are in your second or third trimester. They can help assess whether any follow-up is needed and reassure you moving forward. They can also talk with you about the best way to treat your symptoms during pregnancy.

Pregnancy can already feel uncomfortable at times, so dealing with stomach issues on top of everything else can be frustrating. While some common ingredients like bismuth subsalicylate aren’t recommended during pregnancy, there are options that can help you feel better. When in doubt, it’s okay to ask your healthcare provider or a MotherToBaby specialist. Remember, taking care of your comfort is an important part of taking care of your pregnancy.

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!