By Men-Jean Lee, MD, a maternal-fetal medicine physician and member of MotherToBaby’s sister society, the Society for Maternal-Fetal Medicine

From gender reveal parties to pregnancy photoshoots and prenatal massage, pregnancies are being celebrated in new and sometimes extravagant ways. The travel trend of “babymoons” continues to grow in popularity and most go off without a hitch. Unfortunately, as a maternal-fetal medicine physician in Hawaii, I’ve seen my fair share of trips that do not go according to plan. If pregnant, consult your doctor or midwife, especially when flying or traveling far from home. Also keep these tips in mind if you are a considering a babymoon.

Women with high-risk pregnancy issues should consult their local maternal-fetal medicine physician to discuss any medical and obstetrical issues before putting a deposit down for babymoon. And what do you do if you end up being grounded? Save the money for a really fabulous push present!

Men-Jean Lee, MD, is a maternal-fetal medicine physician and associate professor at the John A. Burns School of Medicine at the University of Hawaii at Manoa practicing at the Kapiolani Medical Center for Women and Children. She is a member of MotherToBaby’s sister society, the Society for Maternal-Fetal Medicine, the only national, professional organization specifically devoted to reducing high-risk pregnancy complications. Dr. Lee’s research interests include maternal stress during pregnancy, diabetes, immigrant healthcare, and placental biology.

1. Bring Your Medications…And Use Them
   Do you need medications that you can only get in the U.S.? Certain life-saving medications cannot be obtained in other parts of the world. Or maybe you are supposed to be checking your blood sugars if you are pregnant and have diabetes? Just because you are on holiday, doesn’t mean you can let yourself go! Stick to your carb-controlled diet and your insulin, so that you don’t end up in a hospital where there is not a medical intensive care unit.
2. Is Your Pregnancy “High Risk”?
   Are you pregnant with twins or triplets? Did you deliver any of your older children earlier than 37 weeks? If so, you are at increased risk of preterm birth. Be aware that if you go into preterm labor on the beaches of Hawaii, you might get stranded and hospitalized in paradise until the babies are born! And if they are born “premie” or prior to 36 weeks, you might need to book a hotel to stay there until the babies are big enough to fly home.
3. Don’t Fly After 36 weeks…and for Some women, Don’t Fly at All
   Are you at the end of your pregnancy? Experts recommend that most pregnant women stop flying once they’ve reached 36 weeks gestation. Air travel is not recommended at any time during pregnancy for women who have medical or obstetric conditions that may be exacerbated by a flight or that could require emergency care (e.g. a history of DVT [blood clot in a vein] or a pulmonary embolus [blood clot in the lung], stroke, heart attack, uterine cramping, leakage of fluid from the vagina, shortened cervix, or vaginal bleeding). If you have one of these conditions or if your doctor told you it’s not safe, stay close to your OB care provider and the hospital where you plan to deliver.
4. Be Mindful of Zika “Hot Spots”
   The Zika virus poses serious threats to your developing baby (for more info, see MotherToBaby’s Zika Virus Fact Sheet). If your idea of the perfect babymoon is a tropical getaway, check to see if your destination has Zika-bearing mosquitoes. Parts of Mexico, South America, and most Caribbean islands are still on the Zika watch list. Unless you and your partner are committed to trading in your sunscreen for insect repellant or staying indoors with the windows closed, you might want to book a trip to picturesque Prince Edward Island!
5. Skip the Glass of Wine
   While in vacation mode, you may be tempted to indulge in a glass of wine, a beer, or a margarita, but don’t do it. There is no known safe level of alcohol consumption during pregnancy. Prenatal exposure to alcohol is the leading preventable cause of birth defects and developmental disabilities. Check out MotherToBaby’s Alcohol Fact Sheet for more info.

Women with high-risk pregnancy issues should consult their local maternal-fetal medicine physician to discuss any medical and obstetrical issues before putting a deposit down for babymoon. And what do you do if you end up being grounded? Save the money for a really fabulous push present!

Men-Jean Lee, MD, is a maternal-fetal medicine physician and associate professor at the John A. Burns School of Medicine at the University of Hawaii at Manoa practicing at the Kapiolani Medical Center for Women and Children. She is a member of MotherToBaby’s sister society, the Society for Maternal-Fetal Medicine, the only national, professional organization specifically devoted to reducing high-risk pregnancy complications. Dr. Lee’s research interests include maternal stress during pregnancy, diabetes, immigrant healthcare, and placental biology.

We Can Help You and Your Pregnant and Lactating Patients Make Informed Decisions

Internists play a vital role in providing comprehensive care to people who are or may become pregnant or who are breastfeeding. Here at MotherToBaby, we understand the challenges that you face when deciding on treatment courses when your patient is pregnant or lactating. No matter if your patient has hypertension or diabetes, depression or anxiety, digestive problems or respiratory problems, our resources will help you weigh the risks and benefits to both your patient who is pregnant and their baby as you determine a treatment plan that maximizes disease management and minimizes maternal and fetal/infant risk. 

Even perfectly healthy patients may have questions about the potential impact of over-the-counter medications, workplace exposures, or cosmetic treatments during pregnancy or lactation – we can answer those questions, too. Whether your patient is engaged in preconception planning, already pregnant, or postpartum, our resources will help you and your patients make more informed decisions to reduce risk to both the parent and their developing baby.

[People who are pregnant] suffering from medical disorders need to be cared for by internists as well as by obstetricians. The internist has to play a key role in coordinating care every time a [person who is pregnant] suffers from a medical disease that touches his area of expertise.

— Pourrat, 2005

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

By Bethany Kotlar, MPH, MotherToBaby Georgia

**This information was current as of the time the blog was published. However, information is constantly changing. Please visit Zika Central for the latest information.**

As a teratology information specialist, I counsel women and their families on medications, chemicals, herbal remedies, and illnesses that could harm developing babies. So as the Zika Virus, a viral infection that can cause severe birth defects including microcephaly (a condition where a baby’s head is much smaller than expected, and may indicate a baby’s brain has not developed properly during pregnancy), spread from the Polynesian Islands, to South America, to the Caribbean, I made sure to educate myself on everything we know about the virus, reading article after article and keeping up to date on the Centers for Disease Control and Prevention (CDC’s) recommendations to avoid infection, knowing that eventually I would need this information to counsel a pregnant woman or her family. I never imagined I would use this information to try to prevent becoming infected myself, and that I would fail.

One week in February I opened an email from my in-laws with the subject “30th Birthday Plan.” My husband’s 30th was a few weeks away, and I was excited to see what they had planned. As I read the email detailing a week-long sailing trip in the Caribbean I felt blessed, and honestly a little scared. I rushed to the CDC’s page on Zika to look up whether the islands we were visiting had outbreaks. Sure enough-16 Caribbean islands, including the two we were visiting, had Zika outbreaks. At first I didn’t want to go, which set off an intense inner debate racked with guilt. “How could I say no to a surprise trip for my husband, especially one planned and paid for by my in-laws?” I thought, and in the next second, “But what if I get Zika? I work with pregnant women, I can’t expose them!” Finally, my Dad stepped in. “You’re too adventurous to let Zika scare you away from a vacation.” he said. “Fine,” I thought, “I’ll go, but I’m going to be careful.”

I was careful. Despite the gentle teasing from my in-laws, I insisted on sleeping indoors with the windows closed, even though it was more comfortable outside. I wore bug spray with 30% DEET when I thought mosquitos would be out. I got three or so bites at dinner one night, and three more at the end of our trip. As we headed home I mentally patted myself on the back; “Only six bites,” I thought, “pretty sure I didn’t get Zika!” I was so sure that three days after our trip when I developed a head-to-toe rash I was certain it was an allergic reaction, but after three doses of Benadryl did nothing, I googled Zika-related rashes. Dead ringer. Symptoms of the Zika Virus include rash, joint and muscle pain, red eye, fever, and headache, and boy did I have them. I rushed in to see an infectious disease doctor, who came to the same conclusion. “My money’s on Zika,” he said. Suddenly everyone wanted a piece of me; my blood was sent to the county board of health, Emory’s lab, and a lab in Washington for testing.

A call from the county board of health confirmed what my aching joints hinted at: I tested positive. My first thought was to thank my lucky stars that I have access to safe, reliable birth control. My second was to start worrying about those around me. I had brunch with a pregnant friend before I had symptoms-could I have given her Zika? Thankfully, the answer is no (more on that below)! I was amazed at how a short vacation and six bites could give me Zika. I thought about all the people going to the Caribbean for vacation. How many of them are pregnant or could become pregnant while traveling? Would they wear bug spray? Would they recognize the symptoms? How many are men who could get Zika and then unknowingly transmit it to their sexual partner? How many people are walking around not knowing they were infected? I called my friend and begged her to wear insect repellant for the rest of her pregnancy.

As of July 27, 2016, 1.658 cases of Zika, including 433 pregnant women have been confirmed in the continental United States; 4 cases of local transmission have been reported in Miami-Dade and Broward counties in Florida. There are likely far more cases since most people don’t have symptoms, so never get tested. Zika is mostly spread through mosquito bites, but can also be spread through sex, blood transfusions, or from a mother to baby during pregnancy. We don’t know how long the incubation period (the time between when you get infected and when you see symptoms) is, but it is likely a few days to weeks. For most people the virus stays in the blood for about a week, but some people still have the virus in their bodies for as long as two months. Currently, the only Zika outbreak in the continental United States is in a small area of Dade County, Florida, however,, the mosquitoes that can carry Zika are found in some areas of the US, making a Zika outbreak in the U.S. very possible. You can follow these steps to protect yourself:

1. If you are pregnant or could be pregnant (planning a pregnancy or not using birth control), don’t travel to a country with an active Zika outbreak. You can find a list of current outbreaks here.

2. If your partner has traveled to a country with an active Zika outbreak and you are pregnant, use condoms correctly every time you have sex for the rest of your pregnancy. Why, you might ask? Because Zika can stay in semen longer than in blood, but we don’t know exactly how long it stays there. To be as safe as possible, the CDC recommends using condoms for 6 months.

3. If your partner has traveled to a country with an active Zika outbreak and has symptoms of Zika (rash, fever, headache, joint pain, and conjunctivitis) use condoms correctly whenever you have sex and avoid pregnancy for at least six months. If he does not have symptoms, use condoms and avoid pregnancy for at least two months.

4. If you have traveled to a country with an active Zika outbreak and you are not pregnant, avoid pregnancy for at least two months. The Zika virus can also be transmitted from a woman to her sexual partner. Because of this, use condoms and/or a dental dam when you have sex for two months. Do not share sex toys.

5. If you are currently pregnant, avoid mosquito bites as much as possible by wearing bug spray outdoors (bug spray with at least 30% DEET is preferable; for information on the safety of DEET during pregnancy, see here), wearing long-sleeved shirts and pants, closing windows or using windows with screens, and removing any standing water from around your house. Two things to remember: the mosquitos that spread Zika are daytime biters and like to be indoors, and they can breed in pools as small as a bottle-cap.

If you have questions about the Zika virus or you have been infected or exposed and want free up-to-date information about what this could mean for a current or future pregnancy, you can contact a MotherToBaby expert by phone at (866) 626-6847 or by visiting https://mothertobaby.org//a>.

Bethany Kotlar is a teratology information specialist with MotherToBaby Georgia. She holds a Masters in Public Health specializing in Maternal and Child Health, and is a Certified Childbirth Educator. She enjoys exercising, traveling (and collecting viral illnesses), and Netflix.

MotherToBaby is a service of OTIS, a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about viruses, alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847. You can also visit MotherToBaby.org to browse a library of fact sheets, email an expert or chat live.

On the heels of National Eczema Awareness Month, MotherToBaby Pregnancy Studies has launched their newest study on Dupixent® (dupilumab), an injectable medication used to treat patients with moderate to severe atopic dermatitis, the most common form of eczema. The study will provide information on the safety of Dupixent® when used during pregnancy, and will help women and their healthcare providers get the information they need to make more informed treatment decisions.

The National Institute of Allergy and Infectious Diseases (NIAID) estimates that eczema affects 30 percent of the U.S. population. The condition is typically characterized by dry, irritated and inflamed skin, which tends to crack or bleed when scratched. Most people who suffer from eczema are more susceptible to skin infections caused by bacteria and viruses. With eczema being more common in women than men, there is an urgent need for more information on treatment safety during pregnancy.

Dr. Christina Chambers, an epidemiologist at the University of California San Diego who specializes in the area of medication exposures and their effects on pregnancy, is leading the study. “Eczema is such a common condition in women, and women who have more severe forms of it may benefit from this new line of treatment. But for pregnant women, a big question remains about whether these medications have any impact on a developing baby. Our study aims to provide this much-needed information,” said Chambers.

Dupixent® was launched in the United States in April 2017 as the first biologic medication approved by the U.S. Food and Drug Administration (FDA) to treat adults with moderate to severe atopic dermatitis. Biologic therapies are unique in that they work by selectively targeting specific immune responses, rather than suppressing the entire immune system.

MotherToBaby aims to recruit 300 pregnant women throughout the U.S. and Canada to participate in the study over the next 5½ years. Pregnant women who are diagnosed with moderate to severe atopic dermatitis may qualify whether they have or have not been exposed to Dupixent®. To learn more about the study, call 877.311.8972 or visit: Eczema/Atopic Dermatitis and Pregnancy Study.

To learn more about MotherToBaby Pregnancy Studies, view our Pregnancy Studies 101 flyer.

More About MotherToBaby

MotherToBaby 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. More than 100,000 women and their health care providers seek information about birth defects prevention from MotherToBaby every year. MotherToBaby Pregnancy Studies are conducted by the Organization of Teratology Information Specialists (OTIS) and coordinated at the University of California, San Diego.

By Chris Colón, Certified Genetic Counselor at MotherToBaby Arizona

During pregnancy, many women make changes in their lives in order to have the best chance to have a healthy baby. I know I did during both of my pregnancies. These changes can involve their diet, exercise habits and other lifestyle factors. After birth, new moms may consider adding back some of the things they cut out over the last 9 months, including drinking alcohol. But is adding it back in that simple? During September’s Fetal Alcohol Spectrum Disorders (FASD) Awareness month, I thought I’d examine the topic of alcohol in breastmilk a little more closely for you. It’s a question I get frequently from the women who contact our service. As you probably know, for years, experts have been saying there is no known safe amount of alcohol use during pregnancy, but does alcohol affect a breastfeeding baby?

Before you raise your glass of favorite vino, here’s what research says…

Studies have shown that alcohol passes into the breast milk. The concentration of alcohol in the breast milk is close to the concentration of alcohol in the woman’s bloodstream. Alcohol can pass back and forth from the bloodstream into the breast milk. It’s a common myth that pumping and discarding breast milk will remove the alcohol from breast milk. Even if you discard pumped breast milk after drinking, alcohol still remains in your blood for a period of time, depending on how much you had to drink. The only way to get rid of alcohol from your system is to wait for your body to break it down and get rid of it. It takes about 2 to 2.5 hours for each standard drink to clear from breast milk. (A standard serving is considered to be 12 ounces of beer, 4-5 ounces of wine, or 1.5 ounces of hard liquor.) For each additional drink, a woman must wait another 2-2.5 hours per drink. Pumping and discarding, drinking water, taking caffeine, or exercising do not help your body get rid of the alcohol faster, because only time can reduce the amount of alcohol in the breast milk.

More misconceptions…

Another common misconception is that drinking during breastfeeding is recommended to help produce more breast milk. It used to be believed that beer raised levels of prolactin, a hormone in the body that plays a role in making breast milk. However, alcohol may actually reduce the amount of milk you produce. It is now known that alcohol lowers the release of another hormone called oxytocin. Lower oxytocin levels can affect the amount of milk that is released from the breast, meaning a baby may get less milk.

Alcohol’s known effect on baby

Many people wonder if alcohol affects a growing baby. Effects on infants from alcohol in breast milk are not well studied. There are some reports that babies whose mothers drink alcohol while breastfeeding may eat less and/or experience changes in their sleeping patterns. One study suggested problems with motor development following exposure to alcohol in breast milk, but other studies did not show the same results. There are many factors that can play a role in how alcohol can possibly affect a developing baby. Differences in genetics and metabolism of alcohol by both the mother and the baby may result in a wide range of risk. The risk may be different even in different babies from the same mother. At this time, it’s not clear how alcohol in breast milk can affect a developing baby.

Depending on the amount of alcohol you drink and the frequency with which you drink, you may not need to stop breastfeeding if you drink alcohol. You can speak with your health care provider as well as the baby’s pediatrician about how much alcohol you are drinking as well as all your choices for breastfeeding. You can also contact a MotherToBaby counselor at (866) 626-6847 to talk about alcohol and other exposures during breastfeeding.

Chris Colón is a certified genetic counselor based in Tucson, Arizona and proud mother of two. She currently works for The University of Arizona as a Teratogen Information Specialist at MotherToBaby Arizona, formerly known as the Arizona Pregnancy Riskline. Her counseling experience includes prenatal and cardiac genetics, and she has served as MotherToBaby’s Education Committee Co-chair since 2012.

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 alcohol, medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847. You can also visit MotherToBaby.org to browse a library of fact sheets.