Coming to America Pregnant

Last year I was pregnant with my first child. At the same time, I was going through the immigration process to apply for permanent residency in the United States. I wasn’t aware of the many things that you must do to get your health records cleared by immigration and how that process can be a great source of anxiety during pregnancy. If you are an immigrant, you may not have health insurance or cannot understand the language, which can be another challenge. In order to have sound and scientifically true advice during that critical period, I always consulted with my doctor and then MotherToBaby.

First, I was told that I needed to get revaccinated for certain diseases, even though I may have had them or may have been previously vaccinated in the past. Those vaccinations included measles, mumps and rubella (MMR), varicella, polio, tetanus diphtheria pertussis (Tdap), hepatitis B, and COVID-19. As soon as I heard this long list, I went online and checked the MotherToBaby facts sheets about those vaccines one by one to see what was known about their use in pregnancy. It turns out the Hepatitis B and COVID-19 vaccines are not associated with risk during pregnancy. Even more, it is recommended to get a Tdap vaccine during pregnancy to provide protective antibodies to your baby against pertussis (whopping cough). Live vaccines like MMR and varicella (chickenpox) are not recommended during pregnancy. Thankfully I was able to get bloodwork done to check antibody levels (protective proteins) showing prior protection. If you can show full protection, you no longer need to get vaccinated for these diseases after pregnancy. 

One other thing I had to find out was my tuberculosis (TB) status. This is done by blood work, but if the results don’t rule out the disease, you would need a lung x-ray. In general, X-rays are not recommended during pregnancy. However, if needed, studies show that a single chest x-ray is not associated with an increased risk for birth defects or pregnancy complications for the developing baby. It is important to know your tuberculosis status before pregnancy since active infection can be associated with preterm labor (early birth before 37 weeks), low birth weight of the baby, or even maternal death. Getting TB treated as soon as possible, even when you are pregnant, is so important. Tuberculosis is a slow-growing, pesky disease that is common in certain countries, including my home country, Turkey, but not common in the United States. That is why it is important to get it checked during the immigration process to prevent spread.

In addition to making sure I was getting my immigration to-do list sorted out, I also had to contend with new feelings brought on by pregnancy, both happy and stressful ones. This included all day nausea, aka the morning sickness, I had lots and lots of morning sickness. My first instinct was to call my mom and ask for help. She gave me a recipe for a concoction that included turmeric, sage, ginger, and mistletoe. I made it and drank it a couple of times without thinking whether that might be safe during pregnancy since it was all natural and herbal. A few days later, I was talking with one of my best friends, who was pregnant as well, complaining about morning sickness and asking for suggestions that have helped her. She said she would not drink any herbal tea without checking with her doctor. Ding ding, after talking with her, I was terrified to research the topic, and when I did, it confirmed my worst fears. The mistletoe in my nausea drink might cause miscarriage if consumed in large amounts. Many of the other herbs hadn’t been studied in pregnancy at all. I didn’t consume any more of the morning sickness drink and am fortunate that I had a healthy term baby. Lesson learned!

As immigrants, we bring our full heritage with us and try to combine the best of both worlds. Those herbal remedies and recipes are our culture; however, pregnancy is a special and very vulnerable time period. Everybody should be cautious about what we put into our bodies, especially herbal remedies since they are mostly not well studied during pregnancy to show whether they are associated with risks to the baby or not. Even if they are studied, the production and harvesting are not regulated or controlled by the Food and Drug Administration (FDA), or other governmental agencies, and contaminations might happen. Better safe than sorry, right?

Carrying my baby through the immigration process and following my dreams along the way was challenging, but I learned on that road that it is important to question my customs and traditional medications when pregnant. Not everything my mother or grandmother did is safe and effective. Also, I was glad that MotherToBaby was there for me when I was going through the immigration process while pregnant to ask my burning questions about vaccinations and x-rays.

Anyone with questions about herbals, vaccines, TB testing, or any other exposure in pregnancy should know that MotherToBaby is a great resource. Call or chat today to get your individual questions answered by a teratogen information specialist so you can rest assured that you and your baby can have a healthy and well-informed entry into America.


Coming to America Pregnant

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Coming to America Pregnant

Ever wonder if you’re getting the right amount of vitamins and minerals during pregnancy or breastfeeding? Like Goldilocks, you don’t want too little or too much — you want just right. Even though it took Goldilocks multiple tries to find the right size chair and the right bowl of porridge, it doesn’t have to take you that long to find the right amount of vitamins and minerals for you!

Everyone has a 3% chance of developing a birth defect during pregnancy. Getting the right amount of vitamins and minerals FOR YOU is not expected to increase the risk for issues during pregnancy and it is not expected to increase the risk for side effects during breastfeeding.

Most people in the United States get some vitamins and minerals in their diet. However, your healthcare provider might have specific goals for you to get certain amounts of a vitamin or mineral, particularly during pregnancy or breastfeeding. One way to get that extra support during pregnancy is to take a prenatal vitamin that has at least 600 mcg of folic acid (for more information on folic acid, check out our fact sheet: https://mothertobaby.org/fact-sheets/folic-acid/.

If you also take other supplements, or drink juices and shakes that list vitamins on the nutrition label, you could be getting more than you need. Reading nutrition labels help you track how many vitamins and minerals you are getting into your body.

DRIs: What Are They?

DRI stands for Dietary Reference Intake. DRIs are a list of nutritional values that are used to guide people to make sure they are getting a well-balanced diet that supports their health. There are a couple different DRIs, but the ones that are used in this blog are called RDA and UL.

  • RDA (Recommended Dietary Allowance): The average daily amount of a vitamin or mineral that most people need.
  • UL (Tolerable Upper Limit): The maximum safe amount you can take in a day without raising the risk of side effects.

Not every vitamin and mineral has an RDA or UL. For the vitamins and minerals that do have DRIs, it’s typically recommended to aim for the RDA every day, unless your healthcare provider tells you differently. For the ones that do have DRIs, they can change based on age or when pregnant or breastfeeding. You will also get many nutrients from your regular diet, so supplements are intended to help fill in gaps — not overload your system.

Why Supplement Safety Matters

Supplements are regulated differently than prescription drugs. Even though the United States Food and Drug Administration (FDA) regulates supplements, the FDA doesn’t check every product for safety or effectiveness before it goes on the shelf. This means labels may not always tell the whole story, and some products could include unknown or unlisted ingredients.

Talk to your healthcare provider before taking a supplement to make sure you are getting the right amount of vitamins and minerals to support your health. You can contact MotherToBaby to get more information on a supplement you are considering.

Have more questions about supplements or exposures during pregnancy or breastfeeding? You can reach a teratogen-information specialist at MotherToBaby.org.

DRIs for Vitamins and Minerals During Pregnancy and Breastfeeding:

Name RDA-pregnancy UL-pregnancy RDA-lactation UL-lactation
Biotin 14+ years old: 30 mcg Unknown 14+ years old: 35 mcg Unknown
Boron Unknown 14-18 years old: 17 mg 19+ years old: 20 mg Unknown 14-18 years old: 17 mg 19+ years old: 20 mg
Calcium 14-18 years old: 1,300 mg 19+ years old: 1,000 mg 14-18 years old: 3,000 mg 19+ years old: 2,500 mg 14-18 years old: 1,300 mg 19+ years old: 1,000 mg 14-18 years old: 3,000 mg 19+ years old: 2,500 mg
Choline 14+ years old: 450 mg   14-18 years old: 3,000 mg 19+ years old: 3,500 mg 14+ years old: 550 mg 14-18 years old: 3,000 mg 19+ years old: 3,500 mg  
Chromium 14-18 years old: 29 mcg 19+ years old:     30 mcg Unknown 14-18 years old: 44 mcg 19+ years old: 45 mcg Unknown
Copper 14+ years old: 1,000 mcg   14-18 years old: 8,000 mcg 19+ years old: 10,000 mcg 14+ years old: 1,300 mcg   14-18 years old: 8,000 mcg 19+ years old: 10,000 mcg
Folic Acid 14+ years old: 600 mcg DFE 14-18 years old: 800 mcg 19+ years old: 1,000 mcg 14+ years old: 500 mcg DFE 14-18 years old: 800 mcg 19+ years old: 1,000 mcg
Iodine 14+ years old: 220 mcg   14-18 years old: 900 mcg 19+ years old: 1,100 mcg 14+ years old: 290 mcg   14-18 years old: 900 mcg 19+ years old: 1,100 mcg
Iron 14+ years old: 27 mg   14+ years old: 45 mg   14-18 years old: 10 mg 19+ years old:  9 mg 14+ years old: 45 mg  
Magnesium 14-18 years old: 400 mg 19-30 years old: 350 mg 30+ years old:  360 mg 9+ years old: 350 mg*   14-18 years old: 360 mg 19-30 years old: 310 mg 30+ years old:  320 mg 9+ years old: 350 mg*  
Manganese 14+ years old: 2.0 mg   14-18 years old: 9 mg 19+ years old: 11 mg 14+ years old: 2.6 mg   14-18 years old: 9 mg 19+ years old: 11 mg
Molybdenum 14+ years old: 50 mcg   14-18 years old: 1,700 mcg 19+ years old: 2,000 mcg 14+ years old: 50 mcg   14-18 years old: 1,700 mcg 19+ years old: 2,000 mcg
Niacin 14+ years old: 18 mg NE   14-18 years old: 30 mg 19+ years old: 35 mg 14+ years old: 17 mg NE   14-18 years old: 30 mg 19+ years old: 35 mg
Omega-3 fatty acids 14+ years old: 1,400 mg Unknown 14+ years old: 1,300 mg Unknown
Pantothenic acid 14+ years old:   6 mg Unknown 14+ years old: 7 mg Unknown
Phosphorus 14-18 years old: 1,250 mg 19+ years old:  700 mg 14+ years old: 3,500 mg   14-18 years old: 1,250 mg 19+ years old:  700 mg  14+ years old: 4,000 mg  
Potassium 14-18 years old: 2,600 mg 19+ years old: 2,900 mg Unknown 14-18 years old: 2,500 mg 19+ years old: 2,800 mg Unknown
Riboflavin 14+ years old: 1.4 mg Unknown 14+ years old: 1.6 mg Unknown
Selenium 14+ years old: 60 mcg 14+ years old: 400 mcg 14+ years old: 70 mcg 14+ years old: 400 mcg
Thiamin 14+ years old: 1.4 mg Unknown 14+ years old: 1.4 mg Unknown
Vitamin A 14-18 years old: 750 mcg RAE 19+ years old:  770 mcg RAE 14-18 years old: 2,800 mcg 19+ years old: 3,000 mcg 14-18 years old: 1,200 mcg RAE 19+ years old: 1,300 mcg RAE 14-18 years old: 2,800 mcg 19+ years old: 3,000 mcg
Vitamin B6 14+ years old: 1.9 mg   14-18 years old: 80 mg 19+ years old: 100 mg 14+ years old: 2.0 mg   14-18 years old: 80 mg 19+ years old: 100 mg
Vitamin B12 14+ years old: 2.6 mcg Unknown 14+ years old: 2.8 mcg Unknown
Vitamin C 14-18 years old: 80 mg 19+ years old:     85 mg 14-18 years old: 1,800 mg 19+ years old: 2,000 mg 14-18 years old: 115 mg 19+ years old: 120 mg 14-18 years old: 1,800 mg 19+ years old: 2,000 mg
Vitamin D 14+ years old: 15 mcg (600 IU) 14+ years old: 100 mcg (4,000 IU) 14+ years old: 15 mcg (600 IU) 14+ years old: 100 mcg (4,000 IU)
Vitamin E 14+ years old: 15 mg 14-18 years old: 800 mg 19+ years old: 1,000 mg 14+ years old: 19 mg   14-18 years old: 800 mg 19+ years old: 1,000 mg
Vitamin K 14-18 years old: 75 mcg 19+ years old:     90 mcg Unknown  14-18 years old: 75 mcg 19+ years old:     90 mcg Unknown
Zinc 14-18 years old: 12 mg 19+ years old:     11 mg 14-18 years old: 34 mg 19+ years old: 40 mg 14-18 years old: 13 mg 19+ years old:     12 mg 14-18 years old: 34 mg 19+ years old: 40 mg

(This chart has last been updated on 9/29/2025)

*Note: The UL for magnesium only applies to supplements. You can safely get more from food since the RDA includes dietary magnesium.

Where Can I Find More Information?

MotherToBaby has fact sheets on a couple of the common vitamins and minerals that might be found in a multivitamin or a prenatal vitamin. For more detailed information on a specific vitamin or mineral, check out our fact sheets below:

References

National Academies of Sciences, Engineering, and Medicine. 1998. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: The National Academies Press. https://doi.org/10.17226/6015.

National Institutes of Health Office of Dietary Supplements. 2025. Dietary Supplement Fact Sheets. U.S. Department of Human and Health Services. https://ods.od.nih.gov/factsheets/list-all/

Office of Disease Prevention and Health Promotion. 2023. Dietary Reference Intakes. U.S. Department of Human and Health Services. https://odphp.health.gov/our-work/nutrition-physical-activity/dietary-guidelines/dietary-reference-intakes


Coming to America Pregnant

By MotherToBaby and experts from the Centers for Disease Control and Prevention (CDC)

At 16 weeks pregnant, Maria is busy planning a summer trip for her family. But lately, every time she opens her phone, she sees another headline about measles outbreaks.

It makes her pause and wonder: What does this mean for me and my baby?

What is measles, and why are people worried about it?

Measles is a highly contagious virus that spreads through the air when someone who is sick with measles coughs or sneezes. Since measles spreads so easily, up to nine out of 10 unvaccinated people who come into close contact with someone who has measles will become infected.

Symptoms often include high fever, cough, runny nose, red eyes, and rash. Measles can lead to serious health complications and severe illness. During 2025, about 1 in 10 people with measles were hospitalized.

In recent years, the United States has seen a rise in measles cases. In the past, measles has mostly affected children, but there are also recent increases among people of reproductive age. In 2025, nearly a third of measles cases (1 out of 3) were in adults 20 years of age or older. So far in 2026, nearly a quarter of measles cases (1 out of 4) have occurred in adults. This trend is one reason Maria may feel especially worried.

Why is measles infection concerning during pregnancy?

When you are pregnant, your body changes in many ways. These changes can increase your chances of getting sick from infections during pregnancy.

For example, if you are pregnant and get measles, you have a higher chance of:

  • Being hospitalized
  • Developing pneumonia
  • Rarely, death

Measles during pregnancy can also increase the chance of health problems for the baby, such as:

  • Pregnancy loss (including miscarriage or stillbirth)
  • Preterm birth
  • Low birthweight

Measles can also pass from mother to baby if an infection happens during pregnancy. This can cause serious illness in newborns, hearing loss, and—very rarely—a fatal brain condition called subacute sclerosing panencephalitis, or SSPE, years later.

Even after birth, measles can be dangerous for babies who are too young to get vaccinated against measles.

How can I protect myself and my baby from measles?

This was Maria’s main question as she started planning her trip. When she talked with her healthcare team, she learned that the MMR (measles-mumps-rubella) vaccine is the best protection against measles. Luckily, Maria had received this vaccine when she was younger. 

If you are not up to date with vaccinations, the ideal time to get the MMR vaccine is at least one month before becoming pregnant. The MMR vaccine is not recommended during pregnancy. However, it can be given after delivery, even while breastfeeding.

If you are not sure whether you have immunity against measles, talk with your healthcare provider. MotherToBaby has a tool to help you start the conversation.  While it is important to weigh the risks and benefits of any vaccine with your healthcare provider, serious reactions from MMR vaccination are rare.

After delivery, when you start taking your baby to their well-child visits, talk with your baby’s healthcare provider about the MMR vaccine and ask any questions you may have. Starting conversations early can help you feel confident when it is time for your baby to get vaccinated.

What should I do if I am planning to travel soon or live in an area with a current measles outbreak?

This was also a key question on Maria’s mind. She brought it up with her healthcare provider, and together they talked about her vaccination status as well the status of others in her household. They also looked up the measles activity at her summer trip location and talked about watching for symptoms of measles for 21 days after travel. If you are pregnant, these are helpful steps to take.

If a measles outbreak is happening near where you live, follow local recommendations. Consider avoiding crowded public settings and avoid contact with people who are sick. Encourage people around you (partners, family members, caregivers) to be up to date on MMR vaccination to help protect you and your baby.

What should I do if I am exposed to measles while pregnant?

If Maria is exposed to measles during her trip, her first step would be to call her healthcare provider’s office right away. They can tell her what to do next and how to get into the office safely, if needed, to avoid exposing others.

For pregnant patients who are not immune to measles or do not know if they are immune, they could be given antibodies called immune globulin (IG) after a measles exposure. If you have measles during pregnancy, talk to your baby’s healthcare provider about IG, which might also be recommended for your newborn.

What if I develop symptoms of measles while pregnant?

If you develop a fever and rash, especially if you live in an area with measles or have recently traveled, call your healthcare provider right away, and they can provide further instructions. Be sure to tell them if you have received the MMR vaccine before and where you have traveled.

A few key points:

  • Fever in early pregnancy can pose risks, especially if it lasts for a long period of time. Talk with your healthcare provider about how best to treat your fever with fever-reducing medications.
  • Taking extra Vitamin A is not recommended during pregnancy because high doses can increase the chance of certain birth defects.

What should I know if I am breastfeeding?

Measles is not spread through breast milk, and infants can receive breast milk from a mother with measles infection. Follow guidance from your healthcare team on precautions, which may include staying away from nonvaccinated people, expressing breast milk, and having a person who is not sick feed your infant your breast milk. Or, they may recommend you wear a mask and practice careful hygiene when breastfeeding and caring for your newborn.

If you are pregnant or breastfeeding and unsure about your immunity to measles or worried about exposure, you are not the only one with these questions. As with Maria, your healthcare provider and MotherToBaby are here to help answer any questions you may have.

References

  1. Joseph, NT. Measles in Pregnancy: Clinical Considerations and Challenges. Obstetrics & Gynecology 147(1):p 44-53, January 2026. | DOI: 10.1097/AOG.0000000000006126:
  2. Rasmussen, SA; Jamieson, DJ. What Obstetric Health Care Providers Need to Know About Measles and Pregnancy. Obstetrics & Gynecology 126(1):p 163-170, July 2015. | DOI: 10.1097/AOG.0000000000000903
  3. Congera P et al. Measles in pregnant women: A systematic review of clinical outcomes and a meta-analysis of antibodies seroprevalence. Journal of Infection 80(2):p152-160, February 2020. | DOI: 10.1016/j.jinf.2019.12.012

Disclaimer: The contents of this post are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. Reference to any third party, company, or product is intended for factual information only and does not indicate any form of endorsement or approval from CDC, or the U.S. Department of Health and Human Services.


Coming to America Pregnant

Helping Your Pregnant and Breastfeeding Clients Make Informed Decisions

For many women, doulas play an important role in the pregnancy and postpartum journey. As you support your clients during this time of enormous change in their lives, you’re probably fielding a lot of questions from them. When those questions are about how pregnancy and/or breastfeeding could be impacted by exposures in your client’s environment – such as the medications they may need to take, illnesses they may contract, vaccines they may be advised to receive, foods or beverages they consume, substances they use, or exposures in their workplace  – that’s when you and your clients can turn to MotherToBaby. 

We’re the nation’s leading authority and most trusted source of evidence-based information on exposures during pregnancy and breastfeeding. Our experts provide this resource at no-cost and without judgment, and our services are confidential and patient-centered. Our goal is to help pregnant and breastfeeding moms understand the benefit/risk of an exposure for them and for their baby so they can make an informed decision.

We can help by:

  • Encouraging your clients to speak with their healthcare providers about immunizations that may be recommended during this specific period of their life, such as seasonal influenza, RSV, COVID-19, and Tdap (Tetanus, Diptheria, and Pertussis). 
  • Not only helping your clients understand their exposures but also supporting conversations they may want to have with their healthcare provider about these exposures.
  • Assisting your clients who are living with chronic health conditions to plan for how health conditions and their treatments could impact the birth and the postpartum period, ensuring their questions around safety are addressed.  

Whatever environmental exposure your client has questions about, we are here to provide evidence-based information to help them understand how that exposure could affect their pregnancy or their breastfed baby. 

Doula support during pregnancy, birth, and during the postpartum period has been shown to be an effective best practice that can enhance the birthing experience, reduce complications, and improve outcomes for women and infants.

Knocke et al., 2022

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