Many women have questions about changing their diet and lifestyle in order to have a healthy baby. Often, the question “is it safe to drink during pregnancy or while breastfeeding?” comes up. For years, it has been recommended that women do not consume alcohol during pregnancy. However, some recent reports suggest occasional drinking is not harmful to a pregnancy. This information can be confusing and may leave you with more questions than answers.

Below are some of the common myths and facts about the use of alcohol during pregnancy and breastfeeding:

Myth – Drinking before finding out you are pregnant is safe.

Fact– Even though you may not realize you are pregnant, the baby is still growing and developing. Drinking at any time in pregnancy, even early on, might have some effects on the baby. It depends on several factors, including how much alcohol you were drinking, how often you drink, and if you continue to drink during pregnancy. It is always recommended for a pregnant woman to stop using alcohol, no matter how far along in her pregnancy she is. The baby will benefit by no longer being exposed to alcohol.

Myth – It’s safe to drink a small amount of alcohol later in pregnancy.

Fact – There are different opinions about this, which can be confusing. Babies grow and develop throughout the entire pregnancy. Right now, there is not enough known about how alcohol can possibly affect a baby at different times during pregnancy to be able to say that any time is safe for drinking alcohol. And, while drinking more alcohol puts the baby at greater risk for problems related to fetal alcohol syndrome, drinking less alcohol does not mean there is no risk. Because there is no amount of alcohol that has been proven to be safe in pregnancy, it is recommended that women do not drink at any time in their pregnancy.

Myth – Certain kinds of alcohol are safe to drink during pregnancy.

Fact – The same amount of alcohol is found in a standard serving of beer, wine, or hard liquor. A standard serving is considered to be 12 ounces of beer, 4-5 ounces of wine, or 1.5 ounces of hard liquor. Because there is no amount of alcohol that has been proven to be safe in pregnancy, it is recommended that women do not drink any alcoholic beverages at any time in their pregnancy.

Myth – Drinking alcohol will help increase milk production.

Fact – 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, 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 actually get less milk.

Myth – “Pumping and dumping” will get the alcohol out of breast milk.

Fact – Even if you dump milk after drinking, alcohol still remains in your blood for a period of time, depending how much you had to drink. Alcohol in the blood can still be passed into your milk. 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. For each additional drink, a woman must wait another 2-2.5 hours per drink. Pumping and dumping, drinking water, taking caffeine, or exercising, do not help your body get rid of the alcohol faster.

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 developing baby may result in a wide range of risk. The risk may be different even in the same mother in different pregnancies. The good news is you can avoid the possible effects of alcohol on a developing baby by choosing not to drink during pregnancy or breastfeeding.

If you are concerned about your drinking or think you cannot stop, talk to your healthcare provider for more information on treatment and counseling for alcohol dependency.

Click here to read more about alcohol’s effects during pregnancy and breastfeeding in our fact sheet.

By: Chris Colón, MS, LCGC.

Atopic dermatitis, commonly known as eczema, is a condition that makes the skin itchy and inflamed and can cause red or darker colored patches during a flare-up. Symptoms can be mild, moderate, or severe and can come and go. If you are one of the many people who are pregnant and dealing with this itchy, inflamed skin issue, you are not alone. Atopic dermatitis is common in pregnancy. Over half of people with eczema develop symptoms for the first time during their pregnancy. Hormonal changes in pregnancy can make symptoms worse.

There are many ways your healthcare providers may treat your atopic dermatitis during pregnancy.  Treatment may be topical (used on the skin) such as moisturizers and creams or systemic (medication taken by mouth or by injection). Information on specific medications can be found in our fact sheets at https://mothertobaby.org/fact-sheets/ or by contacting a MotherToBaby specialist at 866.626.6847.

Generally, the first line of treatment in pregnancy is topical because of the route of exposure. The developing baby is exposed to things in a pregnant woman’s blood. When you take a medication by mouth or swallow something, we know that is very likely to enter the bloodstream, where it can then potentially cross the placenta and reach the baby. With most topical products, the skin serves as a good barrier, so it is not expected that a significant amount of the product would be able to enter the pregnant woman’s blood where it can then reach the baby. This is especially true when the topical product is used on small areas of the body, used infrequently, or used on healthy (non-broken) skin.

If topical treatment is not working for you, fear not, there may be a glimmer of hope – light therapy.

Understanding Light Therapy:

Light therapy, also known as phototherapy, is a treatment option for atopic dermatitis that involves exposing the skin to ultraviolet (UV) light under controlled conditions. There are various types of light therapy including: narrowband (NBUVB), broadband (BBUVB), UVA, UVA1, full-spectrum light, saltwater bath plus UVB (balneophototherapy), psoralen plus UVA (PUVA), and other forms of phototherapy.  UV light is the same light that comes from the sun, and it is not radiation. This therapy aims to reduce inflammation and itchiness, ultimately improving the overall condition of the skin.

Light Therapy During Pregnancy:

While there’s limited research on light therapy during pregnancy, it is not expected to increase the chance of pregnancy complications. Most of the types of light are not expected to be absorbed through the skin and reach the developing baby. However, while NBUVB and BBUVB phototherapy can be used during pregnancy, they may reduce folic acid levels.  Folic acid is very important for baby’s development especially in the first trimester of pregnancy. Make sure you talk with your healthcare provider about folic acid supplementation and monitoring folic acid levels if you do need to get phototherapy in the first trimester. You may find our factsheet on folic acid helpful here: https://mothertobaby.org/fact-sheets/folic-acid/. Additionally, psoralen plus ultraviolet A (PUVA) light therapy should be avoided during pregnancy due to increased chance of low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).

In order to learn more about how atopic dermatitis and light therapy may affect pregnancy, MotherToBaby is currently enrolling people who are pregnant in the Eczema & Pregnancy Study. You can make an impact on the health of future families today by joining the study. Learn more about the study here: https://mothertobaby.org/ongoing-study/eczema-moderate-to-severe-atopic-dermatitis/

Protecting the Skin:

Your healthcare provider may recommend using sunscreen for additional skin protection after light therapy.  Sunscreen ingredients such as avobenzone, homosalate, octisalate, and octocrylene may be absorbed through the skin in small amounts with regular use, especially if they are used on large areas of the body. However, there is no proven increased risk to a pregnancy from using these ingredients. Mineral sunscreens contain zinc or titanium which are physical blocking agents and stay on top of the skin. That means they are not absorbed through the skin and are not expected to reach the developing baby. More information is available on our blog: https://mothertobaby.org/baby-blog/screening-your-sunscreen-during-pregnancy/

As with any medical treatment during pregnancy, it’s essential to weigh the potential risks and benefits with your healthcare provider.

Things to Consider:

Before diving into light therapy, here are a few things to consider:

1. Consult Your Healthcare Provider: Always consult with your healthcare provider before starting any new treatment, especially during pregnancy. Your healthcare provider can help you assess potential risks and determine if light therapy, and what type of light therapy, is right for you.

2. Alternative Treatments: If light therapy isn’t suitable for you during pregnancy, don’t worry! There may be other treatment options available that can help manage your symptoms. Information on specific medications can be found in our fact sheets at https://mothertobaby.org/fact-sheets/ or by contacting a MotherToBaby specialist at 866.626.6847.

3. Consider Joining the MotherToBaby Eczema & Pregnancy Study: Are you interested in joining our community of expecting parents who are sharing their pregnancy journey with our study team?  If you would like more information, visit https://mothertobaby.org/ongoing-study/eczema-moderate-to-severe-atopic-dermatitis/ or call 877-311-8972.

In Conclusion:

Atopic dermatitis can be challenging to manage, especially during pregnancy. However, light therapy offers a ray of hope for many people who are pregnant and struggling with this skin condition. Remember to always consult with your healthcare provider to determine the best course of action for you and your baby. You’ve got this!

Maya has been a healthy, happy vegan since she was a teenager. Now, at age 25 and pregnant for the first time, she is suddenly worried and uncertain about whether she can provide all the nutrients her developing baby needs if she continues to follow her vegan diet during pregnancy. She contacted us at MotherToBaby looking for answers. Maya’s question is not unusual, but since it’s a bit outside our area of expertise, I enlisted the help of an expert in maternal nutrition to help answer it.

Registered dietitian Kerry Jones, MPH, RDN, LDN is the owner of Milestones Pediatric & Maternal Nutrition in Cary, North Carolina. She works with women who are trying to conceive, pregnant, or breastfeeding, as well as children, which makes her a perfect resource for this topic. Kerry was happy to weigh in on Maya’s concerns and other common questions we get at MotherToBaby about vegetarian and vegan diets in pregnancy and breastfeeding.

First, what exactly does vegetarian mean? And how is vegan different from vegetarian? By definition, vegetarian means eating everything except meat, poultry, or seafood. Some vegetarians also choose to exclude eggs but consume dairy products (lacto-vegetarian), or exclude dairy but eat eggs (ovo-vegetarian). A vegan diet takes it a step further by avoiding all ingredients that come from animals, including eggs, dairy, gelatin, and honey. While these diets may seem limiting to someone who doesn’t follow them, vegetarians and vegans still enjoy an abundant variety of foods. Now, on to Maya’s question…

Q: Can I have a healthy pregnancy if I’m vegetarian or vegan?

Kerry Jones: Yes, you can definitely have a healthy pregnancy, even if you follow a vegetarian or vegan diet. However, that does not mean that eating during your pregnancy will be without its challenges, since there are many nutrients that are crucial to your child’s development that can be hard to obtain from a plant-based eating pattern, such as vitamin B12, choline, vitamin K2, DHA, iodine, iron, and zinc, to name a few. However, with proper planning, supplementation, and support, I believe that women who are vegetarian or vegan can have healthy pregnancies.

Q: Are there any vitamins I’ll need to take during pregnancy in addition to my regular prenatal vitamin?

Kerry: As I mentioned, there are several nutrients that are crucial to fetal development that are hard to obtain in a vegetarian or vegan diet. It will be important to make sure that your prenatal vitamin is high quality and contains not only enough of these nutrients, but also the best forms of these vitamins and minerals to ensure they will be well absorbed by your body (such as Methylcobalamin and/or adensylcobalamin when looking for vitamin B12). It is also important to ensure the prenatal vitamin you choose does not contain unwanted additives or nutrients (such as having both calcium and iron in the same supplement, since we know these minerals compete for absorption) and is third-party tested (since there is currently no governing organization that oversees the safety, content, purity, dosage, or effectiveness of supplements). In addition to a high-quality prenatal vitamin, it will likely be beneficial to take an algae-based DHA supplement. However, it is important to talk to your OB/GYN before starting any supplements.

Q: How can I be sure I’m getting enough protein during pregnancy if I don’t eat animal products?

Kerry: That’s a great question. We know that getting enough protein during pregnancy is important for both mothers and developing babies. Luckily, there are a variety of plant-based protein sources, such as: seitan, tempeh, beans, seeds, nuts, and lentils, to name a few. I recommend that all adults, including women who are pregnant, aim to have one-fourth of their plate or bowl be composed of protein sources at each meal and have a protein source at each snack. Following this meal pattern typically allows most pregnant women to meet their protein needs. However, if you are concerned about your specific protein needs during early and late pregnancy, contact a prenatal registered dietitian, such as myself, to get customized recommendations.

The biggest concern related to meeting protein needs for pregnant women following plant-based diets is ensuring they are getting the individual amino acids they need. Animal proteins are often referred to as complete proteins, which means the protein source contains all of the essential amino acids (or protein building blocks) that our body needs. However, not all plant protein sources are complete proteins. Therefore, it is important that pregnant women following plant-based diets not only get enough protein throughout the day, but also eat a variety of protein sources to make sure they are getting all of the needed amino acids.

Q: I love my OB, but she doesn’t have experience with vegetarian and vegan diets in pregnancy. Any advice?

Kerry: If you are getting push back or hesitation from your OB/GYN to support your dietary decision, it is important to remember that your OB/GYN is likely concerned that you and your baby are not going to get the nutrients that you both need during this critical period. Make sure to be an advocate for your health and beliefs to explain why you want to be a vegetarian and vegan while pregnant. Additionally, consider working with a prenatal registered dietitian to get evidenced-based, individualized recommendations on how to meet you and your baby’s nutrient needs. This will help give you the support you need to meet your unique needs and give your OB/GYN the reassurance they need to feel confident in your dietary decisions.

Q: My baby is almost due. Is there anything I need to know about being vegetarian/vegan while breastfeeding?

Kerry: Yes! Just like when you were pregnant, what you eat when breastfeeding matters. This is because when you are breastfeeding exclusively you are still the single source of nutrition for your little one just like you were during pregnancy. While the levels of some nutrients in breastmilk are not affected by maternal diet, the amount of many vitamins and minerals in breastmilk is dependent on how much you consume as a mom, such as vitamin B12, vitamin K2, choline, DHA, and iodine, to name a few. Therefore, it is important to continue your prenatal vitamin or switch to a postnatal vitamin and have a plan to get the nutrients that your baby needs while breastfeeding and you need for postpartum recovery.

After hearing Kerry’s feedback, Maya was relieved to know that by incorporating a few changes to her diet she could indeed have a healthy plant-powered pregnancy! If you have questions about your diet in pregnancy or breastfeeding, talk to your healthcare provider or a registered dietitian with expertise in maternal nutrition. And as always, MotherToBaby is here for you for any questions about exposures during pregnancy and breastfeeding.

Considerations for Patients with Neurologic Conditions during Pregnancy and Lactation

MotherToBaby supports neurologists in managing neurological diseases during pregnancy and while breastfeeding. We understand the challenges that you face when deciding on treatment courses when your patient is pregnant or breastfeeding. Care of people who are pregnant and lactating with serious conditions like multiple sclerosis (MS), epilepsy, or chronic migraines is further complicated by the physiological changes of pregnancy that may alter symptoms, severity, or treatment needs. Our resources will help you weigh the risks and benefits to both the 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. 

We are also dedicated to furthering the information and understanding of medication safety in pregnancy through our observational MotherToBaby Pregnancy Studies. We are proud to lead more than half of all Food and Drug Administration (FDA)-mandated pregnancy registries conducted in the U.S., including studies on MS treatments. MotherToBaby Pregnancy Studies are rigorously designed cohort studies that aim to provide critically needed product safety information – and your patient referrals make all the difference. With your referral, you are helping us generate data that will lead to improved product safety information in pregnancy, thereby providing you and your MS patients with the evidence you need to make more informed treatment decisions.

Neurological disease in pregnancy is becoming more common as a result of both an increase in neurological diagnoses as well as delayed childbearing. Additionally, medications for neurologic conditions have become increasingly sophisticated in their biological targets; therefore, practitioners must stay up to date in understanding their effects during pregnancy and lactation.

— Toscano & Thornburg, 2019

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.

LactRx App

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

Partners

• MyHealthTeams
• National Multiple Sclerosis Society
• Patient Education Genius
• PatientsLikeMe
• Society for Maternal-Fetal Medicine
• Society for Birth Defects Research & Prevention
• The Mighty

Managing Gastrointestinal Conditions in Pregnancy and Lactation

MotherToBaby supports gastroenterologists in managing gastrointestinal diseases during pregnancy and while breastfeeding. We understand the challenges that you face when deciding on treatment courses when your patient is pregnant or breastfeeding. Care of people who are pregnant and/or lactating with serious conditions like IBD, constipation, or GERD is further complicated by the physiological changes of pregnancy that may alter symptoms, severity, or treatment needs. 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. 

We are also dedicated to furthering the information and understanding of medication safety in pregnancy through our observational MotherToBaby Pregnancy Studies. We are proud to lead more than half of all Food and Drug Administration (FDA)-mandated pregnancy registries conducted in the U.S., including studies on IBD treatments. MotherToBaby Pregnancy Studies are rigorously designed cohort studies that aim to provide critically needed product safety information – and your patient referrals make all the difference. With your referral, you are helping us generate data that will lead to improved product safety information in pregnancy, thereby providing you and your IBD patients with the evidence you need to make more informed treatment decisions.

Pregnancy is a challenging period for the gastroenterologist. Chronic gastrointestinal diseases require treatment maintenance during this period, raising the challenging question whether outcomes beneficial to the [parent] may be harmful for the fetus.

— Gomes et al., 2018

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.

LactRx App

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

Partners

• Crohn’s & Colitis Foundation
• MyHealthTeams
• PatientsLikeMe
• Patient Education Genius
• Society for Maternal-Fetal Medicine
• Society for Birth Defects Research & Prevention
• The Mighty