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Feb. 20, 2001 -- For pregnant women, it's 'do this', 'don't do that'. Or perhaps this sounds familiar: 'you must not do this, you must do that.'
In recent weeks, there has been a dizzying array of news from many different sources on what you can and can't do while pregnant -- from taking common medicines or having sex to having a cup of java to get going in the a.m. Here's what you need to know to keep it all straight:
Cup of Joe
So, what's the deal with coffee? According to women's health expert Donnica Moore, MD, president of Sapphire Women's Health Group in Neshanic Station, N.J., "Five or more cups of coffee a day can double your risk of miscarriage during the first trimester and three to five cups per day ups risk of miscarriage by 30% in the first trimester." These findings were reported recently in the New England Journal of Medicine.
"Are you free and clear after the first 12 weeks? Not necessarily," she says. "In the third trimester caffeine can contribute to preterm labor."
Moore's advice: "Limit caffeinated beverages to one per day or avoid them all together. The March of Dimes and Food and Drug Administration say to avoid caffeinated beverages all together," she points out.
Cough Medication
Several new studies suggest that cough medicine containing the cough suppressant dextomethorphan does not raise risk of birth defects in pregnant women. Three years ago, a study found that this cough suppressant did, in fact, cause birth defects -- in chick embryos. But recent studies, with humans, have not supported the link between the over-the-counter cough suppressant and major or minor birth defects.
Over-the-Counter Pain Medication
A Danish study recently found that a class of popular painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve, ibuprofen (Advil and Motrin) and perhaps even aspirin may increase the risk of miscarriage -- but they did not up the risk of birth defects or undergrown or premature babies.
"Women have to talk to their doctor regarding medication use during pregnancy on an individual case-by-case basis," Moore advises. "As in any situation, we are always weighing risks and benefits -- especially with prescription medications."
For example, if a mother has severe asthma and can't breathe without her medication, then the benefits of using the medicine during pregnancy will outweigh the risks to the fetus, Moore explains.
"In cases where we have choices between medications, we try to choose the one that is known to be the least toxic to the fetus and still gives the mom the benefit of the drug," she says.
For over-the counter-medications: "Read the label, read the label, read the label," Moore says.
"And talk to your doctor."
Pregnancy and sex
The idea that continuing to engage in sexual activity in the last trimester of your pregnancy increases your risk of premature delivery appears to be unfounded for most healthy women.
Though it's true that a small amount of substances known to trigger labor are found in the man's semen -- and that labor-triggering substances are released when the woman's nipples are stimulated and during orgasm -- doctors say the risk of labor isn't high enough to warn most women and their partners against making love in the weeks prior to their term (37 weeks).
"We found no evidence that sexual activity in late pregnancy increased a woman's risk of preterm delivery between 29 and 36 weeks' gestation," reports Amy E. Sayle, PhD, lead author of a study published in the February issue of the journal Obstetrics & Gynecology.
Moore agrees. "For a generally healthy woman with a generally uncomplicated pregnancy, sex is safe -- even late in pregnancy," she tells WebMD.
Sayle writes, though, that her study does suggest that a small percentage of women who have risk factors for preterm delivery could further increase their risk by engaging in sex. Risk factors for preterm delivery include having had a previous preterm delivery or other pregnancy-related problem, contracting certain vaginal infections, having uterine bleeding during your pregnancy, and smoking, drinking alcohol, or using drugs.
Other obstetricians and high-risk pregnancy experts do advise women at risk of preterm delivery to avoid intercourse. Ask your doctor about your risk factors and whether or not you should engage in sexual activity.
Seafood
According to a recent report from the FDA, pregnant women should avoid eating certain species of large ocean fish including shark, swordfish, king mackerel, and tilefish because they may contain harmful mercury kevels that may harm the nervous system of a developing fetus.
Michele Curtis, MD, associate professor of obstetrics and gynecology at the University of Texas at Houston tells WebMD that if you eat seafood, "be aware of what the local health department has said if about fish in that area." If you are a sushi fan, "make sure that you go to a reputable restaurant that handles foods properly to minimize the risk of bacterial infections."
More importantly, she says, pregnant women should not consume unpasteurized milk or cheese because it can contain Listeria, which can cause an infection that can sometimes lead to death of the baby. "Some European countries don't pasteurize milk or cheese so be wary when traveling in European countries, " Curtis says.
Aside from the dos and don'ts recently in the news, there are also some tried and true guidelines pregnant women can follow.
First and foremost, "women should continue to have a healthy lifestyle during pregnancy just as they did before pregnancy," says Gideon Koren, MD, director of the Motherisk program, a Canadian organization designed to provide information to pregnant women and their doctors on environmental agents and drugs during pregnancy.
"Do not self-prescribe even things that you used to take yourself; go to the physician and ask before you take any medication even an over-the-counter one," says Koren, also a professor of pediatrics and pharmacology at the University of Toronto in Ontario, Canada.
Also, take folic acid before and during at least the first weeks of pregnancy to prevent neural tube defects. "This is a time that many women do not even know yet that they have conceived," he adds. Folic acid is added to many foods in the U.S. and Canada, but women who don't eat bread or enough vegetables (which also contain folic acid, a B-vitamin) may not be getting enough and should start supplementing as soon as they begin to try to conceive, he advises.