Pregnancy’s Limitations: What Can You Do?

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Remember that 1980s Adam Ant pop song (dare I reveal my age?): “Don’t Drink, Don’t Smoke, What Do you Do?” That’s how a lot of women feel when pregnant. Not that we mind terribly when giving up coffee, alcohol, and substances that will harm our growing babies—but having nine to ten months of bad hair days was too much for me. So many moms out there advise us to not highlight our hair or go to a salon to get nails done as we may breathe fumes. Then there’s the no sushi, large fish, soft cheeses, or mountain bike rides. The list of what we can’t do seems endless. Frankly, some things are necessary to insure that our babies thrive and are born healthy. Who can argue with that? But what about the gray areas, like tanning or highlighting your hair? To shed light on the important things women need to restrict from their diets or not expose their unborn babies to, I consulted Sarah Maddison, M.D., an experienced obstetrician and gynecologist in Raleigh, North Carolina:


Laura: What fish are safe to eat?


Dr. Maddison: Small farm raised fish are the safest. Large fish that eat lots of other fish concentrate mercury, actually methylmercury, which can cause injury to a growing baby’s nervous system. Shark, king mackerel, swordfish, and tile fish should definitely be avoided. More conservative sources also add tuna steak, Spanish mackerel, grouper, and orange roughy to the list. Limited amounts of canned light tuna are probably okay if you limit it to less than 8oz per week. Fish is a good source of Omega-3 fatty acids which are good for the developing nervous system. Two servings per week is a good amount. Salmon, trout, talapia, flounder, and shrimp get the thumbs up. Most states post a list of some locally caught fish that may not be safe to eat pregnant or not, so people should look for any regional restrictions as well.


Laura: Why do some moms avoid deli meats? If it is due to preservatives, why are they unhealthy and are there specific preservatives worse than others in your opinion?

Dr. Maddison: There maybe things like preservatives in lots of foods that we eat that if you really think about it, that may not be good for anyone, pregnant or not. Some things that people avoid like the plague when they are pregnant, they turn around and feed their little children. Anyway, the real issue with deli meats, unpasteurized cheeses (often the “soft cheese”), inoculated cheese (“blue cheeses” that are purposely contaminated with bacteria), and hot dogs is Listeria. Listeriosis is a type of food poisoning that can cause fever, muscle aches, nausea, diarrhea, and sometimes even convulsions. Anyone can get this, but pregnant women are twenty times more likely than other healthy adults to get ill after a listeria exposure. When pregnant women have this it can lead to miscarriage, premature birth, or infection of the newborn.


Laura: Should pregnant women be concerned when renovating? For instance, scraping paint in old houses, tile, etc. Can lead cross the placenta?


Dr. Maddison: Yes, but only about the lead. This could lead to behavioral and learning difficulties in the baby years down the road. Plus, the chips could be a source of poisoning to a toddler down the road. Paint, cleaners, tile—most of these things are not studied, but I think are okay, but keep the room well ventilated.


Laura: Should people stop pesticide use in their homes when pregnant?


Dr. Maddison: No, but if you do a big bomb type thing I would stay away for twelve to twenty-four hours just in case.


Laura: Many women confess that they drank alcohol before they knew they were pregnant and while they’ve sustained once they found out they were pregnant, are worried that the alcohol in the first month will hurt their baby. What can you say on that matter?


Dr. Maddison: Alcohol is definitely a substance that causes birth defects and developmental delay. Most mothers of infants with Fetal Alcohol Syndrome are alcoholics, but no one is exactly sure where the line of too much is. With other things that cause birth defects, called teratogens, early exposure in the first six weeks seem to have an all or none effect. That is too say, if you don’t have a miscarriage, there is no damage. That is not true later on, but people who have a few accidental splurges early on are off the hook.


Laura: Women often feel ugly during pregnancy and I personally knew moms who would not step into a salon to get nails or hair done the whole pregnancy to avoid breathing fumes. Is it okay to have your hair highlighted or nails done when pregnant?


Dr. Maddison: These things will never be studied in pregnancy. You can consider things safe until proven unsafe or unsafe until proven safe. Because the first trimester is the most sensitive time for injury to the baby, I tell people that they can wait until after the first trimester to do highlights, spray tan, tooth whitening, etc.


Laura: What does coffee do to the developing baby? And is one cup a day okay?


Dr. Maddison: Coffee probably does nothing to a developing baby. Extreme caffeine intake is associated with smaller babies and slight increase in stillbirth, but these moms also are more likely to smoke and have poor weight gain. Since it isn’t really studied primarily, it is hard to tell which of those habits is the culprit. One caffeinated beverage a day is well within what would be safe.


Laura: Are artificial sweetners okay?


Dr. Maddison: Yes, in moderation. There are animal studies that show birth defects with high doses of asparatime, but high levels of blood sugar (like in a diabetic) can cause some of the worse defects and that is just glucose!


Laura: I wrote regularly for Fit Pregnancy magazine for the past six years and it seems that more and more OBs are okaying higher levels of exercise with the caveat that if you ran every day for a year before you got pregnant, continue to run. Don’t start something new, but continue with what you did. But for those adventurous types who mountain biked, surfed, and took rigorous hikes, should they tone down their exercise? Or should all women talk with their doctors about the level of exercise they expect to continue with?


Dr. Maddison: I am all for exercise, as you said, at your pre-pregnancy level. I would avoid anything that could cause falls or injury, especially abdominal trauma. Since your center of gravity changes I would avoid surfing, skating, skiing, horseback riding, biking, or other similar activities. A recumbent bike and elliptical trainers are great low impact options. Outdoor activities are okay, but the need for water and subsequently available bathrooms may limit the adventure. I think keeping your heart rate less than 140 and limiting weight bearing to forty pounds is a good idea. Most people start to feel uncomfortable as they get further along and cut back appropriately as they need to.


Laura: Can women take cold medicine or asprin for headaches? I know some who have suffered through migraines and week-long flu symptoms without taking anything for fear of hurting their baby. Is that the course to take, or should a woman immediately consult her doctor and go from there?


Dr. Maddison: Tylenol and Benadryl are fine, but I would not take aspirin or Motrin-like medicines. Some doctors are iffy about Sudafed. It works by causing vascular constriction and could theoretically cause ischemia (lack of blood flow) to developing structures, so you could wait until after the first trimester. There are tons of people who take Sudafed even early in pregnancy and are fine, so people shouldn’t worry. Some birth defects are so rare, we don’t know exactly what caused them so it is hard to rule some things out. For severe headaches that don’t respond to Tylenol, we use the lowest amount of narcotics needed, but migraine medications such as Imitrex should be avoided.


Laura: When is the final cut off for flying?


Dr. Maddison: Most airlines say thirty-seven weeks. We restrict travel for our patients at thirty-five weeks. Flying doesn’t hurt anything assuming you are in a pressurized cabin, but it sure is an inconvenient place to have an obstetrical emergency!



Related Link: Five Tips for Sleeping While Pregnant

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