Free Counseling on Pregnancy & Breastfeeding Exposures!

1. Free Counseling on Pregnancy & Breastfeeding Exposures! Do you have questions about exposuressuch as drugs, medications, alcohol, maternal illness or even family history? We Can Help! MotherToBaby North Texas Part of the Texas Teratogen Information Service 1-800-733-4727 Trained Teratology Information Specialists withover 25 years of experience!!

3. Birth defects can happen to anyone. Babies with birth defects are born to people of all ages, races, & income levels.

4. 3 – 5% General population risk for birth defects.

5. Some Birth Defects and Developmental Disabilities can be PREVENTED

6. Teratogen Any exposure that can harm the unborn baby. In some cases, a maternal condition such as diabetes can be the “teratogen”.

7. Lets talk about the timing of the exposure: “All or none Stage”: Weeks 1 to 4 past LMP A teratogen exposure can result in fetal death and loss of pregnancy.

8. Organogenesis: Weeks 5 to 12 past LMP • Months two and three – possible increased risk for birth defects from many different exposures. • Such as medications, alcohol and illegal substances. • The percentage of possible increased risk is going to vary depending on the dosage, timing, etc. • Always the chance that the baby was not affected is going to be greater than the chance that the baby was affected.

10. Fetus: Weeks 13 to 40 past LMP Teratogen exposure: May increase the risk for CNS abnormalities, learning problems, ADD, ADHD, mental retardation, and growth issues (low birth weight, small size).

11. Variability • Dose • Timing (Embryology) • Host susceptibility/genetics • Other environmental factors?

12. Hazards to the Fetus • Infectious agents • Alcohol • Drugs • Chemicals • Maternal factors

13. Drugs and Chemicals Prescription- Antidepressants Anticonvulsants Nonprescription- Cigarettes, alcohol, over-the-counter meds Street drugs- Cocaine, Amphetamines Marijuana Environmental- Methyl Mercury

14. Methamphetamine use… • Increased risk for miscarriages • Possible small birth defect risk, only with heavy use • Learning problem risk about 10% with moderate use • Significant learning problems possible with daily use • Possible temporary withdrawal type issues in the baby

15. Fetal Alcohol Syndrome (FAS)

16. The rate of fetal alcohol syndrome in the U.S. is about 1 to 3 cases per 1,000 live births.

17. Diagnosis of Fetal Alcohol Syndrome Necessary criteria: Abnormalities must be in allthreeareas for the diagnosis of FAS to be made: Prenatal and/or postnatal growth retardation Central nervous system involvement Characteristic facial dsymorphology Only occurs with heavy alcohol use during pregnancy, 5 – 6 or more drinks frequently.

19. Fetal Alcohol Spectrum Disorder (FASD), Fetal Alcohol Effect (FAE ) or Alcohol Related Learning Problems Moderate drinking, 2 to 4 drinks frequently, about 10% risk.

20. Fetal Cocaine Exposure Birth defects, miscarriages, learning problems…

21. Various levels of use and risk: • Cocaine use in the first trimester – small increased risk for birth defects, specifically heart and limb, 1-2% • With light to moderate use in the 2nd and 3rd trimesters – one to four times a month – increased risk for learning problems, about 10 to 15% risk. • With heavy use in the 2nd and 3rd trimesters, daily or most days, up to about a 30% increased risk for significant learning problems and mental retardation. Also early delivery and a smaller baby. Withdrawal type issues after birth possible.

22. Marijuana and Cigarettes

23. The Division of Reproductive Health of the Center for Disease Control states that 1 in 6 low birthweight births are preventable since they are associated with prenatal smoking.

24. 1% risk with heavy smokers Heavy smokers – About 20 cigarettes/day.Miscarriages, LBW, early delivery….

25. Inhalants • Gasoline • Glue • Paint thinner • Spray Paint • Hairspray • White Out • Dust Off 1st trimester – miscarriages 2nd & 3rd trimesters – learning problems

26. Antidepressant use in pregnancy • Prozac • Paxil • Xanax • Celexa • Lexapro • Zoloft No major birth defects with most, no known learning problems, 1 to 2 week early delivery possible, some temporary withdrawal at birth in about 40% of the babies.

27. Maternal Infections Viruses – Rubella, CMV, Herpes, Varicella, HIV Bacteria – Syphillis Parasites – Toxoplasmosis Most worried about first time, primary infection.

28. Toxoplasmosis

29. Maternal conditions and family history • Obesity • Diabetes (Juvenile) • Severe Asthma • ADHD/ADD • Lupus/arthritis • Bipolar disorder • Epilepsy • Learning disorders

30. Hyperthermia Over 102 degrees F, 1% risk for spinal bifida in 5th – 6th weeks of pregnancy. Learning problem risk with later exposures.

32. Pain medications: Aspirin and ibuprofen – No during pregnancy – blood thinners Tylenol (Acetaminophen) – Yes Hydrocodone/codeine – some possible risks.

33. Caffeine content of select common food and drugs • ProductServing sizeCaffeine per serving (mg) Caffeine tablet (Vivarin) 1 tablet 200 • Coffee, brewed (8 fl oz) 135* • Coffee, decaffeinated (8 fl oz) 5* • Coffee, espresso (2 fl oz) 100* • Chocolate, Dark 1 bar (43 g; 1.5 oz) 31 • Chocolate, Milk 1 bar (43 g; 1.5 oz) 10 • Red Bull (8.2 fl oz) 80 • Soft drink, Coca-Cola Classic (12 fl oz) 34 • Tea, green (8 fl oz) 15 • Tea, leaf or bag (8 fl oz) 50 • Estimated average caffeine content per serving. Actual content varies according to preparation. • Some Caffeine during pregnancy is OK! • Less than 200 to 300 mg per day has no known risk.

34. Artificial Sweeteners – OK during pregnancy!

35. Diagnostic X-Rays Fetal Doses of ionizing radiation: Dental X-Ray: 0.01 mrad Chest X-Ray: 60.0 mrad “Background” radiation: 100.0 mrad Over over the course of 9 months.

36. Microwaves – No known risks during pregnancy.

37. Video Display Terminals – OK!

38. Paternal Exposures – only known risks are for infertility and early SAB’s – no known risks for birth defects from Dad’s exposures.

39. MotherToBaby North Texas Texas Teratogen Information Service Call 800-733-4727 Text 855-999-3525 LWOLFE@UNT.EDU