What to expect when you're expecting (196 page)

Though the chances of your becoming infected are slim if you aren’t immune, an injection of varicella-zoster immune globulin (VZIG) within 96 hours of a documented personal exposure (in other words, direct contact with someone who has been diagnosed with chicken pox) may be recommended. It isn’t clear whether or not this will protect the baby should you come down with chicken pox anyway, but it should minimize complications for you—a significant plus, since this mild childhood disease can be quite severe in adults. If you should be hit with a severe case, you may be given an antiviral drug to further reduce the risk of complications.

If you become infected during the first half of your pregnancy, the chances are very low (around 2 percent) that your baby could develop a condition called congenital varicella syndrome, which can cause some birth defects. If you come down with chicken pox later in your pregnancy, there’s almost zero danger to the baby. The exception is if you get chicken pox just before (within a week of) giving birth or just after delivery. In that extremely unlikely scenario, there’s a small chance your newborn will arrive infected and will develop the characteristic rash within a week or so. To prevent neonatal infection, your baby will be given an infusion of chicken pox antibodies immediately after delivery (or as soon as it becomes apparent that you’ve been infected postpartum).

Incidentally, shingles, or herpes zoster, which is a reactivation of the chicken pox virus in someone who had the disease earlier, does not appear to be harmful to a developing fetus, probably because the mother and thus the baby already have antibodies to the virus.

If you are not immune and escape infection this time, ask your doctor about getting immunized after delivery, to protect any future pregnancies. Immunization should take place at least a month before any new conception.

“I live in an area that’s high risk for Lyme disease. Is Lyme dangerous when you’re pregnant?”

Lyme disease is most common among those who spend time in woods frequented by deer, mice, or other animals carrying deer ticks, but it can also be picked up in forest-free cities via greenery brought from the country or purchased at a farmers’ market.

The best way to protect your baby—as well as yourself—is by taking preventive measures. If you are out in woodsy or grassy areas, or if you are handling greenery grown in such areas, wear long pants, tucked into boots or socks, and long sleeves; use an insect repellent effective for deer ticks on your clothing. When you return home, check your skin carefully for ticks. If you find one, remove it right away by pulling straight up on it with tweezers; then drop it into a small bottle and have it tested by your doctor (removing a tick within 24 hours almost entirely eliminates the possibility of infection).

If you’ve been bitten by a tick, see your doctor immediately; a blood test may be able to determine whether you are infected with Lyme. (Early symptoms may include a blotchy bull’s-eye rash at the bite site, fatigue, headache, stiff neck, fever and chills, generalized achiness, swollen glands near the site of the bite; later symptoms may include arthritis-like pain and memory loss.)

Fortunately, studies have shown that prompt treatment with antibiotics completely protects a baby whose mother is infected with Lyme—and keeps mom from becoming seriously ill.

“One of the toddlers in the child-care center where I work was just diagnosed as having hepatitis A. If I get it, could it affect my pregnancy?”

Hepatitis A is very common, almost always a mild disease (often with no noticeable symptoms), and rarely passed on to a fetus or newborn. So even if you did catch it, it shouldn’t affect your pregnancy. Still, you’re better off not contracting an infection of any kind in the first place. So take precautions: Be sure to wash your hands after changing diapers or taking your young charges to the bathroom (hepatitis A is passed by the fecal-oral route), and be sure to wash up well before eating. You might also want to ask your physician about immunization against hepatitis A.

“I’m a carrier of hepatitis B and just found out that I’m pregnant. Will my being a carrier hurt my baby?”

Knowing that you’re a carrier for hepatitis B is the first step in making sure your condition won’t hurt your baby. Because this liver infection can be passed on from mother to baby during delivery, prompt steps will be taken at your baby’s birth to make sure that doesn’t happen. Your newborn will be treated within 12 hours with both hepatitis B immune globulin (HBIG) and the hepatitis B vaccine (which is routine at birth anyway). This treatment can almost always prevent the infection from developing. Your baby will also be vaccinated at one or two months and then again at six months (this, too, is a routine part of the hepatitis B series), and may be tested at 12 to 15 months to be sure the therapy has been effective.

“Should I be worried about hepatitis C during pregnancy?”

Hepatitis C can be transmitted from infected mother to child during delivery, with a transmission rate of about 7 to 8 percent. But because hep C is usually transmitted via blood (for instance, through past transfusions or illegal drug injections), unless you’ve had a transfusion or are in a high- risk category, it’s unlikely you’d be infected. The infection, if diagnosed, can potentially be treated, but not during pregnancy.

“I woke up this morning with pain behind my ear, and my tongue felt numb. When I looked in the mirror, the whole side of my face looked droopy. What’s going on?”

It sounds like you’ve got Bell’s palsy, a temporary condition caused by damage to the facial nerve, resulting in weakness or paralysis on one side of the face. Bell’s palsy strikes pregnant women three times more often than it does women who are not pregnant (though it’s quite uncommon in general) and most often occurs in the third trimester or in the early postpartum period. Its onset is sudden, and most people with the condition—like you—wake up without warning to find their face drooping.

The cause of this temporary facial paralysis is unknown, though experts suspect that certain viral or bacterial infections may cause swelling and inflammation of the facial nerve, triggering the condition. Other symptoms sometimes accompanying the paralysis include pain behind the ear or in the back of the head, dizziness, drooling (because of the weak muscles), dry mouth, inability to blink, impaired sense of taste and tongue numbness, even impaired speaking in some cases.

The good news is that Bell’s palsy will not spread beyond your face and won’t get worse. More good news: Most cases completely resolve within three weeks to three months without treatment (though for some it can take as long as six months to completely go away). And the best news of all: The condition poses no threat to to your pregnancy or your baby. Though you should definitely put a call in to your practitioner, chances are treatment won’t be necessary.

Medications During Pregnancy

Open any prescription or over-the-counter drug insert and read the fine print. Virtually all will warn against pregnant women using medications without a doctor’s advice. Still, if you’re like the average expectant mom, you’ll wind up taking at least one prescription drug during your pregnancy and even more over-the-counter medications. How will you know which are safe and which aren’t?

No drug—prescription or over-the-counter, traditional or herbal—is 100 percent safe for 100 percent of the people, 100 percent of the time. And when you’re pregnant, there’s the health and well-being of two people, one very small and vulnerable, to consider every time you take a drug. Happily, only a few drugs are known to be harmful to a developing fetus, and many drugs can be used safely during pregnancy. In fact, in certain situations, using a medication during pregnancy is absolutely necessary.

It’s always wise to weigh the potential risks of taking a medication against the potential benefits it will provide, but never more so than during pregnancy. Involving your practitioner in the decision of whether or not to take a drug is a good idea in general, but when you’re pregnant, it’s essential. So check with your practitioner before taking any medication while you’re expecting, even an over-the-counter drug you’ve used routinely in the past.

One of the tools your practitioner will use to determine the safety of a particular medication is the five-letter rating (A, B, C, D, or X) set up by the Food and Drug Administration to determine whether a drug poses a risk to a fetus. Categories A and B drugs are thought to be generally safe, with those in the A category having undergone controlled studies that showed no risk to the fetus, and those in the B category shown to have no risk to animals or no risk to humans even if animal studies showed an adverse effect. Category C means that the data is inconclusive. The other categories (D and X) are given to drugs that have a demonstrated risk to the fetus (though in some rare life-threatening cases, doctors may prescribe a Category D drug because the risk to the mother—if she doesn’t take the drug—is too great). Still, this system is far from perfect since the FDA doesn’t require drug manufacturers to conduct long-term studies on pregnant women, for obvious reasons.

Still confused about the ABCs of medications during pregnancy? Here’s the bottom line: Never take any drug—prescription, over-the-counter, or herbal—without talking to your doctor or midwife first.

A number of medications are considered safe for pregnant women to take, and these medications can be a welcome relief if you’re down and out with a stuffy nose or a pounding headache. Other medications are not recommended in most cases—though in certain cases they may be okayed, such as after the first trimester or for a specific problem. And many medications are completely off-limits when you’re expecting. Here’s the lowdown on some of the more common medications you may come across during pregnancy:

Tylenol.
Acetaminophen is usually given the green light for short-term use during pregnancy, but be sure to ask your practitioner for the proper dosage before taking it for the first time.

Aspirin.
Your practitioner will probably advise that you not take aspirin—especially during the third trimester, since it increases the risk for potential problems for the newborn, as well as complications before and during delivery, such as excessive bleeding. Some studies suggest that very low dosages of aspirin may help to prevent preeclampsia in certain circumstances, but only your practitioner will be able to tell you whether it should be prescribed in your case. Other studies suggest that low-dose aspirin, in combination with the blood-thinning medication heparin, may reduce the incidence of recurrent miscarriage in some women with a condition known as antiphospholipid antibody syndrome. Again, only your practitioner can let you know if these medications are safe for you and under what circumstances.

Advil or Motrin.
Ibuprofen should be used with caution in pregnancy, especially during the first and third trimesters, when it can have the same negative effects as aspirin. Use it only if it’s specifically recommended by a physician who knows you are pregnant.

Aleve.
Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is not recommended for use in pregnancy at all.

Nasal sprays.
For short-term relief from a stuffy nose, most nasal sprays are fine to use. Check with your practitioner for his or her preferred brand and dosing suggestions. Saline sprays are always safe to use, as are nasal strips.

Antacids.
Heartburn that won’t quit (you’ll have plenty of that) often responds to Tums or Rolaids (plus you’ll get a dose of calcium to boot). But check with your practitioner for the right dosage.

Gas aids.
Many practitioners will okay gas aids, such as Gas-X, for the occasional relief of pregnancy bloat, but check with yours first.

Antihistamines.
Not all antihistamines are safe during pregnancy, but several will probably get the green light from your practitioner. Benadryl is the most commonly recommended antihistamine during pregnancy. Claritin is also considered safe, but check with your practitioner, because not all will give it the okay, particularly in the first trimester. Many practitioners allow the use of chlorpheniramine (Chlor-Trimeton) and triprolidine on a limited basis.

Sleep aids.
Unisom, Tylenol PM, Sominex, Nytol, Ambien, and Lunesta are generally considered safe during pregnancy, and they are okayed by many practitioners for occasional use. Always check with your practitioner before taking these or any sleep aids.

Decongestants.
Sudafed is considered the safest oral decongestant if you must use one during pregnancy, as long as it’s used in a limited amount. Be sure to check with your practitioner first and to get the right dosage information.