Pregnancy Week by Week : Week 4 (part 2) - Your Nutrition, Environmental Pollutants and Pregnancy

Information about the effects of a specific medication or drug on a pregnancy comes from cases of exposure before the pregnancy was discovered. These “case reports” help researchers understand possible harmful effects but leave gaps in our knowledge. For this reason, it can be difficult to make exact statements about a particular substance and its effect.

If you use drugs, be honest with your healthcare provider. Tell him or her about anything you take or have taken that may affect your baby. The victim of drug use is your baby. A drug problem may have serious consequences that can be best dealt with if your healthcare provider knows about your drug use in advance.

5. Your Nutrition

You probably won’t be able to eat all you want during pregnancy, unless you are one of the lucky women who doesn’t have a problem with calories. Even then, you must pay strict attention to the types of foods you choose.

Eat nutritious foods. Avoid those with empty calories (lots of sugar and fat). Choose fresh fruits and vegetables. Avoid caffeine when possible. We discuss many of these subjects in later weeks.

Effects of Various Substances
on Fetal Development

Many substances can affect your baby’s early development. Below is a list of various substances and their effects on a developing fetus.

Substance	Possible Effects on Your Baby
Alcohol	fetal abnormalities, fetal alcohol disorders, intrauterine-growth restriction (IUGR)
Amphetamines	placental abruption, IUGR, fetal death
Androgens male	ambiguous genital development (depends on dose given and when given)
Angiotensin-converting enzyme (ACE) inhibitors (enalapril, captopril)	fetal and neonatal death
Anticoagulants	bone and hand abnormalities, IUGR, central-nervous-system and eye abnormalities
Antithyroid drugs (propylthiouracil, iodide, methimazole)	hypothyroidism, fetal goiter
Barbiturates	possible birth defects, withdrawal symptoms, poor eating habits, seizures
Benzodiazepines (including Valium and Librium)	increased chance of congenital malformations
Caffeine	decreased birthweight, smaller head size, breathing problems, sleeplessness, irritability, jitters, poor calcium metabolism, IUGR, mental retardation, microcephaly, various major malformations
Carbamazepine	birth defects, spina bifida
Chemotherapeutic drugs (methotrexate, aminopterin)	increased risk of miscarriage
Cocaine/crack	miscarriage, stillbirth, congenital defects, severe deformities in a fetus, long-term mental deficiencies, sudden infant death syndrome (SIDS)
Coumadin derivatives (warfarin)	hemorrhage (bleeding), birth defects, an increase in miscarriage and stillbirth
Cyclophosphomide	transient sterility
Diethylstilbestrol (DES)	abnormalities of reproductive organs (females and males), infertility
Ecstasy	long-term learning problems, memory problems
Folic-acid antagonists (methotrexate, aminopterin)	fetal death and birth defects
Glues and solvents	birth defects, including shortened stature, low birthweight, small head, joint and limb problems, abnormal facial features, heart defects
Iodine-131 (after 10 weeks)	adverse effects of radiation, growth restriction, birth defects
Isotretinoin (Accutane)	increased miscarriage rate, nervous-system defects, facial defects, cleft palate
Ketamine	behavioral problems, learning problems
Lead	increased miscarriage and stillbirth rates
Lithium	congenital heart disease
Marijuana and hashish	attention-deficit disorder (ADD), attention-deficit hyperactivity disorder (ADHD), memory problems, impaired decision-making ability
Methamphetamines	IUGR, difficulty bonding, tremors, extreme fussiness
Misoprostol	skull defects, cranial-nerve palsies, facial malformations, limb defects
Nicotine	miscarriage, stillbirth, neural-tube defects, low birthweight, lower IQ, reading disorders, minimal-brain dysfunction syndrome (hyperactivity)
Opioids (morphine, heroin, Demerol)	congenital abnormalities, premature birth, IUGR, withdrawal symptoms in baby
Organic mercury	cerebral atrophy, mental retardation, spasticity, seizures, blindness
PCBs	possible neurological problems
Phenytoin (Dilantin)	IUGR, microcephaly
Progestins (high dose)	masculinization of female fetus
Streptomycin	hearing loss, cranial-nerve damage
Tetracycline	hypoplasia of tooth enamel, discoloration of permanent teeth
Thalidomide	severe limb defects
Trimethadione	cleft lip, cleft palate, IUGR, miscarriage
Valproic acid	neural-tube defects
Vitamin A and derivatives (isotretinoin, etritinate, retinoids)	fetal death and birth defects
X-ray therapy	microcephaly, mental retardation, leukemia

(Modified from A.C.O.G. Technical Bulletin 236, Teratology, American College of Obstetricians and Gynecologists)

You Should Also Know

Weight Gain

You must be prepared to gain weight. It’s necessary for your health and the health of your growing baby. Getting on the scale and seeing your weight rise may be very hard for you. Recognize now it’s OK to gain weight. You don’t have to let yourself go; control your weight by eating carefully and nutritiously. But you need to gain enough weight to meet the needs of your pregnancy.

You may be eating for two during pregnancy, but you don’t have to eat twice as much, just twice as smart!

Many years ago, women were not allowed to gain much weight—sometimes only 12 to 15 pounds for their entire pregnancy! Today, we know restricting weight gain to this extent is not healthy for the baby or the mother-to-be.

However, you shouldn’t gain too much weight. Researchers have found that normal-weight women who gained more than 38 pounds during pregnancy with one baby were at higher risk for developing breast cancer after menopause. Not shedding those extra pounds after pregnancy also contributed to a higher risk.

The amount of weight you gain during the first trimester has been tied to the size of your baby at birth. If you gain a lot of weight during the first trimester, your baby may be big. On the other hand, if you don’t gain very much weight in early pregnancy, you may have a smaller baby.

6. Environmental Pollutants and Pregnancy

An environment that is healthful for you will be healthy for your developing baby. Some environmental pollutants may be harmful to you and baby. It’s important to avoid exposure to them.

There isn’t much clear information on the safety of many chemicals. It’s best to avoid exposure when possible, but it may not be possible to keep away from every chemical. If you know you’ll be around various chemicals, wash your hands well before eating. Not smoking cigarettes also helps. If you have a dog or cat that wears a flea collar, don’t touch the collar.

Some latex paints contain lead. You may not want to use some oil-based paints and some solvents. Solvents are chemicals that dissolve other substances. Read labels.

Drinking water may contain lead if your home has brass faucets, lead pipes or lead solder on copper pipes. You can call your state health department and ask them to test your water. Run water for 30 seconds before you use it to reduce levels of lead; cold water contains less lead than hot water.

If you use crystal goblets, they contain lead. Some scented candles have wicks that contain lead. You could increase your exposure to lead with either.

Arsenic may be hiding outdoors in your back yard—furniture, decks and play sets made from pressure-treated lumber may be preserved with chromated copper arsenate. Wash your hands thoroughly after you’ve been outside, and cover picnic tables with tablecloths when you eat on them. Apply a polyurethane sealant once a year.

Some Pollutants to Avoid during Pregnancy

The toxicity of lead has been known for centuries. In the past, most lead exposure came from the atmosphere. Today, exposure comes from many sources, including water pipes, solders, storage batteries, construction materials, paints, dyes and wood preservatives.

Lead is easily transported across the placenta to the baby. Toxicity can occur as early as the 12^th week of pregnancy, which could result in lead poisoning in the baby. If you might be exposed to lead in your workplace, discuss it with your physician.

Mercury has a long history as a potential poison to a pregnant woman. Reports of fish contaminated with mercury have been linked to cerebral palsy and microcephaly.

Our environment has been significantly contaminated with PCBs (polychlorinated biphenyls). PCBs are mixtures of several chemical compounds. Most fish, birds and humans now have measurable amounts of PCB in their tissues. This is one reason to limit your intake of fish during pregnancy.

Pesticides cover a large number of agents used to control unwanted plants and animals. Human exposure is common because pesticides are used extensively. Those of most concern contain several agents—DDT, chlordane, heptachlor, lindane and others.

7. Do You Take Paxil?

If you take the antidepressant Paxil, discuss its use with your healthcare provider immediately. You may need to start other treatment options early in pregnancy. But don’t stop taking any antidepressant medication without consulting your healthcare provider.

Paxil belongs to a class of medications called selective serotonin reuptake inhibitors, sometimes abbreviated as SSRIs. There is continued concern about the safety of Paxil during pregnancy. Paxil use in the first and third trimesters may put your baby at risk.

Certified Nurse-Midwives, Advance-Practice Nurses and Physician Assistants

In today’s obstetric-and-gynecology medical practices, you may find many types of highly qualified people taking care of you. These people—mostly women, but not all!—are on the forefront in guiding couples through pregnancy to delivery.

In a normal, uncomplicated pregnancy, many or most of your prenatal visits may be with a certified nurse-midwife, advance-practice nurse or physician assistant, not the doctor. This may include labor and delivery. Most women find this is a good thing—often these healthcare providers have more time to spend with you answering questions and addressing your concerns.

A certified nurse-midwife (CNM) is an advance-practice registered nurse (RN). He or she has received additional training delivering babies and providing prenatal and postpartum care to women. A CNM works closely with a doctor or team of healthcare providers to address specifics about a particular pregnancy, and labor and delivery. Often a CNM delivers babies.

A certified midwife can provide many types of information to a pregnant woman, such as guidance with nutrition and exercise, ways to deal with pregnancy discomforts, tips for managing weight gain, dealing with various pregnancy problems and discussions of different methods of pain relief for labor and delivery. A CNM can also address issues of family planning and birth-control and other gynecological care, including breast exams, Pap smears and other screenings. In some cases, a CNM may prescribe medications.

An advance-practice nurse (APN) is an advance-practice registered nurse (RN). He or she has received additional training providing prenatal and postpartum care to women. An advance-practice nurse may work with a doctor or work independently to address specifics about a woman’s pregnancy, and labor and delivery.

An APN can provide many types of information to a pregnant woman, such as guidance with nutrition and exercise, ways to deal with pregnancy discomforts, tips for managing weight gain, dealing with various pregnancy problems and discussions of different methods of pain-relief for labor and delivery. He or she can also address issues of family planning and birth-control and other gynecological care, including breast exams, Pap smears and other screenings. A nurse practitioner may prescribe medications or provide pain relief during labor and delivery (as a certified registered nurse anesthetist [CRNA]).

A physician assistant or physician associate (PA) is licensed to practice medicine with the supervision of a licensed doctor. A PA’s focus is to provide many health-care services traditionally done by a doctor. Most PAs work in doctors’ offices, clinics or hospitals.

Physician assistants care for people who have conditions (pregnancy is a condition they see women for), diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, write prescriptions and do physical exams. A PA is not a medical assistant, who performs administrative or simple clinical tasks.