Even women contemplating conceiving have plenty to think about these days.
Whether you’re planning to get pregnant or already are, the headlines about the Zika virus and the government’s new zero-alcohol recommendation may have you wondering about how best to keep your baby (and yourself) safe. Beyond the basics – taking prenatal vitamins, managing stress and limiting caffeine – what do you need to do these days to have the healthiest possible pregnancy?
The ideal way to avoid exposing a developing baby to potential harm would be for the pregnancy to be planned, says Dr. Jeffrey Ecker, chief of obstetrics and gynecology atMassachusetts General Hospital. But since half of pregnancies aren’t, it’s best to take certain steps if conceiving is even a possibility: defend against Zika. With the discovery of Zika-carrying mosquitoes in southern Florida this summer and the expectation that they could arrive in force in parts of the U.S., it’s smart to stay alert for updates from the Centers for Disease Control and Prevention. Besides microcephaly (a smaller than expected head due to abnormal brain development), the virus has been linked with other brain defects in the babies of mothers infected during pregnancy, and with miscarriage. You’ll want to both avoid exposure to the infected bugs and be aware that Zika can be transmitted during sex with an infected man. Several drugmakers are working on developing a vaccine, but it’ll be a few years before one is available.
The CDC advises women who are pregnant or contemplating pregnancy avoid traveling to areas with Zika. (Updated notices of hotspots can be found at wwwnc.cdc.gov/travel.) In fact, “both the woman and her partner should avoid travel to Zika endemic areas,” says Dr. Neil Silverman, a spokesperson for the American College of Obstetricians and Gynecologists and a professor of obstetrics and gynecology at the UCLA School of Medicine.
If a man has traveled to a place where Zika is present, condoms should be used for eight weeks after his return even if he doesn’t develop the telltale symptoms: fever, rash, joint pain, conjunctivitis. If he does, condoms should be used for six months. If you live in or must travel to an infected area, wear long sleeves and pants and use insect repellents that contain the chemicals DEET (20 percent concentration) or picaridin, Silverman says. Women who are infected when not pregnant will likely develop an immunity that will protect future pregnancies, the CDC says.
Go alcohol-free. Having a cocktail or glass of wine per week was once thought to pose little risk. Those days are gone. Earlier this year, the CDC called for a zero-tolerance policy during pregnancy, recommending that even women trying to conceive not partake. The reason: It has become clear that many children – perhaps 1 in 20 – are affected by fetal alcohol spectrum disorders that create issues from low birth weight and heart ailments to intellectual disabilities and attention and behavioral problems. Plus some research suggests alcohol can increase the risk of miscarriage, stillbirth or premature birth.
While “there’s no need to panic if you find out you’re pregnant and you already had three glasses of wine,” says Ecker, “what the CDC is saying is: We can’t define a lower limit that is safe.”
Get a flu vaccination. The medical guidelines advise anyone 6 months old or older to get a vaccination, but half of pregnant women don’t bother. “This is an ongoing source of frustration for those of us on the front lines of the vaccination effort,” says Silverman. The shot is “absolutely safe” for mother and baby, he says, and pregnant women who get the flu are at increased risk of pneumonia and death. And a new Australian study found that the vaccine is associated with a 51 percent lower risk of stillbirth.
Keep moving. Because pregnancy is a significant contributor to obesity in women, ACOG issued guidelines last December calling for at least 20 to 30 minutes of moderate-intensity aerobic exercise per day, plus moderate strength training two or three times per week. Besides assisting with weight control, the regimen should reduce the risk of gestational diabetes.
“In the past we said: Pregnancy is not a good time to change lifestyle. But it’s the best time for behavior modification,” says Dr. Raul Artal, professor and chairman emeritus of obstetrics/gynecology and women’s health at Saint Louis University and lead author of the guidelines. “Women have more access to medical care and supervision” than they do at any other time in their lives.
Of course, it’s important to get the green light from your obstetrician. Assuming you do, walking, jogging, swimming, stationary cycling, modified yoga, low-impact aerobics and cardio machines are good choices.
Eat good fish. Both ACOG and the Food and Drug Administration recommend that women eat 8 to 12 ounces of fish each week to give their developing babies much-needed omega-3 fatty acids. But certain fish contain unsafe levels of mercury, a neurotoxin known to be harmful to developing brains. Now a 2016 study from the Environmental Working Group has ratcheted up this concern: After testing hair samples of 254 women of childbearing age who reported eating that much fish (or more) per week, researchers found that nearly 30 percent had higher than safe levels of mercury; almost 60 percent exceeded what some experts deem to be a protective upper limit.
So what’s an expectant mother to do? “You can get a win-win benefit from eating the right fish – wild salmon, sardines and rainbow trout, which are high in omega-3s and low in mercury,” says Tracey Woodruff, a professor in the department of obstetrics and gynecology and director of the Program on Reproductive Health and the Environment at the University of California–San Francisco. Steer clear of large predatory fish such as swordfish, tilefish, shark and king mackerel, which tend to have the highest mercury concentrations. You can also increase your intake of omega-3 fatty acids by eating walnuts, flaxseed, chia seeds, or boiled or roasted soybeans.
Think twice about antidepressants. A couple of studies have suggested that pregnancy might be a reason to think about suspending or postponing antidepressant use. Researchers at the University of Montreal examined the records of more than 145,000 births and found that expectant mothers who took selective serotonin reuptake inhibitors during the second and/or third trimester had a twofold higher risk of giving birth to a child with an autism spectrum disorder, though the risk measured was still small. It rose from just under 1 percent in the general population to 2.17 percent. Meanwhile, a 2013 JAMA Psychiatry review of the research found an increased risk of preterm delivery and lower birth weight.
On the other hand, depression is very common during pregnancy and can be debilitating, says senior study author Anick Bérard, a professor of perinatal epidemiology at the University of Montreal. So a talk with your doctor is in order.
For mild to moderate depression, psychotherapy plus an exercise program might be sufficient. For moderate to severe depression, or when other approaches haven’t worked, medication in combination with psychotherapy may be appropriate, says Dr. Elizabeth Fitelson, an assistant professor of psychiatry at Columbia University Medical Center.
“You’re weighing risk against risk, because untreated maternal depression affects kids’ emotional and cognitive development,” she says. And it can take a real toll on family relationships.