The use of ultrasound imaging devices for producing fetal keepsake videos is viewed as an unapproved use by the Food and Drug Administration (FDA). Doppler ultrasound heartbeat monitors are not intended for over-the-counter (OTC) use. Both products are approved for use only with a prescription.

"Although there are no known risks of ultrasound imaging and heartbeat monitors, the radiation a.s.sociated with them can produce effects on the body," says Robert Phillips, Ph.D., a physicist with FDA's Center for Devices and Radiological Health (CDRH). "When ultrasound enters the body, it heats the tissues slightly. In some cases, it can also produce small pockets of gas in body fluids or tissues."

Phillips says the long-term effects of tissue heating and of the formation of partial vacuums in a liquid by high-intensity sound waves (cavitation) are not known.

Using ultrasound equipment only through a prescription ensures that pregnant women will receive professional care that contributes to their health and to the health of their babies, and that ultrasound will be used when medically indicated.

Fetal Keepsake Videos "Performing prenatal ultrasounds without medical oversight may put a mother and her unborn baby at risk," says Phillips. "The bottom line is: Why take a chance with your baby's health for the sake of a video?"

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Pregnancy and Birth Sourcebook, Third Edition Fetal keepsake videos are viewed as a problem because there is no medical benefit derived from the exposure. Further, there is no control on how long a single imaging session will take or how many sessions will occur.

FDA is aware of entrepreneurs that are commercializing ultrasonic imaging of fetuses by making keepsake videos. In some cases, the ultrasound machine may be used for as long as an hour to get a video of the fetus.

Doppler Ultrasound Heartbeat Monitors Similar concerns surround the OTC sale of Doppler ultrasound heartbeat monitors. These devices, which people use to listen to the heartbeat of a fetus, are currently marketed legally as "prescription devices" that should only be used by or under the supervision of a health care professional.

"When the product is purchased over the counter and used without prior consultation with a health care professional, there is no oversight of how the device is used and little or no medical benefit derived from the exposure," Phillips says. "The number of sessions or the length of a session to which a fetus is exposed is uncontrolled, thus raising the potential for harm to the fetus."

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Prenatal Radiation Exposures and Home Monitoring Section 28.3 Home Uterine Monitors Not Useful for Predicting Premature Birth From "Home Uterine Monitors Not Useful For Predicting Premature Birth," by the National Inst.i.tute of Child Health and Human Development (NICHD, www.nichd.nih.gov), updated July 25, 2006.

Portable monitors that detect contractions of the uterus do not appear to be useful for identifying women likely to have a preterm delivery, according to a study by the National Inst.i.tute of Child Health and Human Development (NICHD).

Although they are widely prescribed for women at risk of giving birth prematurely, the NICHD study confirms earlier findings that the monitors are not useful for predicting or preventing preterm birth.

The study also confirmed that several other methods being a.s.sessed as ways to predict preterm labor were of little value.

"The study found that while women who gave birth prematurely did have slightly more contractions throughout pregnancy than did women who gave birth at term, there was no detectable pattern that would predict premature birth," said Duane Alexander, MD, Director of the NICHD.

The study was conducted at the 11 centers partic.i.p.ating in the NICHD Network of Maternal-Fetal Medicine Units and appears in the January 25 [2002] New England Journal of Medicine. New England Journal of Medicine. The study was led by Jay Iams, MD, director of the Division of Maternal-Fetal Medicine at the Ohio State University Medical Center. The study was led by Jay Iams, MD, director of the Division of Maternal-Fetal Medicine at the Ohio State University Medical Center.

The portable, or ambulatory, monitors cost up to $100 a day and may be worn for up to 10 weeks. The monitors relay information to a central monitoring office, where any potential signs of early labor can be pa.s.sed on to a physician.

The researchers a.n.a.lyzed 34,908 hours of recordings from 306 women. When the women began the study, they were in their 22nd through 24th week of pregnancy. The authors wrote that the women who gave birth before the 35th week of pregnancy had a slightly greater frequency of contractions than did the women who gave birth 245 Pregnancy and Birth Sourcebook, Third Edition after the 35th week, but this information did not allow them to predict impending premature labor. A pregnancy is considered full term at 37 weeks.

"We could identify no threshold frequency that effectively identified women who delivered preterm infants," the study authors wrote in the New England Journal of Medicine New England Journal of Medicine article. article.

The researchers also found little value of some other techniques in predicting preterm labor, including measuring the cervix and collecting a substance known as fetal fibronectin from the cervix.

"Our data indicate that ambulatory monitoring of uterine contractions does not identify women destined to have preterm delivery," the authors wrote.

Preterm birth complicates from 8 to 10 percent of all births, said Catherine Spong, MD, Chief of NICHD's Pregnancy and Perinatology Branch and coordinator of the Maternal-Fetal Medicine Units. Premature infants are at greater risk for life-threatening infections, for a serious lung condition known as respiratory distress syndrome, and for serious damage to the intestines (necrotizing enterocolitis). Most deaths of premature infants occur among those born before the 32nd week of pregnancy. In addition, the cost of caring for premature infants in the United States exceeds $4 billion each year.

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Chapter 29.

Common Safety Concerns during Pregnancy Chapter Contents.Section 29.1-Hot Tubs, High Temperatures, and Pregnancy Risks .................................................. 248 Section 29.2-Pregnancy and Chiropractic Care ...................... 252 Section 29.3-Hair Treatment during Pregnancy .................... 255 Section 29.4-Tanning during Pregnancy ................................. 259 247.

Pregnancy and Birth Sourcebook, Third Edition Section 29.1 Hot Tubs, High Temperatures, and Pregnancy Risks "Hyperthermia and Pregnancy," 2006 Organization of Teratology Information Services (OTIS). Reprinted with permission. Member programs of OTIS are located throughout the U.S. and Canada. To find the Teratogen Information Service in your area, call OTIS toll-free 866-626-OTIS (866-626-6847), or visit www.otispregnancy.org.

This information talks about the risks that hyperthermia can have during pregnancy. With each pregnancy, all women have a 3% to 5% chance of having a baby with a birth defect. This information should not take the place of medical care and advice from your health care provider.

What is hyperthermia?

Hyperthermia refers to an abnormally high body temperature. A person's normal body temperature averages about 98.6 degrees Fahrenheit (37 degrees Celsius). In pregnancy, a body temperature of at least 101 degrees Fahrenheit (38.3 degrees Celsius) can be of concern.

However, most studies have not shown a concern until your temperature reaches 102 degrees Fahrenheit (38.9 degrees Celsius) or higher for an extended period of time.

What can cause hyperthermia?

Hyperthermia most often occurs from a fever due to illness. Extremely heavy exercise or prolonged exposure (longer than 10 minutes) to heat sources such as hot tubs, very hot baths, or saunas can also raise body temperature.

What effect does hyperthermia in early pregnancy have?

Some studies have shown an increased risk for birth defects called neural tube defects (NTD) in babies of women who had high temperatures early in pregnancy.

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Common Safety Concerns during Pregnancy Studies have suggested there may also be an increased risk for miscarriage. Possible a.s.sociations between high fever and birth defects such as heart defects and abdominal wall defects have been suggested. However, most studies did not find these results. The potential risk for these problems is small.

It is important to know what caused your fever during pregnancy.

Risks may be a.s.sociated with the cause of the fever, such as rubella infection, rather than from the fever itself. Please discuss any concerns you may have with your health care provider.

What is a neural tube defect?

Neural tube defects occur when the spine or skull does not close properly. About 1 to 2 out of every 1,000 births has a neural tube defect. An opening in the spinal column is called spina bifida. The majority of babies with spina bifida grow to adulthood. The most severe open skull defect is called anencephaly. Infants with anencephaly have a severely underdeveloped brain and usually die at or shortly after birth.

Babies with spina bifida may need surgery to close the opening.

While spina bifida can be of varying severity, most children will have some degree of paralysis and may have problems with walking and with bowel and bladder control. Some children with spina bifida may also develop hydrocephalus or "water on the brain." The very mildest form of spina bifida is covered by skin and causes no major problems.

When does the neural tube close?

The neural tube (which forms the spinal cord) is completely closed by the beginning of your 6th week of pregnancy (dating from the first day of your last menstrual period). After the neural tube has closed, a neural tube defect cannot occur. Therefore, if your high temperature occurs after the 6th week of pregnancy, the neural tube has already closed. Then, your pregnancy is not at an increased risk for this birth defect due to the hyperthermia.

I am 5 weeks pregnant and have a high fever. Can this hurt my baby?

There may be an increased risk for a neural tube defect if a woman has a fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher for an extended period of time during the first 6 weeks of pregnancy.

It is not possible to determine the exact risk. With an illness like the flu, it is often hard to separate the effects of a high temperature from 249 Pregnancy and Birth Sourcebook, Third Edition the other effects of an illness. You should contact your health care provider if you have a fever during pregnancy.

What testing is available for neural tube defects during my pregnancy?

Neural tube defects are detectable during pregnancy through a combination of ultrasound and alpha-fetoprotein (AFP) screening at approximately 1520 weeks. AFP screening is a blood test that measures the level of AFP in the mother's blood. This screen can detect 8090% of fetuses with open neural tube defects. Skin-covered neural tube defects are hard to detect during pregnancy.

Elevated levels of AFP in maternal blood indicate an increased risk for neural tube defects and suggest a need for further diagnostic testing, such as amniocentesis or a targeted ultrasound exam. Please talk to your health care provider if you have questions about these prenatal tests.

I have a fever of less than 101 degrees Fahrenheit (38.3 de- grees Celsius) and am pregnant. Is there a risk to my baby?

A temperature below 101 degrees Fahrenheit (38.3 degrees Celsius) does not appear to increase the risk for birth defects above that seen in any pregnancy. However, you should discuss with your health care provider whether the illness causing your fever poses a risk.

I have been using the hot tub and sauna. Is this a risk dur- ing my pregnancy?

Hot tub or sauna use during pregnancy should be limited to less than 10 minutes. This is because it may take only 10 to 20 minutes in a hot tub or sauna to raise your body temperature to 102 degrees Fahrenheit (38.9 degrees Celsius). You may not even feel uncomfortable at this temperature.

Although sauna use alone has not been as strongly a.s.sociated with an increased risk for neural tube defects, the same safety measures are recommended. If you were in a hot tub or sauna for a long period of time early in pregnancy, you may want to talk with your health care provider about ways to detect neural tube defects during pregnancy.

After 6 weeks of pregnancy, normal hot tub and sauna use does not appear to increase the risk for birth defects. However, you should still be careful to limit your use to 10 minutes or less and not get overheated or dehydrated.

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Common Safety Concerns during Pregnancy Will using my electric blanket or heated waterbed during pregnancy increase the risk for hyperthermia?

Electric blankets and heated waterbeds are not likely to raise your body temperature enough to increase the risk for neural tube defects.

Although one recent study showed no increased risk, concerns have been raised, but not confirmed, that use during pregnancy may increase the risk for pregnancy loss or low birth weight.

Can ultrasound hurt my baby?

The use of ultrasound has not been a.s.sociated with adverse pregnancy outcomes. Ultrasound uses sound waves to create an image of a fetus on a screen. Although this procedure can slightly increase body temperature, even a lengthy ultrasound exposure is unlikely to increase your body temperature significantly.

References Chambers CD, et al. 1998. Maternal fever and birth outcome: a pro-spective study. Teratology. Teratology. 58:251257. 58:251257.

Edwards MJ, et al. 1995. Hyperthermia and birth defects. Reprod Reprod Toxicol Toxicol 9(5):411. 9(5):411.

Harvey MAS, et al. 1981. Suggested limits to the use of hot tub and sauna by pregnant women. CMAJ CMAJ 125:50. 125:50.

Layde PM, et al. 1980. Maternal fever and neural tube defects. Teratology Teratology 21:105. 21:105.

Lipson A, et al. 1985. Saunas and birth defects. Teratology Teratology 32:147. 32:147.

Lyndberg MC, et al. 1994. Maternal flu, fever, and the risk of neural tube defects: A population based case-control study. Am J Epidemiol Am J Epidemiol 140(3):244. 140(3):244.

Milunsky A, et al. 1992. Maternal heat exposure and neural tube defects. JAMA JAMA 268(7):882. 268(7):882.

Moretti ME, et al. 2005. Maternal hyperthermia and the risk for neural tube defects in offspring: Systematic review and meta-a.n.a.lysis.

Epidemiol 16:216219. 16:216219.

NCRP. 1983. National Council on Radiation Protection and Measurements Report No 74, Bethesda, MD, p. 72.

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Pregnancy and Birth Sourcebook, Third Edition Ridge BR and Budd GM. 1990. How long is too long in a spa pool?

NEJM 323(12):835. 323(12):835.

Sandford MK, et al. 1992. Neural tube defect etiology: Evidence concerning maternal hyperthermia, health and diet. Dev Med Child Dev Med Child Neurol Neurol 34:661. 34:661.

Warkany J. 1986. Teratogen Update. Hyperthermia. Teratology Teratology 33:365. 33:365.

Wertheimer N and Leeper E. 1986. Possible effects of electric blankets and heated waterbeds on fetal development. Bioelectromagnetics Bioelectromagnetics 7:13. 7:13.

If you have questions about the information here or other exposures during pregnancy, call OTIS at 1-866-626-6847.

Section 29.2 Pregnancy and Chiropractic Care "Pregnancy and Chiropractic Care," 2007 American Pregnancy a.s.sociation (www.americanpregnancy.org). Reprinted with permission.

Chiropractic care is health maintenance of the spinal column, disks, related nerves and bone geometry without drugs or surgery. It involves the art and science of adjusting misaligned joints of the body, especially of the spine, which reduces spinal nerve stress and therefore promotes health throughout the body.

Is chiropractic care safe during pregnancy?

There are no known contraindications to chiropractic care throughout pregnancy. All chiropractors are trained to work with women who are pregnant. Investing in the fertility and pregnancy wellness of women who are pregnant or trying to conceive is a routine treatment for most chiropractors.

Some chiropractors take a specific interest in prenatal and perinatal care and seek additional training. Below represents designations of chiropractors who have taken advanced steps in working with infertility and pregnancy wellness.

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Common Safety Concerns during Pregnancy * DACCP-Diplomate with ICPA reflecting highest level of advanced training * CACCP-Certified with the ICPA reflecting advanced training * Member of ICPA reflecting special interest * Webster Certified-trained to specifically work with breech positions Chiropractors that have been trained to work with pregnant women may use tables that adjust for a pregnant woman's body, and they will use techniques that avoid unneeded pressure on the abdomen.

A chiropractor who is versed in the needs of women who are pregnant will also provide you with exercises and stretches that are safe to use during pregnancy and complement any adjustments made to your spine.

Why should I have chiropractic care during pregnancy?

During pregnancy, there are several physiological and endocrinologi-cal changes that occur in preparation for creating the environment for the developing baby. The following changes could result in a misaligned spine or joint: * protruding abdomen and increased back curve * pelvic changes * postural adaptations Establishing pelvic balance and alignment is another reason to obtain chiropractic care during pregnancy. When the pelvis is misaligned it may reduce the amount of room available for the developing baby.

This restriction is called intrauterine constraint. A misaligned pelvis may also make it difficult for the baby to get into the best possible position for delivery.

The nervous system is the master communication system to all the body systems including the reproductive system. Keeping the spine aligned helps the entire body work more effectively.

What are the benefits of chiropractic care during pregnancy?

Chiropractic care during pregnancy may provide benefits for women who are pregnant. Potential benefits of chiropractic care during pregnancy include: 253.

Pregnancy and Birth Sourcebook, Third Edition * maintaining a healthier pregnancy; * controlling symptoms of nausea; * reducing the time of labor and delivery; * relieving back, neck or joint pain; and * prevent a potential cesarean section.

What about chiropractic care and breech deliveries?

The late Larry Webster, D.C., Founder of the International Chiropractic Pediatric a.s.sociation, developed a specific chiropractic a.n.a.lysis and adjustment which enables chiropractors to establish balance in the pregnant woman's pelvis and reduce undue stress to her uterus and supporting ligaments. This balanced state in the pelvis makes it easier for a breech baby to turn naturally. The technique is known as the Webster Technique.