It is considered normal by some for a baby to present breech until the third trimester. Most birth pract.i.tioners are not concerned with breech presentations until a patient is 37 weeks along. Approximately 4% of all pregnancies result in a breech presentation.

The Journal of Manipulative and Physiological Therapeutics Journal of Manipulative and Physiological Therapeutics reported in the July/August 2002 issue an 82% success rate of babies turning vertex when doctors of chiropractic used the Webster Technique. Further, the results from the study suggest that it may be beneficial to perform the Webster Technique as soon as the 8th month of pregnancy when a woman has a breech presentation. reported in the July/August 2002 issue an 82% success rate of babies turning vertex when doctors of chiropractic used the Webster Technique. Further, the results from the study suggest that it may be beneficial to perform the Webster Technique as soon as the 8th month of pregnancy when a woman has a breech presentation.

Currently, the International Chiropractic Pediatric a.s.sociation recommends that women receive chiropractic care throughout pregnancy to establish pelvic balance and optimize the room a baby has for development throughout pregnancy. With a balanced pelvis, babies have a greater chance of moving into the correct position for birth, and the crisis and worry a.s.sociated with breech and posterior presentations may be avoided altogether. Optimal baby positioning at the time of birth also eliminates the potential for dystocia (difficult labor) and therefore results in easier and safer deliveries for both the mother and baby.

Talk to Your Health Care Provider As more women are seeking the benefits of chiropractic care throughout pregnancy, more health care providers are seeking trained doctors of chiropractic in their communities to refer their pregnant patients to. Discuss these options with your health care provider. If 254 Common Safety Concerns during Pregnancy they are not yet familiar with chiropractic care in pregnancy, ask them to find out more about its many benefits. Most importantly, seek options that support your body's natural abilities to function and find a team of providers who are respectful of your choices.

Your Next Steps * Find a chiropractor [http://www.americanpregnancy.org/members/chiropractors] in your area.

* Talk to your health care provider regarding chiropractic care or other alternative interventions.

* Need help covering the cost of chiropractic care? Receive free info from the Maternity Card discount program [http://www .americanpregnancy.org/insuranceform.html].

Section 29.3 Hair Treatment during Pregnancy "Hair Treatments 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 at 866-626-OTIS (866-626-6847), or visit www.otispregnancy.org.

This text talks about the risks that exposure to hair treatments 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 are the different types of hair treatments?

Hair treatments include hair coloring, hair curling (permanents), hair bleaching, and hair straightening (relaxers) agents. Hair coloring procedures are divided into several groups determined by the length of time the color stays in the hair. These categories include 255 Pregnancy and Birth Sourcebook, Third Edition temporary dyes, semi-permanent dyes, and permanent dyes. Permanent dyes have received the most attention, and they include a variety of chemicals. Hair curling or permanent waves are produced by placing two solutions in the hair. The first solution is a waving fluid and the second is a fixation or neutralization solution. Hair bleaching involves the use of hydrogen peroxide, and hair straighteners or hair relaxers involve a variety of chemicals.

The amount of an exposure, the timing during the pregnancy, and frequency of use may be important factors when thinking about hair treatments in pregnancy. Since many different chemicals are used and manufacturers frequently change formulations, these general guidelines are offered based upon small doses, animal data, and limited data in pregnant women. Cosmetic products are frequently used, but are not generally evaluated for effects on pregnancy.

Do I absorb hair coloring/dye through my skin?

Low levels of hair dye can be absorbed through the skin after application, and the dye is excreted into the urine. This minimal amount is not thought to be enough to cause a problem for the baby.

Before I was pregnant, I had my hair dyed every couple of months. Is this safe now that I am pregnant?

There are very few studies of hair dye use during human pregnancy. In animal studies, at doses 100 times higher than what would normally be used in human application, no significant changes were seen in fetal development. We know that only a small amount of any product applied to your scalp is actually absorbed into your system and therefore, little would be available to get to the developing baby.

In addition, many women have dyed their hair during pregnancy with no known reports of negative outcomes. This information, in combination with the minimal absorption through the skin makes hair treatment in pregnancy unlikely to be of concern.

I would like to have my hair permed and am currently in the first trimester of my pregnancy. Is there any risk for birth defects or miscarriage?

Similar to hair dyes, there is limited information available for the safety of hair permanents in pregnancy. The fixation solution used during the application of the permanent may irritate the scalp, but this has not been a.s.sociated with any other effects in the body. Very 256 Common Safety Concerns during Pregnancy little absorption is likely to occur and it does not seem to cause effects in other parts of the body.

I have my hair straightened every two months. Can I con- tinue this into pregnancy?

A study in humans examined the use of hair straighteners during pregnancy. The use of these products was not found to increase the chance of low birth weight or preterm delivery. The study did not address the chance of other abnormal outcomes (such as birth defects).

Again, it is likely that only a small amount of hair straightening products are actually absorbed into your system, so the developing baby would only be exposed to small amounts.

I work full time as a cosmetologist and recently became pregnant. Should I stop working until the baby is born?

A large study looked at the risk of miscarriage in cosmetologists.

A slightly increased risk of miscarriage was found for cosmetologists who had specific work activities. Activities that seemed to contribute to the slightly increased risk included working more than 40 hours per week, standing more than 8 hours per day, higher numbers of bleaches and permanents applied per week, and working in salons where nail sculpturing was performed. Part time cosmetologists (less than 35 hours per week) did not seem to have an increased risk of miscarriage during pregnancy.

In another study, miscarriage rates among hairdressers were reviewed, and newer data was compared to older data. The older data (from 19861988) showed an increased risk of miscarriage, an extended time trying to get pregnant, and low birth weight. The newer data (from 19911993) did not find increased risks. The authors suggest that newer restrictions on some dye formulas and better working conditions have contributed to the better outcomes.

Both studies support the importance of proper working conditions.

Working in a well ventilated area, wearing protective gloves, taking frequent breaks, and avoiding eating or drinking in the workplace are all important factors that can decrease chemical exposures.

Is it safe to have hair treatments while I am breastfeeding?

There is no information on having hair treatments during breastfeeding. It is highly unlikely that a significant amount would enter the breast milk because so little enters the mom's bloodstream. Many 257 Pregnancy and Birth Sourcebook, Third Edition women receive hair treatments while breastfeeding, and there are no known reports of negative outcomes.

References Blackmore-Prince C, et al 1999. Chemical hair treatments and adverse pregnancy outcome among Black women in central North Carolina.

Am J Epidemiol 149:712716. 149:712716.

Burnett C, et al. 1976. Teratology and percutaneous toxicity studies on hair dyes. J Toxicol Environ Health J Toxicol Environ Health 1:10271040. 1:10271040.

DiNardo JC, et al. 1985. Teratological a.s.sessment of five oxidative hair dyes in the rat. Toxicology and Applied Pharmacology Toxicology and Applied Pharmacology 78:163166. 78:163166.

Inouye M. and Murakami U. 1976. Teratogenicity of 2,5-diaminotoluene, a hair dye component, in mice. Teratology Teratology 14:241242. 14:241242.

John EM, et al. 1994. Spontaneous abortions among cosmetologists.

Epidemiol 5:147155. 5:147155.

Kersemaekers WM, et al. 1996. Reproductive disorders among hairdressers. Epidemiol Epidemiol 8:396401. 8:396401.

Koren G (ed.) 1994. Maternal-Fetal Toxicology: A Clinician's Guide. Maternal-Fetal Toxicology: A Clinician's Guide.

New York: Marcel Dekker, Inc.

Koren G. 1996. Hair care during pregnancy. Can Fam Physician Can Fam Physician 42:625626. 42:625626.

Kramer S, et al. 1987. Medical and drug risk factors a.s.sociated with neuroblastoma: A case-control study. J Natl Cancer Inst J Natl Cancer Inst 78:797803. 78:797803.

Maibach HI, et al. 1975. Percutaneous penetration following use of hair dyes. Arch Dermatol Arch Dermatol 111:14441445. 111:14441445.

Marks TA, et al. 1979. Teratogenicity of 4-nitro-1,2-diamin.o.benzene (4NDB) and 2-nitro-1,4-diamin.o.benzene (2NDB) in the mouse. Teratology Teratology 19:37A38A. 19:37A38A.

Marks TA, et al. 1981. Teratogenic evaluation of 2-nitro-p-phenylenediamine, 4-nitro-o-phenylenediamine, and 2,5-toluenediamine sulfate in the mouse. Teratology Teratology 24:253265. 24:253265.

Paul M (ed.) 1993. Occupational and Environmental Reproductive Occupational and Environmental Reproductive Hazards: A Guide for Clinicians. Hazards: A Guide for Clinicians. Baltimore: Williams and Wilkins. Baltimore: Williams and Wilkins.

Rylander L, et al. 2002. Reproductive outcome among female hairdressers. Occup Environ Med Occup Environ Med 59:517522. 59:517522.

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Common Safety Concerns during Pregnancy Section 29.4 Tanning during Pregnancy "Self-Tanners, Tanning Pills, Tanning Booths and Pregnancy," 2007 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 at 866-626-OTIS (866-626-6847), or visit www.otispregnancy.org.

This text talks about the risks that exposure to self-tanners, tanning pills, and tanning booths 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 are self-tanners?

Self-tanners are lotions, gels, and sprays that are applied to the skin to darken it, making the skin look "tan" without sun exposure.

The active ingredient in self-tanners that makes your skin darker is dihydroxyacetone (DHA). DHA often comes from plant sources such as sugar beets and sugar cane, and is considered a safe skin-coloring agent. The Food and Drug Administration (FDA) has approved DHA as a tanning product in the United States since the 1970s. Most self-tanning products that you can buy in stores contain 35% DHA, while the products used by professionals contain 515% DHA.

The tan color will last about a week, and eventually disappears as new skin replaces old skin. Self-tanning products do not provide protection from the harmful effects of the sun. You should still use sun-screen and protective clothing to shield yourself from the sun when using these products.

Are self-tanners absorbed into my bloodstream if I'm using them on my skin?

Although not well-studied, it is estimated that only one-half of one percent (0.5%) of DHA is absorbed into the bloodstream when self-tanners are applied on the skin. There is no information available as 259 Pregnancy and Birth Sourcebook, Third Edition to whether this very small amount is able to cross the placenta and get into the baby's circulation.

What about using booths which spray self-tanner on me?

The FDA limits the use of DHA to external application only. It is not approved for use on the eyes, lips, or mucous membranes, or for internal use. This may be hard to avoid when using a "spray tanning"

booth, so it is a good idea to protect your mouth, nose, lungs, and eyes when using one. You should request protective measures to cover your eyes and nose, to prevent inhaling the chemical.

Can using self-tanners during my pregnancy cause birth defects?

There is no published information suggesting that using self-tanners during pregnancy causes birth defects. When self-tanners are used, it is thought that only very small amounts of DHA are absorbed into the bloodstream through the skin. Therefore, very little DHA would be available to get to the baby if it does cross the placenta. It is possible that if you are inhaling the self-tanning spray fumes in tanning booths, or applying the product to mucous membranes, more of the DHA could get into your system and result in higher blood levels. Unfortunately, there is no information to prove the safety of using self-tanners while pregnant.

Can I use self-tanners while breastfeeding?

If you decide to use self-tanners while breastfeeding, it is a good idea to avoid putting the self-tanner on areas that the baby's mouth comes in contact with, such as the nipple and areola. There is no evidence suggesting that using self-tanners while breastfeeding is unsafe for a baby.

Can I use tanning pills when I am pregnant or breast- feeding?

Tanning pills are tablets containing a chemical called canthaxanthin as the main active agent. A person has to ingest a very large amount of canthaxanthin in order for his or her skin to change color.

Although canthaxanthin, when used in small amounts, is approved by the FDA as a color additive in food, tanning pills are not approved by the FDA. There are no studies examining the use of canthaxanthin during pregnancy or breastfeeding. Be aware that harmful effects in 260 Common Safety Concerns during Pregnancy adults have been reported, including eye damage, liver damage, nausea, cramping, diarrhea, severe itching, and welts. Therefore, it may be best to avoid the use of tanning pills during pregnancy or while breastfeeding.

What about using tanning booths while pregnant?

Ultraviolet rays do not penetrate the uterus, so the baby is protected while you are pregnant. However, if your body becomes overheated, your body temperature will rise, causing the baby's body temperature to increase. This condition is called hyperthermia, which may increase the risk for miscarriage or spina bifida. It is recommended that you spend as little as 1015 minutes at a time in a tanning booth while pregnant.

Can using self-tanners, tanning pills, or tanning booths make it more difficult for me to become pregnant?

There is no evidence to suggest that using self-tanners makes it more difficult to become pregnant, as very little of the DHA is absorbed into the bloodstream. Tanning pills are taken orally, so there is a greater chance that a person could ingest a very large amount of canthaxanthin. There are no studies regarding the safety of using tanning pills while trying to become pregnant. Using tanning booths is not expected to make it more difficult to become pregnant.

Is it a problem if the baby's father is using self-tanners, tanning pills, or tanning booths while I am trying to be- come pregnant?

For males, there is no evidence that using any of the self-tanning products or tanning pills will cause birth defects. However, constant spikes in body temperature can decrease sperm production, so a male should be careful not to become overheated in a tanning booth.

References Lapunzina P. 1996. Ultraviolet light-related neural tube defects? Am Am J Med Genet J Med Genet 67:106. 67:106.

Merck Index, 12th Edition, p. 3225. p. 3225.

Meadows M. 2003. Don't Be in the Dark about Tanning. FDA Consumer Magazine FDA Consumer Magazine 37:6. 37:6.

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Pregnancy and Birth Sourcebook, Third Edition United States Food and Drug Administration. 2000. Tanning Pills: Office of Cosmetics and Colors Fact Sheet. Available at: http:// www.cfsan.fda.giv/~dms/cos-tan2.html.

United States Food and Drug Administration. 2003. DHA-Spray Sunless 'Tanning' Booths: Office of Cosmetics and Colors Fact Sheet.

Available at: http://www.cfsan.fda.giv/~dms/cos-tan4.html Yourick JJ, et al. 2004. Fate of chemicals in skin after dermal application: Does the in vitro skin reservoir affect the estimate of systemic absorption? Toxicol Appl Pharmacol Toxicol Appl Pharmacol 195:309320. 195:309320.

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Part Four

High-Risk Pregnancies

Chapter 30.

What Is a High-Risk Pregnancy?

Chapter Contents.Section 30.1-Understanding Pregnancy Risk ......................... 266 Section 30.2-Teen Pregnancy ................................................... 268 Section 30.3-Pregnancy after Age 35 ....................................... 271 Section 30.4-Multiple Pregnancy: Twins, Triplets, and Beyond .................................................................. 273 265.

Pregnancy and Birth Sourcebook, Third Edition Section 30.1 Understanding Pregnancy Risk From "High-Risk Pregnancy," by the National Inst.i.tute of Child Health and Human Development (NICHD, www.nichd.nih.gov), part of the National Inst.i.tutes of Health, December 4, 2006.

What causes a high-risk pregnancy?

Before a woman becomes pregnant, it is important for her to have good nutrition and a healthy lifestyle. Good prenatal care and medical treatment during pregnancy can help prevent complications.

But there are factors that can be present before a woman becomes pregnant that can cause a high-risk pregnancy. Risk factors for a high-risk pregnancy can include: * young or old maternal age; * being overweight or underweight; * having had problems in previous pregnancies; * pre-existing health conditions, such as high blood pressure, diabetes, or HIV (human immunodeficiency virus).

Health problems can also develop during a pregnancy that can make it high-risk. Such problems may occur even in a woman who was previously healthy.

What are some conditions that may cause a high-risk preg- nancy?

* Preeclampsia Preeclampsia is a syndrome that includes high blood pressure, urinary protein, and changes in blood levels of liver enzymes during pregnancy. It can affect the mother's kidneys, liver, and brain. is a syndrome that includes high blood pressure, urinary protein, and changes in blood levels of liver enzymes during pregnancy. It can affect the mother's kidneys, liver, and brain.

With treatment, many women will have healthy babies. If left untreated, the condition can be fatal for the mother and/or the baby and can lead to long-term health problems. Eclampsia Eclampsia is a more severe form of preeclampsia that can cause seizures and coma in the mother. is a more severe form of preeclampsia that can cause seizures and coma in the mother.

266.

What Is a High-Risk Pregnancy?