In the exceedingly unlikely event that you are exposed directly to someone with measles and are not immune, your doctor may administer gamma globulin (antibodies) during the incubation period-between exposure and the start of symptoms-to decrease the severity of the illness should you come down with it. Measles, unlike rubella, does not appear to cause birth defects, though it may be linked to an increased risk of miscarriage or premature labor. If you were to contract measles near your due date, there is a risk that your newborn might catch the infection from you. Again, gamma globulin may be administered to reduce the severity of such an infection. Keep in mind that all this is pretty much theoretical, given how rare measles are these days.

Mumps "A coworker of mine came down with a bad case of the mumps. Should I get immunized so I don't get it myself?"

It's not that easy to get mumps these days-in fact, it's pretty close to impossible. Fewer than 250 Americans contract mumps each year, thanks to routine childhood immunization with MMR (measles, mumps, rubella). And chances are you were vaccinated, too, when you were a child (or, less likely, that you actually had the disease), which means you can't catch it now. If you're not sure whether you were immunized against or had mumps, check with your parents or the doctor who cared for you as a child, if that's possible.

If it turns out you're not immune, you can't be immunized now because the vaccine might be harmful to your fetus. Even without immunity, though, the risk of contracting mumps is very low. It isn't highly contagious through casual contact. However, because the disease appears to trigger uterine contractions and is associated with an increased risk of miscarriage in the first trimester or preterm labor later, be alert for the first symptoms of the disease (possibly vague pain, fever, and loss of appetite before the salivary glands become swollen; then ear pain and pain on chewing or on taking acidic or sour food or drink). Notify your practitioner of such symptoms immediately because prompt treatment can reduce the chance of problems developing. You might also want to consider the MMR vaccine before deciding to get pregnant again, just to be on the safe side.

Staying Well In pregnancy, when you need to stay well for two, the proverbial ounce of prevention is worth far more than a pound of cure. The following suggestions will increase your chances of staying well when you're expecting (and when you're not): Keep your resistance up. Eat the best diet possible, get enough sleep and exercise, and don't run yourself down by running yourself ragged. Reducing stress in your life as much as you can also helps keep your immune system in tip-top shape. Eat the best diet possible, get enough sleep and exercise, and don't run yourself down by running yourself ragged. Reducing stress in your life as much as you can also helps keep your immune system in tip-top shape.

Avoid sick people like the plague. As best as you can, try to stay away from anyone who has a cold, flu, stomach virus, or anything else noticeably contagious. Keep your distance from coughers on the bus, avoid lunching with a colleague who's complaining of a sore throat, and evade the handshake of a friend with a runny nose (germs as well as greetings can be exchanged in a handshake). Also avoid crowded or cramped indoor spaces when you can. As best as you can, try to stay away from anyone who has a cold, flu, stomach virus, or anything else noticeably contagious. Keep your distance from coughers on the bus, avoid lunching with a colleague who's complaining of a sore throat, and evade the handshake of a friend with a runny nose (germs as well as greetings can be exchanged in a handshake). Also avoid crowded or cramped indoor spaces when you can.

Wash your hands. Hands are the major spreader of infections, so wash them often and thoroughly with soap and warm water (about 20 seconds does the trick), particularly after exposure to someone you know is sick and after spending time in public places or riding on public transportation. Hand washing is especially important before eating. Keep a hand sanitizer in your glove compartment, in your desk drawer, and in your handbag or briefcase so you can wash up when there's no sink in sight. Hands are the major spreader of infections, so wash them often and thoroughly with soap and warm water (about 20 seconds does the trick), particularly after exposure to someone you know is sick and after spending time in public places or riding on public transportation. Hand washing is especially important before eating. Keep a hand sanitizer in your glove compartment, in your desk drawer, and in your handbag or briefcase so you can wash up when there's no sink in sight.

Don't share the germs. At home, try to limit germ-spreading contact with sick children or a sick spouse as much as possible. Avoiding finishing up their sandwich scraps and drinking from their cups. And while every sick child needs a dose of kiss-and-hug therapy from mom now and then, be sure to wash your hands and face after those comforting cuddles. Wash your hands, too, after touching their germy sheets, towels, and used tissues, especially before touching your own eyes, nose, and mouth. See that the little patients wash their hands frequently, too, and try to get them to cough and sneeze into their elbows instead of their hands (a good tip for adults, too). Use disinfectant spray or wipes on telephones, computer keyboards, remotes, and other surfaces they handle. At home, try to limit germ-spreading contact with sick children or a sick spouse as much as possible. Avoiding finishing up their sandwich scraps and drinking from their cups. And while every sick child needs a dose of kiss-and-hug therapy from mom now and then, be sure to wash your hands and face after those comforting cuddles. Wash your hands, too, after touching their germy sheets, towels, and used tissues, especially before touching your own eyes, nose, and mouth. See that the little patients wash their hands frequently, too, and try to get them to cough and sneeze into their elbows instead of their hands (a good tip for adults, too). Use disinfectant spray or wipes on telephones, computer keyboards, remotes, and other surfaces they handle.

If your own child or a child you regularly spend time with develops a rash of any kind, avoid close contact and call your doctor as soon as you can unless you already know that you are immune to chicken pox, fifth disease, and CMV.

Be pet smart. Keep pets in good health, updating their immunizations as necessary. If you have a cat, take the precautions to avoid toxoplasmosis ( Keep pets in good health, updating their immunizations as necessary. If you have a cat, take the precautions to avoid toxoplasmosis (page 79).

Look out for Lyme. Avoid outdoor areas where Lyme disease is prevalent, or be sure to protect yourself adequately (see Avoid outdoor areas where Lyme disease is prevalent, or be sure to protect yourself adequately (see page 507 page 507).

To each his or her own. Maintain a no-sharing policy when it comes to toothbrushes and other personal items (and don't let those toothbrushes mingle bristle-to-bristle). Use disposable cups for rinsing in the bathroom. Maintain a no-sharing policy when it comes to toothbrushes and other personal items (and don't let those toothbrushes mingle bristle-to-bristle). Use disposable cups for rinsing in the bathroom.

Eat safe. To avoid food-borne illnesses, practice safe food preparation and storage habits (see To avoid food-borne illnesses, practice safe food preparation and storage habits (see page 116 page 116).

Rubella "I might have been exposed to rubella on a trip out of the country. Should I be worried?"

Happily, the vast majority of pregnant women in the United States are immune to rubella (German measles), either because they were immunized against it as a child (it's the "R" in the MMR vaccine) or contracted it at some other time in their lives (usually during childhood). In fact, the CDC considers rubella to be eradicated here, so the odds are good that you can't catch it and, consequently, have nothing to worry about. If you're not sure whether or not you are immune (around 25 percent of women may not be immune because they were born outside the United States), you can find out with a simple test-a rubella antibody titer-that measures the level of antibodies to the virus in your blood and is performed routinely at the first prenatal visit by most practitioners. If this test was not performed earlier, it should be now.

In the unlikely event you turn out not to be immune (or if the antibody levels in your blood are low), you still don't have to consider drastic measures immediately. For the virus to do its damage, you have to actually come down with the illness. The symptoms, which show up two or three weeks after exposure, are usually mild (malaise, slight fever, and swollen glands, followed by a slight rash a day or two later) and may sometimes pass unnoticed. If you did come down with rubella during pregnancy (and, again, the odds are extremely remote), whether your baby would be at risk would depend on when you contracted it. During the first month, the chance of a baby developing a serious birth defect from in utero exposure is pretty high. By the third month, the risk is significantly lower. After that, the risk is lower still.

There is no way of absolutely preventing an exposed woman with no immunity from coming down with rubella-but because the chance of being exposed to rubella in the United States is almost nil, that scenario is just about never encountered. Still, if you aren't immune and don't contract the disease this time around, avoid the concern entirely in subsequent pregnancies by being vaccinated after this delivery. As a precaution, you will be advised not to become pregnant for one month following vaccination. But should you conceive accidentally during this time, or if you were vaccinated early in this pregnancy, before you knew you had conceived, don't worry. Apparently, there is no risk when an expectant woman is inadvertently vaccinated early in pregnancy or if she conceives soon after vaccination.

Chicken Pox (Varicella) "My toddler was exposed to chicken pox at her child-care center-by a child who wasn't immunized. If she comes down with it, could the baby I'm now carrying be hurt?"

Not likely. Well insulated from the rest of the world, a fetus can't catch chicken pox from a third party-only from its mother. Which means you would have to catch it first, something that's unlikely. First of all, your child probably won't catch it and bring it home if she was immunized with the varicella vaccine. Second of all, it's very likely you had the infection as a child (85 to 95 percent of the U.S. adult population has had it) and are already immune. Ask your parents or check your health records to find out whether you have had chicken pox. If you can't find out for sure, ask your practitioner to run a test now to see if you are immune.

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.

Lyme Disease "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.

Hepatitis A "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.

Hepatitis B "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.

Hepatitis C "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.

Bell's Palsy "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.

Common Medications 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.

Antidiarrheals. Most antidiarrheals aren't recommended for use during pregnancy. Both Kaopectate and Pepto-Bismol contain salicylates-an active ingredient that is considered off-limits when you're expecting. Ask your practitioner if there is anything you can safely take for diarrhea during pregnancy (staying hydrated will be key, too).

Antibiotics. If your doctor has prescribed antibiotics for you during pregnancy, it's because the bacterial infection you have is more dangerous than taking the antibiotics to fight it off (many are considered completely safe). You'll usually be put on antibiotics that fall into the penicillin or erythromycin families. Certain antibiotics are not recommended (such as tetracyclines), so be sure that any doctor prescribing antibiotics while you're expecting knows that you're pregnant. If your doctor has prescribed antibiotics for you during pregnancy, it's because the bacterial infection you have is more dangerous than taking the antibiotics to fight it off (many are considered completely safe). You'll usually be put on antibiotics that fall into the penicillin or erythromycin families. Certain antibiotics are not recommended (such as tetracyclines), so be sure that any doctor prescribing antibiotics while you're expecting knows that you're pregnant.

Keeping Current The many lists of safe, possibly safe, possibly unsafe, and definitely unsafe drugs and medication during pregnancy change all the time, especially as new medications are introduced, others change from being prescription-only to over-thecounter, and still others are being studied to determine their safety during pregnancy. To stay current on what is or isn't safe, always ask your practitioner first. You can also turn to the U.S. Food and Drug Administration (contact your regional office, or visit fda.gov) for information. Or try the local office of the March of Dimes, or contact the March of Dimes Resource Center at (888) MODIMES (663-4637); marchofdimes.com. You can also go to safefetus.com to check on the safety of a certain medication during pregnancy.

Antidepressants. Untreated depression in an expectant mom can have many adverse effects on her baby. Though the research on the effects of antidepressants on pregnancy and on the fetus is ever changing, it does appear that there are several medications that are safe to use, others that should be completely avoided, and still others that can be considered on a case-by-case basis, their use weighed against the risk of untreated (or undertreated) depression. See Untreated depression in an expectant mom can have many adverse effects on her baby. Though the research on the effects of antidepressants on pregnancy and on the fetus is ever changing, it does appear that there are several medications that are safe to use, others that should be completely avoided, and still others that can be considered on a case-by-case basis, their use weighed against the risk of untreated (or undertreated) depression. See page 518 page 518 for more on antidepressants. for more on antidepressants.

Antinausea. Unisom Sleep Tabs (which contain the antihistamine doxylamine), taken in combination with vitamin B Unisom Sleep Tabs (which contain the antihistamine doxylamine), taken in combination with vitamin B6, decrease the symptoms of morning sickness but should only be used when recommended by your practitioner. The downside of taking this remedy during the day: sleepiness.

Topical antibiotics. Small amounts of topical antibiotics, such as bacitracin or Neosporin, are safe during pregnancy. Small amounts of topical antibiotics, such as bacitracin or Neosporin, are safe during pregnancy.

Topical steroids. Small amounts of topical hydrocortisones (such as Cortaid) are safe during pregnancy. Small amounts of topical hydrocortisones (such as Cortaid) are safe during pregnancy.

If You Need Medication During Pregnancy If your practitioner recommends that you take a certain medication while you're expecting, follow these steps for increased benefit and reduced risk: [image] Discuss with your practitioner the possibility of taking the medication in the smallest effective doses for the shortest possible time. Discuss with your practitioner the possibility of taking the medication in the smallest effective doses for the shortest possible time.[image] Take the medication when it's going to benefit you the most-a cold medication at night, for instance, so it will help you sleep. Take the medication when it's going to benefit you the most-a cold medication at night, for instance, so it will help you sleep.[image] Follow directions carefully. Some medications must be taken on an empty stomach; some should be taken with food or milk. If your physician hasn't given you any instructions, ask your pharmacist for particulars-most provide handouts with full directions and information (including possible side effects) on each prescription drug they sell. Don't panic if you see that the drug isn't recommended during pregnancy-the vast majority of drugs carry that warning, even if they're considered safe. As long as a practitioner who knows that you're expecting and is familiar with pregnancy drug safety has prescribed or recommended it, it's okay to take it. Follow directions carefully. Some medications must be taken on an empty stomach; some should be taken with food or milk. If your physician hasn't given you any instructions, ask your pharmacist for particulars-most provide handouts with full directions and information (including possible side effects) on each prescription drug they sell. Don't panic if you see that the drug isn't recommended during pregnancy-the vast majority of drugs carry that warning, even if they're considered safe. As long as a practitioner who knows that you're expecting and is familiar with pregnancy drug safety has prescribed or recommended it, it's okay to take it.[image] Explore nondrug remedies, and use them, as appropriate, to supplement the drug therapy. For instance, eliminate as many offending allergens from your home as you can, so your physician can reduce the amount of prescribed antihistamines you take. Keep in mind that herbal remedies are still considered drugs and shouldn't be taken without a practitioner's approval. Explore nondrug remedies, and use them, as appropriate, to supplement the drug therapy. For instance, eliminate as many offending allergens from your home as you can, so your physician can reduce the amount of prescribed antihistamines you take. Keep in mind that herbal remedies are still considered drugs and shouldn't be taken without a practitioner's approval.[image] Make sure the medication gets where it's supposed to by taking a sip of water before you swallow a capsule or tablet, to make it go down more easily, and by drinking a full glass afterward, to ensure that it is washed speedily down to where it will be absorbed. Make sure the medication gets where it's supposed to by taking a sip of water before you swallow a capsule or tablet, to make it go down more easily, and by drinking a full glass afterward, to ensure that it is washed speedily down to where it will be absorbed.[image] For additional safety, try to get all your prescriptions at the same pharmacy. The pharmacist will have you and all your prescriptions on the computer and should be able to warn you of potential drug interactions. Also, be sure you've gotten the right prescription (or over-the-counter medication). Check the name and dosage on the bottle to be sure it's the one specified by your doctor (many drug names and patient names are similar, and pharmacies do occasionally make mistakes). For additional reassurance, ask the pharmacist what the drug is meant to treat or check out the printed material that comes with the drug. If you know you were supposed to get an antihistamine for your allergies and the drug you are handed is for hypertension, you've obviously got the wrong medication. For additional safety, try to get all your prescriptions at the same pharmacy. The pharmacist will have you and all your prescriptions on the computer and should be able to warn you of potential drug interactions. Also, be sure you've gotten the right prescription (or over-the-counter medication). Check the name and dosage on the bottle to be sure it's the one specified by your doctor (many drug names and patient names are similar, and pharmacies do occasionally make mistakes). For additional reassurance, ask the pharmacist what the drug is meant to treat or check out the printed material that comes with the drug. If you know you were supposed to get an antihistamine for your allergies and the drug you are handed is for hypertension, you've obviously got the wrong medication.[image] Ask about possible side effects and which ones should be reported to your doctor. Ask about possible side effects and which ones should be reported to your doctor.

Herbal Cures Herbal supplements and remedies make the most tempting of promises(better memory! sounder sleep! improved immunity!), especially when pregnancy leaves you with fewer selfmedicating options open and your medicine cabinet at least partially closed. Would it really hurt to pop a couple of ginkgo biloba pills to give your brain cells a fighting chance of remembering to pay this month's electric bill? Or melatonin to guarantee that you'll sleep like a baby (even when it's a baby-to-be who's keeping you awake)? And what about an echinacea or two to fend off the germs after you were sneezed on (twice) at that afternoon meeting? After all, the bottles say "all-natural," and you did buy them at the health-food store (what could be healthier than that?).

Actually, it could hurt-particularly now that you're sharing those pills with a little someone else. "All-natural" doesn't make herbal preparations "all safe," and neither does a health-foodstore pedigree. Herbal preparations are not tested or approved by the FDA and are not required to undergo clinicalcal trials, which means that their safety (or lack of) is unknown. Even herbs that you've heard could be helpful during pregnancy could be dangerous at different points during those nine months. For example, some herbs purported to help bring on labor can cause premature labor if taken before full term. And many herbs are downright dangerous if taken at any time during pregnancy (such as basil oil, black or blue cohosh, clove oil, comfrey, juniper, mistletoe, pennyroyal, sassafras, wild yam, and many others).

It's always smart to proceed with caution when you're self-medicating with herbals, but twice as smart when you're self-medicating for two. To play it safe, don't take any herbal preparation-even ones you used freely preconception-unless it's prescribed by your practitioner for use during pregnancy.

If you'd like to feel like a natural woman during your pregnancy, look into other natural therapies that do not include ingesting anything (such as CAM treatments like acupuncture, massage, and meditation).

Once you've made certain that a prescribed drug is considered safe for use during pregnancy, don't hesitate to take it because you're still afraid it might somehow harm your baby. It won't, but delaying treatment might.

CHAPTER 21.

If You Have a Chronic Condition ANYONE WHO'S LIVED WITH A chronic condition knows that life can get pretty complicated, what with special diets, medications, and/or monitoring. Add pregnancy into the mix, and you've got your hands even fuller, with the special diet needing to be tweaked, medications modified, and monitoring stepped up. Happily, with some extra precautions and extra effort, most chronic conditions are now completely compatible with pregnancy. chronic condition knows that life can get pretty complicated, what with special diets, medications, and/or monitoring. Add pregnancy into the mix, and you've got your hands even fuller, with the special diet needing to be tweaked, medications modified, and monitoring stepped up. Happily, with some extra precautions and extra effort, most chronic conditions are now completely compatible with pregnancy.

Just how your chronic condition will be affected by pregnancy and how pregnancy will affect your chronic condition will depend on plenty of factors, many of them uniquely yours. This chapter outlines general recommendations for pregnant women with common chronic conditions. Use this alphabetized list as a guide, but be sure to follow your doctor's orders, since they've probably been tailored to your specific needs.

What You May Be Wondering About Asthma "I've had asthma since I was a child. I'm concerned that the attacks and the medication I take for them might be harmful now that I'm expecting."

Finding out you're pregnant can take any woman's breath away-but when you're asthmatic, being breathless and pregnant can understandably bring up some extra concerns. While it's true that a severe asthmatic condition does put a pregnancy at somewhat higher risk, fortunately, this risk can be almost completely eliminated. In fact, if you're under close, expert medical supervision-by a team that includes your obstetrician, your internist, and/or your asthma doctor-your chances of having a normal pregnancy and a healthy baby are about as good as a nonasthmatic's (which means you can breathe a little easier now).

Though well-controlled asthma has only a minimal effect on pregnancy, pregnancy can have an effect on asthma, but the effect varies from expectant mom to expectant mom. For about a third of pregnant asthmatics, the effect is positive: Their asthma improves. For another third, their condition stays about the same. For the remaining third (usually those with the most severe disease), the asthma worsens. If you've been pregnant before, you're likely to find that your asthma behaves pretty much the same way in this pregnancy as it did in earlier ones.

It's not surprising that getting your asthma under control before you conceive or as early in pregnancy as possible is the best strategy for you and your baby. The following steps will help you do that, if you haven't yet: [image] Identify environmental triggers. Allergies are a major cause of asthma, and you probably already know which ones trigger problems for you. Avoid them, and you'll find the breathing a lot easier during your pregnancy (see Identify environmental triggers. Allergies are a major cause of asthma, and you probably already know which ones trigger problems for you. Avoid them, and you'll find the breathing a lot easier during your pregnancy (see page 205 page 205 for tips on avoiding allergens). Common offenders are pollen, animal dander, dust, and mold. Such irritants as tobacco smoke, household cleaning products, and perfumes can also provoke a reaction, so it's a good idea to steer clear of them (and, of course, you should quit smoking if you're a smoker-ditto for your spouse). If you were started on allergy shots before pregnancy, you'll be able to continue. for tips on avoiding allergens). Common offenders are pollen, animal dander, dust, and mold. Such irritants as tobacco smoke, household cleaning products, and perfumes can also provoke a reaction, so it's a good idea to steer clear of them (and, of course, you should quit smoking if you're a smoker-ditto for your spouse). If you were started on allergy shots before pregnancy, you'll be able to continue.[image] Exercise with care. If your asthma is exercise-induced, prescribed medication taken before your workout or any other kind of exertion can usually prevent an attack. Talk to your practitioner about other exercise guidelines. Exercise with care. If your asthma is exercise-induced, prescribed medication taken before your workout or any other kind of exertion can usually prevent an attack. Talk to your practitioner about other exercise guidelines.[image] Stay healthy. Try to avoid colds, flu, and other respiratory infections, which are also asthma triggers (for tips on staying well, see box, Stay healthy. Try to avoid colds, flu, and other respiratory infections, which are also asthma triggers (for tips on staying well, see box, page 505 page 505). Your doctor may give you medication to ward off an asthma attack at the beginning of a cold, and will probably want to treat any but the most minor bacterial respiratory infections with antibiotics. A flu shot-recommended for every expectant mom-is especially important for you, as is a vaccine for pneumococcal infection, if you're considered high risk (ask your doctor). If you suffer from chronic sinusitis or reflux-both of which are more common in pregnancy anyway-be sure to ask your doctor for a treatment plan, because both conditions can interfere with the management of your asthma.[image] Keep a close eye on your peak flow. Follow your doctor's directions to make sure you're getting the oxygen you and your baby need. Monitor your breathing with a peak-flow meter, according to your physician's directions. Keep a close eye on your peak flow. Follow your doctor's directions to make sure you're getting the oxygen you and your baby need. Monitor your breathing with a peak-flow meter, according to your physician's directions.[image] Take a fresh look at your meds. All the medication rules change when you're expecting, so be sure you use only those that your physician has prescribed during your pregnancy. If your symptoms are mild, you may be able to get away without any medication. If they're moderate to severe, you'll be given one of the several medications that are considered safe during pregnancy (in general, inhaled medications appear to be safer than oral medication). Don't hesitate to take medication that you need-remember, you're breathing for two now. Take a fresh look at your meds. All the medication rules change when you're expecting, so be sure you use only those that your physician has prescribed during your pregnancy. If your symptoms are mild, you may be able to get away without any medication. If they're moderate to severe, you'll be given one of the several medications that are considered safe during pregnancy (in general, inhaled medications appear to be safer than oral medication). Don't hesitate to take medication that you need-remember, you're breathing for two now.

If you do have an asthma attack, treating it promptly with your prescribed medication will help ensure that your baby isn't shortchanged of oxygen. But if the medication doesn't help, call your doctor or head for the nearest emergency room immediately. Asthma attacks may trigger early uterine contractions, but the contractions usually stop when the attack does (which is why it's so important to stop it quickly).

Because of your breathing problems history, you may find the breathlessness that typically comes with late pregnancy especially concerning. But don't worry-it's normal, and it isn't dangerous. Keep in mind, though, that as your growing uterus begins to crowd your lungs, you may notice that your asthmatic flare-ups worsen. Just be sure you treat these attacks quickly.

How will asthma affect your labor and delivery? If you're considering going without medication, you'll be happy to hear that asthma usually doesn't interfere with the breathing techniques of Lamaze and other childbirth education methods. If it's an epidural you have your heart set on, that shouldn't be a problem either (but narcotic analgesics, such as Demerol, will probably be avoided because they may trigger an asthma attack). Though asthma flare-ups during childbirth are rare, your doctor will probably recommend that you continue your regular medications when you're in labor; if your asthma has been serious enough to require oral steroids or cortisone-type medications, you may also require IV steroids to help you handle the stress of labor and delivery. Your oxygenation will be checked when you are admitted to the hospital, and if it is low, preventive medications may be given. Though some babies of moms with asthma experience rapid breathing after delivery, that's usually only temporary.

Cancer in Pregnancy Cancer isn't common during pregnancy, but it happens, just as it can happen during any other time of life. Pregnancy doesn't cause cancer or increase your chances of developing cancer. They're just two life events, one joyous and one challenging, that sometimes take place at the same time.

Treatment for cancer during pregnancy is a delicate balancing act between providing the best treatment for the mother and limiting any possible risk to the fetus. The type of treatment you'll get will depend on many factors: how far the pregnancy has progressed; the type of cancer; the stage of the cancer; and, of course, on your wishes. The decisions you may face in balancing your well-being against your baby's may be emotionally wrenching, and you'll need plenty of support in making them.

Because some cancer treatments can harm the fetus, especially during the first trimester, doctors usually delay any treatment until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait until after the baby is born to begin treatment, or they may consider inducing labor early. The reassuring news is that women diagnosed during pregnancy respond just as well to cancer treatment as women who are not pregnant, all other factors being equal.

For more help, contact the National Cancer Institute: cancer.gov, as well as pregnantwithcancer.org or (800) 743-4471, a support system for expectant women with cancer.

As for your asthma postpartum, chances are you'll find your symptoms will return to the way they were prepregnancy within three months after delivery.

Cystic Fibrosis "I have cystic fibrosis, and I know that makes pregnancy complicated-but how complicated?"

As someone who's lived with cystic fibrosis (CF) for her whole life, you're already used to the challenges that the condition comes with-but you're also used to working hard at overcoming them. And though the challenges do increase somewhat with pregnancy, there are plenty of things that you and your doctors can do to help make your pregnancy safe and successful.

The first challenge may be gaining enough weight, so working closely with your doctors to ensure that the numbers on the scale keep climbing will be important (a nutritionist may be a helpful addition to your pregnancy team). To keep a closer eye on your weight and your baby's growth-as well as on all aspects of your pregnancy-you'll have more frequent prenatal visits than the average mom-to-be (on the plus side, that means more chances to hear your baby's heartbeat-and more opportunities to ask questions). Your activity may be limited, and because you'll be at higher risk for premature delivery, additional precautions will be taken to reduce the risk and help ensure that your baby stays safely put until term. It's also possible that periodic hospitalization may be necessary.

Genetic counseling (if you haven't had it already) will be able to determine whether your baby is at risk for being born with CF or not ("not" being the much more likely scenario). If your spouse isn't a carrier for CF, there's very little chance that your baby will be affected by it (though he or she will be a carrier). If your spouse is a carrier, there's a 1 in 2 chance that your baby will be affected; prenatal testing can let you know for sure.

Since you're breathing for two now, your doctors will be keeping a close watch on your pulmonary care-especially as your growing uterus leaves less room for your lungs to expand. You'll also be monitored for pulmonary infection. Some women with severe lung disease may find that their condition can get a little worse while they're pregnant, but only temporarily. In general, pregnancy doesn't seem to have any negative long-term effect on CF at all.

Pregnancy isn't easy no matter what, and it's certainly more challenging for women with CF. But that cuddly reward-the beautiful baby you're working so hard for-can make all those challenges more than worthwhile.

Depression "I was diagnosed with chronic depression a few years ago, and I've been on low-dose antidepressants ever since. Now that I'm pregnant, should I stop taking the meds?"

More than one out of ten women of childbearing age battles with bouts of depression, so you're far from alone. Luckily for you and all the other expectant moms who share your condition, there's a happy outlook: With the right treatment, women with depression can have perfectly normal pregnancies. Deciding what that treatment should consist of during pregnancy is a delicate balancing act, however, especially when it comes to the use of medications. Together with your psychiatrist and prenatal practitioner, you'll need to weigh the risks and benefits of taking such meds-and not taking them-while you're growing a baby.

Maybe it seems like a simple decision to make, at least at first glance. After all, could there ever be a good reason to put your emotional well-being over your baby's physical well-being? But the decision is actually a lot more complicated than that. For starters, pregnancy hormones can do a number on your emotional state. Even women who've never had an encounter with mood disorders, depression, or any other psychological condition may experience wild emotional swings when they're expecting-but women with a history of depression are at greater risk of having depressive bouts during pregnancy and are more likely to suffer from postpartum depression. And this is especially true for women who stop taking their antidepressants during pregnancy.