Is It Safe?

Cold cures, hair dye, skiing: What's OK and what's not during pregnancy.

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Almost every pregnant woman can look back to her early weeks of pregnancy and recall some type of risky behavior. For some it’s the headache tablet, the dental X-ray or the hair dye that makes them wince. In my case, it was the wine tasting that I attended on the night that I conceived. As it turns out, these slip-ups probably are fine, according to medical experts, although pregnant women do need to be alert to behaviors that could put their babies at risk.

Here, two top medical experts in fetal and newborn health, Craig V. Towers, M.D., and Urania Magriples, M.D., discuss which habits, foods, activities and medications are safe — and which ones aren’t — during your nine-month odyssey. According to Towers, what matters isn’t just what you do, but at what point in your pregnancy you do it.

After conception, it takes five to seven days for your little bundle of cells to attach to the uterine wall. Only then does it start drawing nutrients and oxygen from you, making what you take into your body really count.

Weeks four to 13 are the most important; that’s when the fetus is forming. Exposure to harmful substances at that time may cause birth defects or affect how a body part functions after birth, says Magriples, associate professor of obstetrics at Yale University in New Haven, Conn.

Few studies have been done on pregnant women, for obvious reasons. But when no good data are available and there’s a suspected risk, experts tend to err on the side of caution. Here’s the rundown of what is known.

Alcohol A safe level of alcohol consumption for pregnant women has not been determined, so many experts recommend abstinence. Heavy use during pregnancy can cause fetal alcohol syndrome — a serious, lifelong condition. But don’t stress out about the glass of champagne you had before you knew you were pregnant.

Cigarettes and secondhand smoke Studies have conclusively proven that smoking and pregnancy don’t mix: Babies born to mothers who smoke weigh less on average. Doctors suspect the lower birth weight is due to restricted blood flow, which may also impair the passage of nutrients through the placenta to the baby. The carbon monoxide in cigarette smoke that enters the mother’s bloodstream also reduces the amount of oxygen that reaches the uterus. For these reasons, doctors advise pregnant women to also steer clear of secondhand smoke.

Caffeine Used in moderation, coffee and other caffeinated foods and beverages probably are not a problem. However, consuming more than 300 to 400 milligrams of caffeine a day (the equivalent of three to four 8-ounce cups of coffee) increases the risk of miscarriage, according to Magriples. When tallying your daily caffeine consumption, remember to count colas, iced tea and chocolate.

Cold and flu medications Antihistamines such as Benadryl and Chlortrimeton are safe, as are most cold remedies except for decongestants. Because decongestants work by constricting blood vessels, they can cause high blood pressure and uterine contractions. To relieve a stuffy nose, try a saline nasal spray instead.

Many cold and flu products contain multiple ingredients that treat several symptoms at once. When selecting such products, make sure to read the labels, and take medications that treat only your symptoms, says Towers, author of I’m Pregnant & I Have a Cold: Are Over-the-Counter Drugs Safe to Use? (RBC Press Inc., 1999). For instance, if your primary symptom is a runny nose, take only an antihistamine.

The safest cough suppressant for pregnant women is dextromethorphan. Some medications indicate this active ingredient with a “D” or a “DM” in their names, such as Robitussin-DM.

Diet Sodas Even though saccharin and aspartame have been found to be harmful in animal studies, moderate amounts haven’t been proven harmful in pregnancy. Even so, diet sodas are best avoided. They are filling and allow less space in your stomach for important nutrients. Many also contain caffeine, another no-no when used in excess. Drink milk or water instead.

Exercise If you were in shape before you became pregnant, carry on within reasonable limits if your doctor says it’s OK, but don’t get overheated or dehydrated. Exercise outdoors when it’s cool, but avoid icy ground in winter.

If you’ve waited until you were pregnant to start exercising, begin slowly by walking, swimming or taking an aerobics class for pregnant women, Magriples suggests. Stop immediately if your heart starts racing, you feel faint or short of breath, your uterus begins cramping or you experience any vaginal bleeding. (See “Winter Sports”)

Herbal remedies Both Magriples and Towers advise pregnant women to exercise strong caution when it comes to taking natural supplements. (See “Vitamins”) “Women don’t think these are a big deal because they can get them at health-food stores,” says Magriples, “but a lot of this stuff is very potent. Herbs are not regulated and could be toxic in pregnancy.” It is probably prudent to avoid herbs; if you are already using them, inform your doctor as soon as possible.

Pain relievers Aspirin can affect blood-clotting in the fetus, a concern at delivery time. Acetaminophen (Tylenol) is the pain reliever of choice. Second best are these over-the-counter medications in the nonsteroidal anti-inflammatory drug (NSAID) family: ibuprofen (Advil), ketoprofen (Orudis KT) and naproxen (Naprosyn). But there are caveats.<

Taking limited quantities of NSAIDs — a few pills over two or three days, for example — is OK, Towers says. But if used continuously, they can decrease the amount of amniotic fluid and affect the baby’s kidneys. For these reasons, Magriples recommends not using NSAIDs at all after the second trimester.

Radiation Radiation is encountered everywhere — during X-rays and airplane travel, or when using cell phones or lying on the beach. Don’t panic. “It takes a fair amount of exposure before harm is done,” says Towers. But a concentrated high dose to the pelvis (as with a barium study) or repeated exposures to small amounts (something a flight attendant might experience if she flies overseas frequently) should be avoided, if possible.

Lifting Moderate lifting is not a problem in a normal pregnancy. But proper body mechanics — lifting with your legs, not your back — are more important than ever: Because your center of gravity shifts and your ligaments are looser, it’s easier to get injured. So when people say, “Let me get that for you,” let them.

Sushi And Other Raw Delectables The risks of eating raw fish, shellfish or other meats include bacterial infection, hepatitis and parasites. Eating rare or raw red meat, such as carpaccio, can also cause toxoplasmosis, a parasitic infection that mothers can pass on to their babies. It can impair growth and brain development. To be perfectly safe, eat only well-cooked foods.

Hair dyes Hair dye is absorbed through the scalp and enters the bloodstream. Though scientists don’t know how the chemicals in these colorings affect the fetus, to be safe, wait until your second trimester before perming or coloring your hair.

Hot tubs Hot tubs can cause profuse perspiration. This means more blood is going to your skin and less to the uterus, which could be dangerous for the baby. Stick to a warm bath instead.

Vitamins In high doses, some vitamins can cause birth defects. Megadoses of vitamin A have been linked to defects of the brain, face and heart. Vitamin E also poses the risk of thinning the mother’s blood. The American College of Obstetricians and Gynecologists recommends that pregnant women not take more than 5,000 international units of preformed vitamin A per day or exceed the Recommended Dietary Allowance of 10,000 micrograms of vitamin E.

A dangerous vitamin A derivative is found in the prescription acne medication Accutane. It often causes severe birth defects and should be avoided if there is even a possibility that you will become pregnant.

Travel The second trimester is the best time to travel. There is a higher risk of miscarriage in your first trimester, and in the third, you want to be close to your doctor or midwife. Wherever you go, know the locations of the closest medical facilities. Dehydration and stress often go along with traveling, and both are unhealthful for pregnant women. Because pregnant women are at higher risk for developing blood clots, move around as much as possible when traveling by plane. Winter sports

The risk in skiing and ice skating is falling. This isn’t so bad in the first trimester, but after 20 weeks, when the uterus extends past the pelvis, falling on your abdomen could cause premature labor, separation of the placenta from the baby or a fetal injury. Moderate cross-country skiing and snowshoeing are fine.

And If I Have To Take Something? If you regularly take a prescription medication for a chronic condition, ask your doctor how it may affect your baby or your pregnancy. Experts on high-risk pregnancies generally will tell you to continue taking your medication if your health depends on it. Here are some guidelines for common medical conditions:

Anxiety and depression Selective serotonin reuptake inhibitor (SSRI) drugs, such as Prozac and Zoloft, are now widely prescribed to combat anxiety and depression. These drugs haven’t been studied enough for doctors to know whether they’re safe in pregnancy. The criterion is whether you need them to survive.

Asthma and allergies Most medications (including steroids), whether taken in pill form or via an inhaler, are safe if used as prescribed. The one exception is certain decongestants, which should be avoided, if possible. If you must use a decongestant, do so under your doctor’s care. After all, if a mother can’t breathe properly, her baby could be deprived of oxygen, too.

Diabetes If you take an oral diabetes medication, physicians prefer that you switch to injectable insulin during pregnancy because the latter doesn’t cross the placenta.

Epilepsy Dilantin has been linked to birth defects, but most experts believe that the risk posed by not treating this seizure disorder is greater than the risk posed by the medication itself. Epilepsy patients should see their doctors about this before becoming pregnant.

Thyroid conditions Women who have underactive thyroids and take thyroid medication daily may safely continue to do so. Women with overactive thyroid conditions need to be monitored more closely.

Read Exercise Guidelines for a summary of the American College of Obstetricians and Gynecologists Guidelines for exercising while pregnant.

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