Sickle cell anemia is a disorder where a certain type of hemoglobin — a compound found in red blood cells that is responsible for helping transport oxygen — is abnormally formed. This changes the shape of a person’s red blood cells from a circular shape to a sickle shape, hence the name sickle cell anemia. These cells are not as good at transporting oxygen. They can also block blood vessels because of their abnormal shape and cause organ damage. Sickle cell anemia is a genetic disorder, which means it is passed down from parent to child. It is [autosomal recessive](https://nabtahealth.com/glossary/autosomal-recessive/), meaning both parents have to either have sickle cell anemia or be carriers of it to have a baby who also has the disorder. How common sickle cell anemia is varied by ethnicity. One in 12 African Americans are carriers for the disease (that is, they have one mutated gene but don’t have the full-blown disease, so they are fine but can have a child with sickle cell anemia if their partner is also a carrier), with Greeks and Italians also at high risk. Women who are pregnant and have sickle cell anemia are considered to have high-risk pregnancies because we know sickle cell anemia can complicate pregnancies in multiple ways. Women with sickle cell anemia have an increased risk of: * Preterm labor * PPROM * [Miscarriage](https://nabtahealth.com/glossary/miscarriage/) and [stillbirth](https://nabtahealth.com/glossary/stillbirth/) * Infections after delivery * Having a baby affected by growth restriction or low birth weight Sickle cell anemia can also [lead](https://nabtahealth.com/glossary/lead/) to painful episodes known as pain crises. This is when stress placed on the body (such as pain, stress, cold temperature, or dehydration) leads to an acute episode of pain in the patient. This usually needs to be treated in the hospital with pain medications and oxygen. Labor pain can definitely cause a pain crisis, which is why most women with sickle cell anemia are advised to have an [epidural](https://nabtahealth.com/glossary/epidural/) as soon as their labor starts. Some doctors will recommend that women with sickle cell anemia undergo a few extra tests to monitor their developing babies. These can include extra ultrasounds to monitor the baby’s growth, as well as monitoring of the baby’s heart rate starting in the third trimester to make sure the baby is doing well. Evidence for these practices is limited, however. Pregnant women with sickle cell anemia should be sure to take an increased amount of folic acid both while trying to conceive and throughout pregnancy. The recommended dose is 4 mg a day, whereas women without this disorder only need 1 mg daily. This extra [folate](https://nabtahealth.com/glossary/folate/) helps to support the increased red blood cell production that people with sickle cell anemia have. Luckily a woman can be tested with a simple blood test before she is pregnant to find out if she is a carrier of sickle cell anemia. If she is, her partner can be tested, too. If he is not a carrier, it is impossible for the unborn baby to have sickle cell anemia. If he is a carrier, an [amniocentesis](https://nabtahealth.com/glossary/amniocentesis/) or similar test can be done to know for sure if the baby is affected. **Sources:** * The American College of Obstetricians and Gynecologists * Practice Bulletin #78: Hemoglobinopathies in pregnancy * January 2007. Powered by Bundoo®
Prescription painkillers are a class of drugs that are used to treat pain. Among the most popular prescription painkillers is the group of medications known as opioids. Common opioids include morphine, oxycodone, and codeine, among others. These drugs are in the same class as heroin and derived from the same source, the opium poppy plant. Additionally, pharmaceutical companies have developed synthetic opiates, which are manufactured to have similar chemical properties to opiates. This class includes hydromorphone (Dilaudid), meperdine (Demerol), and fentanyl. Because they are manufactured in a lab, these drugs can be many times stronger than opiates derived from poppies. Whether they are synthetic or natural, all opioids can be highly addictive and may [lead](https://nabtahealth.com/glossary/lead/) to dependence in some patients. It’s true that women may experience pain while pregnant, whether it be from a car accident, undergoing major surgery, or dealing with a chronic pain condition. Because of this, pregnant women may wonder then if they can safely use opioids to relieve pain in pregnancy. The answer is not an easy one. The American College of Obstetricians and Gynecologists (ACOG) readily agrees that pregnant women deserve adequate pain management. However, the current opioid abuse epidemic in the United States can’t be ignored. Based on a 2010 survey, about 4.4 percent of pregnant women have used illicit drugs in the previous 30 days. This includes opioids that have been prescribed by doctors but used inappropriately, or that have been bought illegally. Women who use opioids while pregnant are at risk for a few complications. Opioid use can quickly [lead](https://nabtahealth.com/glossary/lead/) to tolerance and the need for greater quantities of the drug to get through the day without experiencing withdrawal symptoms or worsening pain. The risks of overdose, infection related to injecting drugs or sharing needles, and malnutrition are also present. If a woman goes on to buy opioids illegally, the behaviors associated with this can also put her at risk for being exposed to sexually transmitted infections, domestic violence, losing custody of her children, and incarceration. Heroin use also makes complications such as preterm delivery, fetal growth restriction, [stillbirth](https://nabtahealth.com/glossary/stillbirth/), and placental abruption more likely. Babies born to moms who use chronic narcotics in pregnancy are at risk for developing [Neonatal](https://nabtahealth.com/glossary/neonatal/) Abstinence Syndrome, or NAS. This is when a baby who was exposed to narcotics while in the [uterus](https://nabtahealth.com/glossary/uterus/) is born and then goes through withdrawal. Symptoms include tremors, irritability, problems with sleeping, seizures, and problems with feeding, among others. Some of these babies need to go to the NICU to be treated with small doses of opioids to help ease their withdrawal symptoms. But what about the pregnant woman who has chronic pain prior to pregnancy and who wants to know if she can continue to use her narcotic medication to treat her pain—which may actually be made worse by pregnancy? In this scenario, it is important that your doctor is aware of your history of chronic pain and medication needs. We know that abruptly stopping narcotics in someone who is physically dependent on them can [lead](https://nabtahealth.com/glossary/lead/) to severe withdrawal symptoms. Withdrawal from narcotics in pregnancy can [lead](https://nabtahealth.com/glossary/lead/) to preterm birth, [stillbirth](https://nabtahealth.com/glossary/stillbirth/) and relapse, and the possibility of using street drugs to treat symptoms. To avoid this, first attempt to get to the lowest narcotic dose that is needed to relieve symptoms. Use complementary techniques such as massage, exercise, physical therapy, acupuncture, and mental health counseling to help relieve pain in an alternate way. Enlisting the help of a pain specialist who is comfortable treating pregnant women can also be helpful. Occasionally, switching to the synthetic opioid known as methadone can help women maintain a stable dosing of narcotic during a twenty-four-hour period. Using this drug in women addicted to heroin or prescription painkillers has helped in avoiding withdrawal and illicit drug use in pregnant women safely since the 1970s. If you might be interested in switching to methadone maintenance treatment, ask your doctor to refer you to a local program. The bottom line is that occasionally opioids are needed to treat pain in pregnancy, but they should never be the first therapy for minor pains and discomforts. If you are using chronic narcotics and are pregnant, don’t abruptly stop your medication until you talk with your doctor so a plan can be made to keep you and your baby safe. **Sources:** * The American College of Obstetricians and Gynecologists * Committee Opinion #524: Opioid abuse, dependence, and addiction in pregnancy, May 2012. The American College of Obstetricians and Gynecologists * ACOG statement on opioid use during pregnancy * 26 May 2016. Stanford Children’s Health * [Neonatal](https://nabtahealth.com/glossary/neonatal/) abstinence syndrome Powered by Bundoo®
As of 2015 in the United States, about 9.5 percent of all babies are born preterm, meaning they were born at less than 37 weeks gestation. We know that being born preterm can [lead](https://nabtahealth.com/glossary/lead/) to multiple complications for a new baby, such as problems with breathing, eating, and maintaining normal blood sugar levels. This is why obstetric providers will often recommend injectable steroids if a mother is at risk of having a preterm birth. Also known as antenatal steroids, these injections are usually given in one of two forms: betamethasone (more commonly used, and is a series of two injections 24 hours apart), or dexamethasone (four injections over 48 hours). We know that receiving these injections is one of the best things we can do to improve the outcomes of preterm babies. Specifically, antenatal steroids have been shown to help with the following: They lower the number of babies who are born with the breathing problem known as respiratory distress syndrome (RDS), and of those babies who do have RDS it is less severe. They decrease the risk of internal bleeding in the brain known as intracranial hemorrhage, which if present can often [lead](https://nabtahealth.com/glossary/lead/) to significant problems with development and intelligence. They decrease the risk of the complication known as necrotizing enterocolitis, which is when too little blood flow goes to the intestines and they can become inflamed and die, sometimes leading to death in these fragile babies. Lastly, premature babies who receive antenatal steroids dies less frequently than those whose mothers did not receive these injections. Being able to prevent some or all of these complications is so important for these premature babies, which is why obstetric providers will routinely recommend antenatal steroids in women who are at risk of delivering at less than 34 weeks gestation. More recently, newer data has suggested that these benefits may also last in the late preterm period (35 to 36 weeks gestation), so women who may deliver in this timeframe may also receive these injections. This intervention in preterm babies is so important that an organization known as The Joint Commission, whose purpose is to ensure hospitals are providing evidence-based care for their patients, routinely monitors hospitals in this country to make sure that women who should be receiving this medication actually do. With so many potential complications arising in our smallest babies, it is wonderful to know that an intervention such as antenatal steroids **Sources:** * The American College of Obstetricians and Gynecologists * Committee Opinion #677: Antenatal corticosteroid therapy for fetal maturation * October 2016. March of Dimes * Preterm birth increases in the U.S * for the first time in eight years * 1 Nov 2016. Powered by Bundoo®
Opioids are a type of prescription medicine that is commonly used to treat pain. Drugs that fall into this category include morphine, fentanyl, oxycodone, and codeine, to name a few. While these drugs are legal and play a role in pain management, they are closely related to heroin and have a high potential for being abused. A woman may need to be prescribed opioids during her pregnancy, though in general doctors try to avoid it if possible. Reasons for taking a medicine such as oxycodone while pregnant may include having surgery, recovering from a trauma, or dealing with severe kidney stones, for example. Occasionally, a person can develop a dependence on these drugs, and unfortunately, pregnant women are not immune. Known as opiate use disorder, this is when a person develops the following pattern around opioid use: * Develops a tolerance to the drug, which means they need more to have the same effect * Craves it * Is unable to control the use of the drug * Continues to use it despite have negative consequences such as losing a job or being arrested Rather than using older terms such as opioid addiction or dependence, opioid use disorder is the preferred term. It can then be broken down into mild, moderate, or severe based on how many symptoms a person has when screened. It is important to note that opioids can be used appropriately for medical care, such as in the pregnant woman who needed to have her appendix taken out. Not all women who have prescribed opioids for short-term use will go on to develop opioid use disorder, either. Additionally, women who do eventually abuse opioids are often a diverse group, coming from all walks of life. What this means for midwives and doctors is that recognizing opioid use disorder is not always obvious. Opioids should be used when needed but cautiously, with plenty of counseling about their risks, benefits, and expectations for use. Other ways to treat pain should also be put in places, such as using non-narcotic medications like acetaminophen or employing physical therapy or exercise. Screening for opioid use disorder should be routinely done at the beginning of all pregnancies and whenever a concern for it arises. Possible warning signs that may raise red flags include a patient needing refills of opioids far sooner than they should, missing prenatal visits, or appearing overly sedated. Again, this may not always represent a misuse of opioids, but it is certainly a reason to get more information. If a woman is pregnant and using opioids, this screening tool can help her look at her own risk of opioid use disorder in the privacy of her own home. Some women will not want to tell their medical providers about their opioid use out of fear that legal action will be taken. While reporting laws regarding drug use in pregnancy vary by state, it is still an important piece of health history to share. We know that long-term opioid use in pregnancy can [lead](https://nabtahealth.com/glossary/lead/) to a variety of complications in pregnancy, the most recognizable usually being [neonatal](https://nabtahealth.com/glossary/neonatal/) abstinence syndrome, which is why letting your doctor know is so important. The best way for a pregnant woman to get help with stopping inappropriate opioid use is to let her doctor or midwife know so they can get her the assistance she needs. This will not only help her but get her baby off to his best start in life. If you or someone you know may be suffering from opioid use disorder, please reach out to your medical provider or go here for more information. **Sources:** * The American College of Obstetricians and Gynecologists * Committee opinion #711: Opioid use and opioid use disorder in pregnancy. The Guttmacher Instititute * Substance use during pregnancy. Powered by Bundoo®
Occasionally pregnant women may need to take pain medicine. This may be for a back injury, after recovering from surgery, or during a gallbladder attack. Usually, doctors and midwives will try to use medicine such as acetaminophen and heat or massage to treat pain, but sometimes stronger drugs are needed. This is when opiates may be prescribed. Opiates are drugs like morphine, fentanyl, oxycodone, and codeine, and they are all related to the illicit drug heroin. These legal synthetic forms can be given in pill or intravenous form, and are usually used for short periods of time to try and limit the potential for harm to the developing baby as well as decrease the risk of abuse. Some women, unfortunately, go on to develop opioid abuse disorder, which is when opioids (either obtained legally or illegally) are used in a way that leads to tolerance, craving, and escalated use. Often women in this category will obtain these drugs illegally and may participate in unsafe practices such as trading sex for drugs. Luckily, many women with opioid use disorder will use pregnancy as a time to try and optimize their health. These women are also more likely to interact with medical professionals since they are pregnant, and these practitioners can help them manage their disorder. Many pregnant women hope to decrease their opioid use completely or cut back while pregnant so as to benefit their baby. It is not recommended that a pregnant woman who has been chronically using opioids just stop suddenly. This can [lead](https://nabtahealth.com/glossary/lead/) to acute withdrawal which can be harmful to both mom and baby. Typical withdrawal symptoms include pain, nausea, diarrhea, tremors, and anxiety. These symptoms can be so severe that they can [lead](https://nabtahealth.com/glossary/lead/) a woman to start using again, putting her at risk of using too much and overdosing. Acute withdrawal can also have severe consequences for a fetus, too. It can [lead](https://nabtahealth.com/glossary/lead/) to premature labor as well as [stillbirth](https://nabtahealth.com/glossary/stillbirth/) and [miscarriage](https://nabtahealth.com/glossary/miscarriage/). Some women may think medically supervised withdrawal is the answer, then, but this too is not recommended. The idea behind this is that a woman is slowly weaned off her drug of abuse under the supervision of a doctor or treatment facility. However, these programs have a 60 to 90 percent relapse rate and because of this are not recommended. Medication-assisted treatment (also known as MAT) is what is currently recommended for pregnant women abusing opioids. Pregnant women in MAT programs receive a daily dose of maintenance medication, in the form of methadone or buprenorphine, dispensed directly from an opioid treatment program. These medications prevent withdrawal symptoms but are safely monitored and regulated, providing a consistent dose over time. This means the woman has no craving or physical need for heroin or other opiates. Medications used in MAT also have a lower potential for overdose. Using these medications, combined with addiction counseling, psychosocial services, and prenatal care, MAT has been shown to be the best way for a pregnant woman to safely manage her opioid addiction in pregnancy. These treatments are not perfect, as they will still [lead](https://nabtahealth.com/glossary/lead/) to [neonatal](https://nabtahealth.com/glossary/neonatal/) abstinence syndrome, but it is expected and pediatricians who care for these babies will know exactly how much medication the baby has been exposed to in utero and be prepared to treat it. Women in MAT programs are less likely to use drugs off the street, which means they are less likely to inject drugs, be exposed to [HIV](https://nabtahealth.com/glossary/hiv/) and [hepatitis C](https://nabtahealth.com/glossary/hepatitis-c/), or be exposed to sexually transmitted infections or violence as the result of trading sex for drugs. Ideally, a woman with opioid usage disorder would be able to stop using all illicit drugs prior to becoming pregnant. Unfortunately, this is not always possible and in these cases providing safe, consistent care for these women in a nonjudgmental way is the best thing medical providers can do. If you or someone you know is interested in enrolling in MAT, you can go here for more information. **Sources:** * The American College of Obstetricians and Gynecologists * Committee opinion #711: Opioid use and opioid use disorder in pregnancy * August 2017. Powered by Bundoo®
Mothers have many choices when it comes to creating a birth plan, and some of them are quite controversial among the medical community. Water births — also called immersion births — have long been viewed as problematic for a variety of reasons, but now doctors and public health officials have identified even more reason for concern. Last year, two infants born in birthing pools in Arizona contracted Legionella, a potentially deadly bacteria that thrive in damp environments. Both infants who contracted Legionella from birthing pools during water births were thought to have inhaled contaminated water into their lungs during birth. Fortunately, with antibiotic treatment, both infants survived. Legionella is a bacteria that lives in warm, damp environments, so it can easily multiply in water tanks or pipes. People can then become infected by breathing in the contaminated water droplets, or if the water accidentally goes into their lungs. Legionella can cause pneumonia and other respiratory problems. Left unrecognized and untreated for too long, this can prove to be deadly, especially among immunocompromised individuals, such as infants and the elderly. Legionella can cause outbreaks of illness, often in areas with large heating and cooling systems. This bacteria has been linked to outbreaks in hotels, nursing homes, hospitals, and cruise ships. Public health officials do state that such infections are rare, but infants born in water are at risk due to the fact that there are no standardized infection prevention measures for water births. Even if the birthing tub is thoroughly cleaned and disinfected prior to use, the plumbing system itself could be contaminated. The American College of Obstetrics and Gynecology (ACOG) does not recommend water births, as they have shown no proven benefit to the mother or the newborn. They also state that the safety and efficacy of submersion in water during delivery have not been established, so both the mother and the baby could be at risk. If you do decide to give birth in a birthing pool or tub despite the risks, there are precautions you should discuss with your physician or midwife before you go into labor. Make sure the facility you are using has strict protocols to maintain and clean the tubs as well as criteria for monitoring both the mother and the baby during active labor while submerged. Also, make sure the facility has a plan in place to move you quickly and safely out of the water if an unexpected complication arises. Consider [antenatal test](https://nabtahealth.com/product/antenatal-test/) and get to learn more. **Sources:** * American College of Obstetricians and Gynecologists * Immersion in Water During Labor and Delivery. Centers for Disease Control and Prevention * Legionnaire’s Disease. Red Book Online * Legionella pneumophila Infections. Washington Post * Infants born in water births at risk of Legionnaires’ disease, CDC says. Powered by Bundoo®
Every pregnant woman wonders, “How long will my labor last?” Friends and families are often quick to share their labor stories, ranging from, “My labor was so quick and easy!” to “It took forever.” It can leave many expectant moms wondering just how long labor should really take. The length of labor varies greatly from woman to woman, which is entirely normal, but we do have some general ranges for how long a mom should expect to be in labor. The first stage of labor is when a woman’s [cervix](https://nabtahealth.com/glossary/cervix/) begins to open up, or dilate. The estimated time for what was considered normal was originally based on work done in the 1950s looking at large groups of laboring women. Based on this work, we used to think latent labor should take no longer than 20 hours in women having their first baby and 14 hours for women who’ve given birth before. We also used to think that once active labor was reached, the [cervix](https://nabtahealth.com/glossary/cervix/) should be expected to dilate about 1 to 1.5 centimeters an hour. Based on these definitions, obstetric providers used to diagnose abnormal labor as those taking longer than these above-mentioned times. Newer data, however, has led to big revisions in what we consider normal. Most obstetric providers now believe that latent labor should not have a time limit, and as long as progress is being made and mom is baby is safe it should be allowed to progress. This means that latent labor for some women may take days! A new definition for “active labor” Another change to labor-management is that active labor is now defined as when the [cervix](https://nabtahealth.com/glossary/cervix/) is at least 6 centimeters dilated for most women. Many practitioners used to say active labor was when a woman’s [cervix](https://nabtahealth.com/glossary/cervix/) was just 4 centimeters open, but we now know this is too early and led to some unnecessary C-sections. Once in active labor, many women will in fact dilate 1 to 1.5 centimeters an hour, but it can be normal for this to take longer. The second stage of labor is when a woman’s [cervix](https://nabtahealth.com/glossary/cervix/) is completely dilated and she begins pushing. Again, older data was much more restrictive. We used to say it was abnormal for this phase of labor to take longer than 3 hours in women having their first baby or 2 hours in women who’ve delivered vaginally before. We now know that this stage of labor can take up to 4 hours in some women, especially those having their first baby and with the use of an [epidural](https://nabtahealth.com/glossary/epidural/). The final and third stage of labor is when the [placenta](https://nabtahealth.com/glossary/placenta/) delivers. In general, most women will complete this stage in just a few minutes after their baby arrives. If this stage lasts longer than 30 minutes, this is usually considered abnormal, and additional procedures may be needed to help get the [placenta](https://nabtahealth.com/glossary/placenta/) out. The final word on how long labor should take All told, it is hard to predict how long a woman’s labor will take, especially if it is her first baby. She may have a long latent phase only to suddenly progress into active labor quickly and delivery shortly thereafter. Keep in mind that induced labor often takes longer too, since it will take time to even get a woman into labor before her latent phase of labor even begins. The bottom line is that a woman should be allowed to continue to labor as long as she and her baby are doing well, and progress is being made—even if that progress may seem like it isn’t quick enough for well-meaning waiting family and friends! The good news is that once you’ve had your first baby, most labors after this tend to be shorter. **Sources:** * Safe prevention of the primary cesarean delivery * The American Congress of Obstetricians and Gynecologists * March 2014. Powered by Bundoo®
A seizure is when brain activity becomes abnormal and can cause abnormal movements, awareness, or emotional states. Epilepsy, which is only one type of seizure disorder, tends to be the most well-known. This occurs when there is no known cause for the seizures. Pregnancy can have a major effect on seizure disorders, and having a seizure disorder can affect a developing baby and make a pregnancy high risk. Therefore, if a woman has a seizure disorder and wants to become pregnant or already is, she should get in touch with her doctor immediately to make a plan to have the healthiest pregnancy possible. About 30 percent of women with seizures will notice the frequency increases during pregnancy. The remainder will usually have the same amount or less frequent seizures. If a woman is on anti-seizure medication, she should not suddenly stop taking it because her seizures have decreased, since this can cause them to increase again. Multiple anti-seizure medications exist, with some that are safe to take in pregnancy. Ideally, a woman who is on anti-seizure medication will have a preconception visit so she can make sure the medicine is OK for pregnancy. If not, she can then be switched to one that is. Women with seizures are at a higher risk of having a baby born with birth defects compared to women who don’t have seizures. This is thought to be caused by the disorder itself, but may also be a side effect of some anti-seizure drugs. Because of this, women with seizures should take extra folic acid while trying to conceive (another reason a preconception visit is important!) and in the first trimester to decrease the chance of one group of birth defects called [neural tube](https://nabtahealth.com/glossary/neural-tube/) defects. Seizures during pregnancy can be dangerous both for a mother and her developing baby. Seizures, such as grand mal seizures (where a person loses consciousness and has large jerking motions), can cause falls, head injuries, and abdominal trauma, which may [lead](https://nabtahealth.com/glossary/lead/) to bleeding, placental abruption, and preterm birth. If this happens, a woman should contact her doctor immediately to see if she needs to seek emergent care or be monitored in Labor and Delivery. A woman with seizures should be able to have a vaginal delivery and go on to breastfeed, since many anti-seizure medications are safe to use while nursing. It will be important to review birth control options as certain seizure medications can affect how well some birth control works, and there are even some types of birth control that are thought to help decrease seizure frequency. **Sources:** * The American Congress of Obstetricians and Gynecologists * FAQ 129: Seizure disorders in pregnancy * February 2013. RK Creasy and R Resnik * Chapter 55: Neurologic disorders * Maternal-fetal medicine: principles and practice * 5th Powered by Bundoo®
It’s official: you’ve got a confirmed picky eater. Now what do you do? Here are some DOs and DON’Ts when it comes to managing your little ones and their eating habits. Do these with your picky eater: -------------------------------- Picky Eating : Keep a smile on your face, and have a positive attitude. Even when you are frustrated, overwhelmed, or angry, your young child should not see you lose your cool because this may charge the situation and tempt your toddler to keep getting negative reactions out of you. Offer balanced, nutritious, appealing meals and snacks. These will cover your [child’s nutrient requirements](https://nabtahealth.com/articles/do-children-need-supplements/) and allow her to see many different foods, which is part of readying her to try new foods. Keep the food variety coming, even if your child rejects it. Studies show it takes some children 6 to 15 food exposures before they will try or like a food. Stay on a [meal and snack schedule](https://nabtahealth.com/articles/should-preschools-have-snacks-for-kids/). This is your ace in the hole! Staying on a schedule means your child will have plenty of opportunities to eat during the day, which takes the pressure off when he or she skips a meal. Try new foods. Eventually, your child will probably be excited about new and different foods, especially if he or she is conditioned to see a variety of unfamiliar foods early on. Allow [self-feeding](https://nabtahealth.com/articles/6-foods-you-should-stop-feeding-your-toddler/), even if it is messy. This is the control your child wants. [Letting kids self-feed](https://nabtahealth.com/articles/6-foods-you-should-stop-feeding-your-toddler/) often changes the dynamic around mealtime, making your child more interested in eating and mealtime more pleasant. Require your child stay at the table during meals (even if he or she doesn’t eat). While your child doesn’t have to eat, he or she does need to learn to politely stay at the table while others are finishing their meals. Reassure your child. If your child decides not to eat, let him or her know when the next meal or snack is scheduled. Don’t do these with your picky eater: -------------------------------------- Picky Eating: Show your emotions. No anger, frustration, or annoyance! Your goal is to be steady and not react to any antics. Your child will respond based on your reactions. Cater to your child’s preferences. Don’t narrow the menu to what your child will eat, or you will get stuck doing this possibly for many years! You can make sure one or two items on the menu are foods your child likes or is familiar with, but the rest of the menu should [reflect good nutrition and balance](https://nabtahealth.com/articles/10-toddler-lunch-ideas-that-rule/). Be a sneaky chef. Hiding food in other foods can build distrust in children. Push your child to eat more. Pushing extra bites or sips often backfires, especially when children are picky. Rather than eat more, they may dig in their heels and resist. Nag to try something new. The effect is the same as pushing for more eating. Reward your child with dessert or other food. While this can be an effective tactic in getting your child to eat something you want him to, over time, research has shown it doesn’t help children like food. In fact, it helps children favor the reward, which is often dessert. Punish or discipline your child for not eating. Children can develop a negative association with eating and food when they are punished for not eating certain foods. Feed him or her (force-feeding). This takes all control away from your child, and most children do not respond well to force-feeding or parents taking control of feeding, especially as they get older. Label your child “Picky Eating.” Children live up to expectations. If you label your child picky, he or she will be more likely to live up to it. **Sources:** * Castle JL and Jacobsen MT * Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School, 2013. Powered by Bundoo®
When it comes to pregnancy, many women know that it is important to eat healthy (most of the time…), exercise, and take your prenatal vitamins. But far fewer realize how important it is to take care of one more important thing: your teeth. In fact, a mother’s dental health can directly affect that of her developing baby. Interestingly, disorders of the mouth known as oral health disorders (this includes issues like cavities and gum disease) can have a far-reaching effect on a person’s overall health. People with oral health disorders have higher rates of cardiovascular disease, diabetes, Alzheimer’s, and lung infections. A survey was done recently showed that 35 percent of Americans had not seen a dentist in the previous year and that 56 percent of pregnant women had not visited a dentist during their pregnancy. This means a large percentage of moms-to-be are missing important chances to be screened for dental disease. Pregnancy itself can cause many changes related to oral health, and about 40 percent of pregnant women have some form of dental disease. For example, gums usually bleed more easily in pregnancy and cavities may be more common as acid levels increase in the mouth. Teeth may become more mobile as the ligaments supporting them become looser. If a woman has morning sickness or [hyperemesis gravidarum](https://nabtahealth.com/glossary/hyperemesis-gravidarum/), her teeth enamel may erode because of the exposure to stomach acid. Multiple studies have shown an association between dental disease and higher preterm birth rates. The thought behind this is that increased [inflammation](https://nabtahealth.com/glossary/inflammation/) in the mouth and higher bacterial exposure may cause labor to start prematurely. However, treating dental disease has yet to show an improvement in this increased preterm birth rate, so more studies are needed in this area. One reason so few pregnant women visit the dentist while pregnant may be the misconception that dental exams and treatments may be harmful to the unborn baby. Even some dentists may have this misconception and make pregnant women feel like they should delay routine treatments until after they deliver. However, it’s important to know that almost all routine screenings and treatments are perfectly safe in pregnancy. This includes oral x-rays as well as procedures such as tooth fillings and root canals. If you or your dentist are unsure, ask them to contact your OB/GYN who can give the green light. Another important reason to get good dental care in pregnancy is that the bacteria in a mother’s mouth that has caused her cavities can be passed to her baby by practices such as sharing spoons and cleaning pacifiers with her mouth. Therefore, treating cavities before giving birth and practicing good dental hygiene can help decrease the chance that her baby will eventually go on to develop dental disease. **Sources:** * The American College of Obstetricians and Gynecologists * Oral health care during pregnancy and through the lifespan. Powered by Bundoo®
Morning sickness is a side effect of pregnancy that no woman likes to experience, yet up to 85 percent of women do at some point. With this being such a common issue in pregnancy, expectant mothers should know some of the new guidelines about the treatment of this condition. There are some natural remedies that you can try to treat your nausea and vomiting during pregnancy, but many women do eventually opt to ask their doctors or midwives for a prescription medication to help them feel better. The American College of Obstetricians and Gynecologists (ACOG) released some updated guidelines regarding the management of morning sickness and [hyperemesis gravidarum](https://nabtahealth.com/glossary/hyperemesis-gravidarum/) (the very severe form of morning sickness that about 2 percent of women experience) in September 2015. It’s likely that your obstetric provider has heard of this and may change what he or she is prescribing based on these recommendations. Various drugs exist to treat nausea and vomiting in pregnancy, but a newer one on the market is a combination of two drugs: [vitamin B6](https://nabtahealth.com/glossary/vitamin-b6/) (also known as pyridoxine) and doxylamine (a common sleep aid). This “new” drug is actually an old one, and was on the market in the United States from 1958 until 1983 when it was removed. During this time, about 30 percent of all pregnant women took this medication. Interestingly, when this drug was available the number of women who were hospitalized for nausea and vomiting dropped drastically. As soon as this drug was taken off the market, the rates of hospitalization went right back up. We now know that the combination of [vitamin B6](https://nabtahealth.com/glossary/vitamin-b6/) and doxylamine is safe in pregnancy — over 170,000 exposures have been followed — and because of this, it is again available to American women. One large study also showed that this medication led to a 70 percent decrease in nausea and vomiting. This drug is now available as a delayed release form where 10mg of each ingredient are in each tablet, and it is marketed under the brand name Diclegis. ACOG now states that this drug combination should be the first therapy a woman tries to treat her nausea and vomiting during pregnancy, if she has already tried lifestyle and diet modifications, and they haven’t worked (these include smaller frequent meals, bland meals, etc). Options for taking this medication include getting a prescription from your doctor or midwife or taking [vitamin B6](https://nabtahealth.com/glossary/vitamin-b6/) and pyridoxine separately (which you can get over the counter without a prescription, but they are not in the delayed release form that seems to be more effective in studies). Other medications do exist for treating morning sickness during pregnancy, and many women have tried or will try some combination of them. One popular one is Ondansetron, also known as Zofran. This drug has made headlines recently for concerns over associated birth defects, including cleft palate and heart defects. However, ACOG states that studies are limited and the ones that we do have are conflicting, so more research is needed. With the overall risk likely being very low to the fetus, it is a drug that can be considered after the risks and benefits are reviewed with the patient, but it shouldn’t be the first drug a woman tries to feel better. **Sources:** * The American College of Obstetricians and Gynecologists * Practice Bulletin #153: Nausea and vomiting of pregnancy * September 2015. Powered by Bundoo®
It seems that at a woman’s first prenatal visit she is screened for everything possible—but [lead](https://nabtahealth.com/glossary/lead/) testing isn’t often brought up. With the recent media coverage that [lead](https://nabtahealth.com/glossary/lead/)\-contaminated water has received, should it be? The simple answer is that there is not a straightforward answer when it comes to [lead](https://nabtahealth.com/glossary/lead/) screening in pregnancy. We do know that, as of this time, blood tests for [lead](https://nabtahealth.com/glossary/lead/) are not recommended for all pregnant women. Even though we know that being exposed to high levels of [lead](https://nabtahealth.com/glossary/lead/) while pregnant can [lead](https://nabtahealth.com/glossary/lead/) to health issues for both mom and baby (such as an increased risk of developing high blood pressure and an increased risk of behavior and intelligence problems in [lead](https://nabtahealth.com/glossary/lead/)\-exposed babies), the fact that only 1 percent of all U.S. women of childbearing age have elevated levels mean we would be subjecting the remaining 99 percent of women to unnecessary testing. However, there is definitely a group of pregnant women who should be screened. Women who live in certain communities that are known to be exposed to dangerously high [lead](https://nabtahealth.com/glossary/lead/) levels should be tested. This includes those with battery recycling plants, those where [lead](https://nabtahealth.com/glossary/lead/) mines or smelting factories exist, or where products such as leaded gasoline are still used. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend screening pregnant women for risk factors for [lead](https://nabtahealth.com/glossary/lead/) exposure. If any one of the following risk factors are present, blood [lead](https://nabtahealth.com/glossary/lead/) levels should be checked: Living in an area or recently emigrating from an area where [lead](https://nabtahealth.com/glossary/lead/) contamination is high Living near a [lead](https://nabtahealth.com/glossary/lead/) source (such as a [lead](https://nabtahealth.com/glossary/lead/) mine) Renovating an older home without proper [lead](https://nabtahealth.com/glossary/lead/) hazard controls Drinking water contaminated with [lead](https://nabtahealth.com/glossary/lead/) (i.e. through [lead](https://nabtahealth.com/glossary/lead/) pipes) Working with or living with someone who works with [lead](https://nabtahealth.com/glossary/lead/) (such as paint, battery, or plastic manufacturing) Used [lead](https://nabtahealth.com/glossary/lead/)\-glazed ceramic pottery to cook, serve, or store food Eating non-food substances (also known as pica) Using certain alternative/complementary herbs or remedies Using imported cosmetics or certain imported foods or spices that may be contaminated Having a past history or living with someone who has had a history of high [lead](https://nabtahealth.com/glossary/lead/) levels If any single one of these risk factors is present, a pregnant woman should be screened as early as that risk factor is identified. This is so that appropriate measures, such as doing an environmental evaluation to help reduce her ongoing [lead](https://nabtahealth.com/glossary/lead/) exposure, can be put in place as soon as possible. [Lead](https://nabtahealth.com/glossary/lead/) levels should be tested via a venous blood test, as opposed to a finger stick test as this can give inaccurate results. A blood [lead](https://nabtahealth.com/glossary/lead/) level above 5 micrograms/dL is considered abnormal and requires further investigation and follow-up. If you are pregnant and concerned that your risk for [lead](https://nabtahealth.com/glossary/lead/) exposure has not been assessed, you can review the list above to see if you might fall into a category where you should be screened. If so, discuss it with your doctor or midwife so that the appropriate testing can be done. **Sources:** * The American Congress of Obstetricians and Gynecologists * Committee Opinion #533: [Lead](https://nabtahealth.com/glossary/lead/) screening during pregnancy and [lactation](https://nabtahealth.com/glossary/lactation/) * August 2012. The Centers for Disease Control and Prevention * Guidelines for the identification and management of [lead](https://nabtahealth.com/glossary/lead/) exposure in pregnant and lactating women * November 2010. Powered by Bundoo®
