Is it safe?

The lowdown on safety precautions one should take during pregnancy.

You’re pregnant and everyone’s got advice: how much milk to drink, whether exercise is OK, what to name the baby…. Of course, you get to decide what and who you will listen to.

There are, however, some advisories you shouldn’t ignore. These include recommendations on what foods, medications and chemicals are safe during pregnancy. While this information is available, it can be difficult to find all you need to know in one place. We’re here to help.

What follows is a list of food, medicines and chemicals you should avoid or approach with caution. If you need more in-depth information, check the Health Canada or Motherisk websites.

Food: Protein

Deli meats/hot dogs
These are OK as long as they’re properly reheated. This means warming your sliced turkey or ham until steaming, reaching an internal temperature of at least 71°C. Yes, yuck.

Peanuts
The American Academy of Pediatrics suggests pregnant women at “high risk” for peanut allergy stay peanut-free during pregnancy. Those at high risk include women who have a close relative with a peanut allergy (a child, sibling or parent, for example). However, eating peanuts while pregnant will not cause a nut allergy in the baby.

Protein bars/shakes
A no-no because of how much protein the average bar or shake can pack. One can contain up to 35 g, about half the amount of protein an average pregnant woman needs in a day. (On average, women need about 45 g of protein a day. A pregnant woman needs an additional 25 g a day.) Moreover, protein is something of an appetite suppressant, and the risk of eating too much is that you’ll neglect other important nutrients because you’re too full of protein. You’re much better off getting your daily recommended 60 to 70 g from protein-rich foods, such as meat and eggs.

Soft cheeses
This is confusing because some “soft” cheeses are perfectly fine. These include cottage cheese and cream cheese. However, a mental stop sign should go up when faced with brie, Camembert, feta and blue-veined cheeses. These are generally unpasteurized and could carry the bacteria listeria, which has been associated with miscarriage and preterm labour. And if there is nothing on the label to indicate it has been pasteurized, you should assume it has not. Hard cheeses, such as mozzarella and cheddar, are safe.

Refrigerated pâtés or meat spreads
Pass on these for the same reason — risk of listeria contamination. It is, however, safe to eat canned or shelf versions.

Raw eggs
You’re thinking: Why would I eat raw eggs? But consider — Caesar salads and some sauces are made with raw eggs. Also, read the label before you dip into some non-alcoholic eggnog, sometimes made with unpasteurized eggs.

Fish and seafood
Stay away from refrigerated smoked salmon. Same goes for raw fish like sushi or oysters. Also, Health Canada advises pregnant women to limit shark, swordfish and fresh and frozen tuna to no more than once a month. Canned salmon is considered safe. However, Health Canada says canned tuna should be limited to 360 g a week because of concerns about high levels of mercury in large ocean fish. Fish likely to have relatively low mercury levels include farmed trout, haddock, farmed tilapia and flounder.
Artificial sweeteners
Here’s where accurate label-reading is a must. Some are OK, while others Health Canada suggests you avoid. For example, NutraSweet, which contains aspartame, is considered safe. SugarTwin, which contains saccharin, is not advised. For a complete list, check the Health Canada website.

MSG
Although not considered dangerous during pregnancy, keep in mind that monosodium glutamate is loaded with sodium. Pregnant women are advised to limit the sodium they ingest, so ease up on Chinese takeout, or any other foods high in MSG.

Caffeine
Bad news for java junkies. According to the Centre for Addiction and Mental Health (CAMH), too much coffee “increases your risk of miscarriage and having a low-birth-weight baby.” Just how much coffee is OK depends on who you ask. Health Canada and the CAMH approve up to 300 mg a day (about two to 21/2 cups). But Motherisk advises no more than 150 mg of caffeine a day.

Herbs
Here is a list of herbs determined “unsafe” during pregnancy by Motherisk: aloe vera, black cohosh, burdock, calendula, chamomile, chaste tree, dong quai, feverfew, goldenseal, hops, juniper, licorice, ma huang, passion flower, peppermint and slippery elm.

Alcohol
Just say no. Your best course of action is to avoid alcohol altogether, as a safe amount of alcohol in pregnancy is not known.
Antihistamines
The only reason to proceed with caution when taking an antihistamine is if you’re considering the non-drowsy types to treat seasonal allergies. The “sedating” antihistamines, such as Benadryl, Nytol, Gravol, etc., are safe. Also, antihistamines sometimes prescribed for morning sickness (for example, Unisome Nighttime Sleep Aid) are safe.

Cough medicines
Many over-the-counter cough medicines, such as Benylin DM, Tylenol Cough, and Dimetapp, contain the cough-suppressant DM, or dextromethorphan. According to Motherisk, DM is “probably safe.” By this, Motherisk means “there is no evidence the drug is dangerous to the fetus and the information showing it to be safe is rather large.” Bottom line: The benefit/risk assessment can be weighed in favour of taking the medication. Gideon Koren, director of Motherisk, suggests you try not to use cough medicines for more than a few days at a time.

Cold medicines
Motherisk has a long list of cold medications it deems “possibly safe.” As you might expect, this isn’t as reassuring as “probably safe.” Motherisk says of the meds that fall into this category: “There is no evidence the drug is dangerous for the fetus, but the information showing it to be safe is limited.” This list includes Sudafed Decongestant, Dimetapp Daytime Cold, Dristan N.D., Sinutab Sinus, Sinutab Sinus and Allergy, Tylenol Sinus, Tylenol Cold, Sinutab with Codeine, Tylenol Flu, Triaminic Cold, Robitussin Honey Flu, Robitussin Cough & Cold, Benylin 4 Flu, Advil Cold and Sinus, Claritin Extra, among others.

Asthma medications
If you’ve got chronic asthma, talk to your physician before discontinuing any medication to manage your condition. You could be taking a greater risk by discontinuing your meds. According to Motherisk, uncontrolled asthma is associated with a higher risk for preterm birth and stillbirth. Most first-line asthma drugs, such as Ventolin and inhaled steroids (for example Beclomethasone) have not been shown to harm the fetus. You’re going to want to determine the best course of action with your physician.
Laxatives
Many pregnant women experience constipation. Are you allowed to give things a little, um, push? Motherisk says laxatives such as Dialose and Soflax are “probably safe.” Most dietitians would suggest you try moving things along with a high-fibre diet rather than laxatives. However, if your health care provider believes you need medication, she will likely recommend a fibre-based laxative, such as Metamucil.

Hydrocortisone
You’ll want to check with your physician about taking oral hydrocortisone. There are studies to suggest it may cause a cleft palate or lip if taken orally during the first trimester. The topical creams, however, are described as “probably safe.”

ASA and NSAIDs
Acetylsalicylic acid (ASA), such as Aspirin, and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve), should be avoided in the last trimester. Acetaminophen (Tylenol) is safe for the fetus.

Acne medications
Most health experts recommend avoiding both Retinol and Accutane, which contain vitamin A. High amounts of vitamin A can cause birth defects. Ingredients that have been OK’d for treating acne while pregnant: topical erythromycin, clindamycin and benzoyl peroxide.

Migraine medications
Motherisk is unequivocal about some migraine meds. Cafergot-PB, Bellergal Spacetabs and Ergodryl are decidedly unsafe. However, Imitrex is “probably safe.”

Antibiotics
There are many, many antibiotics that are perfectly safe during pregnancy. Tetracycline, (called Novo-Tetra and Nu-Tetra among others), is one exception, since it is a known cause of birth defects. Make sure your physician knows you’re pregnant before you begin a course of antibiotics.

Blood pressure medications
Health Canada recommends avoiding several of these drugs during pregnancy. Discuss this with your doctor. Specifically, pregnant women should avoid ACE (angiotensin-converting enzyme) inhibitors. When used in the first trimester, ACE inhibitors are associated with increased risk of birth defects. Health Canada points out that there are many approved drugs to treat high blood pressure that do not contain ACE inhibitors.
Interior paints
Painting the nursery? As long as you use latex or water-based paints, you’re fine. No oil-based paints. Do your decorating in a well-ventilated area. If you do start to feel dizzy or sick, stop right away and consult your physician.

Hair dyes
There’s very little data available on the effect, if any, of hair dye on the fetus. Here’s what Motherisk says: “Occasional use of permanent hair dyes in a well-ventilated area is unlikely to be a concern during pregnancy. If, however, you want to be extra safe, you may want to choose a colouring process, such as highlights, where the chemicals don’t touch the scalp.” The same holds true for hair straightening and bleach.

Household cleaning products
When used as directed, most are safe. Avoid industrial-strength products. Make sure you do your cleaning in well-ventilated areas, and stop if you start to feel dizzy or nauseous. One substance to avoid: nitrobenzene. Found in some shoe, furniture and floor polish, it is toxic and has the ability to cross the placenta.

Carbon monoxide
Of course, everyone wants to avoid carbon monoxide poisoning, but now might be the time to invest in a household carbon monoxide detector.

The litter box
Good news! You get a break from changing the litter box. Cat feces can contain a parasite potentially harmful to a pregnant woman and her unborn child, so you’ve got good reason to turn that chore over to someone else for nine months.
Insecticides
If you’re pregnant in late spring or early summer and you’re truly bothered by bugs, you may apply a natural bug repellent (such as the type you’d find in a health food store). Or, choose something that has less than 30 percent DEET.

Pesticides
As a rule, you should steer clear of pesticides, but if you find exposure is unavoidable (for example, your house must be sprayed), Motherisk advises you stay away two to three times longer than recommended by the pesticide manufacturer. A 2004 US study suggests low-dose exposures to agricultural and lawn-care pesticides can cause injury to developing embryos before a pregnancy is even noticed. And if you are a gardener, and you use fungicide or fertilizer, make sure you use gloves and a mask.

Diagnostic radiation
So what are you to do if you need a dental or chest X-ray? If it’s unavoidable, the X-ray should not be aimed at the abdomen, and a lead apron should be worn. Your best course of action, however, is to either be X-rayed before you conceive or after you’ve finished breastfeeding.

Workplace chemicals
Very few industrial chemicals are tested for their effects on an unborn baby. Koren advises using your nose as your guide. If the chemicals you’re exposed to — solvents, glues, etc. — are strong enough to smell, talk to your employer about limiting your exposure to them. Koren asks pregnant women to pay particular attention to lead and organic solvents. Lead levels safe for a pregnant woman may not be safe for her baby, and airborne levels of organic solvents may affect the development of a baby’s vision.

• Health Canada’s Nutrition for a Healthy Pregnancy — National Guidelines for the Childbearing Years: hc-sc.gc.ca

• Motherisk at Toronto’s Hospital for Sick Children: motherisk.org

• Motherisk help line (416) 813-6780, for information about the risk or safety of prescription and over-the-counter drugs, herbal products, chemicals, X-rays, chronic disease and infections during pregnancy

The Complete Guide to Everyday Risks in Pregnancy & Breastfeeding: Answers to Your Questions About Morning Sickness, Medications, Herbs, Diseases, Chemical Exposures & More by Dr. Gideon Koren, Robert Rose 2004.

Better Food for Pregnancy by Daina Kalnins and Joanne Saab, Robert Rose, 2006

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