By Lori J. Wolfe, MS. CGC, OTIS President

Recently while having lunch at my favorite restaurant, I overheard a conversation at the table behind me. A very pregnant lady was discussing with her friend how she was going to get tan. “Now that it is the month of May, I want to get a head start on my tan,” she was saying. They began discussing her options; tanning booths, professional spray tans, tan at home lotions, tanning pills, or laying out in the sun. What would be best and safe during a pregnancy? Well, usually I don’t jump into other people’s conversations, but I just couldn’t help myself. Being that counseling about exposures and associated risks during pregnancy is my job, I felt I just had to give her a little educated advice!

I turned around, introduced myself, learned that her name was Sally, and began discussing the options. The use of tanning booths during pregnancy can be done, but you need to take a few safety precautions. We are always worried about over-heating during pregnancy. This is called hyperthermia. When you are in a tanning booth, it is easy for your body to become over heated if the booth is not well ventilated and/or you stay in the booth for too long of a time period. The ultraviolet rays that are used in the tanning booths do not get to the baby, so that is not the problem. But if you are in the tanning booth for more than 10 to 15 minutes, your body temperature might get too high. So be sure the booth has good ventilation and limit your tanning session to no more than 15 minutes.  Also when using tanning salons and their tanning beds, please be sure to check and see how clean everything is. We do not want you laying down in dirty beds and perhaps picking up some nasty germs!

At this point Sally asked me about the use of self-tanning products, either done professionally or at home. Self-tanning products come as sprays, lotions or gels, and can be applied at home or in a salon. The main active ingredient in self-tanners is something called DHA or dihydroxyacetone. The amount of DHA can vary from 3 to 5% in products you use at home, or up to 15% in products used by professionals. We do know that only a very small amount of the DHA that is applied to your skin will be absorbed into your bloodstream. Therefore, there would be very little in your system to get to the baby. Since we do not have much information about DHA and pregnancy, we do want you to be careful to not get the self-tanning products into your eyes, nose or mouth.

“Hmm, I have heard about tanning pills,” Sally asked me. “What are those and can I use them while I am pregnant?” Tanning pills can be bought over-the-counter and contain something called canthaxathin as the ingredient that changes the color of your skin. Unfortunately we do not have any studies that have looked at taking large amounts of canthaxathin during pregnancy, and we know that you need to use a lot to change the color of your skin. Therefore, it is best to avoid the use of tanning pills when you are pregnant.

“OK,” Sally said, what if I just want to lay out in the sun and get tan the old fashioned way.” I let her know that our main worry with laying out in the sun would be the same as using tanning booths, hyperthermia or overheating. If you do chose to tan outside, be sure to use a good sunscreen product, drink lots of water, and limit your sessions to 30 minutes or less. Be sure that you are cooling off frequently if you are outside for a long period of time. If you follow these good-sense guidelines, you can gradually build up a nice tan, even when you are pregnant.

At this point, Sally thanked me, paid her bill and left the restaurant. I let her know that if she or her friends had any questions about exposures during pregnancy, they can call OTIS, the Organization of Teratology Information Specialists at 866-626-6847 or, if you’re in California, 800-532-3749.

**Lori Wolfe, MS, is a board-certified genetic counselor and the president of OTIS. She is also the director of OTIS’ Texas affiliate, the Texas Teratogen Information Service (TTIS), which she founded in 1991.**

Under the direction of Kenneth Lyons Jones, M.D. and Christina Chambers, Ph.D., M.P.H., both professors in the Department of Pediatrics at UCSD, the new center location will be home to a number of programs, projects and services including:

• The California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a state-wide non-profit organization offering evidence-based clinical information about exposures during pregnancy and breastfeeding through its toll-free hotline, (800) 532-3749, and website, CTISPregnancy.org.
• The Organization of Teratology Information Specialists (OTIS) Research Center, which conducts groundbreaking research on the safety of various medications and vaccines used for the treatment of conditions such as autoimmune diseases and asthma, and to prevent influenza, meningitis and HPV infection in pregnant women throughout the U.S. and Canada.
• The National Children’s Study (NCS) San Diego, which aims to examine the effects of environmental and genetic factors on the growth, development, and long-term health of children, following them from before birth until age 21 years.
• A California study that aims to understand how a child’s learning and behavior may be affected by factors that happened before birth, including various environmental  agents with which the mother came into contact during her pregnancy such as the kinds of food that she ate and how much alcohol she consumed.
• A Genetics/dysmorphology outpatient clinic to evaluate children with birth defects.
• Maternal and fetal health education and training programs.

“We are excited about the opportunity this new Center brings to combine the talents of UCSD and Rady Children’s Hospital researchers and clinicians to focus on learning about the best ways to optimize pregnancy outcomes, and to contribute to the health of children not only in the San Diego community, but all across the state,” said Dr. Chambers.

If you are pregnant or planning a pregnancy and would like to get involved in some of the new research projects at the Center for the Promotion of Maternal Health and Infant Development, please indicate so by filling out our “E-mail An Expert” form.

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor

What do you know about the safety of the cosmetics you use on your face and body every day? I’m not talking just about foundation and lipstick, I’m talking about face cream, body lotion, stretch mark cream, skin lighteners, shampoo, and conditioner? Do you read the labels of all the products that you buy? What about those creams/lotions that you get as gifts?

On March 6, the FDA had a press release alerting consumers and retailers about mercury poisoning/toxicity in women and in some cases, the entire family, as a result of exposure through skin lightening creams that had been brought into the country and were foreign made. A search of the medical literature found reports of mercury toxicity related to creams/lotions manufactured in Mexico and China/Hong Kong/Asia, although the FDA site reports that these products have also been sold illegally in the United States in shops found in Latino, Asian, African or Middle Eastern neighborhoods. Online shops have no borders, so the potential of getting a tainted product may be higher.

Mercury is divided into three types – elemental, inorganic and organic. Organic is the kind that you find polluting streams and fish (methyl mercury).

Inorganic mercury is the type that is found primarily in batteries. It’s also been reported in some disinfectants, health remedies/homeopathic remedies and skin creams/acne/lighteners (illegally). Inorganic mercury can be labeled as mercuric chloride, mercuric acetate, and mercuric sulfide. In the case of lotions containing inorganic mercury, not only is the user exposed, but the entire household may be at risk as the metal containing lotion is exposed to air, becomes a vapor, and members inhale it (or ingest it).

Exposure to inorganic mercury and organic mercury through a route that could result in toxicity is a concern for the entire family, including pregnant women. It’s important to understand, however, that each type of mercury has potential risks depending on the route of exposure and the dose. Some forms are more readily available (absorbed into the body) if inhaled and some more available in the body if ingested.

Mercury crosses the placenta. High levels in the mom would be expected to produce high levels in the developing embryo or fetus. High levels of exposure in pregnancy have been associated with spontaneous abortion (miscarriage). Studies of high levels of methyl mercury exposure (the kind typically found in fish) have been associated with neurologic disorders in the exposed infants/children (see our fact sheet). Studies of methyl mercury in pregnancy or children are more common than studies of inorganic mercury related to exposure in cosmetics or imported homeopathic remedies or others, leaving a gap in our awareness and ability to treat those individuals that have been exposed. This also means that it is difficult to know the levels that may be more or less harmful to the developing pregnancy.

Symptoms of mercury toxicity in the early stages include nausea, vomiting, and diarrhea. Symptoms of high acute exposure or chronic long-term exposure include kidney problems, gastroenteritis, metallic taste in the mouth, hypotension and shock, rashes and excessive sweating as well as others.

The FDA advisory reminds us of the importance of reading labels and understanding the potential risks with using hygiene products or cosmetics products (or supplements, herbal remedies, etc.) that are foreign-made. Per the FDA:

• Check the label of any skin lightening, anti-aging or other skin product you use. If you see the words “mercurous chloride,” “calomel,” “mercuric,” “mercurio,” or “mercury,” stop using the product immediately.
• If there is no label or no ingredients are listed, do not use the product. Federal law requires that ingredients be listed on the label of any cosmetic or drug.
• Don’t use products labeled in languages other than English unless English labeling is also provided.
• If you suspect you have been using a product with mercury, stop using it immediately. Thoroughly wash your hands and any other parts of your body that have come in contact with the product. Contact your health care professional or a medical care clinic for advice.
• If you have questions, call your health care professional or the Poison Center at 1-800-222-1222; it is open 24 hours a day.
• Before throwing out a product that may contain mercury, seal it in a plastic bag or leak-proof container. Check with your local environmental, health or solid waste agency for disposal instructions. Some communities have special collections or other options for disposing of household hazardous waste.

We should probably extend the discussion to U.S.-made products as well. Cosmetic products in the U.S. are, unfortunately, not regulated by the FDA. Furthermore, while companies are required to properly label products, the FDA does not pre-approve cosmetic product labeling either. It is illegal to sell misbranded cosmetics in the U.S., but, again, the FDA does not regulate or approve “cosmetic” products.

Cosmetics are commonly used during pregnancy and typically a low concern to the pregnancy due to expected low absorption into the bloodstream and therefore low exposure to the pregnancy but it can’t hurt to be cautious and take a second look at the products we are using especially in light of recent FDA warning.

So I’ll end with some important questions we should all be asking….How much do we know about the short-term and long-term use of chemicals in the cosmetic products that we use everyday? How much are we as consumers willing to pay for this type of evidence, and how long are we willing to wait for it?

For more detailed information on cosmetics, please visit the FDA website: http://www.fda.gov/Cosmetics/default.htm

Sonia Alvarado is a bilingual (Spanish/English) Teratogen Information Specialist with the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide service that aims to educate women about exposures during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/lactation via CTIS’ toll-free hotline and email service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade. In addition, Sonia contributes to the service’s website, develops training materials for new CTIS staff, and is the supervising Teratogen Information Specialist trainer. Sonia attended San Diego State University and has worked in Tuberculosis Control for San Diego County’s Public Health Department. Sonia’s work has also been published through several tuberculosis studies. In her spare time, she loves to volunteer with the March of Dimes as an expert speaker on themes related to pregnancy.

CTIS Pregnancy Health Information Line is part of the Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. California women with questions or concerns about pregnancy exposures can be directed to (800) 532-3749 or by visiting CTISPregnancy.org. Outside of California, please call OTIS counselors at (866) 626-OTIS (6847).

References:

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm294849.htm

http://www.epa.gov/teach/chem_summ/mercury_inorg_summary.pdf

Mercury exposure among household users and nonusers of skin-lightening creams produced in Mexico – California and Virginia, 2010.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2012 Jan 20;61(2):33-6.

To download the insert, please click: http://doc.mediaplanet.com/all_projects/9342.pdf

Researchers Say Results Show Need For Additional Breastfeeding Support and Education

SAN DIEGO, CA – Researchers at the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide non-profit organization based at the University of California, San Diego, have found women exposed to certain antidepressants during pregnancy were significantly less likely to breastfeed their babies compared to unexposed women. The results of the study were recently published in the February 2012 online edition of The Journal of Human Lactation.

The study uses data obtained by counselors at the CTIS Pregnancy Health Information Line, a toll-free service offering evidence-based clinical information about exposures during pregnancy and breastfeeding.  It focused on 466 pregnant women who contacted the CTIS Pregnancy Health Information Line over a 10-year period with questions about a wide variety of exposures and, after being counseled, agreed to participate in a follow-up study of their pregnancy outcome.

The study specifically examines breastfeeding choices of women exposed to selective serotonin reuptake inhibitor (SSRI) antidepressants at the time of delivery, compared to those who discontinued use of antidepressants earlier in pregnancy, as well as to those women who report not taking antidepressants at all. The results showed women exposed to an SSRI anytime in pregnancy were about 60% less likely to initiate breastfeeding than women who took no antidepressant.

“While the benefits of breastfeeding an infant are very clear, this study suggests that women who are taking antidepressants in pregnancy are not engaging in this behavior as often as we would like to see,” said Christina Chambers PhD, MPH, professor of pediatrics at UC San Diego, CTIS program director, and co-author of the study. “Whether this is due to the mother’s fear of harming her baby by breastfeeding while taking the medication, or due to the mother’s depression itself is unclear.”

According to Chambers, regardless of the reason for breastfeeding choice, the study suggests that women who have depressive disorders and/or who take antidepressants in pregnancy may require additional encouragement and support when making the choice to breastfeed an infant.

Questions or concerns about antidepressants or any other exposure during pregnancy or breastfeeding can be directed to the CTIS Pregnancy Health Information Line at 800-532-3749 or via instant message counseling at CTISPregnancy.org. Outside of California, please call the Organization of Teratology Information Specialists (OTIS) at 866-626-6847.

Since March is National Kidney month, it’s a good time to learn a little about prenatal exposure to drugs as well as maternal diseases that can have an effect on function and development of the fetal kidney.

Although there are a number of conditions that affect the kidney, there are generally two major causes that need to be considered in pregnancy: diabetes and hypertension. Experts worry that the growing number of obese individuals, including women of reproductive age, will mean more diabetes. Diabetes affects kidney function, One of the major categories of drugs used to treat kidney disease in diabetic women as well as others are called angiotensin-converting enzyme (ACE) inhibitors. Unfortunately this group of drugs can cause serious kidney damage in the developing fetus when exposure occurs in the second or third trimester of pregnancy. These drugs are associated with oligohydramnios and anhydramnios (low or no amniotic fluid) and stillbirth, both the result of  damage to the developing kidney.

Hypertension is another condition that is associated with chronic kidney disease (CKD) and kidney failure. CKD as well as first pregnancy, genetic factors, and twin pregnancy are risk factors for the development of preeclampsia, a sudden increase in blood pressure, after 20 weeks of pregnancy. Severe preeclampsia is associated with kidney damage, as well as liver damage and other serious problems.

The fetal kidney is formed in the first trimester of pregnancy, starting at about five weeks. Although the kidneys are formed in the first trimester, they continue to mature throughout pregnancy and are sensitive to several medications that could interfere with their function, often permanently. Many pregnant women are not aware that there are even medications that are available over the counter which could pose a significant risk to the kidney of their developing fetus. For example many pregnant women are told by their doctors to avoid over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen and aspirin, particularly late in pregnancy. However, they don’t know why they need to avoid them. This is a problem, because if the pregnant woman does not understand why she needs to avoid them, she may forget the warning among the many other health messages about food, etc., she is getting from her health care provider, as well as the internet, and brochures. Additionally, women that are not very familiar with pain relievers or medications in general, may confuse acetaminophen (Tylenol), which is recommended for pregnancy, with one of the other drugs. Survey studies suggest that many pregnant women have not heard or understood which pain relievers or fever reducers are recommended for them.

There are multiple reasons why NSAIDS, which are otherwise safe and effective pain relievers, are not recommended during pregnancy. These drugs have an anti-inflammatory effect by decreasing prostaglandin synthesis. Prostaglandins are found in smooth muscle including the uterus, and all over the body and are increased following inflammation. Prostaglandins are also important in maintaining the ductus arteriosus, which is a blood vessel that allows blood to go around the baby’s lungs before birth. Prior to birth, the fetus does not need to receive oxygen from the lungs because oxygenated blood is provided by the placenta. However, immediately after birth, the lungs of the newborn baby are filled with air, and the ductus arteriosus closes. When prostaglandin-reducing drugs such as NSAIDS are taken by the mother and are, therefore,  introduced into the fetal circulation, the ductus arteriosis sometimes closes prematurely, causing a crisis for the unborn and the newborn baby. That is associated with damage to the newborn kidney. NSAIDs are also associated with a risk for fetal intracranial hemorrhage, and gastrointestinal problems (necrotizing entercolitis) above what is normally already seen in premature infants.

The take away message for pregnant women or women of reproductive age is to take care of your kidneys, avoiding lifestyle factors that could put them at risk such as obesity; take medications as prescribed by the physician if you have diabetes or hypertension and, finally, plan every pregnancy, whether there is an underlying illness or not.

Sonia Alvarado is a bilingual (Spanish/English) Teratogen Information Specialist with the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide service that aims to educate women about exposures during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/lactation via CTIS’ toll-free hotline and email service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade. In addition, Sonia contributes to the service’s website, develops training materials for new CTIS staff, and is the supervising Teratogen Information Specialist trainer. Sonia attended San Diego State University and has worked in Tuberculosis Control for San Diego County’s Public Health Department. Sonia’s work has also been published through several tuberculosis studies. In her spare time, she loves to volunteer with the March of Dimes as an expert speaker on themes related to pregnancy.

CTIS Pregnancy Health Information Line is part of the The Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. California women with questions or concerns about pregnancy exposures can be directed to (800) 532-3749 or by visiting CTISPregnancy.org. Outside of California, please call OTIS counselors at (866) 626-OTIS (6847).

We all know that February brings us Valentine’s Day, but did you know it is also American Heart Month? This month, heart symbols are everywhere you look! Recently, a call from a friend of mine made me stop thinking about candy and red paper hearts, and start thinking about beating hearts! My friend is very excited to be experiencing her first pregnancy and I have been sharing in her joy. Last week, she called in tears to tell me that her 20 week sonogram showed that her baby has a heart defect. This news came as a shock to Melissa and her husband Mark as there is no family history of heart defects on either side of the family. As Melissa knows that I am a genetic counselor and work with pregnant women, her first question to me was, “why did this happen to our baby?” So I began to share what I know with Melissa, which I will also share here with you.

Unfortunately, heart defects are much more common than you might think. In fact, congenital heart defects (CHD) are the most common birth defects that occur in babies. About 100 babies are born each day in the United States with a heart defect, for a total of 40,000 babies each year. Can you believe that? Many of us do not even live in towns that have 40,000 people and can’t imagine that many tiny babies are born each year with heart problems! The good news is that these days almost all babies born with CHD do survive into adulthood, and many live a normal lifespan.

So back to Melissa’s question, what causes heart defects and why is her baby affected? Sometimes there is a genetic link, so it is important to know if you have a family history of heart defects. Many times we don’t know why the baby has a heart defect.  Birth defects happen randomly in 3 to 5% of all babies born. But we do know that about 10% of all birth defects, in general, are caused by exposure during pregnancy to things called teratogens. That is a scary sounding word that means any exposure during pregnancy that can harm a baby. The good news is, these kinds of exposures are often preventable. That means the resulting birth defects are potentially preventable too.

So what should you be especially aware of regarding your developing baby’s heart? We do know that over 80% of all women are exposed to a medication during pregnancy and there are some medications that can increase the chance that a baby will have a heart defect. These medications include:

• Lithium, which is used mainly to treat Bipolar Depression Disorder.
• Isotretinoin, a form of vitamin A that is found in Accutane and is used to treat severe acne.
• Phenobarbital, a medication mainly used to treat seizure disorders.
• Alcohol. Drinking alcohol during pregnancy can also increase the chance that your baby will have a heart defect.

It is always important to receive good prenatal care and avoid alcohol and illicit drugs when you are pregnant. If you are taking a prescription medication, you do need to be sure to talk with your doctor before you stop taking medication such as Lithium or Phenobarbital. Your doctor will help you decide if the benefits to you of taking the medication for your condition outweigh the small risk for a possible birth defect such as a heart defect.

For all of the “Melissas” out there, know that you also have a friend to lean on for answers to your questions about preventing heart defects in the field of healthcare. If you have any questions about exposures during pregnancy or while nursing your baby, please call the Organization of Teratology Information Specialists (OTIS) at (866) 626-6847 or check us out at OTISPregnancy.org. So this Valentine’s Day, have a real heart-to-heart conversation to keep your baby’s heart healthy!

**Lori Wolfe, MS, is a board-certified genetic counselor and the president of OTIS. She is also the director of OTIS’ Texas affiliate, the Texas Teratogen Information Service (TTIS), which she founded in 1991. Visit its website at http://www.ttis.unt.edu/. OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and breastfeeding and CTIS Pregnancy Health Information Line’s national affiliate.**

SAN DIEGO, CA- Researchers at the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a state-wide non-profit organization based at the University of California, San Diego, have found new links between the timing of alcohol consumption during pregnancy and certain characteristics of Fetal Alcohol Syndrome (FAS). The results will be published in the April 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View (online version).

The study uses data obtained by counselors at the CTIS Pregnancy Health Information Line, a toll-free service offering evidence-based clinical information about exposures during pregnancy and breastfeeding.  It focuses on 992 California women who contacted the CTIS Pregnancy Health Information Line between 1978 and 2005 with questions about a wide variety of exposures and, after being counseled, agreed to participate in a follow-up study of their pregnancy outcome. The study specifically examines the timing of the mother’s reported alcohol exposure in relation to known physical features of Fetal Alcohol Syndrome (FAS). Importantly, all infants in the study, whether identified as exposed to alcohol or not, received a special screening for birth defects by Kenneth Lyons Jones, MD, chief of the Division of Dysmorphology/Teratology at the Department of Pediatrics and CTIS Medical Director.

The physical features of Fetal Alcohol Syndrome can be very subtle and not easily recognizable, particularly in newborns. These features include a smooth upper lip with thin/smooth red portion of the lip, short eye openings, smaller head size, and reduced birth weight and length.

Researchers found that every pattern of higher prenatal alcohol consumption (no matter the timing in pregnancy) was associated with an increased risk of having an underweight infant or one with a reduced birth length. However, there were also significant associations between higher alcohol consumption in the second half of the first trimester and certain facial features of FAS, in addition to lower birth weight and length. “For every one drink increase in the average number of drinks consumed daily, there was a 25 percent increased risk for smooth upper lip, a 22 percent increased risk for thin red portion of the upper lip border, a 12 percent increased risk for small head size, a 16 percent increased risk for reduced birth weight, and an 18 percent increased risk for reduced birth length,” said Haruna Sawada Feldman, PhD, MPH, CHES, post-doctoral student and lead author of the study.

“These findings show that drinking alcohol between week seven and 12 of pregnancy are clearly associated with a risk for FAS facial features, as well as a decrease in birth weight and length,” said Christina Chambers PhD, MPH, professor of pediatrics at UC San Diego and CTIS program director.  “However, this should not be misinterpreted to mean that drinking during weeks 1 through 7 is safe. This study only looked at data that included live births. It does not include women who had miscarriages or stillbirths possibly resulting from early alcohol exposure,” she explained. “If anything, this further supports the idea that there is no designated ‘safe’ period for drinking alcohol in pregnancy, and that discontinuing alcohol consumption as soon as possible, and, ideally, prior to pregnancy is the best approach to preventing FAS.”

Questions or concerns about alcohol or any other exposure during pregnancy or breastfeeding can be directed to the CTIS Pregnancy Health Information Line at 800- 532-3749 or via instant message counseling at CTISPregnancy.org. Outside of California, please call the Organization of Teratology Information Specialists (OTIS) at 866-626-6847.

Dr. Haruna Sawada Feldman talks about CTIS’ alcohol study on KPBS radio:

Study Results Shed Light On Need For Improved Diagnostic Tools

SAN DIEGO, CA –Researchers affiliated with the Organization of Teratology Information Specialists (OTIS) have found normal pregnancies misdiagnosed as ectopic and treated with methotrexate in the first trimester resulted in severely malformed newborns or fetal loss. OTIS is a North American non-profit that educates the public about exposures during pregnancy and breastfeeding, as well as conducts relevant research. 

Researchers examined eight North American women with normal pregnancies that had been erroneously diagnosed as having ectopic pregnancies, a condition in which the embryo begins to develop outside of the uterus. An ectopic pregnancy is non-viable and life threatening for the woman. Its treatment is generally a non-surgical termination of the non-viable ectopic pregnancy.

The suspected ectopic pregnancies examined in the report were subsequently treated with high doses of methotrexate, a known teratogen. As a result, the pregnancies resulted in either miscarriage, termination of pregnancy or severely malformed babies. The report was recently published in the December issue of the American Journal of Obstetrics & Gynecology.

Study authors said these results may only be a small indication of a much bigger problem. “This report describes a subset of cases that occur in the general population and it suggests that this misdiagnosis is not limited to one center or one part of the United States or Canada,” said Sharon Lavigne, MS, a co-author of the study and coordinator of OTIS’ Connecticut affiliate. “There are likely many more of these scenarios out there that our services never hear about,” she added.

Myla Moretti, MSc, a co-author of the study who also serves as assistant director of Motherisk, OTIS’ Canadian affiliate, hopes the report will encourage positive change in the way ectopic pregnancies are diagnosed and treated. “This is a challenging diagnosis, and efforts to accurately locate the pregnancy in suspected early ectopic pregnancies would benefit from improved diagnostic tools,” explained Moretti. “Establishing non-punitive reporting mechanism to explore the magnitude of this problem will be helpful in increasing awareness and possibly preventing these events in the future.”

The Centers for Disease Control has recognized OTIS as the primary resource for medications in pregnancy information. Questions or concerns women or health care providers have about medications and other exposures in pregnancy or breastfeeding can be directed to OTIS’ California affiliate, the CTIS Pregnancy Health Information Line  counselors toll-free at (800) 532-3749. Outside of California, please call 866-626-6847.

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For more information or if you would like to schedule an interview regarding this story, please contact Nicole Chavez at (619) 294-6262. Spanish-speaking interviews are also available.