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.

******

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.

By Alfred Romeo, RN, PhD

 As a health care professional, few things are more rewarding than when a new health-promotion program emerges. This is true especially in cases where the program has the potential to make a huge difference in the lives of children. Please allow me to introduce you to one of those programs. In Utah, the Pregnancy Risk Line is partnering with the “Learn the Signs. Act Early.” campaign in an effort to help parents of young children learn about healthy development. The free tools and checklists on the website―http://health.utah.gov/utahactearly―help parents determine if their children have reached important milestones for growth and development.

Parents may be familiar with some of the more common milestones, such as learning to walk and talk, but there are others that parents may not know about, such as the child responding to his/her name being called or pointing at objects. Missed milestones can be symptoms of developmental delays, which could be associated with more serious medical conditions. Parents who suspect missed milestones should make an appointment with their regular health care clinician and ask about the results of the last developmental screening test. Research has shown that children who are identified and treated earlier have better outcomes in development, school performance, and social skills.

The “Learn the Signs. Act Early.” campaign was developed by the Centers for Disease Control and Prevention (CDC). Currently, Utah, Alaska, Missouri, and Washington are the only states that have launched the campaign, in an effort by the CDC to test various marketing methods and materials. The research, which will include surveys from the start and end of the grant-funded campaigns, will test to see if parents understand what to do when they have concerns about their children.

The partnership between the Utah Department of Health Pregnancy Risk Line and Utah’s “Learn the Signs. Act Early.” campaign is just one example of how teratology (the study of birth defect-causing exposures) information specialists across North America are working to make sure you have the healthiest pregnancy and child possible. Your phone call with one of the specialists may be brief, but you should feel confident knowing that there are many years of work that have gone into providing the answers you will get on that call. So don’t hesitate to call your local service or the North American toll-free number provided by the Organization of Teratology Information Specialists (OTIS).

As a nurse, I’ve worked in newborn intensive care units to treat infants with birth defects, taught college health classes to promote healthy pregnancies, worked with young adults with disabilities to help them be better self-advocates, and trained doctors to improve their screening processes for developmental delays, including autism. I currently work on three different projects: the Pregnancy Risk Line, the “Learn the Signs. Act Early.” campaign, and our Medical Home program. Similar to my OTIS colleagues in other states, I serve on boards and committees for OTIS, the Utah Parent Center, the Utah chapter of the National Organization on Fetal Alcohol Syndrome (NOFAS), and other organizations. We stay involved in a variety of organizations to learn new information, train other professionals, and help parents find resources. All of these duties, and the constant search for new funding, keep all of us busy, but we have someone standing by, during regular business hours, to answer your phone calls with the latest research-based information.

Speaking of research, OTIS is involved with several studies. These and other studies help us find the best answers to the never-ending list of questions about medications, diseases, and other things a mother may be exposed to during her pregnancy that could harm her or her baby. Currently, OTIS is conducting research on vaccines, including the human papillomavirus (HPV), meningitis, and influenza vaccines. Also, OTIS is conducting studies on medications used to treat asthma and autoimmune conditions like Crohn’s disease and arthritis. We realize that women are busy and may have concerns about volunteering for one more thing. The few minutes of your time on the phone with us will help us find even more ways to protect moms-to-be and develop new health-improving programs. So when you have questions, you can be confident that OTIS is working with you to make sure we have the right answers.

Sometimes women may feel that their questions are not important enough for them to call and ask us, but we look forward to the opportunity to answer those questions, based on your particular situation, to help you provide the best possible start for your child.

Alfred Romeo, RN, PhD, works at the Pregnancy Risk Line, a partnership between the Utah Department of Health and the University of Utah. The Pregnancy Risk Line is also a CTIS affiliate. The Pregnancy Risk Line is part of the Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America.

OTIS is conducting several studies, including vaccine studies for influenza, meningitis, and the human papillomavirus (HPV). Women who have received these vaccines during their current pregnancy can call OTIS at 866-626-6847 to volunteer to participate in the studies or learn more by visiting OTISPregnancy.org.

SAN DIEGO, CA – Experts in pregnancy and breastfeeding health at the California Teratogen Information Service (CTIS) Pregnancy Health Information Line warn expectant moms about the potential dangers of common cold medicines during pregnancy. CTIS is a California non-profit housed at the University of California, San Diego that educates the public about exposures during pregnancy and breastfeeding.

“Every year around this time, we get a significant number of calls from pregnant and breastfeeding women in California who are battling colds and are worried about which meds they can and can’t take,” said Christina Chambers, PhD, MPH, a professor of pediatrics at UCSD and CTIS’ program director.

“The callers I’ve personally spoken to have valid concerns because there are certain ingredients in over-the-counter medications they need to watch out for that could be harmful to their developing babies,” explained Sonia Alvarado, CTIS’ supervising counselor who takes calls through the service’s toll-free hotline and online chat service. As a result of the potential for harm, Dr. Chambers and Alvarado have compiled a list of helpful tips for moms and moms-to-be battling colds this holiday season.

Top 5 Cold Remedy Tips During Pregnancy:

1. Less is More. Remember that “less is more,” or rather, less is more recommendable when it comes to treating colds during pregnancy. Take only those medications that are needed for your specific symptoms. Many cold remedies have 3-6 ingredients, some of which you (and your developing baby) do not need. If your major complaint is a cough, for example, then avoid a combination drug that includes a nasal decongestant, an extra medication you can do without.
2. Oral Decongestion Alternatives. While the majority of studies looking at oral decongestants during pregnancy is reassuring with first trimester use, it’s still best to avoid them in the first trimester due to a possible very low risk for vascular issues in the fetus. Pregnant women could consider saline drops or a short-term nasal spray decongestant alternative.
3. Herbal Ingredient Warning. Watch out for herbal ingredients in many over-the-counter medications. Chances are they have not been studied in pregnancy.
4. Throat Lozenges & Vitamin Overload. Throat lozenges contain mostly sugar, however, some may contain other ingredients such as zinc or vitamin C. When taking vitamin C, the recommended daily allowance in pregnancy is 80-100 mg per day and zinc is only 11 mg per day.
5. Cough Syrups & Alcohol. Some cough syrups contain up to 10% alcohol. Get alcohol-free cough syrup. Your developing baby doesn’t need the alcohol exposure in addition to the other medications.

In California, questions women or health care providers have about specific cold medications and other exposures in pregnancy or breastfeeding can be directed to CTIS Pregnancy Health Information Line counselors at (800) 532-3749 or via instant message counseling at CTISPregnancy.org. Outside of California, please call CTIS’ national affiliate, the Organization of Teratology Information Specialists (OTIS), at (866) 626-6847.

CTIS Medical Director, Dr. Kenneth Lyons Jones talks about cold medications in pregnancy on San Diego 6 News:

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor.

Around the world, December and into January is a time when many people celebrate Christmas, Hanukkah or other holidays that include gift giving, celebrations with food, alcohol, fireworks and other displays of joy and merriment. If you are pregnant, you may feel the need to exclude yourself from activities because of warnings you’ve heard about avoiding certain foods, etc. But there is no need for this! We’ve prepared a list of helpful ideas to help you create an environment that is stress free, with no post-holiday regret!

Meats, cook to temperature and enjoy!

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor.

Listeria infection causes listeriosis and this disease is most dangerous to pregnant women, immunocompromised individuals, children and senior citizens. Pregnant women are reported to be 20 times more likely to get listeriosis. The symptoms of listeriosis are different in the various sensitive groups; pregnant women may experience a mild, flu-like illness, seniors may suffer septicemia: infection throughout the body, and meningitis. Pregnant women may not realize what’s happened until after they’ve suffered a pregnancy loss, one of the risks associated with listeria infection in pregnancy.

• All whole cuts of meat (ground beef, veal, lamb, and pork) to 145 °F as measured with a food thermometer placed in the thickest part of the meat (rest time of 3 minutes before eating)
• Ground meats, (ground beef, veal, lamb, and pork): 160 °F no rest time recommended
• All poultry products (ground beef, veal, lamb, and pork); 160 °F no rest time recommended

By Nadia Mohamedi, OTIS Teratogen Information Specialist

Although going back to school means the end of summer fun, I have always looked forward to the newness that September brings, like the first day of school outfits and the smell of unused books. During this hectic time, some may forget an important requirement for the start of school: vaccines. In fact, some colleges or schools may not let you enroll in classes unless you have received certain vaccines. Recently, I received a counseling call at OTIS (Organization of Teratology Information Specialists, CTIS’ national affiliate) from a young woman concerned about the meningitis vaccine which her college required before she could move into the dormitory. The one problem was that she was pregnant. What should she do?

First of all, why are schools so strict about making sure their students are vaccinated? Vaccines prevent against illness and even death from infectious diseases. Vaccines are arguably the most important innovation in improving public health since the 20^th century because vaccines are crucial to keeping control of diseases, like polio or the measles, which were once very common and caused death or disability in millions of people. In school, since students come from all over the world and share intimate space like showers, bathrooms and sometimes their mattresses, they are at an increased risk for infectious diseases.

Two of the most common vaccines required by schools are the HPV vaccine and the meningitis vaccine. Both of these vaccines are non-infectious, meaning that they can’t give you the disease that they are preventing against. Non-infectious vaccines are generally thought to be a low risk in pregnancy.

HPV is the most common infection transmitted by sexual contact and can sometimes cause genital warts and cervical cancer. Although it has not been well studied in pregnancy, having HPV during pregnancy usually does not cause harm to the pregnancy or the baby. Generally, the HPV vaccine is not recommended in pregnancy because it is best to receive the vaccine before sexual contact and it has not been well studied in pregnancy. One study reported that Cervarix®, one of the brands of the HPV vaccine, was linked to a higher risk of miscarriage when given close to the date that the women got pregnant, however, the rate of miscarriages that happened in the study was similar to the rate expected in the general population, about 15-20%.

Meningitis is a more serious infection and affects the brain and spinal cord. Unlike HPV, meningitis is contagious through saliva, so a simple kiss with an infected person can result in life-long disability and even death. There are two versions of the Meningitis vaccine: MPSV4 (Menomune®) and MCV4 (Menveo® and Menactra®). The MPSV4 vaccine has been studied in a few small studies and has not been shown to be harmful to the pregnancy or the developing baby, however larger studies are needed to confirm these results. The MCV4 vaccine is newer and has not been well studied in pregnancy. Since meningitis is a serious condition, if you have not received the meningitis vaccine and are starting school, they may require that you receive this vaccine, especially if you plan on living in the dorms.

Given all of this information, the caller had her school nurse call OTIS and talk to me about what they should do about giving her the meningitis vaccine. The nurse had talked to the school administration and they were confident that the requirement of having a meningitis vaccine before moving into the dorm would still apply to a woman who was pregnant. The nurse was reassured that the MPSV4 vaccine had been studied in pregnancy and decided to give the pregnant student the MPSV4 vaccine over the MCV4 vaccine. That way the student could be protected against this potential life-threatening illness in an environment that would put her at greater risk of contracting it, while making sure they were taking safety precautions given her pregnancy.

So, this September, take initiative and find out what your school requires and talk to them about your pregnancy. You can always call OTIS’ California affiliate, CTIS at 800-532-3749 or, outside of California, OTIS at 1-866-626-6847 or click here to get free information about vaccines in pregnancy! In preparing ahead and taking care of yourself and your baby, you can enjoy this new adventure and have a great school year!

**Nadia Mohamedi is a teratogen information specialist and also serves as a research assistant/interviewer for OTIS studies in San Diego, CA. She holds a BA in neurobiology and a minor in psychology from Harvard College. She is currently working toward her MD at the University of California, San Diego. In addition to her work with OTIS, Nadia has worked for the Alcohol and Drug Abuse Treatment Program at McLean Hospital as well as served as a teacher’s assistant at a school for children with disabilities in Lima, Peru.

OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and breastfeeding. Questions or concerns about medications and other exposures during pregnancy or breastfeeding.**