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Pregnancy do’s and don’ts – Part 2

©MFMER

Pregnancy creates a tidal wave of hormones. This protects a growing baby — while creating serious discomfort for mom. Co-hosts Angela Mattke, M.D., and Nipunie Rajapakse M.D., discuss the many day-to-day health challenges and disruptions to your routine. Get expert medical opinions on these hot topics:

*          Prenatal vitamins

*          Pain relievers

*          Heartburn treatments

*          Cold and cough remedies

*          Morning sickness

*          Hair dye and nail care

*          Flying and other travel

*          Exercise

*          Placenta pills

Read the transcript:

Dr. Angela Mattke:

Welcome to the “Mayo Clinic Moms” podcast. We’re having candid conversations and answering difficult questions about pregnancy, raising kids, and everything mom-related. I’m Dr. Angela Mattke, and I’m a mom of two and a pediatrician at Mayo Clinic Children’s Center in Rochester, Minnesota. My co-host is Dr. Nipunie Rajapakse, who’s a pediatric infectious disease doctor, also at Mayo Clinic, and is also pregnant. Alright. Let’s dive back in about the ‘do’s and don’ts’ [of pregnancy]. Prenatal vitamins: are you taking prenatal vitamins and how’s it going? I know it can be iffy for some women.

Dr. Nipunie Rajapakse:

Yeah, so prenatal vitamins–definitely taking, but struggling. And I know, I think I sent you a message about this awhile back because I wanted some advice. I’ve been pretty lucky in that I haven’t really had a lot of nausea, but when I have had it, it has always been in association with taking the prenatal vitamins. I know why we have to take them. There are important nutrients in there for the baby, things like folic acid and calcium and iron that a growing baby needs, but it has definitely been a struggle. And I was grateful for advice that you could provide on how to make this a bit less of a struggle.

Dr. Angela Mattke:

Absolutely. And for our listeners, the folic acid is one of the main things that helps prevent neural tube defects—things like spina bifida—so, making sure you’re getting that in. There are a lot of B vitamins in our diet, and in America, a lot of our foods are fortified with some of the B vitamins, but it’s really important to make sure that we’re getting enough. One of the tips that I came up with and the thing that my obstetrician told me about was using kids’ vitamins. And I’m not talking about the gummies. I don’t really know much about the absorption of actual gummy vitamins, but the chewable Flintstone, Centrum, generics, those sorts of things that have iron in it. They have pretty good amounts, especially if you get the ones that are iron-specific, and they have the recommended amounts of folic acid, other B vitamins, calcium, vitamin D, all the things that are going to be really important for your growing baby. Have you tried those yet?

Dr. Nipunie Rajapakse:

I haven’t yet because I made a change to start. I was taking them in the morning. That really wasn’t going well. The first change I made was to try taking them in the evening, and with that, it seems to have started to settle, but I have them pulled up in my shopping cart just in case.

Dr. Angela Mattke:

Okay, sounds good.

Dr. Nipunie Rajapakse:

I think I eventually might need to switch over to them, and I can see those taste a lot better. And so I think that will probably be helpful.

Dr. Angela Mattke:

Yeah. And different brands have different tastes. My kids take two different brands of them because one of them doesn’t like the flavor of the other one. So you can always experiment around. But I love that you mentioned taking them at night. Trying them in the morning, trying them with foods, trying on an empty stomach, and just kind of figuring out what works for you. I think everyone is different, and sometimes it changes during your pregnancy.

Dr. Nipunie Rajapakse:

Yes. I think that’s definitely what I’ve noticed as well.

Dr. Angela Mattke:

Alright. What about maybe some of the over-the-counter medications?

Dr. Nipunie Rajapakse:

Yeah. So, thankfully, so far, I haven’t really had to take anything over-the-counter, but it is an area that I have been wondering about. And I know there are different places you can kind of look online, but I was curious–your thoughts on some of the different types of medications that people may be thinking about.

Dr. Angela Mattke:

Both over-the-counter medications and prescription medications, I think we should talk about. Obviously, prescription medications should be prescribed by whoever is your medical provider during the pregnancy. But it’s interesting; I found one research study that said almost two-thirds of women will take a prescribed medication sometime during their pregnancy. And when we look at whether over-the-counter medications or prescription medications are safe in pregnancy, there is nothing that is a hundred percent safe. They prescribe a rating system to the medications, and they give it like a letter number. But there are very few that we can say are a hundred percent safe because we just can’t do studies. It’s not ethical to do prospective studies when we don’t necessarily know what the effects might be on the growing fetus. Like you said before, nothing is zero risk, right? But you can take a calculated risk. In pregnancy, there are a lot of maladies that we might experience–pain, headaches, those kinds of things. When it comes to pain relievers, acetaminophen is generally safe and can be taken during any of the trimesters during pregnancy. Now, we had a conversation earlier about ibuprofen. When we were in medical school, we learned ibuprofen was an absolute no-no. And tell me, what have you heard about that?

Dr. Nipunie Rajapakse:

Yeah, so I was kind of surprised at one of my early prenatal visits. I was recommended to take aspirin, baby aspirin every day. And apparently there are now studies that have shown that this can decrease your risk of having preeclampsia or problems related to hypertension in pregnancy. And I had it really ingrained in my head from medical school that the class of medications that ibuprofen and aspirin fall into were a no-no during pregnancy. It was a bit of a psychological leap that I had to take to actually be able to swallow the pill because it felt wrong based on what I had known. But I did take the time to review the new studies that had come out and the recommendations from some of the national obstetrics organizations that have found this to be a benefit.

Dr. Angela Mattke:

Oh, that’s fascinating. That’s such a hard dogma for me to, change my mind about stuff. Okay. What about heartburn and stomach? Have you had any of that?

Dr. Nipunie Rajapakse:

I haven’t yet, but I have had–

Dr. Angela Mattke:

It’s coming.

Dr. Nipunie Rajapakse:

Yeah. All of my friends that have been pregnant have told me that that is probably on the way.

Dr. Angela Mattke:

Okay. There are some medications that are generally considered safe in this area. Things like calcium carbonate and Tums is a good place to start, and you can also take things like—Maalox—would be the brand name, but that would be aluminum hydroxide, magnesium hydroxide. Simethicone is like a gas medication that’s generally safe as well. And then there’s something called H2 blockers; they change the amount of acid secretion in the stomach. Ranitidine and cimetidine are some of the ones that are generally on the safe list. If you’re going towards the H2 blockers, it’s a good idea to bring it up to your obstetrical provider and just say, “Hey, I’m thinking about taking this. Does this sound okay with you?”. Keep those on the back-burner. Probably have some in your house for when it hits you at 10 o’clock at night and you’re trying to sleep.

Dr. Nipunie Rajapakse:

Yeah. I was going to say probably when you need it is not when you want to be getting out and going to the drugstore.

Dr. Angela Mattke:

Yeah. But that’s what Tums are for.

Dr. Nipunie Rajapakse:

Yeah, okay. Sounds good.

Dr. Angela Mattke:

Alright. So next: cold and cough. Have you gotten any yet?

Dr. Nipunie Rajapakse:

I haven’t.

Dr. Angela Mattke:

Okay. Good.

Dr. Nipunie Rajapakse:

I’ve been pretty careful. Obviously, as an infectious disease specialist, our job involves going into a room with people who are often sick with some sort of infection. I’ve been washing my hands a lot, and since we’re following masking and things like that in the hospital, I’ve been able to avoid getting sick so far.

New Speaker:

Awesome.

Dr. Nipunie Rajapakse:

But what should I do if I do?

Dr. Angela Mattke:

Well, it’s kind of similar to what we do with pediatrics. I mean, the safest things are going to be the saline nasal drops and also using salt water and gargling when you have a sore throat. Those are going to be safe for you. It’s salt water. It’s not going to harm you in any way. There are some over-the-counter cough medications that are generally safe, but it depends on which trimester you’re in. I would call your obstetrical provider before you take something like Robitussin or guanfacine to help with coughing. Just sucking on something for cough drops might be a good way to decrease that frequency of coughing as well. Have you experienced morning sickness yet?

Dr. Nipunie Rajapakse:

Not really. There have been some days I have definitely felt kind of sick in the morning, but not super severe, which I’m thankful for because I know some people have it pretty badly.

Dr. Angela Mattke:

Yeah. I did not have a pleasant course.

Dr. Nipunie Rajapakse:

I haven’t, but what are things that you recommend, having gone through that yourself?

Dr. Angela Mattke:

Yeah. I mean, I tried all these things. They didn’t work for me, but I’ll tell you what they tell you to try and things that are generally safe. Vitamin B6 at 100 milligrams per day can help with nausea, and it’s a B vitamin. The nice thing about B vitamins is it’s a water soluble vitamin you’re going to pee out. You can’t take too much of it. So it should be safe. Doxylamine is a sleep medication, so that’s for if you can’t sleep at night. Are you able to sleep still so far?

Dr. Nipunie Rajapakse:

So far, so good!

Dr. Angela Mattke:

Okay. Alright. It can help with sleep, but that also can help with nausea. It can make you a little tired, and sometimes they’ll recommend taking the doxylamine, which is also known as Unisom, with the B6. There are other things like amitrol, which is a sugary sort of medication, but you shouldn’t take that if you’re a diabetic because it’s full of fructose and sugar. Have you ever heard of the Sea-Bands?

Dr. Nipunie Rajapakse:

I have seen them, yes, for motion sickness, but I didn’t know.

Dr. Angela Mattke:

Yeah. So something you could try. I mean, my parents used to give these to me because I get sick everywhere, and not during pregnancy. I get sick with motion sickness and traveling and all these other things, especially while pregnant; flying during pregnancy was not fun. I wish I would’ve tried these, but I tried these as a kid, and they did help. And what I think is really interesting when women go into C-sections, at least at Mayo Clinic, they put a little pressure point on this area.

Dr. Nipunie Rajapakse:

Oh, interesting.

Dr. Angela Mattke:

Yeah. There’s some evidence to show this helps, and it’s not going to harm you to put pressure right on that median nerve.

Dr. Nipunie Rajapakse:

I was going to say, there’s no downside.

Dr. Angela Mattke:

There’s no downside to it. Those are some things to try, but it’s also just figuring out what works for you. Morning sickness is not just in the morning for most women. It creeps up on you all the time when you don’t expect it. Usually making sure you’re having something in your stomach at all times can be really helpful. I found it helpful eating salty foods, because I was always chronically dehydrated from all the vomiting I would have, and that would help me stay a little bit more hydrated and retain some of the fluids that I needed, so I wasn’t orthostatic. Foods that you know are going to make you sick–avoid them.

Dr. Nipunie Rajapakse:

Yeah. I will say, I did make the mistake a few times–first thing in the morning, having coffee and orange juice together. And I quickly learned that that combination was not a good one for me. So, yes.

Dr. Angela Mattke:

Yeah. That does sound like an acid stomach recipe right there. The other thing—for me, the smell of fish was… Oh my gosh, it almost sent me into a rage when my husband one time made salmon for me. And I was like, “Get that out of the house!”. Avoid the things that you think are going to trigger you.

Dr. Nipunie Rajapakse:

Okay. That makes sense.

Dr. Angela Mattke:

Any other questions that you have about medications for me?

Dr. Nipunie Rajapakse:

I think that covers a lot of the medication-related things. There have been other things that I have wanted to do and have been a bit hesitant to do: things like getting my hair dyed or getting my nails done–things that I wouldn’t have thought twice about before. I’m kind of taking a bit of a pause to decide: do I really need to do this right now? Is this essential? What are your thoughts on some of those things?

Dr. Angela Mattke:

I had those same thoughts because I dye my hair. This is not all natural. There is a little coloring going on in there. I looked it up as well. I wanted to know the evidence in research because I can go without dying my hair for nine months, I can go without doing my nails–those kind of things. The studies have been shown that usually the chemicals in the permanent and the semi-permanent hair dyes are really not highly toxic. Most research, although it’s limited because again, it’s really hard to do this kind of research on pregnant women, shows that it’s probably safe to dye your hair while you’re pregnant. If you want to eliminate all risk, then don’t do it, or if you wanted to maybe balance your risk, then try not to do it during your first trimester. Some of the studies, when they looked at very, very high levels of chemicals, they might cause harm, but the levels compared in the hair dyes are so low; they are really unlikely to cause concerns. I did highlight my hair during my pregnancy so that I didn’t have a full grow-out. I think it’s probably safe, but everyone has to balance one’s own risk and be pragmatic about what they’re willing to do.

Dr. Nipunie Rajapakse:

For sure. No, I think that makes sense.

INTERMISSION

Dr. Angela Mattke:

Are you thinking about getting pregnant, maybe you’re a current mom-to-be, or you’re like myself and you’re in the midst of raising kids, and you’re looking for practical evidence-based advice from Mayo Clinic experts? Mayo Clinic Press has got you covered. We have a series of four books starting from Fertility and Conception to Guide to a Healthy Pregnancy, Guide to Your Baby’s First Years, and the last book in this series, the one I was the medical editor of, Guide to Raising a Healthy Child. You can find these amazing books from Mayo Clinic Press wherever books are sold, or on the Mayo Clinic Press website.

BACK TO THE SHOW

Dr. Angela Mattke:

We’re coming off of COVID, and in terms of travel, people are starting to get back out there. And I know your family lives in Canada, like you mentioned earlier; have you seen them?

Dr. Nipunie Rajapakse:

I haven’t; it’s been a really long time since I’ve been able to travel back, both because of some of the risks related with traveling, going through airports and airplanes, but also the borders have had various restrictions in place that have made it logistically a little bit challenging for me to go back and forth. We were planning on going on a trip in about a month from now actually, and thought about it pretty carefully. We had actually planned it before we got pregnant, and talked about it after we found out to decide whether this was something reasonable to do, given everything that’s going on right now. Thankfully, the timing kind of fell within the period of pregnancy that they say is the best to travel, which is in your second trimester between 14 and 28 weeks, where you’re feeling probably good enough; you’re mobile enough to get around and enjoy it.

And the risk of a complication during that time is lower than in your first trimester or in your third trimester. For now, we’re obviously keeping a close eye on what the situation is with COVID and the variants, but we are planning a trip to Iceland. We figured, just in terms of overall risks, it’s a relatively short flight from here. All of the stuff that we’re going to be doing are primarily outdoor activities. From a COVID transmission risk, we thought it was pretty low risk, and they’ve had very low rates there as well and high rates of vaccination. We thought about all of those different factors, and for now we’ve kept it, but we’ve booked everything so that it can be canceled. We won’t lose out on too much if we decide to do that at the last minute. Just knowing that the COVID situation is changing, and obviously, things with pregnancy can change as well.

We’ll see how it goes, but there are certain important things to consider if you’re pregnant and traveling. I think it’s important to talk to your obstetrical care provider to get their thoughts based on your situation. If you have certain complications or are high-risk for a preterm delivery or something like that, the recommendations they make for each individual might be a bit different. Beyond some of the infection-related risks, for example, there are risks of blood clots in pregnancy, or a higher risk for having a blood clot. Especially any mode of travel where you’re stationary for more than four hours, I think, has been associated with an increased risk, whether that’s on a plane or a bus or a train or a car. I think we’ll be definitely paying a bit more attention, making sure to stand up and walk around frequently, staying well-hydrated, all of those things to reduce those risks as well. So lots to think about.

Dr. Angela Mattke:

Yeah. And then the other thing is, depending on where you’re traveling, there are different infectious risks in certain countries and stuff, things like rubella and measles. Make sure your immunizations are updated before you get pregnant because you can’t do most immunizations during pregnancy, especially the live vaccines.

Dr. Nipunie Rajapakse:

Exactly. The live vaccines–vaccines against measles, mumps, rubella, chicken pox, some of the travel-related ones like yellow fever, for example, you can’t get during pregnancy. That’s a great point: before you get pregnant, especially if you’re planning on it, to make sure that all of your vaccines are up-to-date. I think if you’re pregnant and traveling, especially to areas that might be a high risk for infectious diseases that we don’t see here, like malaria, we would recommend seeing a travel clinic or a specialist in this area who can make recommendations for how to keep yourself safe during those trips.

Dr. Angela Mattke:

Awesome. What about exercise during pregnancy? Have you been doing some exercise and trying – or are you just so exhausted?

Dr. Nipunie Rajapakse:

Yeah. This has been hard for me. I have always struggled with exercise even before pregnancy. Now I obviously recognize all of the benefits that it has in terms of keeping a healthy weight, decreasing your risk of high blood pressure, gestational diabetes, and helping you recover faster post-delivery as well. There are so many benefits. I have been trying to make a bit more of a concerted effort, but it’s hard at the end of the day after I get home from work. I’m so tired. The last thing I want to do is go for a walk or get on an exercise bike or something like that. This is where my partner Thomas has been a good motivator because he’s usually the one that will try and get me up and going, even if I don’t want to. We’ve been doing mostly lots of walks around. It’s been nice to get some fresh air and enjoy a bit of sun as well. That seems to work best. I do have an exercise bike as well. I try and jump on that if I can, but yeah, it’s been challenging for sure.

Dr. Angela Mattke:

Absolutely. I think things have changed over the years in regards to what’s recommended for women during pregnancy in regards to exercise. We see professional athletes continuing to train and whatnot, but in general, 30 minutes of moderate activity level, more often than the days of the week is recommended. Trying to do that and even strength training is considered safe during pregnancy, as long as you’re not doing really high weights, just especially lower weights and repetition. Like you mentioned, there are so many benefits, even including shorter labor, reduced risk of cesarean section, better endurance levels, better muscle tone, better strength, mood, constipation, bloating, reduced back aches. I think most women suffer from those during pregnancy.

Dr. Nipunie Rajapakse:

Yeah, definitely, lots of things on the plus side there. I guess, are there any types of exercise or activity that should be avoided during pregnancy?

Dr. Angela Mattke:

Yeah, good question. I think there are certain medical conditions, so I would certainly talk to your obstetrical provider before you do it, especially if you’re at risk of premature pregnancy or premature delivery, because sometimes exercise can put you at risk for premature delivery if you have a risk factor for it. That’s something to keep in mind. Sometimes those really joint-jarring exercises are things to avoid, and most women avoid them anyway because they hurt during pregnancy. Your joints are a little bit more lax. Your belly is moving up and down, and it hurts more. A lot of women find those non-joint-stressing activities like you mentioned–biking, swimming, walking–to be better for them. But I think the big takeaway message is do something. It’s not 1940 where you sit and you’re not allowed to do anything. Get out and move because it’s going to help your endurance afterwards when you’re exhausted. And you’re trying to keep up with a toddler someday.

Dr. Nipunie Rajapakse:

Yeah, exactly. You need to start working out for that. It’s interesting because you mentioned biking. My partner, Thomas, he’s an avid road biker. This spring, before we got pregnant, one of the exciting things for us was he really wanted me to get a road bike so I could ride with him. In those couple weeks before we knew, it happened to be when we acquired this bike, and it has been a really long time since I have ridden a bicycle outside. The first trip out did not go well, and I actually fell off the bike twice and since then have refused to get back on it. But yeah, during those first couple weeks, I’ll add that to the list of ‘don’ts’ things that I did – probably falling off your bike twice is not ideal. Maybe not the best time to start picking up a new sport or something where you’re not very experienced.

Dr. Angela Mattke:

That’s a really good point. It’s not the best time. If you’re not previously exercising or not previously doing things, it’s not the time to start hardcore exercising. Maintaining what you were previously doing is usually what’s recommended. I’m glad to hear you’re okay after you fell off the bike.

Dr. Nipunie Rajapakse:

There are a lot of different pregnancy fads out or these things that come in vogue and then go out of style, but there’s a ton out there, and I’m seeing them on social media. I wanted to run by some of them and get your thoughts on whether these are ‘do’s’ or are ‘don’ts’.

Dr. Angela Mattke:

Doctor hat on here. Okay.

Dr. Nipunie Rajapakse:

The first one is ingesting placenta pills. I’ve seen these companies that will accept your placenta after you’ve delivered, make them into pills, and send them back to you to eat. Is that a good idea?

Dr. Angela Mattke:

I would say no as a doctor and so would the CDC; this could cause serious health risks to both you and your baby, plus the science out there showing that this is actually beneficial does not match up to the claims that are out there. Just remember, people can write things and claim things—but when you look at the science, it’s not necessarily supporting that, plus all the risk of serious infection, especially as an infectious disease doctor.

Dr. Nipunie Rajapakse:

Yeah. I was going to say, I know in the last few years there have been some cases reported of an infection called group B strep that can be really life-threatening for newborns, that they traced back to the placenta pills. Definitely one to be really careful about, and cautious with. What about lotus births? This was a bit of a new one. I have to admit for me, this is the practice of keeping the placenta and umbilical cord attached to the baby after delivery and allowing it to fall off naturally, which as an infectious disease specialist kind of blows my mind–but recommended or not recommended?

Dr. Angela Mattke:

No, no, no, not recommended in any way. There are clear risks of infection, especially from umbilical cord to the infant–life-threatening infections. I would not recommend that. I just literally could not imagine walking around carrying the placenta when I’m trying to breastfeed my child as well.

Dr. Nipunie Rajapakse:

Seems kind of tricky to juggle all of that.

Dr. Angela Mattke:

It does, yeah.

Dr. Nipunie Rajapakse:

And then lastly, water births. Obviously, in labor and delivery, people are looking for things they can do to reduce their discomfort. What would you recommend regarding that?

Dr. Angela Mattke:

Oh man, I want to take a pass on this one because I feel like this is best answered by an obstetrical provider, but from what I’ve looked at and the evidence from the gynecological associations and the pediatric associations, they recommended against the laboring or the delivery process while in the water, as it does increase the risk of certain types of infections. I think you can elaborate more on that. Laboring in water seems like a really natural way to help alleviate some of the pain associated with the labor process. When it comes to actual delivery, I’d get out of the water.

Dr. Nipunie Rajapakse:

Yeah. I did see a few reports of a relatively rare but life-threatening infection called Legionella, that is usually contained in water that newborns have gotten when they’ve been delivered into water. I think definitely you’d want to get out of the water for the actual delivery part itself to reduce risk.

Dr. Angela Mattke:

Well, those are our ‘do’s’ and ‘don’ts’ for pregnancy. It seems like there are a lot of ‘don’ts’, but hopefully we’ve helped shed some light on some of the things; and you can look up a little bit more about the evidence and decide what works best for you. Also, try and lead a healthy pregnancy with having healthy habits, healthy lifestyles, and taking care of yourself–doing exercise and other things. Thanks everyone for joining today. Make sure you don’t miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoy this episode and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We’ll see you next time.

Angela Mattke

Angela C. Mattke, M.D.

Dr. Mattke is the medical editor of Mayo Clinic Guide to Raising a Healthy Child and  a pediatrician in the Division of Community Pediatrics and Adolescent Medicine at Mayo Clinic Children’s Center in Rochester, Minnesota.

Nipunie Rajapakse, M.D.

Dr. Rajapakse is a pediatric infectious diseases physician at Mayo Clinic in Rochester, Minnesota. Her clinical focus includes management of pediatric infections. Her primary research interests include studying ways of optimizing antibiotic use in children (antimicrobial stewardship) to decrease antibiotic resistance and other harmful effects. She has worked for the World Health Organization and has an interest in global health and outbreaks of emerging infectious diseases.

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