Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
M edications in Pregnancy and Breastfeeding Little information is available on the effects of most drugs on the human fetus. Avoiding all medications is ideal, but if you need medications during pregnancy keep the following points in mind: • • • • • • • Avoid use of drugs in the first trimester (prior to 12 weeks) whenever possible. Use non-pharmacologic remedies if possible. Use only medications that are essential to the health of the mother. Choose the lowest effective dose for the shortest period of time. Benefits should outweigh the risks. Many if these medications are available in generic form, so check with your pharmacist. Always check with the office if you have questions about medications. Do not take Pepto-Bismol; Alka seltzer, Goody powders; aspirin, Advil (ibuprofen), Aleve (naproxen), Orudis (ketoprofen), or other NSAIDS (anti-inflammatories); Nyquil or any other medications that contain alcohol. Influenza Vaccines The American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the Centers for disease control and prevention advise flu vaccination for pregnant women. Pregnancy places women at an increased risk of pulmonary complications related to the flu and vaccination is the single best way to protect women and their babies. Both the seasonal flu vaccine and the swine flu (H1N1) vaccine are recommended for essentially all pregnant women. Both are safe to administer in any trimester and can be given at the same time. Pregnant women should get the flu shot, not the nasal spray version of the vaccine. More information will be provided to you as we approach flu season. TDaP Vaccine The American College of Obstetricians and Gynecologists and the Centers for Disease Control and advise the TDaP vaccine with each pregnancy. This will be offered to you between 27 weeks and 36 weeks of gestation. This vaccine is an effective and safe way to protest you and your baby from serious illness and complications from pertussis. The TDaP vaccine should be administered during each pregnancy. More information will be provided to you as you approach your 27th week. Medications approved during preg nancy (H ang this on y our refrig erator f or q uick reference) Headaches,aches,and pains Tylenol (acetaminophen) Colds Sudafed (pseudoephedrine) Tylenol cold Saline nasal spray/drops Mucinex Cough,sore,throat Robitussin or Robitussin DM Cough lozenges Chloraseptic spray or lozenges Allergies Allegra Benadryl Claritin Tavist Chlor-Trimeton Zyrtec Indigestion Tums Rolaids Maalox Mylanta Zantac Diarrhea Imodium AD Kaopectate Constipation Metamucil Citrucel Fibercon Colace Senokot Milk of Magnesia Miralax Hemorrhoids Anusol Preparation H Tucks or Witch Hazel Pads Vaginal yeast Monistat-7 Gyne-Lotrimin Lice Rid Pronto R&C Common Nutrition problems in pregnancy Heartburn • Eat small, frequent meals (6 small meals per day) • Eat slowly, chew your food • Stay upright for at least 45 minutes after eating • Sleep propped up on pillows • Avoid fried, spicy, or greasy foods • Limit fluids with meals. Instead, drink liquids 30 minutes after meals • Avoid caffeine • Avoid carbonated drinks • Avoid gas producing foods (onions, garlic, broccoli, cabbage, etc.) • Avoid acidic foods (citrus, coffee, lemon, etc.) • Avoid peppermint and spearmint • Avoid using straws • Limit conversation at mealtime • Avoid bending at the waist to pick something up; instead bend at the knees. Constipation • Increase your fluids- especially fruit juice and water • Increase your activity • Increase your fiber (fresh and dried fruit, bran products, veggies, beans, and peas) Nausea & Vomiting • Take your prenatal vitamin after lunch or before bed • Eat small, frequent meals • Try dry foods high in carbohydrates (crackers, dry cereal, graham crackers) • Try cold foods (they give fewer odors than hot foods) • Drink liquids between meals, not with meals • Suck on ice chips • Avoid greasy foods • Avoid strong odors, get plenty of fresh air • Sit and rest after eating • Eat something every 2-3 hours • Try sour foods (lemonade, sour candies, etc.) Special Nutritional Concerns in Pregnancy Alcohol Consumption Alcohol is not recommended in any amount in pregnancy. Babies born to women who consume alcohol can be born with fetal alcohol syndrome (FAS), a combination of facial abnormalities, growth retardation, and mental retardation. Even casual intake has been associated with higher rates of miscarriages and low birth weight babies. Artificial Sweeteners Saccharin (Sweet n’ Low), Aspartame (Equal, Nutrasweet or Nutra-Taste), Acesufame K (sweet One and Sunette), and Sucralose (Splenda) are all available in commercially made food items and sold separately for home use. Saccharin crosses the placenta during pregnancy and may be cleared more slowly by a developing fetus, so small amounts are recommended in pregnancy. The other sweeteners mentioned either pass through the mother undigested or do not cross the placental barrier. Studies conducted on animals and in humans have suggested that these are safe to use in pregnancy. Use of these sweeteners in moderation (2 servings per day) is still recommended. Caffeine and Herbal Teas Human studies relating to caffeine and pregnancy are limited. Some studies have indicated a possible increase in fertility problems, pregnancy complications, birth defects, lower birth weights, fetal growth retardation, and miscarriage from caffeine consumption. As a result, it is recommended that caffeine be limited in pregnancy. Herbal teas are not subject to any safety testing and should be limited to no more then 16 ounces a day (or less) in pregnancy. Teas made lobelia, sassafras, coltsfoot, comfrey and pennyroyal should be avoided completely as they have been shown to have harmful side effects. Herbal teas made from rosehips, mint, lemon, and fruit trees are though to be safe. Nicotine Women who smoke while pregnant are more likely to go into pre-term labor, suffer miscarriages, and have lower birth weight babies and their babies have an increases risk of dying of SIDS Sudden infant death syndrome). Research indicates that second hand smoke can be detrimental to your developing baby as well. It is recommended that you quit smoking while you are pregnant. Food safety in pregnancy When you are pregnant, you are at higher risk for food borne illness or “food poisoning”. Certain foods should be avoided during your pregnancy. Additional foods, although they do not cause food born illness, should also be limited when you are pregnant or breastfeeding. Foods to avoid in pregnancy: • • • • • • • • Raw or undercooked eggs Caesar salad dressing, soft boiled eggs, meringue pies, hollandaise sauce Raw dairy products Unpasteurized (or “raw”) milk or cheese (brie, feta, blue, camembert, queso fresco blanco, gorgonzola, etc.) Refrigerated or deli pates, meat spreads, smoked seafood (salmon, lox, trout) Can also be labeled “nova-style”, “lox”, “kippered” or “jerky” Raw or rare meat Raw or uncooked shellfish Raw fish (sushi) Deli meats/ lunch meats, hot dogs- unless they are heated until they are steaming Raw sprouts (alfalfa sprouts, etc.) Foods safe to eat in pregnancy: • • • Hard cheeses, mozzarella, cheese spreads, cream cheese, cottage cheese Canned meat pates or meat spreads Canned smoked seafood Foods to avoid while pregnant, breastfeeding, or anticipating another pregnancy: • • • • Shark Swordfish Tilefish King Mackerel **Due to the risk of mercury contamination, these fish should be avoided in pregnancy or breastfeeding. ** Brought to you by the Registered Dietitians at Novant Health WomanCare Jennifer F. Greenly and Sandi Hamilton (336) 765-5470 Foods to limit while pregnant, breastfeeding or anticipating another pregnancy: • • • • Fish in general should be limited to 12 ounces total per week due to mercury levels Locally caught fish : limited to 6 ounces per week, with no other fish consumption that week Tuna : no more than 6 ounces of tuna per. Week; canned chunk white tuna is fine; tuna steaks contain higher levels of mercury and should be limited or avoided. Recent studies show that fish should not be avoided in pregnancy strictly due to the risk of mercury contamination. The omega-3 fatty acids provided by fish and seafood appear to have a beneficial on cognitive later in life. Keeping food safe: • • • • • • Wash hands and surfaces often Separate raw, cooked and ready to eat foods when shopping, preparing and storing Cooks foods thoroughly and to a safe temperature Refrigerate perishable foods promptly Keep cold foods cold and hot foods hot When in doubt, throw it out! Brought to you by the Registered Dietitians at Novant Health WomanCare Jennifer F. Greenly and Sandi Hamilton (336) 765-5470 H erbal Products N ot recommended i n Preg nancy or Breastfeeding Many herbal products have not been evaluated for their safety in pregnancy and breastfeeding. Some supplements are known to have adverse effects in pregnancy, such as starting uterine contractions. Products taken by a breastfeeding mother have the potential to be passed to the baby in breast milk. Please check with your healthcare provider before beginning any herbal or botanical supplements. This list may not represent all of the herbal products unsafe for pregnancy or breastfeeding. Agnus Castus Aloe Angelica Apricot Kernal Asafoetida Aristolchia Avens Blue Flag Bogbean Boldo Boneset Borage Broom Buchu Buckhorn Burdock Calamus Calendula Chamomile, (German or Roman) Chaparral Cohosh, (Black or Blue) Cola Colstfoot Comfrey Cottonroot Cornsilk Crotalara Damiana Devil's Claw Dong Quai Dogbane Ephedra Eucalyptus Eupatorium Fenugreek Feverfew Foxglove Franfula Fucus Gentian Germander Finseng Golden Seal Ground Ivy Grounsel Guarana Hawthorne Heliotropium Hops Horehound Horsetail Hydorcotyle Jamaica Dogwood Juniper Liferoot Licorice Lobelia Mandrake Mate Male Fern Meadowsweet Melliot Mistletoe Motherwort Myrrh Nettle Osha Passionflower Pennyroyal Petasites Plantain Pleurisy root Podohyllium Pokeroot Poplar Prickly Ash Pulsatilla Queen's Delight Ragwort Raspberry Red Clover Rhubarb Rue Sassafrass Scullcap Shepard's Purse Skunk Cabbage Stephania Squill St. John's Wort Tansy Tonka Bean Uva-Ursi Vervain Wild Carrot Willow Wormwood Yarrow Yellow Duck Yohimbe Prenatal Vitamins and Omega-3 Supplements Some women are more sensitive to prenatal vitamins and may experience slight nausea or constipation from prenatal vitamins. There are tips at the bottom of page 2 to help with these side effects. You may use any brand of prenatal vitamin of your choosing. Feel free to bring your vitamins with you to any appointment if you have questions or concerns regarding quality. Iron: 30mg/day. Foods high in iron should be included in the prenatal diet. In addition, you may be advised to start taking an oral, low-dose iron supplement. Do not take iron supplements unless directed to do so by your provider. Strict vegetarians need to make special efforts to get adequate iron in their diet. Sources: eggs, lean red meat, liver, beans, fortified cereals, leafy greens. Folate: 400 to 800 mcg/day. Although adequate folate intake is easily achieved with dietary sources, supplementation is recommended to reduce the risk of neural tube defects associated with intakes less than 400 mcg per. Day. For women who have a child with a neural tube defect, supplementation of up to 4g per. day is recommended. Sources: dark leafy green vegetables, citrus fruits, beans and other legumes, wheat bran, pork, poultry and shellfish. Calcium: 1500 mg/day. Most prenatal vitamins contain limited amounts (200-250 mg) of calcium. By including 3-4 servings of calcium-rich foods per. day, requirements can be met. If dietary intake is low, a separate calcium supplement should be taken. Since calcium and iron compete for absorption, they are best taken at separate times. Sources: low-fat dairy, enriched soy products, fortified juices, and leafy greens. * If you begin to experience leg cramps during pregnancy a calcium supplement that contains magnesium would be recommended to ease the frequency/intensity of cramping.* Omega-3 fatty acids: This nutrient is not found in your standard prenatal vitamin. These are fats that are essential to human health; but cannot be manufactured by your body. Current research is inconclusive as to whether or not dietary supplements provide the same health benefit as eating foods high in omega-3 fatty acids. The FDA has not established a minimum daily value nor has it approved health statements associated with omega-3 fatty acid supplementation and pregnancy. Omega-3 fatty acids come primarily from fish oils (EPA and DHA) and plant oils (ALA). Choose high-fat, cold- water fish such as salmon, mackerel, halibut, sardines, and herring over supplements. Plant sources of omega-3 fats include flaxseeds/oil, canola oil, soybeans/oil, pumpkin seeds/oil, walnuts/oil, however, your body is inefficient at converting plant oils (ALA) into the omega-3 powerhouse DHA, so it is theorized that you will get more benefit from the omega-3 fats coming from animal versus plant sources. Also widely available at the grocery store are omega-3 enriched eggs (found with the regular eggs). If you choose to take an Omega-3 supplement, make sure it is mercury free and contains between 200-300mg of DHA, such as Expecta Lipil. Omega- 3 fatty acid supplements should be used cautiously by people who bruise easily, have a bleeding disorder, or who take blood-thinning medications. Please discuss this with your provider before starting an omega-3 supplement. Constipation: Prenatal vitamins contain increased amounts of minerals that may contribute to constipation. Dietary changes such as more water, exercise and fiber may help. In addition, you may benefit from an over-the-counter stool softener such as Docusate Sodium (Colace). Nausea: Many women complain of nausea after taking their prenatal vitamin. Try taking vitamins with a meal or just before with a light snack. *If you have continued nausea/vomiting with no relief from light snacks, taking prenatal at recommended times, and or other recommended techniques, please discuss this issue with your provider. Medications may need to be prescribed to ease nausea and or vomiting.*