Archive for the ‘Environmental Issues & Pregnancy’ Category

Radiation Exposure in Pregnancy

Friday, June 17th, 2011

Safe level of radiation for fetusNothing causes panic like the words “radiation exposure”. The earthquake and tsunami that devastated Japan also caused major damage to several nuclear reactors and have magnified our fears about the risks of radiation poisoning.

Radiation studies from past catastrophes such as Hiroshima and Nagasaki, (1946) Three Mile Island, (1979) and Chernobyl, (1986) have helped us determine the amount of radiation exposure that is considered safe. Still, many of the answers have yet to be determined, especially for pregnant women. Therefore, I thought it important to share some information about radiation exposure with specific regard to the fetus and pregnancy.

1) How is radiation released in a nuclear reactor?

Nuclear reactors use uranium or plutonium to produce energy that heat water to steam which turns turbine generators. Radioactive by-products are released in the process of producing this energy. The core, where this energy is created, has a cooling system surrounded by a steel canister and a surrounding concrete envelope. When damage occurs to a nuclear reactor the cooling system can get damaged and the surrounding protective structures can be damaged by explosions and elevated temperatures. The radioactive material in the core can then escape releasing radioactive material into the environment.

2) Who will be affected by the release of radiation?

Exposure can occur directly to employees or emergency individuals who work within the plant itself. Skin and/or deep internal organs can be affected depending upon dosage and type of radiation released.

Radioactive products can also leave the plant and reach people living in the surrounding region. Both skin or internal organs can be involved depending upon dosage and type of product released.

Internal contamination occurs when radioactive by-products are ingested from contaminated water, fruits, vegetables, and seafood inhaled, or enter the body through an open wound. Large numbers of individuals can get radiated in this fashion.

3) Why is radiation dangerous?

Radiation exposure can cause DNA damage resulting in death of cells. Mutations can alter developing cells or cause changes in reproductive cells which can get passed onto future generations. This damage can have both short and long term effects on every organ system in the body. Results can be manifested as deformities, congenital malformations, fetal loss, stillbirths, infant deaths, stunted growth, abnormal brain development, or cancer later on in life. Damage is dependent on the type of radiation, the dosage, length of time of exposure, the particular tissue exposed, and the depth of penetration.

Babies have some added protection being shielded inside the mother so their radiation exposure is less.

4) How is radiation dosage measured?

Radiation is measured in rads, the amount of energy deposited per kilogram of tissue. Gy is also used which refers to the absorbed dose and Sv (sievert) or the effective dose (the absorbed dose multiplied by the sensitivity of tissues and the biologic effect of different types of radiation)

One hundred rads is equal to 1 Sv or 1 Gy

5) What are some of the typical dosages of radiation that people are normally exposed to?

Chest x-ray .01 mSv (.02-.07 mrads) per film
CT of the chest 7 mSv (less than 1 rad)
Mammogram 7-20 mrad
Barium enema 2-4 rads
Crew on an airline flight (annual) 2 mSv
Passenger on an airline flight .07 mSv
Emergency workers in chernobyl >100mSv
Person living at boundary of Three Mile Island >1mSv

Reference: ACOG Committee opinion: Sept 2004; NEJM April 2011


6) Is exposure to x-ray or imaging procedure during pregnancy safe?

Exposing a pregnant woman to diagnostic x-ray procedures should only be performed when the benefits outweigh the risks. A single x-ray procedure does not warrant any significant risk to the fetus according to the American College of Radiology. If multiple x-rays are warranted, dosages of total exposure can be calculated by a specialist. Risks are related to dosage and to gestational age of the fetus.

It appears that exposure between 8 to 15 weeks provides the greatest risk, especially for central nervous system defects.

Procedures with less than 5 rads, as in most diagnostic procedures, generally are not considered problematic.

It is estimated that exposure to 1 to 2 rads can increase the risk of leukemia by 1.5 to 2 fold.

Radiation exposure during the first 2 weeks of pregnancy mostly carries a risk of fetal death if  greater than 100 mGy or 10 rads since organ formation occurs afterward (3 to 5 weeks post conception).

Radiation exposure between 2 and 18 weeks is the most critical time because of the high radiation sensitivity of the developing central nervous system which can be severe. Results from studies of atomic bomb survivors demonstrated mental retardation, lower IQ scores, skeletal anomalies and other birth defects.

Exposure from 18 to 25 weeks can have similar effects occur similar to those previously described when the dosages are extremely large.

After 26 weeks, the risk is mostly the increased chance of having cancer later on in life rather than birth defects. The cancer most commonly observed is leukemia.

Imaging procedures using ultrasound and magnetic resonance imaging (MRI) should always be used preferentially over x-rays since there are no known adverse effects. Use of radioactive iodine is contraindicated in pregnancy. If a woman has been exposed to radioactive iodine, she should wait 4 to 6 months before trying to conceive.

Are X-ray machines at the airport safe during pregnancy?

The x-ray machines at the airport are shielded and there is no increased risk to pregnant passengers.

Are tanning beds dangerous to the fetus?

Tanning beds use concentrated ultraviolet A radiation which is very superficial and does not penetrate through the skin to the fetus. It is therefore considered safe in pregnancy.

Is it safe for pregnant women to fly?

Commercial flights expose passengers to cosmic rays in the atmosphere. Flights at latitudes close to the magnetic poles, such as international flights between Canada and European countries have radiation doses that are higher in comparison to short-distance flights at lower altitudes and latitudes. Calculations of radiation received during a flight can be calculated using the website http://www.helmholtz-muenchen.de/epcard

It is recommended that cosmic radiation dose to a fetus not exceed 1 mSv , or 2 mSv to a woman during the entire pregnancy. A pregnant air flight attendant may have to modify her schedule to ensure that this requirement is met. Generally, during a commercial flight the average dose of radiation to a fetus is 5.28 uSv (this is half the dose that the mother receives). A pregnant crew member can travel by air for approximately 190 hours during the entire pregnancy safely. The 2 mSv limit would be exceeded after 8 round trip flights from Canada to Germany.

It can be assumed that the casual traveler has minimal radiation exposure when traveling by air during pregnancy.

Summary:

Radiation risks are determined by a combination of stage of pregnancy and dosage. Significant risks occur when organs are forming and decrease with each trimester.

Dosages below 50 mGy, 10 mSv or 5 rads are considered safe.

Termination of pregnancy might be considered for dosages of radiation between 100 and 500 mGy, based on individual circumstances.

Dosages above 500 mGy have been found to have significant fetal damage.

Further research is necessary to determine if chronic lower dosages may also cause significant effects.

Central nervous system is particularly sensitive between 8 to 15 weeks to radiation effects.

Important diagnostic procedures involving radiation can be done if the benefit far outweighs the risks, but MRI and ultrasound should be done preferentially.

Lead shields can be worn during an x-ray procedure to reduce exposure to the fetus.

Post to Twitter

Color Me Safely: Hair Dyes In Pregnancy

Monday, March 7th, 2011
When it comes to your own personal grooming, is there anything more satisfying than being crowned with a head of thick, shining hair? Do you divide your life into good hair days and bad ones? Does a bad hair day leave you depressed and lethargic while a good one propels you through glass ceilings. Guess what? You are not alone!

Hair being dyed

According to Hoovers® there are about 65,000 hair care salons in the United States with combined annual sales of about $19 billion! A small portion of these sales are for hair cuts, but most of this money is spent on… hair color.

If you are pregnant, planning to get pregnant or if you have a job in one of these salons, please read the following carefully: Over 20 million Americans, mostly women, are exposed to hair dyes each year. It has been estimated that at least 35 to 40% of all women in the United States and Europe use hair dyes. Solutions are applied either by a salon hairdresser or by individuals purchasing over the counter products.

According to the International Agency for Research on Cancer (IARC), concerns exist pertaining to the safety of these products. Why? Because some of the ingredients in hair dye are considered to be carcinogenic and teratogenic (causing malformation in fetuses). Reports of hairdressers having increased risk of spontaneous abortion, congenital malformations, childhood cancer and developmental problems exist. Older literature from the 1980′s report that men and women exposed to hair dyes in their occupations may experience increased risk of developing leukemia and cancers of the bladder, ovary, GI tract, and respiratory systems. Nasca, reported in the Journal of the NCI, that there is a higher risk of breast cancer in women that use hair dyes.

Pregnant women throughout the world who commonly use beauty products worry about the risk of exposure to themselves, and to their fetus, because of the potentially carcinogenic chemicals contained in these products. Many women are hesitant to use dyes during pregnancy due to fears regarding chemical use and absorption with risks to the fetus.

More concerning is the fact that many women are giving birth at later ages and therefore the use of hair dyes will become increasingly more popular. The combination of hormonal hair growth increase during pregnancy, and the increased need for coloring as a woman ages, obviously predicts an increased use of these products.

With all this in mind, I thought it would be a good idea to write a blog that reviews the literature to date regarding the safety concerns of hair dyes so that you can make the right decision, for yourself, about whether or not to use these products. Overall conclusions, however, should be based upon the method of dye application (personal vs hairdresser), the colors used, the frequency of coloring, and the differences between varying product components available on the market.

How are hair dyes classified?
There are three classifications:

  • Permanent,
  • Semi-permanent
  • Temporary

Chemical composition of the hair dye determines in which classification it is placed

Permanent dyes are the most prevalent and comprise about 75% of all hair dyes. They act by oxidation with hydrogen peroxide of dye precursors that permeate the hair fiber producing the color associated with the dye. Permanent hair dyes are commonly applied with a brush and by a hairdresser. Permanent hair dyes allow more dramatic changes in hair color. They do not wash out and they last until the hair grows or is cut.

Semi-permanent dyes comprise approximately 20% of all dyes and directly penetrate the hair cortex without the use of oxidizing agents. Generally the color lasts between 6 and 12 washings. These dyes, often applied by hand, are mostly used to cover gray or highlight the natural color, and are often purchased over the counter.

Temporary dyes, comprising about 5% of all hair dyes and are used for a single wash. This hair coloring is deposited on the cuticle layer of the hair and remains until shampooed out. It generally will not lighten hair but used to intensify natural color, tint hair another color, or add highlights to natural or tinted hair. It is also used to cover a limited amount of gray hair or eliminate yellowish shades from white or gray hair.

Which hair dye chemicals raise concerns in pregnancy?
Several reported studies have shown an increased risk of childhood brain tumors (CBT) associated with exposure to N-nitroso compounds, commonly found in hair dyes.

There are 2 broad classes of the N-nitroso compounds

  1. nitrosamides
  2. nitrosamines

Nitrosamides are unstable and do not require enzymatic activation and are inclined to tumor formation at the exposure site. In rats, they cross the placenta and are neurocarcinogens.

Nitrosamines ,commonly found in tobacco smoke and beer, are considered carcinogenic agents.

Chemicals found in hair dyes are aromatic amines which get converted into nitrosamines. Nitrosamines, require this bioactivation and can initiate tumor formation in places at locations other than the initial exposure site. Hair dyes are considered NOC-related aromatic amines and contain ammonia based solutions, hydrogen peroxide, coal-tar dyes, and lead acetate. Many studies classify these agents as carcinogenic in animals when dosed orally because they alter DNA, but there exists “inadequate evidence” to determine carcinogenicity in humans when applied topically.

Other toxic chemicals found in hair dyes include phthalates, cobalt salts, formaldehyde releasing preservatives, lead acetate, nickel salts, 1,4-dioxane, diethanolamine/triethanolamine, and parabens.

How does exposure to the fetus occur when a pregnant woman uses hair dyes?
Exposure to the fetus occurs during routine use since many of the chemicals used are skin permeable. The particular characteristics of the dye products and their ability to penetrate skin influence their toxicity. Exposure can also occur via ocular, oral, or inhalation routes which can then cross the placenta and affect the fetus. Many of these chemicals can also be stored in body fat and also enter the mothers milk.

What type of toxicities have been described in pregnancy?
There have been many inconsistent results between use of hair dyes and various childhood cancers.

Some studies have shown an association between maternal hair dye and elevated risk of childhood cancer. The immature nervous system of the fetus has been found to be especially vulnerable to carcinogens and mutagens. If exposure occurs during the development of the nervous system during the first trimester, this may make the nervous system more susceptible to cancer and brain tumors.

Neuroblastoma, comprising about 6 to 10% of all childhood tumors in the developed world, is one of the most common cancers in children during the first year of life. A 3 fold increased risk was found in children of women exposed to hair dyes during pregnancy according to an article written by Kramer in the Journal of the National Cancer Institute in 1987. This increased risk is also confirmed by McCalls article in 2005 in Cancer Causes and Control. Wilms tumor, a cancer of the kidneys in children, had a 4 fold increased risk according to a study by Bunin in Cancer Research in 1987. Many of the chemicals used in 1987 in hair dyes have since been discontinued (2-4-diaminoanisole, 4-amino-2 nitrophenol, and HC Blue No.1) but other chemicals in the N-nitroso aromatic amines commonly used in hair dyes are still present which are carcinogenic in animals.

Other studies from the West Coast have found no association with hair dye use before or during pregnancy. (Holly in Pediatric Perinatal Epidemiology, 2002) One large study by Effird in Journal of Neuro-Oncology in 2005 also confirmed no statistically significant association between temporary, semi-permanent, or permanent hair dyes during pregnancy and childhood brain tumors, except for a 3 fold higher incidence of for brain tumor among Israeli children using semi-permanent hair color.

Do different types of hair dyes present different levels of risk?
Temporary dyes (includes semi-permanent) appear to have more toxicity than permanent dyes in pregnancy. Studies of scalp penetration of semi-permanent dyes compared to permanent dyes in both humans and monkeys found that semi-permanent dyes penetrated the scalp more than permanent dyes in both species. Unlike permanent dyes that contain oxidizing agents that allow the dye to irreversible bind to the hair shaft and therefore has lower skin absorption, semi permanent dyes achieve their coloring action via the use of various solvents (alcohols and ethylene glycol ethers) which penetrate the scalp more efficiently compared to permanent dyes. Also, greater skin contact occurs with semi-permanent dyes since they are applied as foam, rinse or surfactant solutions which tend to facilitate uptake by the skin. Semi-permanent hair coloring products also contain nitro derivatives of phenylenediamines or aminophenols, azo dyes and aminoanthraquinone dyes and N-nitroso compounds that have been shown to be transplacental neurocarcinogens in rodents.

Also, semi-permanent dyes are more likely applied by the person herself whereas permanent dyes were more likely applied by a hairdresser. With self-application there is more exposure to skin surface, such as hands, than if an outside person did the applications.

Smokers were also found to have greater toxicity than nonsmokers with dye use. Added exposure to nitrosamines and other carcinogens in cigarette smoke added to those carcinogens present in the hair dyes.

Do hairdressers have added risk?
The occupation of being a hairdresser may entail some risks that are possibly carcinogenic.(International Agency of for Research on cancer-IARC-1993) Certainly skin disorders like contact dermatitis and occupational asthma are major health problems for hair dressers. Other studies have not supported increased risk of reproductive disorders among hairdressers, such as infertility, reproductive loss, congenital malformations, childhood cancers, and developmental disorders in offspring. (Kersemaekers, 1995)

Summary:
Limited human data, inconsistent results, and differences among products with varying chemical formulations used make it impossible to draw conclusions on safety. Differences in duration of exposure and amount of exposure can also determine differences in toxicity. Overall, many studies support no consistent association of congenital anomalies with hair dyes after many of the regulated carcinogens were removed. However, risk cannot be completely excluded so precautions should be taken.

There does appear to be some difference between the use of permanent and temporary hair dyes in pregnancy. Risk seems to be higher for mothers using semi-permanent dyes at any time during pregnancy, or the months prior to pregnancy, compared to the other types of hair dyes used.

Hair dye formulations have changed over time with removal of some substances and inclusion of new and better ones for color range. There has been a reduction in certain nitrophenols. The FDA has discontinued use of 2,4-diaminotoluene, and 2,4-diaminoanisole in permanent dyes and HC Blue No 1 and 4-amino-2-nitrophenol used in semi-permanent dyes because of possible carcinogenic effects.

It is imperative that pregnant women reduce their level of exposure, especially during first trimester. If dyes are going to be used, using protective gloves and facial mask, using a well-ventilated room, avoiding eating or drinking during exposure, and avoiding frequent exposure are essential. Avoid chemicals that may enhance absorption into the scalp or the hair shaft.

If one chooses to use hair dyes, it is generally recommended to wait until after first trimester when most of the baby’s organ systems have been formed. If you must dye your hair during pregnancy, ask your stylist to use the old fashioned method — a plastic cap with tiny holes to pull the hair through. Dying the strands in this manner will prevent the chemicals from contacting your scalp, reducing the absorption risks.

Once again, this information is provided so that you can make the best decision for yourself and your baby. Consult your obstetrician for further information.

Post to Twitter

Recipies for Natural Bug Repellent

Wednesday, July 21st, 2010

Dear Friends, Parents and Customers, Pregnant or Not,

Baby, it’s warm outside. If you are pregnant or traveling with a newborn and/or a breast feeding baby, please take the time to read this great information about how to make your own, natural insecticide. Exposure to insect repellents has always been a source of concern with regard to adverse outcomes to the infant because they contain the chemicals DEET (N,N-diethyl-m-toluamide) or permethrin which can cross the placenta and are considered toxic in high doses. Generally 6 to 8 % of the repellent is absorbed when applied topically to the skin.


If you want to remind yourself regarding all the reasons to remain natural against bugs, read my previous blog on pesticides here.

Mosquito Repellent Recipe
Insect Repellent with Essential Oils
Charts and information provided by Abdelkrim Amer and Heinz Mehlorn(2006)

*Many of these essential oils, although natural and herbal, are not designed to be ingested or used during the first trimester of pregnancy when all the organs of the fetus are forming. The compounds mentioned have not had any harmful effects noted in pregnancy but we recommend that pregnant women should still avoid insect infested areas and not use these essential oils on a daily basis.

If you must use a repellent with insecticide:

  1. Never spray insect repellent in an enclosed area. This might cause breathing difficulties for your baby.
  2. Never spray the repellent directly on the baby’s face. Instead, first spray the repellent on your hands and then apply to your baby’s face and exposed skin.
  3. Before trying any insect repellent for babies, apply a small patch on the baby’s arm to check if the baby’s skin is sensitive to it or not.
  4. Do not use insect repellent near the baby’s eyes, mouth and avoid applying the insect repellent on cuts.
  5. Avoid, using insect repellent on the baby’s hands as most babies have the habit of putting their hands into their mouth.
  6. Avoid applying the insect repellent on the baby’s skin more than once a day.
  7. Once you and your baby are back inside the house, wash off the insect repellent immediately with unscented soap and water.
  8. Never use insecticide on your breast or chest if you are breast feeding.

Best regards,

Dr. Michele Brown,
OBGYN and Founder of Beauté de Maman

You can purchase our nipple gel at drugstore.com

Post to Twitter

BPA and other Chemical Contaminants in Plastic Containers can be Harmful to Pregnant Women

Monday, April 12th, 2010

Much has been written about particular ingredients contained in products that pregnant women use. However, emphasis should also be placed on the tubes and containers that hold these products. Toxic chemicals can be found in plastics that can seep into products exposing pregnant women via skin contact when applying products from these containers.

DBP (Di-n-butyl phthalate) can be found in a variety of plastic containers. A recent study by Dr. Ge in Shanghai Hospital found an association of phthalate exposure and low birth weight in infants. Low birth weight infants had 5 to 10 times higher levels of DBP and mono-2 ethylhexyl phthalate (MEHP) in cord blood and meconium samples. Two hundred and one newborn/mother pairs born at term showed 88 with birth weights less than 2,500 gms and 113 with normal birth weights when no other differences between the groups could be found except the levels of phthalate between the groups. Infants with high DBP exposure were 3.5 times more likely to have low birth weight and those with high MEHP exposure were associated with shorter birth length.

Another study from the University of Cincinnati showed bisphenol A or [BPA], another common additive in plastics, can be harmful to the heart in women. In the past it was demonstrated that bisphenol A or [BPA] was associated with neurologic defects, diabetes, breast and prostate cancer. Now research has shown that exposure to BPA can also increase the frequency of arrthymias, especially in the presence of estrogen in rats and mice.

The Beauté de Maman product line has been very careful about eliminating any harmful chemicals in the plastic tubes and containers that hold the natural, herbal ingredients. Special effort has been made to guarantee safety in both ingredient choices and in the materials used to hold the products. No phthalates or bisphenol A were used in any of the plastic containers that hold and store our products.

Post to Twitter

Reduce Baby Allergies Before Delivery?

Tuesday, March 16th, 2010

Oh Maybe, My Baby

Parents are persistent in asking their obstetricians, “Is there anything we can do when pregnant or breastfeeding to try and prevent allergies from occurring in our child? Why? Because Parents worldwide are noticing that the incidence of allergy, or atopy, in children is dramatically increasing. This includes asthma, allergic rhinitis (runny nose due to allergy), skin allergies (eczema), and food allergies.

Why is this increase in childhood allergies occurring and are there any nutritional options during pregnancy and lactation which will help prevent allergic disease?

In order to understand what to do, parents must first understand the severity and scope of the problem. This is what my research has uncovered.

What is the incidence of atopy (different allergies) in children?

It is estimated that 5-10% of children suffer from food allergies. Peanut allergy in particular is a growing public health problem effecting 1% of all British and US preschool children. The incidence has doubled in the past decade. Asthma incidence in the U.S. has increased 160% in children up to 4 years of age. Eczema is estimated to effect 10-20% of school age children and has increased 2 to 3 fold.

What causes atopic disease?

Atopic disease has a genetic basis but environmental factors, such as early nutrition, may also play an important role. Food allergy, eczema, and asthma are more likely to occur in infants with a family history of allergy in one or more first degree relatives. Chicken eggs, cow milk, peanuts, fish, nuts, wheat, and soy are the most likely foods that cause an immunologic reaction in childhood, many of which persist into adulthood.

Will altering maternal diet when pregnant prevent or delay atopic disease in children?

Here is what the American Academy of Pediatrics has recommended In the past.

Pregnant women avoid allergenic foods in their diet such as peanuts, eggs, and cows milk. However, recent evidence has NOT felt that dietary manipulations or restrictions make any difference. A large Cochrane review study done in 2006, involving 334 women, concluded that avoidance diets during pregnancy are UNLIKELY to substantially affect the child’s risk of atopic disease. In fact, such diets might adversely effect maternal or fetal nutrition which can cause lower gestational weight gain, slightly higher risk of preterm birth, and a reduction in birthweight of the infants. However, future trials with a larger sample size were recommended.

Similarly…

Another researcher, Muraro in 2004 after reviewing all the literature concluded that there is NO evidence that maternal diet during pregnancy or lactation prevents the development of atopic disease.

However, a study concludes…

A recent study by Soutter at the American Academy of Allergy, Asthma, and Immunology in 2010, involving 274 high risk pregnant women, each with a previous documented child with food allergies, showed that children whose mothers avoided certain allergenic foods during late pregnancy and lactation had a lower chance of developing asthma and allergic sensitization when avoiding peanuts, tree nuts, milk and eggs when examined at 18 months and 3 years of age.

By age 3, there was no significant difference between the groups for eczema symptoms and dust mite sensitization but the differences in rates of peanut and egg sensitization as well as asthma was large and significant. It is felt that avoidance behavior may work for certain people and not for others.

Does breastfeeding effect the development of atopic disease?

There is some evidence that breastfeeding in the first 3 to 4 months of life is associated with a reduced risk of developing allergic disease in early childhood, especially eczema during infancy and childhood asthma and wheezing.

As far as food allergy, breastfeeding for at least 4 months had a lower incidence of cow milk allergy in some studies but in others there was no difference. A Cochrane review from 2006 found that feeding an infant with a hydrolyzed formula compared to cows milk formula did reduce the the development of infant and childhood allergy.

There is no evidence that breastfeeding for greater than 6 months has any protective effect against allergic disease. The studies are controversial and mostly retrospective. Long term effects of breastfeeding on the development of allergy in later life is uncertain.

Why is the peanut allergy so common?

There are many theories as to why there is a rising prevalence in peanut allergies in western countries.

Peanuts are a staple of the American diet and is being used more commonly in “quick energy foods.” Considered excellent nutritionally due to its high protein content it is being ingested more frequently in pregnant and breastfeeding women (One peanut contains 200 mg protein). Peanut protein can be found in breast milk and in utero 1 to 3 hours after ingestion.

Most American children are exposed to peanut butter in their first year of life in contrast to other countries. Americans eat dry-roasted peanuts requiring higher temperatures, which increase the allergenicity. Other countries eat peanuts that are boiled or fried.

Even though the European guidelines and the American Academy of Pediatrics do not recommend avoidance of dietary allergens during pregnancy, the avoidance of peanuts during pregnancy might be an exception for families with a history of peanut allergy.

In summary:

At this time, current evidence does not support a role for dietary restrictions during pregnancy or lactation to prevent allergic disease. It is felt that more studies are needed.

For high risk infants with a strong family history of allergy, there is evidence that exclusive breastfeeding for at least 4 months compared with cow milk formula, decreased or delayed the risk of eczema, cow milk allergy and wheezing in the first 2 years of life.

For infants that are not breast fed but who are at high risk for allergy, there is some evidence that the use of hydrolyzed formula, compared to cows milk, helps prevent or delay allergic disease. Soy formulas are not recommended to prevent allergy.

Peanuts are the one exception where avoidance during pregnancy and breastfeeding may decrease the risk of subsequent peanut allergy.

Post to Twitter

The Buzzzzz About Bug Bites and Babies

Monday, January 11th, 2010

Baby and MosquitoBaby, it’s cold outside but perhaps you are lucky enough to have a nice trip planned to someplace warm and romantic. If so, and you are  pregnant or traveling with a newborn and/or breast feeding baby, please take the time to read this warning about insecticides.

Pregnancy and Insecticide

Exposure to insect repellents has always been a source of concern with regard to adverse outcomes to the infant because they contain the chemicals DEET (N,N-diethyl-m-toluamide) or permethrin which can cross the placenta and are considered toxic in high doses. Generally 6 to 8 % of the repellent is absorbed when applied topically to the skin.

Studies in the past have shown that exposure of DEET to the skin of rats has caused developmental problems, low birth weight, and even death of the rat embryo. Exposure to DEET in chick embryos has caused cardiovascular malformations. Topical use of DEET by children has documented reports of toxic encephalopathy and anaphylactic reactions. Other previous studies in humans have shown minimal or no health risks or adverse pregnancy outcomes in the neurological, gastrointestinal, or dermatological systems with exposure to DEET.

Permethrin is another insecticide. It is sold as a 5% cream and is commonly used in the treatment of scabies during pregnancy. Similar controversies exist from reports of no reproductive effects to feminization of male rats.

A new study published in Occupational and Environmental Medicine by Nieuwenhuijsen in December 2009 reviewed 471 cases of hypospadias born to women in South East of England between January 1997 and September 1998. There was a significant association between the incidence of hypospadias and the use of insect repellents during the first trimester of pregnancy. In addition there was an association between multiple pesticide use and hypospadias.

Hypospadias is a common birth defect where the opening of the urethra (meatus) is on the underside of the penis. The incidence of hypospadias has increased with reported occurrences varying between 1 in 500 in the 1970’s to 1 in 250 in the 1990’s. The opening can be located in various places from the under-surface near the tip of the penis to to the base of the penis, or even behind the scrotum (more severe cases). Some cases can be genetic, some due to surgical injury, but some can also be environmentally associated. It can also be associated with other congenital anomalies. Children can have abnormal spraying of the urine, malformed foreskin, and often have to sit down to urinate. All male infants should be carefully examined by their pediatricians after birth for this condition since these infants should NOT be circumcised. The foreskin is commonly used for surgical repair.

In summary, a common congenital anomaly, hypospadias has been associated with insect repellents. Further studies are needed to delineate the type, and the mechanisms of action of pesticides in causing this problem. Because of the controversy regarding toxicity, recommendations have been to apply the smallest amount of insecticide on protective clothing rather than directly to the skin. It is also advisable that better protection from biting insects through use of long sleeved shirts and leg coverings be used. All male children should be carefully examined for this condition at birth.

Newborn, breastfeeding babies and insecticide

Researchers are still trying to connect the dots between disease, breathing problems and pesticides, but there is no reason to take any chances. Here are few alternative ideas to insecticide usage that both parents could follow when in an area prone to biting insects.

  1. Avoid taking yourself and your baby outdoors at dusk or dawn.
  2. Do not use scented soaps for bathing yourself or your baby, as they attract mosquitoes easily.
  3. When going outside dress yourself and your baby in lose and light colored clothing, and preferably full sleeved tops and pants.

If you must use a repellent with insecticide:

  1. Never spray insect repellent in an enclosed area. This might cause breathing difficulties for your baby.
  2. Never spray the repellent directly on the baby’s face. Instead, first spray the repellent on your hands and then apply to your baby’s face and exposed skin.
  3. Before trying any insect repellent for babies, apply a small patch on the baby’s arm to check if the baby’s skin is sensitive to it or not.
  4. Do not use insect repellent near the baby’s eyes, mouth and avoid applying the insect repellent on cuts.
  5. Avoid, using insect repellent on the baby’s hands as most babies have the habit of putting their hands into their mouth.
  6. Avoid applying the insect repellent on the baby’s skin more than once a day.
  7. Once you and your baby are back inside the house, wash off the insect repellent immediately with unscented soap and water.
  8. Never use insecticide on your breast or chest if you are breast feeding.

You can purchase out nipple gel at drugstore.com

Best regards,

Dr. Michele Brown,

OBGYN and Founder of Beauté de Maman

Post to Twitter

Familiar Music Can Work Wonders For Your Pregnancy

Monday, December 14th, 2009

Listening to MusicPregnancy can be emotionally stressful due to the hormonal and physical changes that women experience during this special time. Mental changes that women experience can result in anxiety, depression, fear, and frustration which can have adverse effects on their infants. Poor eating and sleeping patterns can limit overall functioning which can be associated with a higher risk of prematurity and low birth weights along with delayed infant development and negative temperaments in children. Drug therapy in pregnancy to control stress always has risks of side-effects to both mother and child, making non-pharmacologic intervention a safer alternative.

Music has always been used as a form of therapy to reduce stress, pain, and anxiety by promoting relaxation through creation of a healing environment for physical, emotional, and spiritual well being. As early as 555 BC, a well known Greek philosopher and mathematician named Pythagorus felt that music was an important therapy in medicine to maintain good health and often recommended music to maintain harmony and healing in the body.

Stress can effect the hypothalamus, pituitary, and adrenal cortex arousing the sympathetic nervous system. Music can cause a pituitary response with release of hormones and endorphins which are natural opiates that can relieve pain. It stimulates the thalamus and limbic areas of the brain, stimulating good feelings and emotions. Music has been shown to effect blood pressure, heart rate, and respiration along with emotional balance in adults.

Pregnancy, delivery, and newborn care are likely areas to complement and expand conventional medical care by using alternative therapy such as music to reduce stress, anxiety, and pain. Music has been found to stimulate pleasure response and distract from labor pains. Sidorenko published a paper in 2000 showing that music improved relaxation in pregnant women by decreasing heart rates, blood pressure, breathing patterns, and pulse. In addition there was a a reduction in the need of pain killers and improved sleep patterns, and reduction in the number of premature births. Women who listen to music during labor and delivery had reduced anxiety and decreased pain during childbirth for both vaginal and cesarean deliveries. It also allowed for decreased labor time and shortened hospital stay.

The choice of music has been found to be important to its success. The most beneficial responses occur when the music is familiar, desirable and meaningful. Browning in Canada conducted a study demonstrating that music can be an important adjunct to pain and stress management during labor when the music was chosen by the mother, with emphasis on pieces that have significant meaning to both mother and her partner. Daily listening should begin by the third trimester to gain familiarity prior to labor in the hopes of promoting a positive conditioned response during labor.

Music has also been found to be therapeutic to infants. Studies on premature and low birth weight infants have shown shorter hospital stays, less weight loss and fewer apnea episodes when taped music was played in intensive care unit settings. (Casino 1992, Stardley and Moore 1995) A study by Keith in 2009 showed significant reduction in frequency and duration of inconsolable crying in infants as result of music intervention, as well as improved heart rate, respirations, oxygen saturation and mean arterial pressure. Other studies showed an increase in head circumference and decreased heart rate in premature infants in the newborn intensive care unit between 28 and 32 weeks when listening to music. (Cassidy 2009)

A newborn infant has a predilection for the maternal voice and also to musical pieces to which they have been exposed to in utero indicating that the fetus may have a capacity to learn in utero. (Gerhardt, 2000) It is believed that the fetus can hear by late gestation. Studies from Canada have shown heart rate increases in response to Brahms’ Lullaby starting at 28 weeks.

Some additional guidelines published in the Journal of Perinatology in 2000 by the Physical and Developmental Environment of the High Risk Infant Center Study Group on Neonatal Intensive Care Unit Sound and the Expert Review Panel recommend that:

  1. Pregnant women avoid prolonged exposure to low frequency sound levels (<250 Hz) above 65 dB during pregnancy.
  2. Earphones and other devices for sound should not be attached directly to the gravid abdomen.
  3. The fetus does not require supplemental auditory experience for normal auditory development.
  4. Infant neonatal intensive units should develop a system of noise control since exposure to loud background noise will interfere with auditory development and frequency discrimination.
  5. Earphones and other devices should never be attached to the infants ears.

In summary: With the holiday season rapidly approaching, listening to music can have physiologic effects on the pregnant woman which can result in positive effects on mood, stress and anxiety. This can enhance a strong sense of well-being and create a happier atmosphere which can promote fetal and maternal well-being.

Post to Twitter

Can Air Pollution During Pregnancy Affect the IQ of Your Baby?

Monday, August 17th, 2009

A recent study published in Pediatrics, July 2009, disclosed an adverse relationship between high levels of polycyclic aromatic hydrocarbons (PAH) found in air pollution and IQ scores of children tested at age 5.

Air Pollution Over City

Air Pollution Over City

PAH’s are pollutants released by the air during combustion of fossil fuels, tobacco, and other organic matter. Urban minorities tend to have excessive exposure to these compounds. This is especially concerning for pregnant women because of the potential effects these pollutants may have on the fetal brain and nervous system.

Studies in the past have shown that PAH’s from diesel exhaust decreased learning in mice. Fetal growth reduction, including reduction in fetal weight, decreased head circumference, reduced mental development scores, and developmental delays were also found with PAH exposure. This new study now shows an association between high PAH levels and IQ score.

Two hundred and forty nine children were followed from nonsmoking, black and Dominican women age 18 to 35 in the South Bronx. Approximately 56% of the children had high exposure to PAH as measured by monitors during the third trimester of pregnancy. After testing IQ scores at age 5, these children had lower full scale IQ scores and lower verbal scores. The lower scores are of concern since they are predictive of subsequent academic performance in elementary school. The mechanism of how PAH’s affect the fetal brain are unknown.

Communities should strictly enforce greater energy efficiency and control air contamination. In addition, there should be continued search for alternative energy sources to control exposure to PAH and prevent harmful effects on the neurodevelopment of children.

Post to Twitter

Risk of Leukemia Increases with Exposure to Formaldehyde

Friday, May 15th, 2009

News Alert!

Recent data just published in the Journal of the National Cancer Institute has shown that exposure to formaldehyde can increase risks of blood and lymphatic cancers, in particular myeloid leukemia.
Approximately 25,000 workers followed from 1979 to 1994 exposed to formaldehyde working in industrial plants had a 37% increase risk of death from these cancers. The mechanism of how formaldehyde can cause leukemia is unknown but most likely involves chromosomal changes on blood cells.
(more…)

Post to Twitter


The information provided in these articles and on this website is intended for educational and informational purposes only.
This information should not be used in place of an individual consultation or examination or replace the advice of your medical professional,
and should not be relied upon to determine diagnosis or course of treatment.
sign up for the Beaute de Maman NewsletterFind us on Facebookfollow us on twitter