Can Your Baby Hear You?

The birth of a healthy baby is a miracle. The child emerges with ten fingers and toes, perfectly formed to touch and kick in a big, new world. Nose and taste buds yearn for the first meeting with mother’s nutritious milk. A baby even opens its eyes trying to focus on the blurry faces of parents looming close, cooing their hellos and declarations of love.

“Wait,” thinks one baby out of 1,000. “Something is missing. You’re cooing and kissing but I can’t hear a thing!?” Indeed, no adults seem to notice that in spite of all this activity, all is silent to the baby.

After the birth, our baby is pulled out of its mother’s warm and protective arms into the hands of a pediatrician for examination. Seemingly, with a fine tooth comb, he makes sure that all is complete and well, and that there are no defects or deficiencies to be addressed before the baby leaves the hospital. The physician looks into every opening, fold and crevice, tests the limb joints and reflexes, listens for the heartbeat and breathing, and almost always gives the delighted parents the clean bill of health, congratulations and the measuring tape with the baby’s length noted.

Why was this baby, and nearly 50% of all babies with later-discovered hearing loss, sent home from the hospital after delivery with undetected hearing loss? The reason is that hearing loss detection tests were not routinely performed on infants until recently, when Government sponsored universal screening programs were initiated for newborns.

Beauté de Maman Nipple Gel

Why is it important to identify infants with hearing loss?
The ability to detect hearing problems in newborn infants is crucial. Studies have shown that being able to process auditory information early in life is crucial for later development of reading and spoken language skills. Hearing loss is associated with social and emotional developmental lags in children as well as poor academic achievement.

What is the incidence of congenital hearing loss?
Congenital hearing loss can be found in two to three infants per 1,000 live births. That means that there are approximately 5,000 babies born in the United States each year with bilateral permanent hearing loss.

How do you define hearing loss in newborns?
Newborns are checked for moderate to severe bilateral permanent hearing loss. Current testing after birth does not pick up loss that is progressive or acquired later in life. The current testing programs detect hearing losses at a threshold of 30–40 dB in the frequency important for speech recognition (500–4,000 Hz)

What are the characteristics of children that are most likely to have hearing loss?
Babies who were determined to be at high risk for hearing loss include children that were admitted to the neonatal intensive care unit for more than 2 days, (1–2 cases of hearing loss for every 200 babies), premature infants, children with craniofacial anomalies, family history of hearing disorders, children whose mothers developed infections in utero, and children who are born with certain syndromes. However, it was found that close to half of all the children not in the high risk group were missed. Therefore, about 50% of all children with hearing problems were sent home from the hospital with undetected hearing loss.

What are the current state requirements to have children checked prior to leaving the hospital?
Currently in all 50 states, Guam, and the District of Columbia regulations direct testing of all children for hearing loss before leaving the hospital. All states and US territories have Early Hearing Detection and Intervention (EHDI) programs funded by the Federal Government which delineate the screening protocols, follow-up care and collection of data. This data collection has been initiated only since the 1990’s. The US Department of Health and Human Services now has clear guidelines which include a universal protocol that screening should occur before 1 month of age, follow-up for infants not passing the test no later than 3 months of age and follow-up intervention prior to 6 months of age for infants identified with hearing loss. Due to initiation of these programs, the number of infants screened for hearing loss increased from 46.5% in 1999 to 97% in 2007.

What are some of the causes of hearing loss in infants?
Hearing loss can be divided into 4 categories:

1. Central
   This is due to deafness caused by problems along the auditory pathway to the brain or in the brain.
   High levels of bilirubin (breakdown product of blood cells—often causing jaundice in the newborn.)
   Hypoxia (low oxygen levels)
   Intraventricular hemorrhage (bleeding within the brain.)
2. Conductive
   This is caused by problems with the outer ear, middle ear, the tympanic membrane, or the bones of the ear and affects all frequencies equally. This may also be due to congenital cholesteatoma (growth in the middle ear.)
3. Sensorineural
   This is caused by problems in the inner ear or auditory nerve. About 50% of these are due to various genetic diseases and syndromes (Alport’s Syndrome, Turner’s, Usher’s, Waardenburg’s syndrome). Scientists have now mapped genes that cause hereditary hearing loss, in families. In 20–30% of cases, sensorineural defects can also be due to infectious causes such as cytomegalovirus ( most common), group B strep infections, herpesvirus, rubella, toxoplasmosis, and syphilis. Mothers can acquire these infections during pregnancy and pass it to the fetus in utero. Children can show no signs at birth but go on to develop deafness later on in life. Unknown causes (idiopathic) and anatomic causes are also in this category.
4. Mixed
   This includes a combination of the above etiologies.

What are the most common tests used for screening?
There are 2 infant tests available called the AABR and the TEOAE. Both diagnose sensorineural hearing loss in newborns. There is no evidence that one test is superior to the other to date, although some studies have shown a lower rate of false positives with AABR. Children with positive testing are referred for further testing and details are obtained about genetic and family history.

1. Automated brainstem response (AABR)
   This checks the auditory pathway from the outside ear to the lower brainstem. Infants have their ears covered with earphones that emit a series of clicks. Electrodes on the infants forehead and neck measure brain wave activity in response to the clicks which is then fed into a computer that assess the brain wave activity.
2. Transient evoked otoacoustic emissions (TEOAE)
   This test evaluates the function of the cochlea by placing a small microphone in the external ear canal and testing the echo responses to a series of clicks which is then placed thru a computer and compared to the standard.

With any kind of testing, the important issue is the false positive and false negative rates. Universal newborn screening has a high number of false positive rates, mostly due to motion artifacts. Other causes of false positives can be due to fluid in the ear or ear infections. False positive rates can be as high as 30% with a one step test, to less than 1% if a child is tested twice. If a child fails the test twice, an ear, nose, and throat referral is directed by the pediatrician.

Proper counseling of the parents allays the anxiety caused by false positives. The overall benefit far outweighs the risks of missing a potentially deaf child with delayed intervention.

What are the future goals to improve the medical care of infants with hearing loss?
Future goals include devising a system for providing better follow-up care on children who do not pass the initial screening and for screening children that fall below the threshold and have milder forms of hearing loss or late onset and progressive forms of hearing loss that can be missed. Also, ensuring that children with documented disorders are enrolled in intervention programs is critical. Children that have risk factors should not only be screened at birth but again throughout childhood.

Recommendations by the Joint Committee on Infant hearing recommends testing every 6 months before 3 years of age in high risk children. More Federal programs are being initiated to track follow-up care on infants and to increase education and awareness.

Summary:
Hearing loss detection in infants has markedly changed in the last decade, with over 95% of all newborns being screened. Follow-up interventions and enrollment in programs still remain a challenge. The Federal programs now in place, with universal testing and better data collation and tracking systems, are expected to bring vast changes. Improvements in overall quality of life will occur as a result of earlier detection and treatment as children avoid limitations in speech, language, and cognitive capacity. Hopefully this will obviate the damage caused by hearing limitations that affect academic performance, social interaction and deficits that negatively impact ability to work.

Please feel free to leave your experiences, or questions, regarding hearing loss in infants in the comments section below. I would enjoy hearing from you.

Best Regards,
Dr. Michele Brown OB/GYN

And don’t forget to check out our natural and herbal products for pregnant women.

Hey, all you pet lovers out there. This article is not to frighten you away from having a cat or two, but nowhere is the expression “an ounce of prevention is worth a pound of cure” more applicable than when one discusses toxoplasmosis in pregnancy. This blog is intended to be a red alert for pregnant women on how to reduce the chances of having their baby acquire congenital toxoplasmosis.

Why? Because toxoplasmosis is a devastating disease for the fetus and the newborn throughout the world. It often goes completely unrecognized but can be prevented with the proper precautions. Roughly 400 to 4,000 cases occur per year in the United States. Women are routinely tested in high risk countries like France, Austria, and Italy but the American College of Obstetrics and Gynecology does NOT routinely recommend screening in the United States.

Therefore, it is essential that all obstetricians take careful histories from their pregnant patients to determine if they are likely to have acquired this disease. If the patient clears the toxoplasmosis screening, the physician should further instruct  specific rules the pregnant woman should follow to avoid getting infected.

What is toxoplasmosis?
Toxoplasmosis is caused by ingestion of cysts from the protozoan Toxoplasmosis gondii. The primary host of the parasite is cats which excrete the oocyte in the feces. Humans become infected by eating raw or undercooked meats containing the oocyte, ingesting oocytes from soil where unwashed fruits and vegetables have grown, or from contact with cat litter. The oocytes can remain infectious after being deposited for over 1 year. After ingestion of the oocytes, infection can occur between 4 and 21 days.

What happens after the oocytes are ingested?
The protozoan after ingestion will invade muscle, heart, liver, spleen, lymph nodes, and the central nervous system. This can result in inflammation and cell death. Most normal adults with no immune problems go without symptoms and the disease is self limited. Occasionally one will have fever, swollen lymph nodes, and fatigue. If a woman is infected prior to pregnancy (greater than 6 months), transmission generally does not occur to the fetus except when her infection becomes reactivated due to a change in her immune status. (taking steroids, or she develops AIDS).

Are there special risks with pregnancy?
If a woman is pregnant and acquires the disease, the protozoan can travel through the placenta and infect the fetus resulting in mental retardation, seizures, malformations, blindness, deafness, and death. There is a classic triad of chorioretinitis (inflammation of the choroid and the retina of the eye), calcifications within the brain, and hydrocephalus (fluid accumulation within the brain) that occurs in less than 10% of cases.

Many infected newborns have no symptoms at birth (70–90%) and manifestations may not occur until the second or third decade of life where one can see learning and visual disabilities, retinal damage and loss of vision. Some infants do show signs of infection at birth with fever, enlargement of the liver and spleen, and rash. Other cases are suspected when ultrasound findings reveal the presence of structural abnormalities. Risk of the fetus acquiring the infection is lowest when maternal infection occurs first trimester and highest when infection occurs third trimester. However, infection tends to be worse if it occurs first trimester.

How is the infection detected and treated?
Infection is detected by a blood test that picks up antibodies to the protozoan (IgG and IgM). Using the results from these antibody tests, one can determine if an infection was never present, acquired before the pregnancy, or contracted during the pregnancy. Amniocentesis can also be performed to detect fetal infection. The earlier the blood test is obtained, the more helpful it will be in determining the timing of an infection. Treatment is with spiramycin early in the pregnancy or after 18 weeks with pyrimethamine-sulfadiazine and folinic acid since this crosses the placenta more readily. It is recommended that infected newborns should receive treatment, regardless of symptoms for up to a year since it is felt that treatment may improve the outcome.

Summary:

1. Obstetricians must inquire from all their pregnant women on their initial prenatal visit if they own cats. Do not purchase a new cat or pet stray cats when pregnant. Cats should be fed cooked meat and kept indoors to prevent them from acquiring toxoplasmosis. Pregnant women should avoid changing the litter box. If it is completely unavoidable, gloves should be worn and the litter box should be changed daily.
2. Gloves should be worn when gardening or when a pregnant woman has any contact with soil or sand.
3. Pregnant women should avoid eating uncooked meat. Meats that are smoked, cured in brine, or dried can still be infectious. Wild game and venison are especially high in oocytes from toxoplasmosis. Spores are very resistant to environmental conditions except when heated to 55–60 degrees C for 1 to 2 min or when deep freezing meat (-12 degrees C or lower). All fruits and vegetables should be thoroughly washed before eating to prevent cross contamination from other foods or soil. Do not drink unpasteurized milk. Drinking unfiltered water or when rain and surface water lands into drinking water and irrigation water, infection can occur.
4. Screening should be done in high risk women to decrease the incidence and severity of congenital toxoplasmosis by identifying the disease early and initiating treatment in an infected woman.
5. Public health measures may have to be instituted in high risk communities around the world necessitating the filtering of water, testing and labeling meat as being toxoplasmosis free and improving farm hygiene.

Please feel free to post any questions you may have below. I would love to help prevent this disease from happening to any family looking forward to a new baby in the home.

Today’s pregnancy health topic is a bit delicate, but we have never been shy about discussing important health issues for pregnant women and we won’t tip-toe around hemorrhoids either. Fortunately there is nothing life threatening about hemorrhoids, but don’t tell that to a pregnant woman who has developed symptoms. You may be risking a bloody nose.

The problem is two fold in that many women are embarrassed to admit, even to their doctor, that they have excruciating pain “down there”. But pregnancy can exacerbate an existing condition or cause hemorrhoids to appear for the first time. Approximately 40% of pregnant women develop hemorrhoids but only 10% require some form of therapy. They are more common in the second and third trimester of pregnancy, more common in women who have been pregnant several times and increase in severity with each subsequent pregnancy.

What Are Hemorrhoids?

Hemorrhoids, also known as piles, are a conglomeration of swollen blood vessels in and around the anus and lower rectum.

Hemorrhoids can be classified into two kinds, internal and external. Internal hemorrhoids lie inside the anus or lower rectum, beneath the anal or rectal lining. Internal hemorrhoids generally present with bleeding and discomfort due to prolapse. External hemorrhoids lie outside the anal opening and present with irritation and discomfort. Both kinds can be present at the same time.

Hemorrhoids are a very common medical complaint. More than 75% of Americans have hemorrhoids at some point in their lives, typically after age 30.

What Causes Hemorrhoids?

The causes of hemorrhoidal disease are similar to those which cause varicose veins, i.e., genetic weakness of the veins, excessive venous pressure, low fiber diets (associated with constipation and increase straining), prolonged standing or sitting, and heavy lifting are considered factors.

The physical and hormonal changes associated with pregnancy tend to make women more prone to develop hemorrhoids or worsen existing hemorrhoidal symptoms.
Those changes include:

• Increased abdominal pressure caused by the pregnant uterus.
• Straining at defecation and constipation often accompanying pregnancy.
• Dilation and engorgement of the veins due to increased blood volume.
• Hormonal changes leading to increased laxity of connective tissue.

Symptoms

The symptoms most often associated with hemorrhoids include itching, burning, pain, inflammation, irritation, swelling, bleeding and seepage. Itching is often due to the mucous discharge from prolapsing internal hemorrhoids.

Pain does not occur unless there is acute inflammation of external hemorrhoids. As there are no sensory nerves ending above the anorectal line, uncomplicated internal hemorrhoids rarely cause pain.

Bleeding is almost always associated with internal hemorrhoids and may occur before, during or after excretion. When bleeding occurs from an external hemorrhoid, it is due to rupture of an acute thrombotic hemorrhoid. Bleeding hemorrhoids can produce severe anemia due to chronic blood loss.

Therapy

As with all diseases, the primary treatment of hemorrhoids is prevention. This involves reducing those factors which may be responsible for increasing pelvic congestion such as straining during defecation, and sitting or standing for prolonged periods or time.

A high-fiber diet is crucial for the maintenance of proper bowel activity. Spicy foods should be avoided.

Specific treatment of hemorrhoids should be tailored to the severity of the symptoms. In pregnancy special consideration should be made to the developing fetus. Drugs should therefore be used sparingly and surgery only done when absolutely necessary.

Dietary factors

Hemorrhoids are rarely seen in countries where high fiber, unrefined diets are consumed. A low fiber diet, high in refined foods, contributes greatly to the development of hemorrhoids.

Individuals consuming a low fiber diet tend to strain more during bowel movements since their smaller and harder stools are difficult to pass. This straining increases the pressure in the abdomen, which obstructs venous return. The increased pressure will increase pelvic congestion and may significantly weaken the veins, causing hemorrhoids to form.

A high fiber diet is perhaps the most important component in the prevention of hemorrhoids. Diets rich in vegetables, fruits, and legumes help keep the feces soft and easy to pass. The net effect of a high fiber diet is significantly less straining during defecation.

Bulking agents

Natural bulking compounds can be used to reduce fecal straining. They are the first basic step in your preventative strategy. These fibrous substances, particularly Psyllium seed, possess mild laxative action due to their ability to attract water and form a gelatinous mass.

Hydrotherapy

The warm sitz bath is an effective non-invasive treatment for uncomplicated hemorrhoids. A sitz bath is a partial immersion bath of the pelvic region. The Temperature of the water in the warm sitz bath should be 100–104 °F.

Topical therapy

Topical therapy, in most circumstances, will only provide temporary relief. Topical treatment involves the use of suppositories, ointments and anorectal pads. Many over the counter products for hemorrhoids contain primarily natural ingredients, such as witch hazel, shark liver oil, cod oil, cocoa butter, Peruvian balsam, zinc oxide, live yeast cell derivative and allantoin.

Surgical Intervention

In severe cases where conservative therapy was unsuccessful, consideration should be given to surgical treatment. These patients should consult a colorectal surgeon to determine the procedure of choice. Procedures such as elastic band ligation, injection sclerotherapy, (5% phenol in almond oil) and infrared photocoagulation have been performed successfully in pregnancy. Infection and bleeding in the peri-anal area is the major risk factor. Surgical hemorrhoidectomy has been performed in pregnancy successfully in severe cases where office based procedures have failed. Some patients have required further therapy postpartum.

In summary:

Hemorrhoids are a common problem during pregnancy. Treatment should focus on prevention and particularly high fiber diet and proper hydration.

When conservative measures fail, consulting a colorectal surgeon and discussing surgical options may be indicated.

Prior to the mid-1940’s, women had been allowed to eat during labor. Then, a 1946 study showed that women who ate during labor had a higher chance of aspiration, (involuntary inhalation of stomach contents during anesthesia.) After the publication of the study by Curtis Mendelson, women were strongly advised that they should stop eating as soon as they felt contractions or thought that they were in labor.

Do women need to fast during labor?

Since this 1946 study, standard conventional obstetrical practice in the United States has adhered to the belief that women in labor should restrict the amount of oral and fluid intake. These concerns have been based on the presumption that potentially fatal aspiration of stomach contents, or asphyxiation, from large food particles could occur if an emergency cesarean section was warranted under general anesthesia. Recent studies in the obstetrical literature have re-evaluated this position and questioned the evidence to support this practice.

What are the actual risks of aspiration in labor?

The actual incidence of aspiration during birth is 7 per 10 million births in cases accumulated between 1979 and 1990 in the United States. A study in which 11,814 women were allowed to eat and drink during labor reported no maternal damage or death occurring from aspiration. There have been no maternal mortalities due to aspiration in Australia since 1987 and only one death in the UK in the 1990’s despite a recent liberalization of oral intake policy.

What are the reasons that women in labor are more at risk to aspirate?

Pregnancy causes slowed gastric motility or action. Gastric emptying is further delayed in labor due to the use of narcotic analgesics that can predispose women to aspirate abdominal contents. In addition, the acidic nature of the stomach content can cause bronchospasm and congestion which can result in pulmonary edema and death. Certain high-risk conditions make a person more prone to aspiration, such as obesity, small airways and patients with a history of gastroesophageal reflux. Also, poor anesthesia technique can contribute to aspiration, such as blowing air into the stomach and anesthesia that is too light which may cause bucking and coughing with a full stomach and then, essentially, aspiration of the regurgitated stomach content.

What is the common philosophy that hospitals use to avoid aspiration in labor?

Intravenous hydration with Ringers lactate has been the mainstay of fluid and nutritional replacement during labor, with the occasional use of ice chips.

What are the problems associated with intravenous hydration?

Energy requirements are increased during labor, similar to an athlete doing strenuous exercise requiring increased caloric expenditure. Exclusive intravenous therapy may not be sufficient to meet these requirements. Long labors without eating can cause a woman to metabolize fats instead of carbohydrates, which can lead to a buildup of ketones which has been associated with prolonged labors.

Large infusions of glucose solutions can lead to elevated blood sugar levels in the infant, while after birth this is followed by low glucose levels, jaundice, low ph, electrolyte problems and rapid breathing. Lower dose 5% glucose solutions have been associated with greater weight loss in the infant after the first 2 days of birth. In addition, women may be more prone to fluid overload, immobilization, and increased stress when only IV fluids are used.

Does restriction of oral intake actually prevent aspiration pneumonia?

The restriction of oral intake and reduction of the volume of contents in the stomach prior to Cesarean section has not eliminated the reported very rare risk of aspiration. Fasting women in labor have been found to have gastric contents with more concentrated acidic content which may increase the maternal morbidity and mortality.

What can be done to eliminate the risk of aspiration in labor?

Proper anesthetic precautions should always be followed, such as avoidance of unnecessary Cesarean sections, preferential use of spinal or epidural anesthesia and protection of the airway when general anesthesia is used. Additionally, the use of medications to prevent or neutralize acid secretion in the stomach from reaching the lungs has been one of the most effective means of preventing this complication. In addition, some anesthesiologists use medications to enhance gastric emptying.

• It may be best to avoid intake of solids during labor.
• It may be best to consume only clear liquids, isotonic drinks and light meals, which will not increase intragastric volume and may be well tolerated.
• Women who have a high risk of Cesarean section can be further restricted in their oral intake.

What are some of the official guidelines for women to follow in labor?

The World Health Organization states that women need increased energy for the requirements of labor and a woman’s desire for food and liquid should not interfere with the natural process of labor and will ensure both fetal and maternal well-being. This philosophy is echoed by the WHO-Euro as well as the Society of Obstetricians and Gynecologists of Canada for women in normally progressing labors.

In Summary

The pulmonary aspiration of gastric contents in labor is not a major problem in today’s obstetrical world. More evidence is now available pointing to the safety of light liquid and food regimens during labor in women who are in the low-risk population.

High-risk woman, who are more likely to need a Cesarean section should probably avoid solid foods. Anesthesiologists should administer appropriate antacids and other stomach neutralizers. They should also provide agents to promote gastric emptying before surgical procedures, with protection of the airway, should general anesthesia be required.

This is the latest information regarding the Swine Flu Pandemic.

• Flu activity appears to be decreasing in the United States.
• Pregnant women have an increased risk of severe disease.
• Pregnant women with mild or moderate symptoms can have a rapid deterioration with progression of disease.
• Pregnant women with other health related issues (ex. asthmatics) can have even further increased risk of flu related complications.
• The overall maternal mortality in the United States for 2009 may be increased due to the high maternal mortality of H1N1.
• Majority of hospitalized severely ill women infected with H1N1 were in the second or third trimester of pregnancy.
• Rapid antiviral treatment, generally within 48 hours of presentation of symptoms, is essential to reduce morbidity and mortality in pregnant women and all suspected cases for up to 2 weeks after delivery, according to the CDC.
• Delays in treatment of greater than 48 hours had a four fold greater risk of ICU admission or even death.
• Rapid tests for diagnoses of the disease have poor sensitivity and therefore should not be used to make clinical decisions on whether to start treatment.
• Vaccination is critical in pregnant women and benefits not only the mother but also the newborn with decreased respiratory infections for 6 months after delivery.
• Children shed virus longer than adults but whether this implies they are contagious longer is unknown.

(source NEJM Dec 2009)

I developed my Beauté de Maman Nipple Gel because certain products on the market contain ingredients that may not be safe for breast feeding babies. If you are a breast feeding mom, please be wary of nipple gels and creams containing the following ingredients.

Please forward this to anyone that is pregnant or breast feeding. Click “Share” above.

Lanolin

If the nipple product contains lanolin, do not use. Please see our article below regarding pesticides, lanolin and breast feeding babies.

Read more about pesticides in lanolin-based products

Olive Oil

If the nipple product contains olive oil, we recommend you put it back on the store shelf. Why? Because Beauté de Maman did a trial of products containing olive oil prior to being released onto the market and found that the product crystallized and became rancid after 3 months, similar to olive oil that is used for cooking. We therefore opted to use a different omega 3 fatty acid — one that is healthy for newborns and maintains shelf-life for a much longer period of time.

Marshmallow Root

There is no data on the safety of marshmallow root and therefore this ingredient should not be used for infant ingestion until clear safety data is available.

Beeswax

There is also no data on the safety of beeswax and therefore this ingredient should not be used for infant ingestion until clear safety data is available. Beeswax comes from honeycombs which is found in candles. Furthermore, honeycombs are where bees produce and store their honey. Honey may contain spores that contain botulism. Pediatricians warn new parents to never give honey to an infant under one year of age. Beeswax may still contain honey particles and therefore I would not recommend using a nipple gel product containing beeswax.

Shea Butter

Shea butter is a cholesterol compound similar to cocoa butter. It is considered a saturated fatty acid which most individuals are trying hard to eliminate in their diets as recommended by the National Institute of Health. Beauté de Maman uses a monounsaturated fatty acid base, which is a much healthier alternative for the newborn infant.

Consumers be wary: Watch for companies that make blanket statements regarding ingredients that are not factually based. Many of the sources used by these companies are from cosmetic databases derived from online retailers solely written to lure consumers. Only use products researched on databases that pull safety data from evidence based medical research studies.

Beauté de Maman Nipple Gel contains only safe ingredients that have been researched by a board certified obstetrician from unbiased scientific literature from the Reproduction Toxicity Database.

This is an information system that lists environmental hazards to human reproduction and development. It also contains summaries regarding the specific effects of medications, chemicals, infections, and physical agents on pregnancy. It is used by clinicians, scientists, and government agencies to make decisions regarding the safety of products in the US. We are proud of our record regarding infant safety.

The reproduction toxicity database provides information that we, at the Beauté de Maman laboratories, rely upon for safety standards.

About the Vitamin E in Beauté de Maman Nipple Gel

Toxicity has a great deal to do with purity and dosages.

All Beauté de Maman ingredients are pure and well within the acceptable dosages for pregnant and lactating women.

The recommended daily allowance (RDA) for vitamin E is 15 mg/d during pregnancy and 19 mg/d during lactation. The recommended upper limit is 800 mg/d for pregnant and lactating women under 18 years old. The recommended upper limit is 1000 mg/d for pregnant and lactating older women. Beauté de Maman Nipple Gel contains 1% of purified vitamin E. The most a baby ingests from our product line is 1 gram of nipple gel a day, or about 10 mg/d of Vitamin E per day—well within the normal range. Therefore, the amount and purity of Vitamin E in Beauté de Maman is safe in pregnancy.

Back by popular demand!

Below is a reprint of our previous article on lanolin and pesticides.

As you may know, most breast feeding women are sent home from the hospital, after giving birth, with a lanolin-based product to help relieve their sore, chapped nipples. As a physician and OBGYN, I am very concerned about this and want to send you this warning about lanolin-based products.

The first thing you need to know is that pesticides have not one, BUT TWO, ways of getting into lanolin-based nipple gels and creams. It all begins with sheep, as lanolin comes from the sebaceous glands of these animals.

Lanolin is an animal based product, 100% cholesterol, and is taken from sheep that graze on grass that is treated…

Read more about pesticides in lanolin-based products

Or, Go Shopping for Beauté de Maman Nipple Gel

Please forward this to anyone that is pregnant or breast feeding.

And be sure to check out all our pregnancy-safe health products…

Pregnancy, due to suppression in the immune system, can make a woman more susceptible to certain bacterial infections. Among the more serious infections is listeriosis, caused by the bacteria Listeria monocytogenes. This organism is a common colonizer of the gastrointestinal tract. It originates in the environment commonly found in soil, dust, water, produce, processed foods, and the feces of domestic and wild animals and humans. Invasive disease is rare but pregnant women have a 17 fold increased incidence compared to non-pregnant women.

What is the importance of listeria infections in pregnancy?

Listeria can be the cause of spontaneous abortions, premature labor, stillbirths, and infants with sepsis or meningitis. The newborn mortality rate from this disease is between 30 and 63%. The fetus gets infected either through the placenta via the maternal bloodstream, or ascending from the vaginal canal after having been infected from the gastrointestinal tract.

What is the incidence of listeriosis?

The general population has an incidence of invasive disease of 0.7 per 100,000 but pregnancy increases the incidence to 12 per 100,000. CDC has estimated approximately 2,500 cases per year in the U.S. resulting in approximately 500 deaths. About a third of the cases of listeria occur in pregnant women. The bacteria can be found as a colonizer in the feces of 70% of healthy people and 44% of pregnant women. It is rarely found in the vagina. Although colonization is common, invasive disease is unusual.

Pregnant women that are immunocompromised with HIV infections, diabetes, steroid use, and splenectomy are especially susceptible to this pathogen.

How do pregnant women get infected with Listeria?

Food contaminated with the bacteria is the main source of infection. Main reservoirs include soft cheeses (feta, brie, camembert), blue veined cheeses, Mexican-style cheese (queso blanco), coleslaw, pâté, pork tongue, unpasteurized milk, foods prepared from raw milk, turkey franks, and delicatessen foods. Listeria has the capacity to multiply at refrigerator temperatures (4–10 degree C) and therefore can contaminate undercooked meat and vegetables. All surfaces and utensils must be washed carefully when exposed to uncooked meats.

What are the symptoms of infection in the mother and the newborn?

Most pregnant women are asymptomatic or present with a flu like illness with low grade fever, myalgia, headache, abdominal cramping or diarrhea. Rarely are the symptoms serious. Miscarriage or premature labor can occur 50% of the time with fetal distress 35% and meconium stained amniotic fluid 75% of the time. Occasionally a macular/papular rash can be present on the trunk and extremities. The placenta can also have evidence of micro-abscesses.

Onset of the disease in newborns is generally within 1–2 days of birth and appears as sepsis or pneumonia. There is also a late onset version of the disease in newborns that can occur 7–14 days after delivery and presents as meningitis.

A rare finding in infants is called granulomatous infantiseptica which is characterized by multiple widespread abscesses and granulomas.

The later in gestation that the disease occurs, the worse the outcome for the mother and the fetus.

Diagnoses is generally made with positive blood cultures. Organisms can also be found in the placenta or amniotic fluid. It can be isolated from urine, cerebrospinal fluid, and the oropharynx in infants.

What is the treatment for Listeria in pregnancy?

Treatment of choice for listeriosis is ampicillin, amoxicillin, or penicillin. For patients allergic to penicillin, treatment with erythromycin or vancomycin is recommended. Trimethoprim/sulfamethoxazole is another alternative for penicillin allergic patients but it is not recommended in the first trimester due to the anti-folate activity which can possibly lead to a neural tube defect. In utero therapy has been successful in several case reports averting the need for prompt delivery which is recommended in most other cases of chorioamnionitis.

Ampicillin along with an aminoglycoside is the management for newborn listeriosis. Length of treatment is controversial and some reports feel 3 to 4 weeks of high dose therapy is essential.

In summary, the key to prevention of listeria in pregnancy is avoidance of food products that may be contaminated with this bacteria. The FDA and CDC regularly monitors any reports of contamination but it is always best to avoid high risk foods. In addition, food should be stored, handled, and cooked properly to reduce the risk of acquiring this infection.

One of the most popular classifications of medications used throughout pregnancy are antibiotics. Many of the common drugs used by pregnant women such as penicillins, erythromycins, and cephalosporins have been considered safe with minimal risk of birth defects. However, with the creation of more resistant bacteria and the development of newer drug classifications, more choices have recently become available with less data and safety information available for use in pregnancy.

A recent study published by Crider, from the CDC’s National Center for Birth Defects and Developmental Disabilities, published in the Archives of Pediatric and Adolescent Medicine, November issue, discussed the association of birth defects found in pregnant women taking antibiotics anytime from one month before conception through the end of the first trimester.

The study involved 3,863 case mothers and 1,467 controls in a retrospective analysis that showed associations between exposure to certain antibiotics and birth defect outcomes. It did not attribute any causal relationship. In addition, the study was done by telephone interview approximately 6 weeks to 2 years after the pregnancy which could result in an inaccurate recall of medications.

Results showed confirmation of safety profiles for the commonly used penicillins, erythromycins, and cephalosporins. However, several other antibiotics commonly used in pregnancy to treat urinary tract infections, such as sulfonamides and nitrofurantoins, were associated with several birth defects. Among the defects for the nitrofurantoins (Macrobid) were anophthalmia or microphthalmos, hypoplastic left heart syndrome, atrial septa1 defects, and cleft lip with cleft palate. Associations with sulfonamides (Bactrim and Septra) were more numerous and included anencephaly, left sided heart defects, coarctation of the aorta, choanal atresia, transverse limb deficiency, and diaphragmatic hernia.

In conclusion, more data is needed to further analyze these associations of potential adverse effects on the fetus with the use of these medications. In the meantime it is always prudent to use the commonly prescribed medications as first line therapy where possible negative effects are almost nonexistent.

It has been well known that glucose abnormalities in pregnancy are predictive of a greater risk of diabetes later in life. However, a recent study in the Canadian Medical Association Journal by Retnakaran and Shah has now shown that mild glucose abnormalities in pregnancy, even if not diagnostic of gestational diabetes, can also predict an increase in the risk of heart disease later in life. Heart disease is the number one killer of women in the United States.

The American College of Obstetrics and Gynecology recommends that glucose screening be performed in all pregnant women in the third trimester of pregnancy using a 50 gram glucose challenge test. If results are abnormal, a 3 hour oral glucose tolerance test using 100 grams of glucose follows with the results determining which women are diabetic and which are not. Diabetic pregnant women are considered higher risk pregnancies and are closely monitored with finger stick glucose results for the remainder of the pregnancy with medications added as needed. Most commonly the diabetes disappears at delivery and many of these women are lost to follow-up care. This new study is critical in the conclusion that those women with glucose abnormalities, no matter how slight, should be followed for cardiovascular disease for the remainder of their lives.

The study was retrospective and included all women between the ages of 20 – 49 in Ontario, Canada who delivered between 1994 to 1998 and did not have a preexisting diagnoses of diabetes. Women were followed for 12.3 years after delivery. The results showed greatest risk in women with gestational diabetes, 4.2 vs 2.3, in women who failed the 1 hour but passed the 3 hour test, and 1.9 rate per 10,000 person-years in women who passed both tests. This demonstrated that women with even mild glucose abnormalities had an increased risk of future cardiovascular disease compared to the normal population but not as great as the gestational diabetics who clearly had higher vascular mortality.

The authors also suggest that the diabetes does not occur prior to the heart disease but rather that the two develop in parallel. There may be some damage to the vascular system that is not clinically apparent by the time the diabetes testing is positive. Correcting the sugar levels in diabetic patients fails to reduce the mortality or change the cardiovascular risk rates adding credence to the fact that the vascular damage has occurred prior to the high blood sugar levels. Still, controlling the sugar levels in the early stages of pregnancy is important to prevent congenital malformations and also to prevent excessive growth of the fetus. It is also important in the mother to allow for proper wound healing and the prevention of infections. In addition, women who had borderline glucose abnormalities and those who were diabetic were more obese than normoglycemic women and perhaps it is the obesity causing the hyperglycemia, which can cause an increase in cardiovascular risk.

In conclusion, continued surveillance after delivery in all women who had any glucose abnormalities during their pregnancy is essential. Special emphasis on modifications of other risk factors (obesity, smoking, hypertension, cholesterol) in this population may have a beneficial effect on future prevention of heart disease in this new high risk group.

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Ground Ginger as used in Beauté de Maman Dietary Supplement for Nausea in Pregancy

Ginger Bread House. Everyone knows how good Ginger Bread tastes but did you know that GINGER helps alleviate Morning Sickness?

Ginger (Zingiber officinale) is a nutritive, herbal supplement considered safe by the Food and Drug Administration. It has been used for thousands of years in many countries such as Rome, Greece, India, and Arabia for digestive disorders. It is listed in the pharmacopoeias of the United Kingdom, Thailand, and China as effective treatment for
nausea and vomiting of pregnancy.

The components of ginger are gingetol and shogaol appear to have only local effects on the gastrointestinal system in comparison to prescription anti-nausea medications which effect the central nervous system.

Nausea complicating pregnancy occurs in over 80% of women and therefore finding a natural, herbal remedy as first line therapy that health care providers can offer safely is highly desirable. Many articles are now being published that point to the safety and effectiveness of ginger in pregnancy. (more…)

Much confusion exists between the health benefits of eating fish during pregnancy versus the contamination acquired from toxins found in fish. So, what recommendations should we give to pregnant women?

The Benefits:

Eating fish during pregnancy is due to the presence of omega 3 fatty acids EPA and DHA.

These compounds have been shown to: (more…)

Body art in the form of tattoos and piercing are becoming more popular in the general population. Roughly 13% of the U.S. population has a tattoo and 45 to 50% of college students have a piercing.

Tattoo and body piercing on woman.

Tattooing is equally common in both sexes but body piercing is more common among females. (more…)

Many pregnant women have  concerns about using seat belts  when driving because of fears that  the constraint might be more harmful to the baby during an accident. However, new research has shown that seat belts and airbags reduce the risk of trauma, fetal loss, and early delivery caused by motor vehicle accidents.
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With summer vacations approaching, holiday air travel is common. Pregnant women often question the safety of air travel.
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FERTILITY MAGAZINE • VOLUME 10 • WWW.FERTMAG.COM

by Michele Brown, MD, FACOG and Kristi Cristello, BS, MEd

Joseph Pilates, creator of the popular fitness program, said “Physical fitness is the first prerequisite of happiness.” The same can be said for pregnancy A healthy well nourished and fit body and a sound mind are best prepared to tackle the stresses of pregnancy. Preparing your body for pregnancy will not only it increase your odds of becoming pregnant, it will also promote a healthy and enjoyable pregnancy and a favorable outcome.
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With the summer months approaching, pregnant women are concerned about the risks to themselves and their baby in swimming pools and saunas. There is no question that the risk of bacterial, viral, and parasitic infections can increase during this time.
(more…)