Is it safe? - Common questions during pregnancy

Pregnancy is a time when you get extra careful about what you eat and drink and your environment.  You are responsible not just for yourself but your baby as well.  Here is a guide that can help you in making the decision about what’s safe for you and your baby.

It is best for Indian mothers to confirm with their doctors when there are any doubts or questions.

Here are the common questions:

• Medicines
• Coffee
• Water
• Dental visits
• Non-vegetarian food
• Eggs
• Paint the house
• Insecticides and Pesticides
• Travel
• X-Rays
• Household cleaning products
• Hair dyes and treatments
• Sex
• Exercise
• Alcohol
• Smoking
• Driving

Medicines¹

Short answer: You should always check with your doctor as to what’s safe, when, and in what dosage during your pregnancy.

Many times, women do not have a choice and really need to use medicines while they are pregnant. You should discuss regular medicines you have to take with your doctor. This should be done during your pre-pregnancy checkup and during your first visit to the doctor after becoming pregnant.

Sometimes, women need medicines for a few days or a couple of weeks to treat a problem like a bladder infection or strep throat. Other women need to use medicines every day to control long-term health problems like asthma, diabetes, depression, seizures or high blood pressure. Many women might have pregnancy related problems like severe nausea and vomiting.

Sometimes, common ailments like fever cold etc. get unbearable and come in the way of your being healthy.  Talk to your doctor. It’s best to know about the best medicines to take during pregnancy to help you with common pregnancy discomforts like nausea, headaches, backaches, constipation or common ailments like cold, fever, flu, loose motions etc. early on. This way you will not need to worry and you will be prepared when the time comes.

For everyday ailments like fever, colds etc., many over-the-counter (OTC) drugs can be used during pregnancy after you obtain your doctor's approval. In general, paracetamol  (also called acetaminophen) is safe during pregnancy—for example brands like, Crocin or CalPol.  But always check with your doctor about the medicines that are safe, the dosage and your specific circumstances (other medicines you are taking, the degree of your problem, which stage of pregnancy you are in etc.).

A few OTC medicines are known to be unsafe. Aspirin is one OTC drug that should be avoided in the last three months of pregnancy. In 1990, the Food and Drug Administration of the United States issued a warning that it is especially important not to use aspirin during the last trimester of pregnancy unless specifically directed to do so by a doctor because it may cause problems in the unborn child or complications like bleeding during delivery.  Anti-inflammatory drugs such as ibuprofen are also not advised especially in the last trimester.  In the last few months, check with your doctor as to what medicines you should take for your backaches etc.

Also, check with your doctor if you are taking any alternative supplements or medicines.

Some alternatives to medicines:

• If you have the flu or the cold, try and beat the flu with common herbal remedies like herbal teas with ginger, lots of garlic in soup, drink lots of fluids especially hot fluids, and get plenty of rest.
• “Wait out” a cold instead of resorting to your cold medicine.

Coffee (or other caffeinated products)

Short answer: Moderate your consumption. Not more than 1-2 cups of coffee per day assuming no tea, colas, chocolate etc.,

Caffeine is found not only in coffee but also in tea, chocolate, soft drinks like coke etc.

Caffeine can increase your blood pressure because of its stimulative properties and makes you more alert. Increased wakefulness and higher blood pressure are not helpful during a pregnancy.

Caffeine also crosses the placenta easily and reaches the baby. Since baby's metabolism is still developing, the baby cannot fully metabolize the caffeine⁴.

Some studies have shown that excess caffeine  may increase the likelihood of infertility, birth defects, miscarriage, stillbirth, premature birth, fetal growth restriction, and SIDS. . But there is no conclusive research on this. There were numerous other factors that may have caused this, besides caffeine⁴.

The general medical advice for pregnant women is to moderate consumption of caffeine containing beverages like coffee, tea, colas that contain caffeine etc.

The United Kingdom's Food Standards Agency  advises that pregnant women not consume more than 200 mg/day⁵ of caffeine (In October 2008, the UK FSA revised its advice to 200mg/day from 300 mg/day). The US FDA (the United States Food and Drug Administration) advises pregnant women to avoid coffee or use it sparingly during pregnancy and keep your intake below 200 mg/day. Different countries have different limits. Currently, there is not much conclusive research done on this in India.

The caffeine in coffee depends on the kind of coffee (Robusta beans have more caffeine than Arabica beans, Filter coffee has more caffeine than instant coffee) preparation of coffee (black coffee has a lot more caffeine than coffee with milk) and the brand of coffee.  According to the Indian Coffee Board, regular coffee (roast and ground arabica beans) typically has 120 - 150mg of caffeine in each glass (8 oz, ~250ml⁶.

Based on a 300 mg/day limit, the consumption of average regular Indian coffee with milk can be 1-2 cups per day for pregnant women. However, the less consumed the better.

Here is the amount of caffeine found in some everyday items (source: International Food Information Council)⁷

• Some soft drinks - Typically 24 mg with a range of 20 to 40 mg per 250ml
• Energy drinks - Typically 80 mg
• Milk chocolate - Typically 6 mg with a range of 1 - 15 mg per 30 grams
• Dark chocolate - Typically 20 mg, with a range of 6 - 35 mg per 30 grams
• Chocolate syrup - Typically 4 mg per 30ml

It is easy to keep adding caffeine in your system as you eat and drink all these caffeine-rich items. Be careful and reduce your intake of these items as well along with coffee.

Replace coffee with…

• Tea has little less than half the caffeine than coffee so if you really need that caffeine kick, it is better to have tea over coffee.
• You can also reduce the caffeine in your coffee by adding more milk than before (added calcium and protein as well for you and your baby)
• Green tea
• Lots of hot water

But if you really need to have coffee on a regular basis, discuss with your doctor and try and cut back caffeine in other forms like soft drinks, chocolate etc.

Water

Short answer: Filter your water, then boil it before consuming it.

When you are pregnant, you are more aware and discerning about what you eat and drink in general and water is important.  You are advised to drink a lot of water and fluids during pregnancy as well.  You need to be careful of the water you drink.

Typically, filtered & then boiled water is safe to drink during pregnancy.

But it’s possible your tap water might contain high levels of lead. Galvanised water pipes use lead. Unfortunately, these are very prevalent in India's water supply infrastructure and in our buildings especially the older buildings.

Lead can have adverse effects on everyone, but children and unborn babies face the greatest risk. Exposure to high levels of lead during pregnancy can increase the risk of miscarriage, preterm delivery and cause low birth weight and developmental delays in the baby⁸.

Here are some suggestions to avoid/minimize the likelihood of lead in tap water:

• Have the cold water tap run for about 30 seconds.  If you suspect lead in your pipes, you could let the water run for longer--35 seconds to 2 minutes.
• The longer you have not used the tap, the more the chances are that lead content is high when you first open the tap. So, if you have not opened the tap for a long time, (for example after a vacation or in the morning), you might need to open the tap for a longer time. This will ensure that you drain out the first gush of water which is high in lead content.
• Do not drink the hot water from your pipes or use it in cooking. The hot water might contain more lead than cold water.

In addition, you should get your filter serviced regularly to ensure that it continues to work properly.  It does not remove lead but can remove other impurities.

Now, you can relax and enjoy that glass of filtered, boiled water.

Dental visits

Short answer: Don't fail to do essentials like teeth cleaning. Postpone cosmetic dentistry till after the pregnancy.

The rise in hormone levels during pregnancy cause sensitive and inflamed gums. Also, the bacteria from gum disease can affect the baby adversely.

• It is very important to do normal preventive dental work (dental check-ups, routine teeth cleaning etc.) because of the pregnancy changes. Routine teeth cleaning is safe.
• The safest course of action is to postpone all unnecessary dental work until childbirth. However, sometimes, emergency dental work such as a root canal or tooth extraction is necessary.
• But dental work such as cavity fillings need to be done to reduce the chance of infection. If dental work is done during pregnancy, the second trimester is ideal. Once you reach the third trimester, you might find it difficult to lie on your back for a long time.
• Cosmetic procedures like teeth whitening etc. should be postponed until after childbirth. It is best to avoid exposing the developing baby to strong chemicals.
• The medications used during dental work do cross the placenta and reach the baby but there is no conclusive research on adverse effects on the baby of using these medications. Dentists are careful to use minimal anaesthesia, just enough to make you comfortable. If you feel pain, do ask for more anaesthesia or other pain relief. There is no point in getting stressed with unbearable pain. Remember your stress affects the baby also. Also, if you are relaxed, the anaesthesia will work better.
• The dental x-rays are far away from the abdomen and also the radiations are not very high. But to be safe routine dental x-rays should be postponed until after pregnancy if possible. If there is a problem and dental x-ray is needed, dentists do take precautions while taking x-rays of your teeth. Usually, Dentists will make you wear a metallic covering over your abdomen.

Here is how you can take care of your teeth during pregnancy:

• Brush your teeth thoroughly, twice a day. Ask your dentist about flossing. Flossing can really take out particles from your teeth and help prevent gum disease.
• Eat a nutritious well-balanced diet.
• Have preventive check-ups and teeth cleaning during your pregnancy.

While at the dentist:

• Let your dentist know that you are pregnant
• Keep your legs uncrossed while you sit in the dentist’s chair. This will keep the flow of circulation and prevent swelling.
• Take a pillow to be more comfortable.
• Listen to your own music.

Non-vegetarian food

Short answer: Eat fully cooked non-vegetarian food.

Meat can be packed with protein and iron, but, stay away from meats like salami and hotdogs. They have been known to be contaminated with Listeria, which can cause miscarriage. Listeria has the ability to cross the placenta and may infect the baby leading to infection or blood poisoning. If you really need to eat these meats, make sure that you have cooked or boiled or steamed them properly.

Avoid eating raw meat. Ensure that whatever you eat is cooked thoroughly and fully.
Also be careful about traces of raw meat (which can also have harmful bacteria and viruses) in your utensils (cutting board, knives etc.). Wash these carefully after they have been in contact with raw meat.

Eggs

Short answer: Eat only fully cooked eggs. Do not eat raw eggs or preparations containing raw eggs.

Eggs are full of protein and calcium and are especially recommended for pregnant women. But raw eggs or any foods that contain raw eggs should be avoided because of the potential exposure to salmonella. Some items like mayonnaise in sandwiches and burgers, some salad dressings like Caesar dressings etc. are made with raw eggs and it’s best to avoid them when you are pregnant.

Paint the house or the baby's room

Short answer: Stay away from paint fumes

Unfortunately, there are no medical studies that show that house-paint exposure can have adverse effects on pregnant women and their babies Currently, the assumption is that household paints involves very low levels of exposure.

However, exposure to lead paint can cause potential lead poisoning. See our article on lead poisoning.

But to be safe it is best to postpone painting or go away somewhere else while the house is being painted. After painting, before you move in, make sure that the house has been well ventilated.

Use insecticides or pesticides

Short answer: Stop using insecticides and pesticides. Or stay as far away from them as possible.

Some common pesticides used around the house are mosquito spray (BayGon etc.), cockroach repellents, rat poison, gardening pesticides etc. Pesticides and insecticides contain chemicals that are used to attack the nervous system of the insects and cause them to die.

The first trimester is a delicate phase and the nervous system of the baby and other organs are developing fast. So, you should avoid any exposure to strong toxic chemicals like pesticides and insectisides at this time.

Some tips to avoid pesticide exposure during pregnancy

• The safest plan is to avoid using pesticides or insecticides in your home, on your pets, or in the garden during pregnancy. Especially avoid them during the first trimester when the baby's nervous system is developing.
• If there must be pesticide treatment to your home, your pet, or your garden for pesticides, follow these guidelines to decrease the likelihood of exposure:
  • Leave the area for some time
  • Remove food and from the area before the pesticide is used
  • Wash the area where food is normally prepared following any application of pesticides in the home
  • Open the windows and allow the house to ventilate after the treatment is completed
  • Don't panic if you realize you have been exposed to a pesticide. It’s the long term and intense exposure to pesticides that is risky. Talk to your doctor.

Travel

Short answer: Safe for normal pregnancies, except in the last month

As long as there are no big concerns or complications in your pregnancy, it is generally safe to travel during your pregnancy except during the last month.

But to be safe, do check with your doctor before you travel especially if it is overseas or an exotic adventurous place. Also, if you are travelling for pleasure, be sure your schedule  is practical. You will need lots of rest, so plan for breaks between each attraction you will visit.

Most airlines allow pregnant women to travel during pregnancy except during the last month. And even in the last month, the airlines usually allow you to travel if you have a doctors certificate allowing you to travel.

The ideal time to travel during pregnancy is the second trimester—also called the “honeymoon” phase your pregnancy. In most cases you are past the morning sickness of the first trimester and several weeks from the third stage of pregnancy when you get tired.

Here are some tips for comfortable travel:

• Rest often. Take short walks and do stretches to keep blood circulating.
• Be careful while walking down the narrow aisles and using the tiny bathrooms that most airlines have. Hold on to the seats while walking so that you do not fall down during turbulence.
• It’s a good idea to sit on the aisle seat instead of the window seat. This will make it easier for you to make the frequent bathroom room trips.
• Keep healthy snacks with you at all times.
• Dress comfortably.
• Carry your prenatal records with you.
• Make frequent trips to the bathroom to empty your bladder and prevent urinary infections and stay comfortable.
• Drink a lot of water to stay hydrated (healthy for you and your baby and prevent premature labor)
• Use your common sense and stay safe and make sure you eat clean food and drink clean water.
• Bon voyage and make the most of your travels. It might be a while you travel after the baby.

Nowadays, many working women also travel in buses to their offices. Wear comfortable clothing, and take a pillow along for back support. Also keep a handy bottle of water.

X-Rays

Short answer: If your doctor decides you need X-rays, it is better to get an X-ray

There are no conclusive studies about whether/or how much the radiation in x-rays can affect your baby. Your doctor or a specialist will evaluate your need to get an x-ray. It is important that you inform your doctor before you undergo any x-ray.

If you have some complication and you really need an x-ray, then doctors take precautions (your abdomen might be covered by special a metallic vest). Remember in some cases not getting an x-ray can harm you more than it can harm your baby and a healthy mother means a healthy baby.

X-rays for different parts of the body are different, implying different levels of exposure to your baby

• X-ray examinations on the arms, legs, or chest have minimal risk of exposure to your reproductive organs and the baby.
• However, x-rays such as the abdomen, pelvis, lower back and kidneys, have a greater chance of exposure to the baby.
• Dental x-rays hardly expose any other part of the body except the teeth. Still, to be safe, dentists postpone dental x-rays until after childbirth and do these x-rays only when they are really necessary.

Household cleaning products

Exposure to mild cleaning agents is generally safe. But it’s a good idea to stay away from very strong fumes and harsh cleaning agents. For example, if the phenyl or disinfectant used in mopping the floor is too strong, ask your maid to reduce the phenyl in the water and stay away from strong polishes like Brasso (brass polish) or silver polish.

• Buy branded and top quality cleaning products
• Make sure that you have good ventilation when the house is being cleaned

Hair dyes and treatments

Short answer: Try and avoid these if you can. If you must, do it in a well ventilated location.

Hair dyes and other hair treatments are probably safe to use during pregnancy because very little dye is absorbed by the skin. However, to be safe, many doctors recommend that pregnant women not use any hair treatment products that contain strong chemicals and fumes during the delicate first trimester when the baby’s organs are developing. These hair treatment products include hair dyes, hair bleach, hair relaxers and hair straighteners.

Try other alternative herbal remedies like Henna (Mehendi) at this time.

But If you really need to color your hair or are very keen to use other hair treatments, follow these safety tips:

• Wait until the second trimester for these hair treatments.
• Ensure that your salon has good ventilation. If at home, have the treatment applied in a well-ventilated room.
• Leave the chemicals for the minimal time that is necessary.
• Rinse your scalp thoroughly with water after treatment.
• If you are applying these treatments yourself, wear gloves when applying these.
• Follow directions on the product package carefully.
• Do a patch test for allergic reactions before completely applying to your hair.

Sex

Short answer: It is safe to have sex during a normal low-risk pregnancy

Good news. Unless your doctor advises you otherwise, you can enjoy sex during pregnancy. It will not harm your or your baby. The baby is protected with many different layers: the amniotic fluid in your uterus, by your abdomen, and by the mucus plug that seals your cervix and helps guard against infections. Do check this with your doctor in your visits.

In fact many women, report an increased sex drive because of the hormonal changes, especially in the second trimester, the “honeymoon” phase of pregnancy when the first or third trimester discomforts are not there. So, if there are no complications, make the most of this time.

Changes you can expect?

• Your body is changing and you might need to make some adjustments to enjoy sex fully. You might need to experiment with alternative positions that might be more comfortable.

Exercise

Short answer: Exercise, in general, is great for you and your developing baby.

Discuss your exercise routine with your doctor early in your pregnancy. If you have a normal pregnancy, then the general rule of thumb is that you can continue doing whatever exercise routine you were doing before you got pregnant. Do not start a new exercise routine while pregnant other than very low impact exercises like walking and swimming. That is why it’s important to start exercise before you conceive---you can continue with your exercise during your pregnancy and enjoy being healthy and having a healthy baby.

Say no to these exercises - Don't try deep knee bends, sit-ups, toe-touches, stomach crunches or any exercise that requires you to lie on your back after the first trimester.

Walking and swimming  - Generally, low impact exercises like walking and swimming are safe and encouraged during pregnancy.

Yoga  - It’s a popular form of exercise these days and for good reasons—it is great for the body and the mind. If you have been doing yoga before pregnancy, then it is generally safe as well. Do check with your doctor and your yoga teacher or expert as to which forms of yoga are safe at different stages of your pregnancy.  These days, pregnancy yoga classes are very popular. They have special yoga asanas that are especially safe and beneficial for pregnant women and help in an easy labour. But make sure that you get an expert and reputed teacher. Many women gain a network of friends for themselves and their babies in these classes.

Running, jogging, cycling - Check with doctor about exercises like running, jogging and cycling. Runners who continue exercising during pregnancy tend to gain less weight, have leaner babies and shorter labors. If you are experiencing any pregnancy complications, you will probably be advised to stop jogging. Typically, if you have a normal pregnancy, running and jogging might be okay. But cycling can have falls and can be risky.

Aerobic exercise - Aerobics in general are healthy for most women and their developing babies. Low impact aerobics with a certified and expert instructor can be beneficial. But high impact aerobics is not recommended because of the extensive jumping, hopping and bouncing during the routine.

Tips while exercising…

• Wear a supportive bra (sports bra). You will feel more comfortable (since during pregnancy your breasts feel tender and get swollen) and your breasts will get more support.
• Wear properly fitting athletic shoes. Good shoes will reduce the impact of exercise on your abdomen as well.
• Do not overdo exercising.
• Stop if you feel dizzy, faint, overheated, or are in pain.
• Drink plenty of water.

And don't forget to do your Kegel exercises, to help you during childbirth

Staying in shape will help you feel better, strengthen your muscles for the arduous feat of labor and delivery. And later, the accumulated muscle mass will help you lose the pregnancy weight faster.

Alcohol

Short answer: No.

Do not drink when you are pregnant.  Remember when you drink that glass of wine, beer or whatever, your baby does too.  There is no conclusive research on how much alcohol is safe before your baby is harmed.  In the meantime, it is safest to avoid alcohol altogether.

Prenatal exposure to alcohol can interfere with the healthy development of the baby. Alcohol consumption during pregnancy can lead to Fetal Alcohol Syndrome or other developmental disorders. If you had alcohol before you knew you were pregnant, discuss with your doctor. Do not worry about that, but stop drinking now.

Smoking

Short answer: No.

Most people know that smoking causes cancer, heart disease, and other major health problems.  But women who smoke during pregnancy put themselves and their unborn babies at risk for other health problems.  The dangers of smoking during pregnancy include premature birth, certain birth defects (like cleft lip or cleft palate), and infant death².  Even being around cigarette smoke puts a woman and her baby at risk for problems.

Women who smoke during pregnancy are more likely than others to have a miscarriage. So it is best to stop smoking early, even before you conceive.

It is important to quit smoking for good. Some women might think it is safe to start smoking again after their baby is born. But these babies are not out of harm's way. Babies who are around cigarette smoke have weaker lungs than other babies. They are more likely to have other health problems such as infections and more frequent asthma attacks. Being around cigarette smoke is also one of the causes of SIDS (Sudden Infant Death Syndrome)².

Studies show that maternal smoking can also increase the risk of colic in babies³.

Though quitting for good can be hard, the benefits are worth it—a healthy baby and many more years of good health to enjoy with him or her.

Driving

Short answer: Yes

In a normal pregnancy, it is safe to drive till about 37th week or so.  But drive carefully and avoid sudden jerks. Put on the seat belt carefully below the belly, to avoid the belt from pressing on your belly in case the car stops suddenly.

Make sure that you carry water and some snacks to nibble on in the car.

Minimize long distance driving:

• Avoid doing long distance driving if you are going out of town or something.  It will be uncomfortable and sitting for a long time can cause backaches and you might need to go to the bathroom often. Take the train or fly.
• If you drive, long distance to work—more than an hour or so—try having someone drive you or take your work shuttle (For example: many far flung IT campuses offer free shuttles to their employees). Remember to ask the driver to drive carefully.
• You could even try and see if your company will let you work from home a few days in a week.

References

1. “Pregnancy and Medicine”, The US Federal Government Source for Women’s Health Information

2. Centers for Disease Control and Prevention, "Recommendations to Improve Preconception Health and Health Care --- United States" April 2006

3. Shenassa, Edmond D., Brown, Mary-Jean "Maternal Smoking and Infantile Gastrointestinal Dysregulation: The Case of Colic" Pediatrics 2004 114: e497-e505

4. Edmund Hey, "Coffee and pregnancy" BMJ 2007;334:377

5. "When you're pregnant", UK Food Standards Agency

6. India Coffee Board "Coffee-Part of a healthy, balanced diet", Coffee & Health, October 2006

7. Reprinted from the International Food Information Council Foundation and Association of Women’s Health, Obstetric, and Neonatal Nurses, August 2002

8. U.S. Preventive Services Task Force, "Screening for Elevated Blood Lead Levels in Children and Pregnant Women: Recommendation Statement", December 2006. Originally published in Pediatrics 2006;118:2514-18. Agency for Healthcare Research and Quality, Rockville, MD

Last updated: Nov 14, 2008

 Former member 2013-04-28 22:04:31

Hi, This is a great post. There is a new Center that has opened up in Chennai called Baby Bliss. At Baby Bliss, they ensure a Healthy Baby & Happy Mom while getting pregnant, during pregnancy (prenatal care) and post pregnancy (post natal care). Check out their website at www.haselfrebabybliss.com

chahar999 2011-06-06 15:56:07

really a gud article almost cover each and every point. Very informative for pregnant ladies.

Pandian 2010-08-13 00:05:01

Excellent article, every parents should read this especially pregnant ladies. Really useful!!!