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Toxins and Pregnancy

You're finally pregnant – and the world seems fraught with dangers. Here's a guide to help you navigate through the legitimate concerns and the baseless worries.

Confusion Over Paxil

Black-box warnings on prescription labels indicate the highest level of risk determined by the FDA.

But the recent black-box labeling of the antidepressant Paxil causes confusion for pregnant women, says Martinez.

"Two recent published studies show a slight risk for heart defects with Paxil, a selective serotonin reuptake inhibitor, or SSRI. But four large cohort studies that followed women through pregnancy and followed the children until they were 9 years old don't show higher risk.

"We're letting people know about the studies, but we're withholding judgment," she says.

Martinez explains that a problem arises when depressed women are taken off Paxil and other SSRIs, which have been associated with problems of neonatal adaptation. "Some women are then given tricyclic antidepressants, which carry a much higher risk for far more significant neonatal withdrawal. Or they're taken off antidepressants altogether.

"In the cohort studies, the children in a control group of depressed women taking no antidepressants were more likely to have delayed developmental milestones and more difficulties in school than the children whose mothers took antidepressants," says Martinez.

Important Diet Precautions

The U.S. Environmental Protection Agency (EPA) estimates that 630,000 babies in the U.S. are born annually with high levels of mercury, which can lead to neurological, cognitive, and developmental problems. Most often, the mothers were exposed to methylmercury from eating contaminated fish. Nursing mothers can also pass mercury to their infants.

Because mercury lingers in the blood, all women of childbearing age should follow these guidelines issued jointly by the EPA and FDA:

  • Do not eat shark, swordfish, king mackerel, or tilefish.
  • Eat no more than 12 ounces (two average servings) a week of fish with lower levels of mercury, like shrimp, canned light tuna, salmon, pollock, and catfish.
  • Eat no more than 6 ounces a week of albacore (fancy, white) tuna.
  • Check fish advisories before eating locally caught fish.

Don't exclude fish and shellfish from your diet, however, says Lola O'Rourke, spokeswoman for the American Dietetic Association. They are sources of high-quality protein and omega-3 fatty acids, and are low in saturated fat. She advises varying the types of "safe" fish you consume to lower any risk of contamination.

O'Rourke offers these additional food tips:

  • Avoid raw sprouts and unpasteurized juices, milk products, and soft cheeses. They are potential sources of harmful bacteria such as salmonella, E. coli, listeria, and shigella.

  • Avoid raw or undercooked meat, fish, poultry, and eggs.

  • Avoid cold cuts and deli meats unless heated until steaming.

  • All leftovers should be heated until steaming.

  • Wash hands often. Wash produce well. Keep raw meats separate from other foods.

  • Refrigerated foods should not be left out more than two hours. Set the refrigerator between 35 and 40 degrees.

Also, "The more whole food and the fewer processed foods, the better," O'Rourke tells WebMD. "You'll get fewer preservatives, trans fats, and additives.

"Also, consult your doctor about vitamins. There's such a thing as getting too much," she says.

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