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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.

    Worse Than Thalidomide continued...

    Martinez tells WebMD that if a woman takes the drug during pregnancy, there is a 30% to 35% risk for major birth defects, including complete absence of the thymus gland; serious, often lethal, heart defects; absence of the inner and outer ears; and severe, possibly lethal, hydrocephalus - a buildup of excess fluid in the brain. Furthermore, of the 65% of babies born without structural malformations, 50% are profoundly mentally retarded.

    "It's interesting to me that by comparison, Accutane's risk is much higher than thalidomide's -- which carries a 20% risk -- and its harm to the child is far worse," she says.

    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.

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