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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.

The Big Gray Area

According to ACOG, there is "limited evidence of varying degrees to document teratogenicity" for a number of agents -- some of which may surprise you.

Linda R. Chambliss, MD, MPH, spokeswoman at ACOG, explains that the lack of conclusive data on such agents is due to research constraints.

"The best research requires randomized studies in which you have a group of people exposed to a substance and a control group that's not exposed. Researchers are loathe to put pregnant women into randomized studies [exposing some to potential toxins], so they rely on animal studies or on women reporting what they were exposed to during pregnancy," she says.

Chambliss, a professor of obstetrics and gynecology at St. Louis School of Medicine in Missouri, talks to WebMD about her advice on some of the most common "gray area" substances:

Aspirin:

"You do not want [to take] aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin. They can affect platelet count and bleeding time, and have been associated with fetal defects. I would advise a pregnant woman to avoid these unless they're prescribed by a physician." Acetaminophen, or Tylenol, should be taken instead of aspirin, Advil, or Motrin for fever, headache, minor aches, and pains.

Antihistamines:

"There's little data on newer antihistamines. The older ones work by causing vasoconstriction [constriction of blood vessels], so there's some concern about using them in the first trimester." Examples of antihistamines include Claritin, Zyrtec, Allegra, and Benadryl.

Aspartame:

"not a lot of information".

Caffeine:

"ACOG and the American Academy of Pediatrics say that moderate use, about a couple of cups per day, does not increase reproductive risk. Many people who use caffeine also smoke and drink alcohol, so it's hard to tease out caffeine. Is it the smoking, caffeine, alcohol? Or do they work synergistically? It's not clear."

Occupational chemical agents:

"Fertilizers might pose a problem for agricultural workers, but for occasional residential use, you don't have to leave your house when your lawn gets fertilized. Working in an office where you use Wite-Out or permanent markers is not a concern, but tell your physician about occupational exposures in industrial or agricultural environments. A lot of obstetricians don't think to ask about occupational exposure."

Oral contraceptives:

"If a woman continued taking oral contraceptives because she didn't know she was pregnant, I would tell her to stop. There have been some problems in terms of birth defects. The doctor will take a look at possible interactions and perhaps use an ultrasound to look at the fetus. What has been reported is a less than 1% risk of masculinization of the female fetus."

Pesticides:

"If you have your house sprayed for bugs routinely, I'd be concerned; but if it's a one-time exposure, use common sense. Pesticides have real risks, but most of the data involves agricultural workers."

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