Pregnant Women Wrongly Advised to Eat More Fish

Recently a non-profit organization, the National Healthy Mothers, Healthy Babies Coalition, held a press conference urging women to eat more seafood. They were enthusiastically encouraging pregnant women to eat at least 12 ounces of seafood per week. They were confident in their recommendation despite the fact that it was in direct opposition to the National Academy of Sciences, the Department of Health and Human Services and the Food and Drug Administration. The coalition made no mention of the risks of mercury in large fish. Days later, many of the members of the coalition distanced themselves from the recommendations. It turns out that their coalition received a $60,000.00 grant from the National Fisheries Institute.

In response to the coalition’s statement, the March of Dimes put out a statement urging pregnant women to not exceed 12 ounces of seafood per week. So before you up your intake of seafood, consider the standing recommendations of the FDA on fish consumption during pregnancy:

1.) Don’t eat shark, swordfish, mackerel or tilefish
2.) Eat no more than 3 to 4 servings per week of fish like tuna, salmon, Pollock, catfish and seafood like shrimp and shellfish
3.) Minimize consumption of tuna; especially albacore tuna

You can also take an omega 3 supplement called Expecta Lipil to get your healthy fatty acids without the risks associated with tainted fish.

New Study Shows Stress Affects Pregnancy

A new study has found that in the weeks and months following 9-11, there was an increase in low birth weight babies born in and around New York City. The study, published in the journal Human Reproduction, found that in the week following the disaster, there was a 44 percent increased risk of newborn babies weighing below 3.3 pounds, and a 67 percent increase in those weighting between 3.3 and 4.4 pounds, compared to babies born three weeks before the disaster.

The rates then stabilized for a few months, but in December and January, there was another peak in low birth weight babies, and yet another in April and May. The authors postulated that the stress of 9-11 immediately caused a higher incidence of pre-term births. The second wave of low birth weight babies may have occurred because the holidays after 9-11 were an emotionally difficult and stressful time, and the third wave may have occurred because these babies were in the earliest—and most vulnerable—phase in their gestation during 9-11.

When an expectant mom is exposed to stress, those stress hormones can pass through the placenta wall and expose the baby. This can do trigger labor to begin prematurely and also initiate the final physiologic shifts toward maturity. Unfortunately rushing the process often leaves the baby with deficits that threaten its health and wellness. If you’re exposed to a stressful situation or are experiencing chronic stress, try to minimize it through stress busting activities like yoga, meditation, biofeedback, and massage.

Your spouse’s habit can affect your pregnancy

You’ve probably made many changes in your lifestyle since you’ve become pregnant, but here’s one your partner should make. Two large studies in the Journal Sleep found that pregnant women exposed to second hand smoke were far more likely to have problems related to sleep. They found that when expectant women were passively exposed to tobacco smoke by being near smokers, they were more likely to experience inadequate sleep, problems falling asleep, frequent premature awakenings and increased snoring. Interestingly, those exposed to second hand smoke had about the same incidence of sleep disturbances as pregnant women who smoked. These findings were based upon questionnaires of over 30,000 pregnant women polled in 2002 and then in 2006 providing even greater credibility to the finding. In about 80 percent of these cases, the woman’s spouse was a smoker.

Although sleep disturbances may seem inconsequential to the pregnancy, they have been shown to increase your risk of preeclampsia, gestational diabetes, prolonged labor and cesarean section. These studies provide one more reason why pregnant women should avoid tobacco smoke—at home, when socializing, and in the workplace. Tobacco smoke is also associated with heart disease, cancer, and having a low birth weight baby. So ask your partner to take a pledge to stop smoking during your pregnancy. You, he and your child will all benefit from a smoke-free home.

Our New Baby

On September 10th, my wife Morgan gave birth to a beautiful baby girl. I wanted to thank all of you—friends, patients, readers, and family—for your support and kind thoughts. The birth of our daughter was the culmination of nearly two years of fertility treatment. Morgan and I have included details of our story in my book Perfect Hormone Balance For Fertility, which will be published in April, 2008. Having watched Morgan live the principles of this book and my pregnancy book, and seeing her thrive throughout her pregnancy, I feel emboldened even further to encourage you to consider the recommendations we offer in Perfect Hormone Balance for Pregnancy.

While pregnant, Morgan truly had minimal symptoms. All of her tests indicated that her risk for pregnancy complications was equal to that of a woman half her age; Morgan is in her early forties. Throughout her prenatal visits, her obstetrician expressed disbelief at her health and the development of our daughter. Morgan and I live a healthy lifestyle to begin with, but she really applied herself to take an active role in her pregnancy. We improved our food choices, worked together to minimize the impact of stress on her, created a truly green household environment, and she was still walking about five miles per day up until her date of delivery. Now that we’re completing our first week as parents together, I am pleased to say that we’re enjoying ourselves, our new baby, and each other.

To any of you that read my book, I encourage you to embrace whatever aspects of this program you find applicable. Better still, I’d love to hear from you. If you have any comments or anecdotes that you’d like to share, please post them here or send them to me at drrobertgreene@aol.com. Thank you again for all your support.

Best thoughts,
~Robert

Gestational Diabetes Can Lead to Obesity in Children

Here’s more evidence that an expectant woman’s hormonal status has a life-long effect on her developing child. Through a process known as hormonal imprinting, the hormones that a fetus is exposed to in the womb can set what’s “normal” for him for the rest of his life. This latest study looked at the lasting impact of gestational diabetes—having high blood sugar during pregnancy—on a baby, and found that the disorder raises the child’s risk of obesity.

Researchers in the study examined the records of nearly 10,000 pregnant women and their children up until age 7. They found that the higher a woman’s blood sugar during pregnancy, the more likely her child became obese during those early years of life. The researchers also found that effectively identifying and treating gestational diabetes reduced the future risk to the child. The bottom line is that there is a direct connection between what you eat, particularly if you overindulge, and your baby’s future life and health. Avoiding too much weight gain, and choosing healthy whole grains, vegetables and fruits over processed starches and sweets can keep your blood sugar at healthy levels. It’s also important to avoid skipping meals. Instead, consume your meals and snacks at regular times throughout the day and before bedtime as recommended. Any steps you can take to improve your health will have a lasting impact upon your child.

Non-stick Pans Lower Newborn's Weight

Non-stick chemical surfaces are in the news again; this time for their impact upon infant birth weight. The same coatings that save us minutes of cleanup time in the kitchen can reduce the weight of your baby according to a recent study that tested the blood from 1,400 pregnant women in Denmark and then tracked the outcome of their birth. Although the effect was small, these are the same chemicals—perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA)—that have already been clearly linked to cancer and developmental problems in animals tested. In fact, they have been shown to kill pet birds exposed through routine exposure in people’s homes.

A more detailed analysis of birth outcome and exposure to PFOS and PFOA was recently performed at Johns Hopkins Hospital in Baltimore. Not only did they find a reduction in birth weight, but there was also a reduction of the head circumference in the babies exposed, suggesting an impact upon brain development. The news regarding these chemicals has already convinced the EPA to persuade eight manufacturers of these BioMutagens to voluntarily phase out production by 2015. I suggest that you begin taking simple steps to protect yourself, your baby and the rest of your family now. Here’s how:
• Don’t preheat nonstick pans—temperatures high enough (600 degrees) to release these chemicals can be produced in two to five minutes. Cooking at temperatures below 400 degrees seems to be safe.
• Discard old cookware with flaking surfaces—The Green Guide suggests replacing frequently used nonstick cookware every two years, about the time they begin to degrade even if there’s no evidence of wear.
• Plan your next set of cookware—purchasing cast iron, enameled cast iron or stainless steel will provide more durable and safe cooking surfaces as well as an eco-friendly solution to this problem.
• Keep pet birds out of the kitchen—they are extremely sensitive to these chemicals and can be killed by even a single exposure to these compounds which can easily occur by becoming distracted and overheating a pan.

Breastfeeding Prevents Overfeeding in Newborns

Researchers have just identified one more reason why breast feeding is better than formula. While all babies lose weight during the first few days after birth, a new study published in the Journal of Human Lactation found that exclusively formula-fed newborns lost substantially less weight than breast-fed babies. On the surface, this would seem like a drawback of nursing. In fact, researchers suggest that newborn weight loss is a normal form of self-regulation of infants, and providing formula overrides it, possibly setting up infants for weight gain and obesity later in life.

Newborns mostly lose water weight and meconium as well as a small amount of fat, in the first few days as they learn to regulate their own body temperature. Additionally, the breast milk that they are typically sipping on in the first few days after birth is colostrum, a yellowish, nutrient-dense, but low-calorie substance that new moms produce before their milk comes in. Newborns typically lose 5 to 7 percent of their birth weight in the first week.

If your newborn is in this healthy weight loss range, and the nurses or doctors recommend supplementing with formula to boost your baby’s weight, discuss your concerns about overfeeding. Just like when you’re mother insisted that you “clear your plate,” we’re just now learning that eating more than you need isn’t always a good thing!

Other benefits of breast feeding include:
For the baby:
Lower risk of infections
Lower risk of food allergies and asthma
Higher IQ
Lower risk of obesity and diabetes

For the mom:
Reduced postpartum bleeding
Stress relief
Lower risk of depression
Stronger bones
Greater weight loss

Pregnant Women: Beware Bisphenol A (despite "experts panel's" reassurance)

Once again a panel convened by the government to investigate possible health risks offered reassurance where independent scientists found only concern. The National Toxicology Program (NTP), a division of the Department of Health and Human Services, put together a 12 member panel, whose members included scientists tied to plastics manufacturing to investigate the effects of bisphenol A (BPA)—a chemical used in the manufacturing process of plastics. It is estimated that over 6 billion pounds of this hormone-disrupting chemical have already been produced often for use in food packaging. The panel took a reassuring stance, finding that bisphenol A poses minimal risk. The panel’s report did, however, acknowledge “some concern” that prenatal exposure to bisphenol A causes changes in the brain that can create abnormalities in infants and children. By contrast, non-governmental scientists and those not tied directly to plastics manufacturers consistently publish studies and opinions warning about the effects of the BioMutagen.

The Environmental Working Group , comprised of independent scientists, engineers and attorneys, has been warning of the effects of bisphenol A for years, citing nearly 150 research studies that demonstrate links to birth defects, infertility, recurrent miscarriage, and prostate and breast cancers. The EWR hired a panel of nine independent experts to analyze last week’s NTP report. Their findings: The NTP report “contains 300 potential errors, 195 incomplete reviews and 48 basic inconsistencies.” In addition, last week the National Institute of Health enlisted an international panel of 38 experts on bisphenol A, which concluded that the chemical presents a clear health risk to people, especially pregnant women. I recommend that you err on the side of caution.

Rather than accept a false sense of security from the recent NTP report, consider taking steps to reduce exposure for you and your developing baby. Begin with the following:
• Don’t heat foods in plastic containers (heating, especially in a microwave oven, increases the release of BPA into your food).
• Stop putting plastics into the dishwasher (harsh detergents increase the release of BPA).
• Only use glass baby bottles.
• Throw out any plastic bottles, cups, or containers that have hairline cracks or are more than a year old.
• Tell manufacturers of products that you purchase for consumption to stop using the plastics that contain the highest amounts of BPA (#3, 6 & 7) by reviewing this chart.

Progesterone in Pregnancy: Useful but not a panacea

The hormone progesterone (named for its ability to “promote gestation”) is essential for a healthy pregnancy. Indeed, research over the last several years suggests that low levels of this hormone may be the most common reason for preterm labor. This has been an important finding, allowing doctors to prescribe progesterone to women at risk of a premature delivery (they’ve already had a preterm birth). This week, the New England Journal of Medicine published two articles that can help physicians more accurately target women that can be helped by progesterone.

One study found that when women with a shorter than normal cervix—the funnel shaped transition between the womb and vagina—were given progesterone starting late in the second trimester, it reduced the risk of a preterm delivery by about 50 percent. The other study found, however, that women carrying twins did not appreciably reduce their risk with this same strategy. That’s not surprising since there is probably a different triggering event in these two scenarios. Women with a shortened cervix may have a uterine muscle that isn’t able to stretch rapidly enough to accommodate the growing baby. Progesterone helps relax the muscle fibers so that they can stretch more easily. In a twin pregnancy however, it is more likely that the placenta is unable to meet the nutritional needs as the babies enter the accelerated growth phase of their third trimester. If you’re pregnant with twins, your best strategy is to promote uterine blood flow through good nutrition and regular exercise as well as good prenatal care to monitor the growth of your babies. For many others, progesterone remains an excellent strategy to reduce the incidence of preterm births.

Diet Coke and Friends Lead to Obesity and Heart Risks??

A recent widely publicized study found that those who consumed even one Diet Coke (or regular Coke) a day had at least a 50 percent greater risk of obesity, diabetes, and heart disease. Immediately theories started circulating about why Diet Coke, which has artificial sugar, causes these health risks: Does artificial sugar trigger a behavioral response that increases your desire for all sugar—fake and real? Does the artificial caramel coloring cause insulin resistance, which leads to these diseases? Doubtful. A far more plausible interpretation is that people who drink soda are likely to be less health conscious and to make other poor diet choices—haven’t you seen the co-worker drinking Diet Coke while munching down a bag of M&Ms? The reality is that calories cause weight gain and shifts in insulin that lead to obesity, diabetes and heart disease. The real take-home message of the study: If you drink soda, that may be a red flag that you need to improve your diet on the whole. By carefully considering everything you eat and drink, you can have a very significant reduction on your health risks for you and your baby.

A second prominent study suggested that obesity is contagious. By tracking the health and relationships of a large group of people, researchers demonstrated that when a friend becomes obese, the risk of obesity almost doubles among his or her closest friends. They also showed that close friendship had a stronger impact on body weight than family members (and genetics), even when buddies are separated by 1000 miles or more. The hopeful news is that they also found when someone began losing weight these same close friends would follow the same trend. The results were very compelling but again should be interpreted carefully. The friendship connection is most likely because our friends’ activities, choices, and preferences influence our own. Again the implication is that by being careful about your food choices, you can have a positive impact on your own health as well as others.

Although neither of these studies focused on pregnant women, their implications are important. Rather than adopt the outdated “eating for two” mentality that your friends might espouse, and satisfying every craving and indulgence, be “twice as careful about what you eat and drink.” You’ll not only improve your health and your babies, but also have a positive influence on your friends and families.

Flexitarian Diet Recommended for Pregnant Women

I have long believed that there are health benefits for people who reduce the amount of meat that they eat but a recent study demonstrated even more clearly that during pregnancy cholesterol intake should be minimized. Cholesterol is a type of fat that we each make very efficiently in our liver. It also serves as the precursor for some of the most important hormones that we make, including estrogen, testosterone and progesterone. Even during the high production needs of pregnancy however, dietary cholesterol can build up and cause a compromise in blood flow.
A recent study demonstrated that when women ate a low fat diet during pregnancy, they not only reduced their risk of preterm labor but there was an improvement in their baby’s blood flow as well. This suggests that making better food choices during pregnancy may not only reduce the risk of preterm delivery but also give your child a healthier heart and blood vessels. I’m not suggesting you have to completely give up your favorite foods but at least consider reducing your consumption of meat, switch over to reduced fat dairy and take an omega-3 supplement like Expecta LIPIL for a healthier pregnancy.

First Trimester Screening in Pregnancy

Knowing you have a healthy baby as early in your pregnancy as possible can significantly ease your worries and stress. And, if there is a problem, it’s better learning this early on, no matter what you decide to do about it. In the past, women had to wait until the second trimester to have an amniocentesis to test for Down syndrome. But in recent years, first trimester screening involving a simple blood test of several hormones and a non-invasive ultrasound, has become available. The combination of these tests detects about 75 percent of fetal problems. When they’re followed by second trimester testing, the detection rate is above 95 percent.

Though the American College of Obstetricians and Gynecologists now recommends first trimester screening for all pregnant women, many doctors still don’t offer it to their patients. Since it is fairly new, some may not know about it and others may not be trained to do the ultrasound, but some don’t offer it for ideological reasons—they don’t want the patient to consider terminating the pregnancy. A new study of over 38,000 pregnant women determined that all women should undergo first trimester testing, and when the results suggest a woman is at high risk, she should then be offered a minor surgical procedure involving a needle biopsy of the placenta (chorionic villus sampling or CVS) for confirmation or reassurance. This combination of universal screening followed by the CVS in those with a positive test is called contingent sequential testing. All of this should be completed before the twelfth week of pregnancy as it is in other Western countries like England.

The problem is, only 10% of people have easy access to CVS, so some drive to other cities to get it or others wait until they can do an amnio. I urge patients to ask their doctors about first semester screening—the more women who ask, the more doctors will be pressured into offering this important screening and as the demand for CVS increases, it will become more readily available as well.

The China Syndrome: Not During Pregnancy

Made in China is taking on new meaning. First it was tainted pet food imported from China, then toxic fish—from China, and now Veggie Booty sprinkled with Salmonella-laced seasonings—again from China. In recent weeks, a number of foods, drugs, toys, and other products produced in China have been found to contain harmful toxins, and this, many experts think, is just the tip of the iceberg. China itself is closing manufacturing plants in an attempt to avert a backlash against Chinese products. Many Americans have been asking the question of where our food comes from, and how rigorously it is tested for contamination.

It’s estimated that at least 15% of your food comes from foreign countries; though at least 80% of seafood does. Some of these countries, as we now know, often look the other way when it comes to the use of toxic agents and pesticides. Because it’s nearly impossible for consumers to know where the food they buy in food markets comes from, the US Department of Agriculture has established rules that require fish and seafood to contain Country of Origin Labeling (COOL). The USDA expanded these rules in 2004 to cover beef, lamb, pork, peanuts, and fresh and frozen fruits and vegetables, but they have not yet taken effect because of repeated delays. The rules are up for public comment until September 30, 2007. You can send your comments by email: cool@usda.gov or fax: 202.720.1112. COOL rules will enhance accountability among foreign manufacturers and help consumers to make educated decisions about their purchases.

During pregnancy, you’re eating for two and have to be twice as careful about what you’re eating. There are several ways to protect yourself and your vulnerable baby from potentially contaminated food. First, try to purchase organic products when you can. Second, try to buy food produced from local farmer’s markets. Third, buy from countries with the safest profiles. In order of safety, the US, Canada and Europe are first; Mexico is below US standards, then Latin America, and at the bottom of the list is Asia. Fourth, eating a Flexitarian diet— reducing your consumption of meat, fish and chicken, while increasing your fresh fruits and vegetables can also help lower your exposure to toxins from animal products—no matter where they come from. Avoid processed and prepared foods and choose fresh foods instead.

Too much sugar during pregnancy

We’ve long known that women with gestational diabetes put themselves and their babies at risk of several complications and lifelong problems, but a new study shows that women with glucose levels that are within the normal range, but on the high side, may also be at risk. About 4 percent of pregnant woman in the US—or 135,000—are diagnosed with gestational diabetes each year. The disorder allows excess glucose to cross the placenta, putting the baby at risk of being born too large (a risk for cesarean section), as well as for developing obesity and diabetes later in life. It can also increase a woman’s own risk of weight gain, diabetes, and cancer.
The new study, reported at last month’s meeting of the American Diabetes Association, tracked 25,000 pregnant women over seven years and found that the current threshold for “normal blood sugar” levels may be too high. When women had blood sugar values that were within the upper end of the normal range, there was an elevated risk of the problems I mentioned above that are typically associated with gestational diabetes. Stricter guidelines are clearly in order to lower risk to you and your baby.
I recommend that you err on the side of caution, and request a blood test for glucose, called HgA1C (also known as “glycosylated hemoglobin"), which provides an estimate of your average blood sugar. Typically, women are tested for blood sugar problems during the 28th week of their pregnancy—following a drink of an overly sweetened beverage called a glucose challenge. Don’t wait until 28 weeks, but request this inexpensive blood test when you’re having blood drawn for other prenatal tests—typically around the second prenatal visit. If the number is in the high end of the normal range or above normal, request a referral to a registered dietician so that you can learn ways of improving your diet to lower your risks to yourself and your baby.

Second Hand Smoke: Unhealthy for Pregnant Women

As rates of cognitive and behavioral problems in children continue to rise, there’s a growing body of evidence that environmental pollutants are a significant contributor to the troubling trend. A new study has strongly implicated second hand smoke. The study found that regular prenatal exposure to second hand smoke has been linked to attention deficits, aggressive behavior, acting out, and regular confrontation with rules in children—a group of problems collectively called externalizing behaviors. Infants born to women regularly exposed to tobacco also experience more colic and can be more difficult to soothe. Single episodes of smoke exposure are unlikely to have an effect.

It is firmly established that children born to women who smoked during their pregnancy have a higher risk of behavioral disorders. Studies have shown that daughters born to moms who smoked were nearly five times more likely to develop attention deficit hyperactivity disorder (ADHD) whereas sons were twice as likely as those born to nonsmokers. ADHD is a growing problem in the US, affecting an estimated 5% of children. Tobacco contains many toxins including lead and various chemicals that can act as anti-estrogens and affect fetal development including brain development.

This study provides all the evidence you should need to take steps to avoid second hand tobacco smoke. Make your house and car smoke-free and support businesses that are smoke-free or provide a non-smoking section. Tell smoking family and friends that you’re pregnant and you don’t want to put your baby at risk. Ask to get reassigned if to a nonsmoking area at work. And if you’re a smoker, talk to your doctor about what you can do to quit.

Prenatal Vitamins and the FDA

Taking a prenatal vitamin as soon as you know you’re pregnant (or even better, while you’re trying to get pregnant) is one of the most important steps you can take for the health of your baby. You probably know that taking a prenatal vitamin containing folic acid will reduce their child’s risk of various birth defects, especially those of the spine, heart and face. A recent study found that it may also prevent the most common types of childhood cancers including leukemia and brain tumors. But it’s also important that you take a high quality vitamin that contains nothing harmful, and for that reason, I’ve always recommended taking a prescription prenatal vitamin.

But that may change. Last week the Food and Drug Administration (FDA) passed new standards regarding the purity and the contents of supplements. Manufacturers will have to ensure that their supplements are free of toxins and that a product contains exactly what the label claims. This is a great step towards greater regulation of the multi-billion dollar supplement industry. The FDA will have the power to oversee manufacturing plants and do regular quality testing, but the ruling won’t be fully enforced until 2010. Until then, I still recommend that you take a prescription prenatal vitamin, or if you choose to take an over-the-counter supplement, I recommend you subscribe to Consumer Lab , an independent testing agency that rates supplements for purity and quality. Be sure to speak to your physician about any other supplements you’re taking while pregnant. With a few exceptions, I advise pregnant women to stay away from over-the-counter supplements altogether because of these purity concerns and because most ingredients have not been well studied

Pregnant women risk gaining too much weight.

Many a mom-to-be expects to eat enough for two, thanks to the enduring lore of voracious appetites and powerful cravings of pregnant women. This pervasive thinking often leads to overindulging and excessive weight gain. Yet studies over the last few years show that gaining too much in pregnancy is the greatest contribution to the rising rate of childhood obesity as well as to a growing list of pregnancy complications. The question is: What is too much? The current recommendations for weight gain, developed in 1990 and based on even earlier studies, appear to be set too high. A 2007 study demonstrated that children born to women that met or exceeded these guidelines were about four times more likely to be overweight or obese by their third birthday and also tended to have higher blood pressure than those whose mothers gained less weight. In fact, maternal weight gain during pregnancy had a greater effect on whether a toddler was obese than other known risk factors such as how much television the child watched, how much fast food or sweetened drinks he consumed, and even his genes. Eating excessive calories during the first trimester, when the developing fetus really doesn’t need much energy, can lead to early complications. Most women should try to have minimal weight gain (no more than four pounds) during their first trimester. Set a target weight that is about 10 pounds lower than recommended and monitor your weight (without obsessing over it) throughout your pregnancy. If you’re gaining too much, speak to your doctor or a nutritionist about how to gain less without dieting. You and your child will both benefit from your efforts.

Antidepressants and pregnancy

Even before Tom Cruise provided his unsolicited “medical advice” to Brooke Shields on her depression during her pregnancy, the antidepressant-pregnancy debate has been a heated one dominated by emotion and opinion rather than science. This week, in The New England Journal of Medicine, two large studies provided reassuring evidence that some of the most popular antidepressants, called SSRI’s, do not pose a significant increase in the risk of birth defects. Although they did find an increase in a couple of malformations in patients who took Paxil, these were rare. Finally, these risks are limited to those taking antidepressants during the first trimester of pregnancy.

Yet despite the good news, the New York Times peppered their report with words of caution, and neglected to provide any information on the risks of not treating depression. The latest evidence shows that the risk of untreated depression is clearly greater than the risk of several of these SSRIs. Here’s why:

When a pregnant woman is depressed, her stress hormones surge, increasing her risk of preterm labor and gestational diabetes. What’s more, several stress hormones cross the placenta where they can increase your child’s risk of developing depression and anxiety as well as learning disabilities and attention deficit hyperactivity disorder. These risks need to be weighed against the risk of treatment—and this point is chronically absent from the debate and most media reports.

The bottom line: I urge you to track mood changes during your pregnancy. Take preventive steps including getting regular daily exercise and prenatal yoga, and take an omega-3 fatty acid supplement (DHA) which has antidepressant effects (and is great for your baby’s brain). If depression is getting worse, talk to your healthcare provider about treatments like cognitive behavioral therapy and the use of these safe antidepressants. The NEJM studies support my own recommendation that Zoloft (sertraline) has the best safety profile—probably because it does not cross the placenta as easily as the others.

Why we conceived this blog.

As an OB/GYN and reproductive endocrinologist, I believe that pregnant women can play an important role in the health of their pregnancy and the development of their baby. The research on hormones clearly states that a developing fetus is exposed to a unique hormonal cocktail in the womb, and this distinctive mix directly affects its brain development. Therefore, the mother's hormonal makeup has a powerful impact on the developing brain of her fetus, and indeed, who that baby eventually would grow up to be. I have long believed that hormone balance represents health and wellness during pregnancy--the more well balanced you are, the easier your pregnancy will be. I also know that today's fast-paced lifestyle conspires against hormone balance and can set you up for complications during pregnancy. Laurie and I are strong advocates of educating women so they can make the right choices for themselves. We have written the book Perfect Hormone Balance for Pregnancy, which lays out an easy-to-follow plan for feeling great during your pregnancy and having a healthy baby. We continue this dialogue in this blog, bringing you information to help you feel your best throughout your pregnancy, reduce your risk of miscarriage, and avoid possible causes of birth defects, developmental delays, and other complications. Through this blog, we seek to improve the nature of the pre-natal conversation you’ll have with your family, friends, and even your own obstetrician or nurse midwife.