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.