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Having a Healthy, Empowered Pregnancy
by Ted Peck, MD

After the initial excitement of finding out that you are pregnant, you are concerned how your baby will grow and develop in a safe environment within you. Unfortunately, much of what you are told about pregnancy care is untrue and often leads to unnecessary anxiety and personal suffering. Some of the information you may get when you talk to your friends, your doctor, or your midwife may be old or incorrect and prenatal books and internet sources are frequently contradictory.

We're often asked about the effect of emotional stress on the developing baby. It is a difficult question to answer. It's fair to say that most pregnant women who feel emotional stress have little to fear. If a woman becomes so stressed that it significantly affects her health, her diet, or her long-term emotional stability, it can cause problems such as pre-term labor, poor fetal growth, or in the case of those who need anti-anxiety drugs, newborn drug-withdrawal problems.

Many of the things you might have heard which supposedly cause babies problems start out with a little bit of science and then get exaggerated outrageously. Fear of hot tubs is such an example. Before the third month of pregnancy, there may be a very small chance that an increase in maternal body temperature (over 102 degrees F.) may result in incomplete closure of the fetal spine resulting in a spinal or cranial defect. After this time and after the normal closure of the spine, elevated maternal temperatures cannot cause fetal abnormalities.

Another good example in the "a little knowledge is a dangerous thing" category is the frequently heard recommendation that pregnant women should not lie on their backs or something terrible will happen to their babies.

The truth is that some women, especially in the last half of pregnancy, have a problem lying on their back. The lightheadedness that a woman may feel in this position is due to compression of a large vein bringing blood to the heart and is of no importance to the developing baby. If you are lying on your back at home and begin to feel uncomfortable, turn to your side to feel better.

Prohibitions against certain types of food or drinks has caused a great deal of anxiety for millions of pregnant women. Let's set the record straight on a few: caffeine, alcohol, nutrasweet and ibuprofen (Advil).

Caffeine is a drug. It is found in varying amounts in coffee, teas, soft drinks and some pain medications. Studies on the use of caffeine in pregnancy have shown that drinking five cups of coffee per day increases the chance of miscarriages somewhat. Four cups a day may be associated with an increased risk of pre-term labor or reduced fetal growth. That is a lot of caffeine! Most caffeinated soft drinks have far less caffeine than a cup of coffee. A moderate amount of caffeine, such as you may consume in two cups of coffee or two or three cans of Pepsi a day, has never been related to significant fetal or newborn medical problems. So, those of you who want a can or two of Pepsi daily during your pregnancy can relax and enjoy it.

Alcohol is also a drug. If taken in sufficient amount during pregnancy, it may cause a baby to have facial abnormalities, defects of the central nervous system, mental retardation or behavioral and developmental disorders. The question about alcohol in pregnancy is: How much alcohol is safe? In looking at all the statistics, it's clear that if a pregnant woman consumes less than two drinks per week, there is very little chance of her baby being affected. In general, avoiding alcohol is the wisest policy. Two drinks can lead to three, then four, etc. But an occasional glass of wine with dinner will not cause any harm.

Aspartame (NutraSweet) is the chemical found in most sugar-free drinks. It has been studied more than any other substance by the FDA. There is no evidence that it causes any fetal, newborn or childhood problems when consumed during pregnancy. You can very safely drink diet soda during pregnancy. I suggest water, however. It has a lot less sodium.

Nearly all pregnant women have a variety of aches and pains for which they would like to take a safe, effective pain pill. In the first 32 weeks of pregnancy the most effective, safe pain medicine is Ibuprofen (most common brand is Advil). Acetaminophen (commonly Tylenol) is also very safe but in my experience, not very effective for pregnancy-associated pains. Ibuprofen is not associated with fetal malformations, but should be avoided in the last eight weeks of pregnancy because it may reduce blood flow through various arteries in the baby leading to a number of potential complications.

More information on reducing anxiety in pregnancy can be found in Dr. Peck's new book Empowered Pregnancy (Frederick Fell Publishers; 2003; $14.95), co-authored with his wife, Vicki. He's a specialist in high risk obstetrics and she is a former OB nurse.