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Understanding and Preventing Fetal Alcohol Spectrum Disorders

Thursday, May 1st, 2014

Do you know what the only preventable form of mental retardation is?  Fetal Alcohol Syndrome.

For some reason, there seems to be a lot of confusion among pregnant women about how much alcohol they can safely consume. The answer is extremely simple: NONE.  There is no amount of alcohol consumption known to be safe during pregnancy, and no specific minimum amount a pregnant woman must drink in order to put her baby at risk for being born with a fetal alcohol spectrum disorder (FASD).

Unlike an adult, the fetus does not have the liver enzyme alcohol dehydrogenase and consequently cannot metabolize alcohol; resulting in alcohol hanging around and causing damage. 

FASDs occur in babies whose mothers drank alcoholic beverages while pregnant, and can cause a range of symptoms including physical, behavioral, and learning problems. It is very common for a person with an FASD to have a combination of these problems. FASDs are entirely preventable – by simply not drinking while you’re pregnant. There is no known safe time during pregnancy to drink, and no known safe amount you can drink. And because women often don’t know they’re pregnant until several weeks in, any woman who might become pregnant should not drink, either.

Signs and Symptoms of FASDs

FASDs is a term that refers to the whole group of possible disorders babies whose mothers drank while pregnant are vulnerable to. The specific symptoms range from mild to severe and may include:

  • An abnormal facial appearance
  • A smaller-than-normal head
  • Short stature and low body weight
  • Problems with coordination
  • Hyperactivity, attention deficit, memory problems
  • Learning disabilities
  • Mental retardation
  • Speech delays
  • Poor reasoning skills
  • Sleep problems
  • Hearing or vision problems
  • Heart, kidney, or bone problems

Types of FASDs

There are several types of FASDs. The term used to describe an individual disorder depends on the specific symptoms present. For example, fetal alcohol syndrome refers to the more severe symptoms on the FASD spectrum. Fetal death is one such possible outcome of maternal drinking during pregnancy. Fetal alcohol syndrome sufferers may also have growth problems, problems involving the central nervous system, and abnormal facial features, among other problems.

Alcohol-related neurodevelopmental disorder can cause intellectual disabilities, and these individuals generally do poorly in school, especially when it comes to math, attention, memory, and impulse control. There are also alcohol-related birth defects which can range from hearing loss to heart problems and more.

Treatment for FASDs

There is no cure for FASDs. However, early treatments are imperative and can be effective at improving a child’s development and quality of life. Treatment options include medication for certain symptoms, certain types of therapy, parent education, and more. There is no one treatment that will be right for every child or every type of FASD. Early diagnosis and intervention, a stable and loving home environment, and involvement with special education services can all help people with FASDs overcome their disability and reach their full potential.

It’s never okay to drink alcohol while you are pregnant.  Read my book, Inside Information for Women, for more information on this. You’re only pregnant for a few months, and the choices you make now last two lifetimes: yours and your baby’s.

– Yvonne S. Thornton, M. D., M. P. H

Use of Decongestants During Pregnancy May Be Linked to Birth Defects

Monday, July 22nd, 2013

Women have a long checklist list of products to avoid during pregnancy, from alcohol and caffeine to more serious chemicals that can seriously affect fetal development. However, the effects of certain medicines and other products have largely been unknown. One of the more common medications that women ask if they can use during pregnancy is the simple decongestant—something which most people take for granted. For a woman who is already suffering the discomfort of pregnancy, the idea of asking her to shoulder the burden of a stuffy nose and sinus pressure may seem a little harsh. However, new studies are suggesting that decongestants taken in the first-trimest of pregnancy may be a major item on the “to avoid” checklist, as they have been linked to birth defects.

The decongestants that researchers focused on in the study included both oral and nasal remedies. While the correlations between certain types of decongestants and potential birth defects still requires further investigation, this finding presents and opportunity to discuss one of the more important aspects of obstetric medicine. The simple fact of the matter is that there is no way to know all of the potential risks a woman faces during pregnancy.   Some women may not even know they are pregnant when taking these over-the-counter decongestants.  Therefore, any woman in the childbearing years who is not using effective contraception should think twice about relieving symptoms of an annoying stuffy nose as a trade-off  for increasing the risk of a child with birth defects.

While research has come a long way in identifying major risk factors, a number of other risk factors are still unknowns. This is even more so the case as new products are released into the market, new chemicals make their way onto store shelves, and ultimately pregnant women are exposed to an increasingly wider range of products during pregnancy. It is also a good reminder of the importance a woman should place on responsible behaviors during pregnancy, which include rethinking her normal habits and routines and consulting with a medical professional before taking any medication—even ones that seem fairly mild or harmless.

I hesitate to call women who take these products irresponsible or negligent—after all, not everyone is a doctor and not everybody has the access to medical information that can tell her at a glance what is and is not safe. That is why part of a responsible pregnancy is not only knowing to avoid certain products and materials, but is developing a good relationship with the medical professional in charge of one’s healthcare during pregnancy.

– Yvonne S. Thornton, M. D., M. P. H.

Studies Show Lack of Evidence that IVF Causes Birth Defects

Monday, June 24th, 2013

From the moment a woman realizes she is pregnant, she is overwhelmed with worries about the health of her future child. These worries are only compounded when the woman in question has had a difficult time becoming pregnant. Those women who have undergone infertility treatment in order to conceive have perhaps the most difficult task ahead of them as they await the delivery of their child—a wait that is made only more difficult by the belief that many people have that infertility treatments cause birth defects and birth complications at a higher rate than among women who conceived naturally.

It certainly raises a lot of questions. If it were true that births after infertility treatment produced higher rates of birth defects, it would also raise quite the moral dilemma. Do doctors and potential parents have the right to produce children that may suffer health problems and defects? Infertility treatments have been the subject of much debate since the first test-tube baby was born, and many people are still uncomfortable with the idea. However, for millions of parents who would have been unable to conceive, IVF is a blessing. It’s my opinion that everybody has the right to become a parent, and thought it is wonderful that many parents can conceive naturally, it is also wonderful that there is an option for parents who face more difficulty in having children.

Thankfully, studies have shown that the worries people have about children produced through IVF may be unfounded. The rate of birth defects in children born through IVF are no higher than the rates among children born through natural conception once parental factors have been taken into account. People who are still worried about the health “risks” of IVF for children in this day and age need to learn to trust the research rather than the propaganda, and they need to stop spreading misinformation that might lead parents who turn to treatment to conceive to feel guilty about their decision.

– Yvonne S. Thornton, M. D., M. P. H.

An Acne Treatment That Requires a Waiver

Thursday, March 28th, 2013

I don’t blame you if you’re desperately trying to find a cure for your acne. Acne is embarrassing and unsightly, and severe forms of it can even cause lifelong scars. Any woman in her right mind would feel the urge to do whatever she could to get that clear complexion you see in the magazines. Unfortunately, one type of effective acne treatment can cause serious birth defects, and it should be ruled out for any woman hoping to conceive even just within the year. Isotretinoin is a medication that can cure the severe type of nodular acne that cannot be cured otherwise. It is usually sold under the brand name Accutane, and women who start taking it actually need to sign a waiver stating that they won’t get pregnant during the prescribed amount of time.

Avoid any type of medication with isotretinoin if you’re hoping to become pregnant someday soon. While your complexion might become clearer, your baby would be born with eye and ear defects, or even cleft palate or serious heart defects. Worse yet, women who take this type of medication soon before their pregnancy often have miscarriages or stillbirths.

Essentially, if you are of childbearing age, seek an alternative to isotretinoin. The risks are too great, and your being on the medication will limit your options if you become pregnant even accidentally. The birth defects are permanent and very serious. While acne is frustrating, it is nothing compared to the lifelong problems that your child might have from a heart defect or the serious and expensive surgery that would be required for a cleft palate.

If you are in your reproductive years and are sexually active, talk to your doctor about the alternatives if he or she prescribes a medication like Accutane with the active ingredient isotretinoin. Though some may not be quite as effective, they are worth a shot to avoid birth complications. Only if you are absolutely sure you won’t be having any children in the next few years should you take the pill; even then, pregnancies can still occur. However, people are famous for changing their mind frequently about starting a family, so don’t make a hasty decision of requesting Accutane.  Keep your options open as much as possible and look at the whole picture when it comes to using an acne medication that has the capability of causing birth defects.
– Yvonne S. Thornton, M. D., M. P. H.

Your High Blood Pressure Meds May Have to Wait

Thursday, March 14th, 2013

The importance of being healthy before going into a pregnancy cannot be stressed enough.  While it’s true, many women find out they’re pregnant and immediately alter their lifestyles to something healthier, this is not always immediately possible.  In fact, there are some ailments that can’t be medically treated once you get pregnant because of the dangers to the baby.  High blood pressure, in some cases, is one of these issues.

According to the New England Journal of Medicine, doctors studied more than 29,000 infants in Tennessee who were born within the years of 1985-2000.  209 of those babies were exposed to ACE (angiotensin-converting enzyme) inhibitors during the first trimester and 202 more were exposed to other medications also prescribed for hypertension.  Upon birth, they found that the infants exposed to ACE inhibitors were more likely to develop congenital defects.  These included malformations in their cardiovascular systems and central nervous systems, as well as kidney abnormalities.  These findings have led them to believe that exposure to ACE inhibitors during the first trimester is not safe for developing babies and should be avoided.  Luckily, exposure to antihypertensive medications not classified as ACE inhibitors did not seem to increase the risk of defects.

This is why it’s so important to get medical issues like high blood pressure under control before deciding to get pregnant.   Preconceptionally, there are other things you can try besides medication. Try to exercise, lose that extra weight around your waistline and eat a healthy diet.  In this diet, you should restrict your intake of sodium, if at all possible.  However, if you find yourself pregnant and still struggling with hypertension, your obstetrician or perinatologist will prescribe antihypertensive medications that are safe for pregnancy.  Continued high blood pressure during pregnancy is not good for you or the baby.  You may suffer a stroke or develop kidney compromise and the baby may be born very small or not survive the pregnancy.

So, although high blood pressure may have an adverse effect on your pregnancy, and some medications may be harmful to the health of your fetus, taking the right medication to control it can make all the difference in the world.

– Yvonne S. Thornton, M. D., M. P. H.


How Safe is Your Acne Medication?

Monday, September 10th, 2012

It seems that every teen goes through skin issues because of all those hormones.  However, many women suffer from acne far into adulthood.  This has them using a variety of treatments to keep their skin looking nice.  Unfortunately, one acne medication has dangerous side effects, including birth defects.

If you are pregnant, breastfeeding, or planning to become pregnant in the next year, you will need to avoid medications, including acne treatments, that could be unsafe for your baby.  One brand in particular, commonly known as Accutane, can cause birth defects like cleft palate, heart defects, hydrocephaly, and microcephaly.  There have been warnings issued, but many women are unclear as to whether or not their medication is dangerous or not.  Take the time to check the ingredients and warning label on your acne medication boxes and bottles.  You’ve likely been using it for years, so you might not have thought to check these areas once you became pregnant.  Don’t just look for Accutane when weeding out your products though.  The drug is also found under the name Isotretinoin.  If you see either of those words on the label, you’ll need to replace it with a safer brand.  These particular ingredients are normally found in pills for treating nodular acne, so there are many other safe alternatives.

Getting a handle on skin care can be frustrating, but clear skin is not worth the price your child and your family will pay if you have a baby born with defects, some of which are life threatening.  As soon as you think you might want to become pregnant, take a look through all of the products you put on and in your body, because very soon, you’ll be sharing it with a very delicate new life.

– Yvonne S. Thornton, M. D., M. P. H.

You are what you eat…and so is your baby

Thursday, October 20th, 2011

We’ve all been told how important it is to eat well in order to stay healthy. Now, new research shows that what you eat when you’re pregnant can be as important for your baby as it is for you.

A study published in the Archives of Pediatrics and Adolescent Medicine shows that when mothers-to-be ate healthful foods, such as those that make up the so-called Mediterranean diet, their babies had fewer birth defects such as cleft palates and neural tube defects.

The Mediterranean diet focuses on vegetables, beans, fruits, grains and fish, and is lower in meat, dairy and “empty” carbs.

Before you panic if you’re reading this while gorging on burgers and fries, no, your baby isn’t going to be born with birth defects just because you’re taking a vacation from your diet. The birth defects researchers looked at in the study are quite rare to begin with. It’s just that they are rarer still among women who eat well.

But the study does hint at something we know: your baby’s development depends, in part, on the nutrients you consume. So, give your little one a head-start on a good future. You’ll be doing a favor for both of you.

– Yvonne S. Thornton, MD, MPH

The Latest News From the CDC on Birth Defect Risks

Saturday, March 5th, 2011

In a report published in the American Journal of Obstetrics and Gynecology, the Centers for Disease Control (CDC) [] warned against using prescription opiate-based painkillers such as codeine, hydrocodone or oxycodone (brand names include Vicodin and Oxycontin) during pregnancy.

According to an article about the CDC report:

In the study of data from 10 states, the CDC researchers found that 2 percent to 3 percent of mothers interviewed received prescription opioid pain killers, or analgesics, just before they got pregnant or early in their pregnancy. Any illicit use of painkillers was not assessed.

For those women, the risk of having a baby with hypoplastic left heart syndrome — a critical heart defect — was about double that of women who took no opioid drugs.

Risks of other birth defects, including spina bifida (a type of neural tube defect), hydrocephaly (build up of fluid in the brain), congenital glaucoma (eye defect), and gastroschisis (a defect of the abdominal wall), also somewhat increased among babies whose mothers took these drugs either shortly before or during pregnancy.

I have concerns about the generalization of both articles, but the conclusions may be valid. Taking a drug before you’re pregnant, or up to 17 days after conception, is unlikely to cause birth defects. It will either cause a miscarriage or will have no effect. But because most women don’t know precisely when they conceived, it’s best to avoid taking drugs at any time during pregnancy.

The greatest risk to a developing baby from a pregnant mother taking potentially toxic drugs occurs between 17 days post-conception to 12 weeks (end of the first trimester).

You’ve probably heard of Thalidomide, a sedative given in the 1950s to pregnant women in their first trimester. It dramatically illustrated the risks to a fetus’s development from drug effects during the critical first weeks. Thalidomide given early in pregnancy stunted the development of babies’ arms, legs, hands and feet, and caused other limb deformities.

If you’re pregnant, or planning to be, you should also be aware that most drugs, whether prescription or over-the-counter can have unknown effects on a growing fetus. The bottom line is: Every drug is, in some sense, a poison. Don’t consider any drug safe in pregnancy unless prescribed by someone who knows its toxicity as well as the risks and benefits of the drug.

– Yvonne S. Thornton, MD, MPH