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United States Pregnancy Rates Continue to Drop

Monday, May 26th, 2014

For decades, pregnancy rates in US women have been sliding, and this is largely thanks to a steep decline in teen pregnancies, according to a new report.

The study showed that teenage pregnancies reached a historic low in 2009. For all US women between 15 and 44 years of age, the pregnancy rate in 2009 was 102.1 per 1,000 women, down 12% since 1990. The only time it has been lower was in 1997, and even then, the difference was slight. The birth rate for married women is 72% higher than for unmarried women; the abortion rate is five times higher for unmarried women than for married women, and has also dropped overall.

For women across all categories, unintended pregnancy accounts for almost all abortions, so the decline in abortion rates is closely correlated with the decline in unintended pregnancies, and this has been seen in all groups including married women. Increasing options and education are clearly beneficial for all women.

Pregnancy rates are down in every category except women over 30, the only group with a continually increasing incidence of pregnancy. Women in their 20s represent the largest group of pregnant women, but even their rates have dropped.

The data stopped at 2009 because the complete set of more recent data is not available yet, but newer statistics do suggest that pregnancy rates continue to decline, although at a slower pace than the dramatic drop from 1990 to 2009.

The recession that began in 2007 probably has had an impact. Birth rates plummeted during the Great Depression of the 1930s; a similar effect is probably taking place now. In addition, women have been having fewer children than their mothers and grandmothers, and more women are waiting until their 30s to start their families, waiting for either the economy or their personal financial situations to stabilize.

While the levelling-off of the decline in most categories may be a sign of the recession’s abating impact, the teen birth rate shows no signs of slowing its striking drop. In 2012, the teen birth rate was less than half its 1992 peak of 62 birth per 1,000 girls, making this the group with the largest decline. The data show that fewer teenagers are having sex as well as a significant increase in contraceptive use among the ones that do. The exact reasons for the decline may not be clear, but those teaching both abstinence and sexual health, including contraceptive use, are probably on the right track.

Even with the decline, the pregnancy rate in the United States is still among the highest in the industrialized countries. The countries with the ten highest birth rates worldwide are all located in Africa.

– Yvonne S. Thornton, M. D., M. P. H

Pregnancy Weight Gain: When the Guidelines Might Not Be Right for You

Monday, May 19th, 2014

When you find out you’re pregnant, one of the first things your doctor will probably want to discuss with you is how much weight you should gain over the course of your pregnancy. The guidelines say that most pregnant women should gain between 25 and 35 pounds – more if they start out underweight, less if they are overweight to begin with. How does that weight gain break down?

  • 1  pound for the placenta
  • 2 pounds for amniotic fluid
  • 2  pounds for the increased weight of the uterus
  • 1 pound for increased breast size
  • 3 ½ pounds for increased blood volume
  • 6 ½ pounds for maternal fat stores
  • 6-7 ½ pounds for the full-term baby

All of this adds up to between 22 to 24 pounds that a healthy woman of normal weight can safely gain during her pregnancy.  The operative term here is “normal weight”.

However, many women don’t start pregnancy at their ideal weights. For a woman who is very underweight, somewhat more weight gain may be optimal, and may be the natural outcome of eating enough nutritious food to nourish herself and her growing fetus.

A much more common problem, though, is that of the woman who starts her pregnancy overweight. One in five pregnant women (20%) are obese at the start their pregnancy.   Gaining too much weight during pregnancy is one of the most preventable causes of complications, ranging from gestational diabetes to preeclampsia to overly large babies that require cesarean deliveries.

A woman who is overweight or obese can safely gain less than 25 pounds during her pregnancy as long as she eats a healthy diet. Keep in mind that “eating for two” should mean that you are eating twice as well, not twice as much.  The fetus usually weighs less than 1/20 of its Mom’s weight. So for an overweight or obese woman, switching to the healthy diet she needs for pregnancy may actually mean a reduction in calories, and gaining less than the recommended amount or even losing weight may be the natural result.  And, an obese pregnant woman shouldn’t get overly concerned about it.  If you are obese, you already have a fluffy substrate or matrix upon which your pregnancy will grow.  A numerical end-point, i.e., weight gain or loss, should not be used in obese pregnant women, but rather a healthy, balanced nutritional intake should take priority. 

This is perfectly fine as long as your doctor agrees (always discuss matters related to your pregnancy with your own doctor, because your situation is unique), and as long as your diet contains all the necessary nutrients and fluids you and your baby need.  I, as the principle investigator, have done the original research and have published the first and, to date, the only randomized clinical trial regarding the outcomes of nutritionally monitored obese pregnant women.  A well-balanced diet is the way to go resulting in less problems during the pregnancy.

A pregnant woman should be drinking lots of water – at least eight cups a day – and another four cups of skim milk, leaving very little room for soda or fruit juice (which are both mostly sugar). And eating all the fresh fruits, vegetables, lean meats, fish, and whole grains you need does not, for the most part, leave room for junk food.

The occasional treat is fine. A cup of coffee, a small serving of chocolate, and the like do not have to be abandoned entirely for nine months, and trying to do so would most likely set you up for failure anyway as the temptation to “cheat” would be too great. Tell yourself you can have treats – just not every day and not in large amounts.

Exercise will also help you feel better and keep your weight in check during pregnancy. Walking, swimming, and using a stationary bicycle are excellent exercises now. Keeping track of everything you eat and which exercise you perform each day and for how long can help you stay accountable and motivated.

Just because countless people – even strangers – will tell you that you “should” be gaining 25-35 pounds does not make this necessarily right for you. They don’t even know you!  Talk to your doctor to determine whether you can safely gain less; delivering a baby in better shape than they were in nine months ago is a very real possibility for many women. See my book, Inside Information for Women, for much more information on this and other women’s health issues.

– Yvonne S. Thornton, M. D., M. P. H

Newly Discovered Dangers of Secondhand Smoke

Thursday, April 10th, 2014

Researchers already know that secondhand smoke, or passive smoking, is linked to myriad risks, including an increased risk of hearing loss, diabetes, and obesity. Now they have discovered new risks to add to the growing list: the increased risk of ectopic pregnancy, miscarriage, and stillbirth.

The new study points out that while smoking during pregnancy is known to be related to a higher risk of birth complications and miscarriage, more information was needed to determine whether passive smoking by pregnant women has similar effects. The study included over 80,000 women who had been pregnant at least once and gone through menopause.

Some of the women were current smokers (around six percent), some were former smokers, and some had never smoked. The women who had never smoked (or, more specifically, had smoked fewer than 100 cigarettes in their lifetimes), were divided into groups according to their secondhand smoke exposure as children, adults at home, and adults at work.

The study found that women who had been smokers during their reproductive years had a 44% higher risk of stillbirth, a 43% higher risk of ectopic pregnancy, and a 16% higher risk of miscarriage than the women who had never smoked and had not been exposed to secondhand smoke.

This was probably not a huge surprise to anyone, but the really interesting results were found in the group of never-smokers. The ones who had experienced secondhand smoke exposure also had a higher risk of miscarriage, stillbirth, and ectopic pregnancy compared with the ones who had never smoked and had not been exposed to secondhand smoke. In addition, the increase in risk was directly related to the level of secondhand smoke exposure the women had experienced.

The women with the highest levels of secondhand smoke exposure – over ten years either as a child, as an adult at home, or as an adult at work – had an extremely elevated risk of miscarriage, stillbirth, and ectopic pregnancy. The risk of having an ectopic pregnancy was a whopping 61% percent greater than that of women with no cigarette smoke exposure, and they were also 55% more likely to have experienced a stillbirth and 17% more likely to have had a miscarriage.

With many states enacting bans on smoking in public places and places of business in recent years, we are certainly headed in the right direction. However, the new research certainly highlights the need for more progress, especially in the states that still have no bans on smoking in public places whatsoever, in order to further protect women and their future babies from secondhand smoke, which appears to be even more harmful than previously thought.  

– Yvonne S. Thornton, M. D., M. P. H

Is It Safe to Get the Flu Shot During Pregnancy?

Monday, January 13th, 2014

If you are pregnant, chances are that you are questioning everything that goes into your body, and for good reason. It’s your job during pregnancy to nurture and protect your baby from a wide range of potential dangers. During the winter months, you may be wondering whether the flu vaccine is among those dangers.

It’s not. The fact is that it is completely safe for pregnant women to get the flu vaccine. In fact, getting vaccinated against the flu could make a big difference in your baby’s health; it could even be the difference between life and death. The CDC (Centers for Disease Control and Prevention), the American Academy of Pediatrics, the ACOG (American Congress of Obstetricians and Gynecologists), the American College of Nurse-Midwives, and numerous others all strongly recommend that pregnant women get flu shots.

Getting the flu while pregnant can cause serious complications. Pneumonia is one major concern. Pneumonia is potentially life-threatening and could be a risk factor for preterm labor. In addition, there is evidence that when you get the flu shot during pregnancy, your baby may continue to benefit from this protection after birth. Also, if you avoid catching the flu yourself postpartum, then your baby is less likely to be exposed to it at all. And protecting your newborn from the flu is important, because the flu is particularly dangerous for young babies, who can’t be vaccinated themselves before they are six months old. (Therefore, not only you but other family members as well should get flu shots.)

The flu vaccine may have no side effects at all, or you may notice mild side effects such as mild pain, tenderness, or redness at the site of the shot. Some people notice muscle aches, nausea, fever, or headaches after the shot, but these generally only last a day or two. Allergic reactions are extremely rare.

Anyone considering the flu shot, including pregnant women, should tell their doctors or anyone who is administering the shot if they have severe allergies to eggs or anything else that may be present in the shot. It is important to note that pregnant women should receive the flu shot, and not the nasal spray, which contains live flu virus.

Pregnant women can get flu shots at any point in their pregnancy. Getting vaccinated as early as possible to avoid being unprotected when flu season begins is best. However, if you have avoided getting the vaccine because you were concerned about safety during pregnancy, go ahead and get one even if it is later in the season. Flu season can last well into the spring, so even women getting vaccinated later on can still benefit.

Lately there has been some concern among people getting vaccinated about thimerosal, a preservative used in some flu shots. However, the CDC has uncovered no evidence that thimerosal presents any risk whatsoever. Besides, the benefits of getting a flu shot far outweigh even any theoretical risk. If you are worried, though, don’t let it stop you from getting a flu shot; ask your doctor about thimerosal-free vaccine. If it isn’t available in your area, go for the regular flu shot, and don’t worry – it’s much safer than not getting one at all.

– Yvonne S. Thornton, M. D., M. P. H.

Thyroid Problems and Pregnancy

Monday, January 6th, 2014

The thyroid gland is one that most people never give much thought to – until it causes problems. The gland itself is about two inches long and shaped like a butterfly. It sits in the front area of the neck just below the larynx with one lobe on each side of the windpipe. Along with the other components of the endocrine system, the thyroid’s job is to produce hormones. It can also store these hormones and release them into the bloodstream.

The hormones produced by the thyroid are very important, as they affect metabolism, weight, breathing, nervous system functions, muscle strength, body temperature, and menstrual cycles. If the thyroid produces too much or too little hormone, nearly every organ in the body can be affected. Hypothyroidism is underactivity of the thyroid; overactivity is called hyperthyroidism. Because the thyroid affects the menstrual cycle, a woman with a thyroid disorder may find it more difficult to get pregnant.

If a pregnant woman has a thyroid problem, there are special considerations to keep in mind. A woman with thyroid disease can certainly have a healthy, normal pregnancy and baby if she talks about this problem with her doctor, educates herself on the ways in which the thyroid is affected by pregnancy, stays up to date on her thyroid function testing, and takes the proper medications on the proper schedule.

How Is the Thyroid Affected by Pregnancy?

The thyroid gland is basically responsible for controlling our body’s metabolism.  It is regulated by a hormone known as thyroid-stimulating hormone or TSH, which is secreted by the pituitary gland. Pregnancy causes the production of many hormones, one of which is human chorionic gonadotropin (hCG).  In early pregnancy, the growing placenta makes human chorionic gonadotropin (hCG).  HCG increases the production of progesterone, which is crucial for the growing fetus and without it may increase the risk for miscarriage. What does hCG and TSH have in common?  Well, they are two different hormones;  one (hCG) plays an integral role in maintaining pregnancy while the other (TSH) regulates the thyroid gland.  However, hCG can mimic TSH , causing the thyroid gland to become hyperstimulated.  It turns out that the molecular structure of both of these “different” hormones are very similar. 

Both are composed of two different protein subunits. One of those protein subunits is called “alpha” and the other “beta.” The alpha subunits of hCG and TSH are identical but the beta subunits are different; but not by much.  The beta subunits of hCG and TSH are about 40 percent identical.  Given that mechanism, very high concentrations of hCG can actually stimulate the thyroid gland sending it a message to become hyperactive. In other words, hCG can sometimes act like TSH, which is the reason an elevated thyroid function test in the first trimester (which may be interpreted as an overactive thyroid), should be repeated in the second trimester when the levels of hCG have stabilized.

The fetal thyroid becomes active at 12 weeks. Until then, it depends on the mother’s supply for brain and nervous system development.

The thyroid also becomes slightly enlarged during pregnancy, but not enough to be viewed as abnormal during a physical exam. If a thyroid is noticeably enlarged, this could be a sign of thyroid disease. But again, thyroid problems are tricky to diagnose during pregnancy, because the thyroid hormones levels are higher than normal and also because fatigue and other symptoms of thyroid disease are often similar to normal pregnancy symptoms.  That is why subspecialists, like myself, known as maternal-fetal medicine specialists, may need to be called upon by the midwife or obstetrician when caring for a pregnant woman with suspected thyroid dysfunction.

How Is Pregnancy Affected by Thyroid Problems?

Depending on whether you are dealing with hyper- or hypothyroidism, uncontrolled thyroid disorders in pregnancy can cause a number of health risks to mother and baby, including congestive heart failure, thyroid storm, neurologic deficits in the fetus, miscarriage, fetal growth restriction or neonatal Graves disease (hyperactive thyroid function in the newborn).   Thyroid disease has an autoimmune component and other autoimmune diseases also need to be ruled out.  Antibodies (TSI—thyroid stimulating immunoglobulins) from a hyperactive, hyperthyroid patient can cross the placenta and cause fetal goiter.

For these reasons it is extremely important that a woman with a thyroid disorder optimize her health by eating a balanced diet with iodized salt, taking a prenatal multivitamin that contains iodine (which the thyroid uses to make hormones), and taking the appropriate medication to control symptoms and regulate hormone production.  Up to 10% of postpartum patients develop new-onset of Graves disease or autoimmune thyroid dysfunction.  In my practice, patients who were six weeks postpartum all underwent thyroid function testing.  It is not the standard, but, after diagnosing several patients with thyroid dysfunction, I did not want to miss an abnormally functioning thyroid gland in any of my postpartum patients.  Thyroid conditions often require lifelong monitoring, but with the right medical attention, are easily controlled.

 – Yvonne S. Thornton, M. D., M. P. H.

Everything Old is New Again when it comes to Morning Sickness

Thursday, December 19th, 2013

Back in the 60s, and 70s, when I was a medical student, resident and perinatal Fellow, the drug of choice of morning sickness was Bendectin.  Bendectin, Bendectin, Bendectin.  It was prescribed like jellybeans to pregnant women in their first trimester to treat nausea and vomiting of pregnancy (morning sickness). It worked!!  I don’t think I would have gotten through my certification Boards without Bendectin when I was eight weeks pregnant with my daughter.

Then, all of a sudden, its was unceremoniously removed from the market and was unobtainable in 1983.  Why? Because the original manufacturer, Merrell Dow, could not continue to defend the lawsuits brought against the drug for supposedly causing birth defects.   After numerous horrific episodes of birth defects due to Thalidomide (which was not FDA approved in this country), women were quicker to blame medications taken during pregnancy for complications and birth defects.  Unfortunately, attorneys set their sights on Bendectin, which became the “whipping boy” for medications taken during early pregnancy and soon the mounting lawsuits (which were unfounded) resulted in its removal from the market.  In other words, this very effective medication was removed totally based on fear.

However, those of us who knew that the ingredients were just an antihistamine (doxylamine) and Vitamin B6 (pyridoxine), continued to direct our patients to the over-the-counter combination of Unisom and Vitamin B6.  In 2004, the American College of Obstetricians and Gynecologists sanctioned this jerry-rigged, improvised approach to “homemade” Bendectin as a first-line treatment for nausea and vomiting of pregnancy (morning sickness).

Well, thirty years later, a “new” drug, under a new manufacturer, called Diclegis (the brand name for doxylamine succinate and pyridoxine hydrochloride) was approved by the FDA earlier this year for use in pregnant women for the treatment of nausea and vomiting.  The drug is exactly the same as Bendectin.  However, this time, it has been categorized as Class A by the FDA, which means that there is no evidence that the drug causes birth defects in the human fetus.  With this FDA category of Class A, hopefully, it will reduce the threat of lawsuits.

As you are probably aware if you are or have been pregnant, so-called “morning” sickness can actually strike at any time of day, even lasting all day long in some cases. There are simple self-care strategies to try that are effective in many cases: avoiding fatty foods, eating smaller, more frequent meals, and avoiding smells that seem to trigger nausea. However, more often than not, these measures are not enough. Diclegis offers a welcome solution for many women.

Studies have shown Diclegis to be effective and safe. 261 women who had been pregnant for anywhere from seven to 14 weeks, were all 18 years old or older, and were all experiencing nausea or vomiting, were evaluated. In the study, there was more of a decrease in nausea and vomiting seen in women who took Diclegis than in women who took a placebo. The drug was also found to be completely safe for the fetus.

Women whose doctors prescribe Diclegis can expect to take two pills at night to start with. If this does not improve symptoms, the dose can be increased to a total of four pills per day (one in the morning, one in the afternoon, and two at night). Drowsiness is among the possible side effects (because of the antihistamine), so women who take the drug should not drive. If you have questions about Diclegis or need further information on morning sickness, see my book, Inside Information for Women, and talk to your doctor. He or she can help you decide if Diclegis is the right choice for you.

Pregnant women who suffer from morning sickness may be worried that their babies aren’t getting enough nutrition, but in most cases, there is no cause for concern. The caloric needs of a fetus are tiny, especially in the first trimester, when the majority of morning sickness occurs. Occasionally a woman develops hyperemesis gravidarum, which is a very severe form of morning sickness in which she may not even be able to keep water down and may need to be hospitalized. Diclegis has not been tested on women with this form of severe nausea and vomiting.

– Yvonne S. Thornton, M. D., M. P. H.

Obsessive-Compulsive Disorder and Pregnancy

Monday, December 9th, 2013

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unwanted, recurring thoughts or fears (obsessions) and the behaviors a person develops to try and stop the fears from coming true (compulsions). People with OCD get into cycles of obsessive thoughts which are followed by compulsive behaviors. The compulsive behavior brings temporary relief from the anxiety, but only temporary. Soon the obsession and its accompanying anxiety return, and the cycle starts all over.

For example, a person might repeatedly wash his or her hands, clean the house, or check things such as locks or light switches. Sufferers are aware that there is no need for the behavior, but they are unable to stop themselves from repeating it. OCD can be very time-consuming and cause more anxiety or stress, rather than reliving it. In severe cases, it can stop people from leading normal lives.

Pregnancy and OCD have a relationship that is not yet well understood. Sometimes, a woman experiences OCD for the first time during pregnancy or following childbirth. Also, some women who have existing OCD may find that their symptoms worsen during pregnancy or in the weeks or months following childbirth. Still other women find that their symptoms improve during pregnancy.

OCD and depression are commonly found together; new mothers with OCD may be more likely to experience postpartum depression, or they may experience postpartum depression that is more severe. Among the general population, OCD is thought to affect about one in 100 people; about twice that number are affected during pregnancy and after childbirth. 

How Do You Know if You Have OCD?

Worries and fears are normal and common among pregnant women or new mothers. Such thoughts and fears usually do not signal OCD. However, OCD could be a concern if the anxiety is overwhelming or if it leads to needless and repetitive behaviors.

Fears that the baby is in some kind of danger are common among pregnant women with OCD. A woman may be afraid that she will somehow harm her baby herself, and therefore develop compulsions to try to protect her baby. For example, she may stop eating certain foods she believes may harm her unborn baby, even if her doctor says they are safe to eat. Or, after the baby is born, the new mother may compulsively check on the sleeping baby. She may constantly clean areas the baby has contact with, or she may even avoid spending time with her baby.

Why Is OCD More Common During Pregnancy?

The reason for this is not fully understood. Often, the reason for OCD cannot be pinpointed, even when pregnancy is not a factor. In some cases, it could be that new mothers feel the added pressure of the extra responsibility having a new baby places on them. Or, it may be that a mother suppresses negative emotions because she is “supposed” to be experiencing a joyful event. It is also possible that changes in brain chemistry play a role, or that hormonal fluctuations have an effect.

If you think you may have OCD, ask your doctor about it. He or she can refer you to someone who is trained to help people with OCD. Talking to someone who understands what you are going through is usually very helpful.

– Yvonne S. Thornton, M. D., M. P. H.

Pregnant Women and Work Concerns

Monday, November 25th, 2013

In 2012, women account for 47 percent of the salaried labor force in the United States ( It’s only natural that concerns would arise regarding pregnant women and working. Today, many pregnant women plan to work throughout their pregnancies – probably too many. Pregnancy alone places an extraordinary amount of stress on a woman’s body, and it is extremely important to get enough rest. The decision to stop working can be a tough one, financially, emotionally, and socially, but it may be essential to protecting maternal health and the health of the baby.

If a woman cannot stop working or chooses to work despite the risks, she should be aware of safety precautions that must be taken in order to minimize the risks involved. Even if she sits at a desk all day, she must remember to get up and move around regularly, drink plenty of water, and eat a healthy diet – those office fast-food runs aren’t going to cut it. If she stands for an extended time as a supermarket cashier, hairstylist, bank teller, etc, the pregnancy may be at risk for preterm delivery.  Therefore, she must walk around or sit down every hour or so.  Getting enough iron, calcium and protein may help somewhat with fatigue, but women should realize that fatigue is their bodies’ way of telling them to rest, so that’s what they should do.

Pregnant women should take steps to stay as comfortable as possible, including making sure the chairs they sit in are supportive, that they are not standing for prolonged periods of time, and that they are not doing excessive bending or lifting. Heavy lifting and twisting while lifting should be avoided altogether. Exposure to harmful substances should also be avoided.

A pregnant woman who works should seriously consider ways to cut back on activities in other areas of her life. For example, shopping online can create more time for rest. Or, if possible, hiring a service to clean the house or do yard work or enlisting the help of other family members is a good idea. She should also do everything in her power to get enough sleep, including going to bed early and lying on her side with pillows between her knees and under her belly for maximum comfort and to prevent swelling in her feet.

It will also be important to keep stress under control. Pregnant women should do what they can to reduce workplace stress. For example, making to-do lists and prioritizing tasks can help them take the work day one task at a time as well as identify tasks that can be delegated to someone else. Taking a few minutes alone to practice some relaxation techniques several times a day can keep stress at a minimum, as can having someone to talk to about frustrations.

The bottom line is that women should discuss their jobs with their health care providers to determine whether they need to make other arrangements for the duration of the pregnancy. A woman who is at risk for preterm birth should not work, period – she should be focused on resting with her feet up and drinking plenty of water. Although pregnancy is a normal physiologic process, the workplace may be unkind to a pregnant woman and if that is the case, a pregnant woman should seriously consider giving up her job, if at all possible, or at least cutting way back on her hours.

– Yvonne S. Thornton, M. D., M. P. H.

Sex during Pregnancy: When to Indulge, When to Abstain

Thursday, October 24th, 2013

Pregnant women and their partners often have questions about sex. Is it safe during pregnancy? Will it induce labor? How long do we have to wait after delivery to have sex? In spite of doctors’ reassurances, many pregnant women still have fears related to sexual intercourse while they are pregnant, such as whether it could cause miscarriage or otherwise harm the fetus. In addition, body image, physical discomfort, and fatigue often curtail the sex lives of pregnant women.

In fact, for women with low-risk pregnancies, sex is perfectly safe. Studies have shown a slightly increased risk of preterm labor in women who had sex and symptoms of lower genital tract infection, but in low-risk women with no symptoms of infection, sex does not in any way increase the risk of preterm labor. Fears of harming the fetus are also unfounded; the fetus is very well-protected and completely oblivious to the mother’s sexual activity.

Women at increased risk for complications, such as those who have a history of preterm labor, incompetent cervix, or multiple gestation, may be advised by their doctors to abstain from sex, but even in these women, an increased risk of complications may not exist. Studies have not shown elevated risks of preterm labor even in women with higher-risk pregnancies, despite the fact that these women are often cautioned that sex could be dangerous for them. Studies also show that women with twin pregnancies and women with cervical cerclage due to incompetent cervix have no greater risk than other pregnant women of preterm labor caused by sex. Although these women are commonly advised not to have sex, the evidence does not exist to support these concerns.

What studies have shown is that women with a higher number of sexual partners throughout their lifetimes do have an increased risk of preterm labor. This is probably because in these women there exists a higher probability of asymptomatic bacterial colonization in the genital tract, which does present a higher risk. Therefore, women with high-risk pregnancies should, at a minimum, be screened for bacterial vaginosis before engaging in sexual intercourse.

It should be said that regardless of actual risk, abstaining from sex causes no harm and is a simple intervention that can be implemented to remove any doubt about whether sex during pregnancy is safe. Therefore, in women with high risk pregnancies, this is still a reasonable recommendation, until further studies present even more solid evidence.

Besides preterm labor, other possible complications thought to arise from having sex during a high-risk pregnancy are venous air embolism, antepartum hemorrhage in placenta previa, and pelvic inflammatory disease.

As for whether sex can be used to induce labor in a full-term pregnancy, there is no evidence showing that it works. Nipple and genital stimulation have commonly been recommended as ways to induce labor by supposedly promoting the release of natural oxytocin, and prostaglandins in semen have been said to encourage cervical ripening. However, there is no scientific evidence to prove that these methods have any effect. But again, there is no harm in trying them in low-risk pregnancies, either.

The bottom line is that there are very few known risks involved in sexual intercourse or other sexual activity during pregnancy, so don’t worry.  I fondly remember my grandmother saying, “Why would you want to have sex?  You’re already pregnant!”  With that said, abstinence may be a reasonable action to take to remove the risk altogether in high-risk pregnancies, but still, the evidence does not show that this makes a difference in the outcome of the pregnancy. After delivery, follow your doctor’s instructions and your own physical and emotional comfort level in deciding when to resume intercourse.

– Yvonne S. Thornton, M. D., M. P. H.


High Rate of Smoking Relapse After Pregnancy and Delivery

Monday, August 5th, 2013

It is no secret that smoking can have an incredibly harmful effect on a growing fetus. Smoking during pregnancy can lead to major problems, from fetal deformities to miscarriages and stillbirths. All women are encouraged to quit smoking well before conceiving, and those that do not are encouraged to quit smoking as quickly as possible after discovering that they are pregnant. There are many intervention programs in place to help women who smoke quit during pregnancy. However, there has been a lot of concern in recent years that smoking cessation during pregnancy is not permanent.

Studies have shown that upwards of 48 percent of women who do quit smoking during pregnancy will relapse afterwards, with a sharp increase in relapse occurring up to a point about six months after delivery. Traditional intervention programs designed to help women quit smoking during pregnancy have shown low success rates in helping a woman quit smoking overall.

This is important because the risks of second-hand smoke are still much higher than is safe, especially with the association of second-hand smoke and the development of childhood asthma. Women are encouraged to make every attempt to quit smoking, not only for their own health, but also for the health of their families.

It is becoming increasingly obvious that quitting during pregnancy—when there is a strong motivation to quit—does not have the lasting effects that could be hoped for. Additionally, the stressful time after delivery is often debilitating to a woman’s efforts to remain nicotine-free.

It is strongly suggested that women who quit smoking during pregnancy seek some sort of aid, counseling, or even medical intervention after delivery in order to prevent smoking relapse. There are a number of products and coping strategies available that can help. While it is admirable to want to quit, it may not be wise to attempt to go “cold turkey”, even for women who have gone without a cigarette for up to, or over, nine months.

Women should remember that their lives change in many ways after they deliver a child. The coping strategies a woman develops during pregnancy may not work in the postpartum period, especially without the motivation of being pregnant to prevent smoking relapse. As a woman’s Ob-Gyn will most likely be the doctor a woman sees the most during the postpartum period, they are an incredible resource for helping their patients stay off the cigarettes for good.

I have helped many women quit smoking in my years as a doctor, and with help a good number of those women never smoke again.  Women need to take extra steps to quit smoking permanently to ensure both their health and that of their families.

– Yvonne S. Thornton, M. D., M. P. H.