The Perplexities of Pregnancy : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 3)

What About Weight Gain?

Thirty years ago, the National Research Council's Food and Nutrition Board advised women to gain 20 to 25 pounds during pregnancy. Studies have since shown that underweight women, or those who gain fewer than 20 pounds during pregnancy, are at an increased risk of delivering low-birth-weight babies. Based on a 1990 study, IOM now recommends a weight gain of 25 to 35 pounds during a normal pregnancy to decrease this risk. Adolescents and black women, who often have smaller babies, are now strongly advised to gain a greater amount.

The recommended increase in weight gain does not give a green light for mothers-to-be to overeat. Although the extra nutrients are required, an increase of only 300 calories per day is recommended. Weight gain during pregnancy should be gradual. The American College of Obstetricians and Gynecologists recommends 3 to 4 pounds in the first three months and 3 to 4 pounds per month during the rest of the pregnancy. Approximately 6 to 8 pounds of the total weight is the baby, and the remaining weight consists of an increased fluid volume, larger breasts and uterus, amniotic fluid, and placenta.

Contrary to popular belief, sodium, which helps to regulate water in the body, is needed in larger quantities during pregnancy. Larger than normal amounts of this electrolyte are needed because of increased fluid volume in the mother, the requirements of the fetus, and the level of sodium in the amniotic fluid. For those who do not have high blood pressure, salt restriction is not recommended. Those with medical problems that require salt restriction should consult their physicians. Trace minerals, such as iodine, usually needed in small amounts, are needed in greater quantities during pregnancy. Iodine can be obtained in iodized salt and spinach.

Is Caffeine Okay?

Caffeine — a stimulant found in colas, coffee, tea, soft candies, chocolate, cocoa, and over-the-counter and prescription drugs — has been a controversial topic in pregnancy nutrition for more than a decade. A 1980 study by FDA found that caffeine, when fed to pregnant rats, caused birth defects and delayed skeletal development in their offspring. At that time, although the human implications were unknown, FDA advised pregnant women to eliminate caffeine from their diets.

Since then, more studies have been done to determine the effects of caffeine on the fetus. A study of women in Costa Rica, where coffee consumption is high, showed a significantly lower birth weight for infants and a lower concentration of iron in mothers who were coffee drinkers. This report indicated that maternal coffee intake may also contribute to maternal and infant anemia.

Consumed in large quantities, caffeine can cause irritability, nervousness and insomnia. In addition to crossing the placenta and affecting the fetus, it is also a diuretic, dehydrating the mother's body of valuable water. After the baby is born, caffeine can also be transmitted through breast milk.

As mentioned, caffeine is an ingredient in some over-the-counter (OTC) and prescription drugs. Before taking any drugs, a pregnant woman should consult her physician.

Deciding About Drugs

Drugs may pose dangers to the embryo or fetus throughout pregnancy, but they are especially of concern during the first trimester, when the vital organs and systems are developing, and the last trimester, when excessive bleeding can occur during labor.

According to the New England Journal of Medicine, an estimated 10 to 45 percent of pregnant women in the first trimester, unaware of their condition, reach for the most common OTC drug, aspirin. Aspirin and other drugs containing salicylate are not recommended throughout pregnancy, especially during the last three months, except under a doctor's supervision. Acetylsalicylate, a common ingredient in many OTC painkillers, may prolong pregnancy and cause excessive bleeding before and after delivery.

Overall, according to Debbie Limkins of FDA's division of OTC drug evaluation, most other OTC drugs can be used during pregnancy with the supervision of a physician. Although scientists do not know the effects on the fetus of all OTC and prescription drugs, some drugs are known to cause birth defects and should be avoided. (See "Drugs and Pregnancy: Often the Two Don't Mix" in the June 1989 FDA Consumer.)

Since 1984, all OTC drug products have carried the following warning: "As with any drug, if you are pregnant or nursing, seek the advice of a health professional before using this product." In July 1990, FDA issued a regulation requiring all oral and rectal nonprescription aspirin and drugs that contain aspirin to include the additional warning "It is especially important not to use aspirin during the last 3 months of pregnancy unless specifically directed to do so by a doctor because it may cause problems in the unborn child or complications during delivery."

One drug that can cause severe birth defects is Accutane, or isotretinoin. Accutane, a derivative of vitamin A, is a powerful prescription drug that can clear severe cystic acne, but can cause birth defects (such as heart defects, small jaw, cleft palate, and skull and facial disfigurements) in about 1 out of every 4 exposed fetuses. Accutane can also cause miscarriages.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.