Frequently Asked Questions

• What is a teratogen?
• What would Motherisk rate as the most significant recent breakthrough in mother-child health care and research?
• If I eat a healthy diet, do I still have to take folic acid?
• Why is it important to take folic acid when planning to get pregnant?
• Must a woman avoid all medication while she is pregnant?
• How many women has Motherisk counselled?
• Do drugs ingested by the mother reach her breast milk?
• Is it safe to take antibiotics for a urinary tract infection during my first trimester?
• Is it safe to paint the nursery during pregnancy?
• What is the safest medication to take in pregnancy?
• I did not know that I was pregnant and had a chest-x-ray done during my first trimester. I am worried that I may have caused harm to my baby.
• Should I allow my fever to run its course to get rid of the infection naturally or should I take medication? I heard that when you are pregnant it is best not to take any medication.
• What happens if a woman drinks alcohol while pregnant?
• What is Fetal Alcohol Syndrome (FAS)?
• What is Fetal Alcohol Spectrum Disorder (FASD)?
• What is the prevalence of FASD in Canada?
• How much alcohol is safe to drink while pregnant?
• When is it safe to drink alcohol while pregnant?
• Does "passive smoking" (secondary exposure to tobacco smoke) reach a woman's unborn child?

What is a teratogen?
A teratogen is an agent that causes physical or developmental abnormalities in the fetus. In order for a drug or chemical to be considered a teratogen there must be substantive evidence that taking the drug or being exposed to the chemical causes congenital abnormalities.

What would Motherisk rate as the most significant recent breakthrough in mother-child health care and research?
The most exciting news these days is what medical science has learned about the prevention of neural tube defects, such as spina bifida and anencephaly. We now have concrete evidence that these conditions can be prevented if women take enough folic acid before and while they are pregnant. Folic acid is a vitamin found in foods like dark green vegetables, liver and lentils. Please see our recommendations about Taking Folic Acid Before You Get Pregnant. It is crucial that women of childbearing age get this message.

If I eat a healthy diet, do I still have to take folic acid?
Eating healthy foods is one of the important ways to nurture the baby inside you. However, a healthy diet does not necessarily mean that you are eating folate rich food, such as fortified grain, spinach, lentil, chick peas, asparagus, broccoli, peas, brussel sprouts, corn and oranges, consistently. About 40% of women of reproductive age and 36% of pregnant women in Ontario do not have enough folate in their system to ensure maximum protection against Neural Tube Defects, such as spina bifida. Studies have shown that in most cases, taking 0.4 mg of folic acid daily increases folate to the protective level.

Why is it important to take folic acid when planning to get pregnant?
The crucial time for development of the neural tube is in the first month of fetal life. If the neural tube fails to close properly, this may lead to defects in the brain and spinal cord such as anencephaly, and spina bifida. The risk of having a child with neural tube defect in the general population is 1 per 1000 births. The best time to start taking folic acid is before conception to ensure that your body has enough folic acid during the crucial period of neural tube formation in the baby. It is recommended that folic acid supplementation be started 3 months prior to conception. Most experts agree that supplementing with 0.4 to 1 mg of folic acid is sufficient during pregnancy. In some cases, women are advised to take more than 1 mg of folic acid each day. Go to http://www.motherisk.org/women/folicAcid.jsp to learn more about folic acid supplementation before and during pregnancy.

Must a woman avoid all medications while she is pregnant?
Although there is good reason for therapeutic caution during pregnancy, in some instances the benefit/risk ratio favours continuation of drug therapy. Some of the best examples are the proper use of medication to treat seizure disorders and the use of antidepressants to control mood disorders common in pregnancy.

How many women has Motherisk counselled?
Since its inception in 1985, the Motherisk team has counselled over half a million women, their families and health professionals. Motherisk counsels approximately 200 callers each day. The telephone information service at Motherisk operates daily from 9:00 a.m. to 5:00 p.m. Each week 10 to 20 women are scheduled for the Motherisk clinic following exposure to known or suspected teratogens, new drugs with sparse information, chronic drug therapy or drugs of abuse.

Do drugs ingested by the mother reach her breast milk?
Quite often. But that doesn't mean they will affect the baby. Motherisk is currently working to understand what controls the amounts of drugs that find their way into breast milk. Most medications enter the breast milk to some degree. Researchers and clinicians who study the use of drugs during lactation will tell you that in most cases, the amount of medication that enters the breast milk will not be high enough to cause harm to the baby (less than 10% relative infant dose). In most cases, there is no need to interrupt breastfeeding. To know which specific drug is safe to use while breastfeeding, please talk to your doctor or call Motherisk.

Is it safe to take antibiotics for a urinary tract infection during my first trimester? Urinary tract infections, if not treated in pregnancy, may lead to complications such as an increased risk of preterm delivery, so it is important to treat the infection. You are right to be cautious about taking medications during the first trimester since this is a crucial time in the baby's development . However, there are antibiotics that are safe to use during pregnancy -- even in the first trimester. Talk to your doctor for more information.

Is it safe to paint the nursery during pregnancy?
Studies have shown that pregnant women who worked with organic solvents (occupational exposure) are at increased risk of having babies born with birth defects. It used to be that virtually all paint was solvent-based. Advances in paint technology mean that modern, water-based paints, often referred to as acrylic emulsions, are increasingly replacing organic solvents. Water-based paints contain significantly less organic solvent than oil-based (solvent-based) paint. To minimize exposure, water-based paints are preferred when painting the nursery. Short term exposure to solvent –based paints is unlikely to cause harm. Still, pregnant women who wish to paint the nursery themselves should take protective measures such as wearing work clothes (to avoid contact of chemicals with skin), gloves, goggles, and avoid eating and drinking near open paint containers. Work in well ventilated room.

What is the safest medication to take in pregnancy?
When it comes to medication use in pregnancy, we try to assess the safety based on animal and human studies, or on the pharmacologic and pharmacokinetic property of the drug. The safest medication should be the drug that will work best for you, has the least number of side effects, and has not been shown to cause harm to the fetus. The benefit of taking the medication should outweigh the potential risk. Always talk to your doctor before taking medications in pregnancy.

I did not know that I was pregnant and had a chest-x-ray done during my first trimester. I am worried that I may have caused harm to my baby.
The risks associated with medical irradiation of pregnant women have been derived from data of survivors from nuclear explosions and radioactive fall out, children exposed in utero to diagnostic X-rays, and animal studies. Experts agree that exposure to less than 0.1 Gray (100 milli-Grays, threshold dose) is unlikely to cause harm to the baby. Most medical diagnostic radiology examinations result in a fetal dose less than the threshold dose, including a chest X-ray which is less than 0.00001 Gray. Talk to your doctor for more information.

Should I allow my fever to run its course to get rid of the infection naturally or should I take medication? I heard that when you are pregnant it is best not to take any medication.
Some studies suggest that women in the first trimester of pregnancy with high fever (38.9°C) lasting at least 24 hours or more, have higher risk for birth defects. It is not clear whether this is due to the fever itself or the maternal illness. In animal studies, inducing hyperthermia has shown to cause increased risk for birth defects. If you are in your first trimester, it may be prudent to take medication to lower the temperature. Depending on the cause of the fever, there are times when antibiotics should be taken to prevent complications in pregnancy. Always consult your doctor when feeling ill or feverish during pregnancy.

What happens if a woman drinks alcohol while pregnant?
When a pregnant woman drinks an alcoholic beverage, the alcohol is quickly absorbed into her bloodstream and passes through the placenta directly to the developing baby. Because of the baby's size and its developing system, the alcohol can be more harmful to the baby than to the mother.

What is Fetal Alcohol Syndrome (FAS)?
Fetal Alcohol Syndrome is a specific medical diagnosis used to describe a combination of permanent brain damage, physical birth defects and growth deficiencies resulting from prenatal exposure to alcohol. There are other diagnostic terms that are used to describe some, but not all of these defects and disabilities.

What is Fetal Alcohol Spectrum Disorder (FASD)?
A woman who drinks alcohol during pregnancy risks giving birth to a child with Fetal Alcohol Spectrum Disorder (FASD). FASD is an umbrella term used to describe the range of disabilities and diagnoses resulting from prenatal exposure to alcohol. Diagnoses under the FASD umbrella include:

• Fetal Alcohol Syndrome (FAS)
• Partial FAS (pFAS)
• Alcohol-Related Neurodevelopmental Disorder (ARND)
• Alcohol-Related Birth Defects (ARBD)

FASD is the leading developmental disability in Canada.

Many individuals affected by FASD often have difficulty integrating within society, and experience secondary effects, such as: joblessness, homelessness, mental health problems, social isolation, anger management problems and difficult personal relationships. Affected individuals affected often need ongoing support from the health, education, social services, child welfare, justice, corrections, and housing systems.

The cost of FASD to Canada has been estimated to be $5.3 billion annually (Stade et al, 2009). This cost includes health, education and social services for individuals 0 to 53-years-of-age. Justice, corrections, housing and other related costs are not included as part of this total cost.

What is the prevalence of FASD in Canada?
Prevalence rates of FASD are difficult to determine as FASD is often an 'invisible' disorder, meaning that the majority of individuals affected do not have visible signs of the disorder, nor have they been diagnosed. While an accurate national prevalence rate is not currently available here in Canada, it is estimated that approximately 9.1 out of every 1,000 (or approximately 1 percent) of babies born in Canada may be affected by prenatal alcohol exposure based on US data.

How much alcohol is safe to drink while pregnant?
Currently there is no research to indicate how much alcohol is safe. It is best not to drink any alcohol while pregnant. All alcoholic drinks are potentially harmful in pregnancy - a mixed drink, a wine cooler, a glass of wine or a bottle of beer - all contain alcohol.

When is it safe to drink alcohol while pregnant?
While most of the baby's organs develop during the first and second trimesters, brain development continues throughout pregnancy and even after birth. Exposure to alcohol at any time in the pregnancy can affect the baby's brain. Therefore, it is safest not to drink any alcohol throughout pregnancy. In fact, it is best to stop drinking before pregnancy.

Does "passive smoking" (secondary exposure to tobacco smoke) reach a woman's unborn child?
Yes. Motherisk's neonatal hair test has been used to detect fetal exposure to maternal passive smoking. The use of this "biological marker" has helped to establish the first direct proof that environmental tobacco smoke accumulates in the unborn baby in measurable and clinically relevant concentrations.