First Trimester

You may not look or even feel very pregnant in the first few weeks. However, a healthy first trimester is crucial to baby’s development. The brain, spinal cord, and other major organs are beginning to form, and they are at peak susceptibility to alcohol, medications, chemicals, and toxins in the environment. At just six weeks pregnant, your baby’s tiny heart is beating and pumping blood, and by eight weeks, nerve cells in the brain are forming primitive pathways.

At around six weeks, the same hCG hormone (human chorionic gonadotropin) that triggered your positive pregnancy test can also make you feel queasy. The good news is that morning sickness is often considered a positive sign of an established pregnancy, although this may not offer much comfort as you pay frequent homage to your bathroom fixtures. Seventy-five percent of all pregnant women experience some type of nausea, while half experience nausea and vomiting.¹ Many women also report a heightened sense of taste and smell, which can bring on strange cravings and sensations. Don’t be surprised if coffee, your must-have morning drink, suddenly becomes repulsive, and bland crackers turn into your favorite breakfast, lunch, and dinner.

Just remember that the first trimester (aside from minimizing exposure to toxins and medications) is about surviving, de-stressing, and getting plenty of rest. Frankly, you have never had a better reason to take a nap. The longer you sleep, the faster your second trimester will get here!

Weeks 1-8

Medical tips

• Estimate your due date with an online calculator, or if you’re good at math, add seven days to the first day of your last menstrual period (LMP) and subtract three months. Note: 40 weeks is the gestation period calculated from day one of your LMP to your expected due date. The 40-week calculation includes the first two weeks of pregnancy that happened before a woman conceived. A full term baby is born nine and a half months from conception or 10 months (40 weeks) from the start of mom’s last period.
• Check your health insurance coverage for pregnancy and childbirth.
• Find an obstetrician (OB or OB/GYN), certified nurse-midwife (CNM), certified professional-midwife (CPM), or family practice doctor for your prenatal care. Make sure the practice accepts your insurance and check to see if your doctor or midwife can deliver at the hospital or birthing facility of your choice. If you desire a natural childbirth, find a practitioner who will support your choices.
• Schedule your first prenatal checkup, usually between six and 10 weeks. Some high-demand obstetricians may not see you until 10-12 weeks. Note: This can be an excruciatingly long wait for first time parents. Just know that OBs are in high demand and short supply for good reason. They have a difficult lifestyle, round the clock demands, and one of the highest premiums for malpractice insurance among physicians. This comes after a minimum of 12 years of school (and probably debt) required for training as a surgeon.
• If you have had a previous miscarriage(s) or other health issues such as diabetes, tell your doctor, and you may get an appointment sooner.
• Strive for a partner or spouse to attend critical OB/midwife appointments, such as the first appointment, the 20-week ultrasound, and any visits due to complications. However, requiring 100% attendance may be out of the question in light of today’s work demands. If you are without a supportive partner, bring a friend or family member with you to the first prenatal visit.
• Expect doctor visits every four weeks, until approximately 28 weeks pregnant.
• Purchase or borrow a week-by-week pregnancy guide and make sure that it’s up to date (i.e., not What to Expect copyright 1984 but the What To Expect When You’re Expecting latest edition.) I consider this a “must have” for pregnancy.

Financial tips

• Calculate how a planned maternity leave will affect your finances.
• Consider increasing your current life insurance coverage, or purchase life insurance.
• Make sure that you and your spouse have short and long-term disability, if eligible.
• Research maternity options at work before telling your boss or co-workers. Investigate how maternity leave is really perceived at your firm. Friends and I have noticed that some companies boast generous maternity policies during the recruiting process; however, if a woman actually takes her full paid maternity leave, she may return to a tacitly altered career track, fewer advancement opportunities, and stolen clients. Hopefully, this is not the case for you but reveal your news carefully.
• Be courageous. With good performance, consider asking for a salary raise before you present your maternity plan. The higher pay will help offset a longer maternity leave or reduced work schedule later, if desired.

Nutrition, health, and well-being tips

• If you are single and expecting, know that you are not alone. 40% of children in the U.S. are born to single mothers, while 53% of births to mothers under age 30 are to single mothers. If a partner or spouse is not in your life, seek support from family and friends.²
• Try not to worry excessively about miscarriage. The majority of pregnancies result in healthy babies. Miscarriage risk lies somewhere between 10 and 25% of known pregnancies (about 15% for women under age 35 and higher for over 35), and roughly 80% of those occur during the first trimester. Once a care provider detects a heartbeat, it is estimated that miscarriage risk drops to 5-10%.³
• Begin eating as healthy a diet as possible (Pregnancy: What to Eat) and head to bed early.
• Keep hydrated with eight to 12 ounce glasses of water per day. Take a reusable water bottle to work and fill it regularly.
• Take a daily prenatal multivitamin with 27 milligrams iron and 600 micrograms of folic acid, as recommended by the American College of Obstetricians and Gynecologists (ACOG).⁴ Most women do not get all the folic acid they need from food alone, yet it can prevent major birth defects of the brain and spine. Some researchers think that folic acid may also play a role in heart health and preventing cell changes that lead to cancer.⁵
• Get a prescription-level prenatal vitamin at your first doctor’s visit. An over-the-counter (OTC) prenatal vitamin is better than nothing. However, there are no FDA requirements for what constitutes a prenatal supplement, and most OTC prenatal offerings are inferior to prescription ingredients.
• If you are nauseated, eat small meals throughout the day, since low blood sugar and stomach acid build-up can make nausea worse (Morning Sickness and Nausea).

Fun tips

• Share the early news with at least one other trusted family member or friend, in addition to your partner, for support. You might want to wait with telling everyone else until the risk of miscarriage decreases, around 12-14 weeks.
• Sign up for weekly pregnancy emails from Baby Center or the Bump.com, if you want to keep track of your baby’s development and size. These are the fruit comparison emails that take baby from the size of a tiny seed to a plump watermelon.
• Start pregnancy photos to journal your experience. Use the app CineMama to document your belly bump through pictures. At the end, the app compiles the photos and makes a movie set to a soundtrack of your choice. For cool, photo announcements or week-by-week collages, try Pic Monkey or Pic Collage.
• Be discerning when purchasing pregnancy mobile apps—47% of mobile users with one or more health apps are using a pregnancy app. This creates a market ripe for scams. I have purchased some real duds exploring app recommendations for this book.
• Take a deep breath. This is a lot of information to absorb, but knowledge is power. It can help reduce your stress and anxiety and make you more confident as a new parent.

Practical Tips from Real Parents: Conception after Fertility Treatments

• If you had assistance conceiving with IVF, expect a roller coaster of emotions throughout pregnancy, especially in the first trimester.
• All of the money spent and the pain endured from the ART process, in addition to previous miscarriages, can create a deeply seeded fear of losing your pregnancy.
• I had major anxiety throughout my pregnancy after years struggling with fertility.  
• If you had IVF, the difference between your fantasies about being pregnant and the actual experience can cause added stress. My husband was always reminding me not to complain, but I really just needed him to listen and acknowledge my discomfort.

Weeks 8-14

Medical tips

• Write down any questions that you may have prior to your doctor’s visits. Many OBs will whisk in and out of the examining room faster than you can say, “Next patient,” so be prepared. 
• Seek to understand the purpose of various first and second trimester prenatal tests (See: Is It Safe: Prenatal Testing).
• If you are over age 35, expect to be designated Advanced Maternal Age (AMA). Though the term may seem similar in context to “old maid,” age 35 is a statistical cutoff when chances for having a chromosomal abnormality are slightly higher than the risk of miscarrying from a diagnostic test, such as amniocentesis. It is also an insurance indicator, since some tests may be covered after age 35, but not before.
• Check hospital schedules for childbirth preparation and breastfeeding classes ahead of time, especially if you live in a densely populated area.

Financial tips

• Start buying maternity clothes, or better yet, borrow them. To extend your non-maternity wardrobe, loop a thick rubber band or hair tie through the buttonhole of your pants and cover with a long stretchy tank.
• Once you have exhausted your friends, garage sales, and consignment shops, try some favorite maternity brands: A Pea in the Pod, Top Shop, Motherhood, Target, Gap, Ann Taylor Loft, and Old Navy. Note: Maternity return policies are strict. Most stores require returns within 10 days with a receipt and tags for store credit. No cash refunds.
• For trendier maternity collections, try StellaMaternity.com, PinkBlushMaternity.com, Asos.com, OlianMaternity.com, Seraphine.com, and IsabellaOliver.com.
• For a special occasion, rent a designer maternity dress for up to 75% less at Renttherunway.com.
• Buy or borrow a few new bras, or extend your current ones with a $2-3 bra clip extender. Many women increase a full cup size during the first few weeks of pregnancy.

Nutrition, health, and well-being tips

• Stock up on natural moisturizers to pamper your skin and soothe an itchy, growing belly.
• Talk to your doctor about an exercise routine. Exercise modification may be required for women who have undergone fertility treatments or who have pregnancy complications.
• Suspend your gym membership for a few months, if you are unable to use it.
• Expect any of the following pregnancy-related body changes and nuisance issues.^{1, 6, 7}
• Congestion/sniffles. Hormones cause the mucus membrane lining in your nose to swell. For relief, try saline nose drops and a humidifier.
• Constipation. Two major issues contribute to increased constipation during pregnancy. First, hormones relax the smooth muscles in your stomach and intestines, slowing food passage through your system. Secondly, you may not be drinking enough fluids to keep up with your increased blood flow, causing you to be dehydrated. For relief, drink plenty of water and eat plenty of fiber. Drink a cup of hot water or prune juice, if you need to get things moving. 
• Heartburn. Increased levels of progesterone cause your muscles and muscle sphincters to relax. Therefore stomach acid is more likely to come up, especially as your growing uterus compresses your stomach. Food is also pushed through the digestive system more slowly, allowing for a backup of gastric contents. For relief, avoid spicy, greasy, and acidic foods, and try not to eat and lie down, a surefire way for anyone to get heartburn.
• Headaches. To minimize pregnancy headaches, control your blood sugar with frequent small meals, drink plenty of water, and try to rest. For drug-free pain relief, try a head, neck, and face massage or apply a hot or cold compress. Do not take aspirin or ibuprofen while pregnant.
• Varicose veins (or spider veins): Increased blood volume and pressure from a growing uterus, especially on the large vein on the right side of your body, causes weakened veins in your legs to bulge and twist. For relief, elevate your legs often and wear support hose if you are getting varicose veins in your legs and feet.
• Hemorrhoids. Hemorrhoids are varicose veins on your bottom. Increased blood volume, pressure from the uterus, and straining from constipation (and childbirth) can cause these veins to bulge. Sit in a warm tub or sitz bath for relief.
• Vaginal discharge. A thin, milky white discharge is okay. If the discharge is yellow, green, bloody, or foul-smelling, talk to your doctor.
• Incontinence or peeing in your pants. We’re back to relaxed muscles and increased pressure from the uterus. Panty liners can save the day after a good belly laugh or sneeze.
• Acne/pimples. Changing hormone levels can cause an increase in oil or sebum production. Wash face, neck, and back with a gentle natural cleanser twice a day and avoid adult acne prescriptions and treatments with salicylic acid.
• Melasma. This skin darkening process is often called “the mask of pregnancy,” due to hormones triggering the production of melanin in skin cells. Avoid skin-bleaching creams. Some cases of melasma may clear spontaneously without treatment after pregnancy.
• Sun sensitivity. Pregnancy hormones cause increased sun sensitivity. Be sure to wear sunscreen.
• Hair growth. You may have hair growth in unwanted places due to increased hormone levels. Stick with shaving and tweezing for removal, due to lack of information on the effects of hair removal creams, electrolysis, and laser hair removal.
• Constant pressure in your lower abdomen. Visit the restroom often, due to pressure on the bladder and fluid imbalances. If you feel as though you can’t empty your bladder when urinating, bend over while seated, lean forward to reduce uterine pressure, and get the last few trickles out.

Fun tips

• Record your baby’s heartbeat at your 12-week appointment with a clever phone app, such as My Baby’s Beat.
• Give your partner a few nights off to hang out with friends and have a few beers, and you may receive more cheerful help around the house.
• If your partner keeps telling you that he, too, feels queasy or exhausted, he’s not completely nuts. As many as 65-80% of expecting fathers experience some form of Couvade Syndrome, a psychosomatic condition better known as sympathetic pregnancy.⁸

Second Trimester

Hurray! The second trimester is here. Your risk of miscarriage has decreased dramatically, and you may feel more comfortable sharing your news with extended family and friends. Nausea and fatigue should also improve by weeks 13-16, as you feel more energized for work, travel, exercise, sex, and planning for baby’s arrival (your house is probably a mess, too). You should also regain a normal appetite. Although, remember that you are not actually eating for two; it’s more like one and a sixth, since your body needs only 300 additional calories per day (½ cup of almonds = 411 calories). This equals a weight gain of one half to one pound per week in the second trimester. The average weight gain for women who start pregnancy at a normal weight is 25 to 35 pounds, while the average weight gain for twins is 34 and 45 pounds.⁴

Weeks 14-20

Medical tips

• Expect triple screen testing during weeks 15-20, if offered.
• Expect the option of amniocentesis during weeks 16-20, if required. This is usually reserved for women with a family history of birth defects, maternal age > 35, diabetes, or exposure to a viral infection, radiation, drugs, or harmful medication use during pregnancy.
• Anticipate a mid-pregnancy ultrasound at week 20. Decide if you want to know the baby’s gender before your appointment and tell the technician your desires.

Financial tips

• Lay out a maternity plan for your boss. Come to the table with a list of your contributions and negotiate the maternity leave that you desire.
• Research childcare options (Choosing a Child Care Center and Hiring a Nanny). Day care centers fill up fast (some have wait lists), and high-quality nannies meeting your scheduling requirements may be hard to find. Get your partner involved in the process.

Organizational tips

• Start loosely planning a baby shower so that family and friends can “save the date.” Baby showers are typically scheduled six to eight weeks before your due date.
• Start planning the nursery. No painting or sanding for mom. Homes built before 1978 may have lead paint. Note: Lead is a potent neurotoxin with links to miscarriage, preterm birth, and developmental delays.

Fun tips

• Hit the sheets! As long as your doctor gives you the okay, enjoy your second trimester energy boost and bond with your partner. Many women report stronger orgasms during pregnancy, due to increased blood flow and genital sensitivity.
• Keep taking pregnancy photos each week. Set up an alert on your phone for reminders. For a fun progression, take photos in the same place with signs indicating the week.
• Expect baby’s first kicks during this time, which feel like bubbles or wings fluttering in your tummy.
• If you don’t already know the sex of baby, have fun playing gender guessing games. Do these tricks actually work? Yes, 50% of the time.
  • The Carrying Game: Look at mom’s belly. Girl = carrying high, Boy = carrying low.
  • The Heartbeat Game: Girl = 140 beats per minute and higher, Boy = 140 bpm and lower.
  • The Sweet or Savory Game: Girl = craving sweet foods, Boy = craving savory or salty foods.
  • The Ring Game: Tie a ring, such as a wedding ring, with a string and hang it over your belly. Girl = it swings back and forth, Boy = it swings in a circle.

Weeks 20-28

Medical tips

• Ask for pediatrician recommendations. Doctors, nurses, doulas, midwives, and other parents are great resources. Your baby will be checked at birth by your selected pediatrician or pediatric practice.
• Research cord blood banking. This process allows expecting parents to store baby’s umbilical cord blood as a potential source for stem cells used to treat cancers and other disorders. Your baby’s cord blood can be shared for the public good or stored for family use.
  • Pros: Cord blood banking could be lifesaving to your child, a sibling with a disease, or someone else using a public bank.
  • Cons: Your baby may never need it. It’s also not a guaranteed cure for disease, and it’s expensive at $1500-3000 for collection up front, plus $100-200/month for storage.
  • Companies: ViaCord, Cord Blood Registry (CBR), and Cryo-Cell
• Find a doula, if desired. A doula is a childbirth assistant who can provide physical, emotional, and informational support to parents during labor and delivery. The word “doula” comes from ancient Greek meaning “woman who serves”, and this person can be helpful in assisting a woman through natural birth. Hiring a doula for childbirth costs an average $400-$800 or $800-$1500 for a DONA certified doula in an urban area, depending on her experience (Childbirth Options).
• Expect a glucose screen test to check for gestational diabetes between weeks 26-28. This test includes drinking a yucky, sugary drink, waiting an hour, and getting blood drawn. Note: Gestational diabetes affects 18% of pregnancies. It occurs when your body is not able to produce or use all the insulin it needs to “escort” glucose (the type of sugar in your blood) into your body’s cells. This is where your body turns glucose into energy.⁹  

Nutrition, health, and well-being tips

• Think daily about your iron intake. Foods high in iron include lean beef, chicken, fish, lentils, spinach, and fortified cereals. You will need plenty of iron to make hemoglobin, the protein in red blood cells that carries oxygen to both mom and baby. By the third trimester, expect to have your juices flowing with up to 50% more blood volume.⁷
• Expect more rapid weight gain during the second trimester and don’t be surprised if you have at least one whopper of a weigh-in at the doctor’s office during this period.
• Work on your marriage or relationship during pregnancy. Even if there is no trouble on the horizon, stormy waters may lie ahead, especially in the intimacy department. Studies show that new parents have about a third of the alone time they had before having children.

Organizational tips

• Update or write a will, including specifications for your child’s inheritance and guardianship.
• Send out baby shower invitations.
• Register for baby gifts with your partner. Take an experienced mom with you who can help you cut out the fluff, or at least consult an experienced parent before adding items in the store or online.

Fun tips

• Take a babymoon now before your feet and back are aching. You will want to stay closer to home in the third trimester. 
• If you are having a bad day, search “awkward pregnancy photos” in Google images and have a good belly laugh.

Third Trimester

You are in the home stretch! However, be prepared. The third trimester can be very physically demanding. Expect backaches (due to a growing belly and two pounds of extra breast weight), knee aches (due to weight gain), swollen feet (due to fluid retention), difficulty sleeping (thanks to your belly, heartburn, baby’s acrobatics, and frequent urination), and other lovely side effects of growing a human being inside of your body. Despite these minor distractions, take a few moments to spend quality time with your loved ones and reflect on this amazing process.

Weeks 29-35

Medical tips

• Expect doctor/midwife visits every two weeks from 28-35 weeks.
• Prepare your birth plan and ask questions about labor and delivery (See: Birth Plan). Watch online videos of births to get a realistic sense of natural birth vs. epidural vs. C-section deliveries.

Nutrition, health, and well-being tips

• Enjoy your baby shower! Don’t let family and friend dynamics stress you out.
• Expect back pain, not just from your belly and weight gain, but also because the ligaments supporting your abdomen are becoming more stretchy and pliable for childbirth.
• Expect your belly to itch as the skin stretches and expands. Moisturizing creams, lotions, and oils can help soothe dry, stressed skin.

Organizational tips

• Send thank you notes for baby shower gifts. Buy a big box of cards to have on hand for gifts that you receive after birth.
• Purchase any baby items still needed, returning duplicates and non-essential items. Use merchandise credit from returns to buy essentials, such as feeding and health supplies.
• Complete a childbirth class, preferably with your spouse or a partner.
• Pre-register for your hospital or birth center. Take a tour of the labor and delivery unit, if possible.
• Pack a hospital bag (Hospital Packing List).
• Read up on baby care now. You will be too tired to do this after baby is born.
• Read up on breastfeeding now and line up support with a lactation consultant or a breastfeeding nonprofit group in your area, such as La Leche League.
• Read up on natural childbirth, if desired. The term natural birth implies a goal of no drugs and no interventions. Educate yourself and your support team about natural birth, be sure to write a birth plan, and strongly consider using a doula to help get you to the finish line without drugs or an epidural.
• Get baby’s car seat installed and inspected. Watch online videos for installation for your brand and model.

Fun tips

• Wash baby’s clothes and linens in a dye and fragrance-free detergent. Do not remove tags from clothes that may not be worn, such as newborn dresses, sweaters, jeans, etc. You can resell, re-gift, or donate them later.
• Schedule newborn photos before baby is born, especially if you have a popular photographer in mind.
• Buy a baby memory and photo book and fill out the pregnancy sections while the memories are still fresh. Take it with you to the hospital and record details of baby’s birth.
• Check out an app, such as Full Term or Contraction Master, to help time contractions.    
• Go out to eat, go to the movies, and enjoy time out with family and friends before you have to pay a babysitter $15 an hour.

Week 35-delivery

Medical tips

• Expect weekly doctor or midwife visits until delivery.
• Stay close to home, since you are generally no longer safe to fly at 35 weeks, and you never know what could happen.
• Expect a Group B strep test (GBS) between weeks 35-37, which is just a vaginal swab.
• Talk to your doctor or midwife about delayed cord clamping. Instead of immediately clamping the umbilical cord, studies have shown that delaying the clamping by two to three minutes allows iron-rich, stem-cell rich, and oxygen-rich blood to be pumped to baby after birth.¹⁰
• Call your health insurance provider and ask about the requirements for adding your baby to your policy.
• Select your pediatrician. Baby will need to be checked right after birth.

Nutrition, health, and well-being tips

• Expect interrupted sleep during the final weeks of pregnancy, due to frequent bathroom trips, back pain, leg cramps, heartburn, baby’s kicks, and general discomfort.
• Sleep on your left side with a pillow between your legs. This keeps the uterus and baby’s weight off your liver, which sits on the right side of your abdomen.
• Try not to push too hard in the final weeks. You want to keep that bun in the oven to full term, if possible. Baby’s eyes, lungs, skin, and other systems are still developing after 35 weeks.
• Find some time to stretch (especially on all fours for the lower back), breathe deeply (to calm yourself and prepare for contractions), and meditate or pray about your upcoming labor and delivery.
• Expect false labor pains in the final weeks before delivery, also known as Braxton-Hicks contractions. These contractions are an infrequent tightening of the belly that typically stops or lessens after you change activity. Real labor contractions are more regular, more frequent, and more painful, and they increase in frequency and intensity with time.
• Prepare for labor and delivery with positive psychology. Remind yourself that labor is “helpful pain” and “useful pain” for allowing you to meet your child. Try to limit using words about childbirth that instill fear.
• If your due date has passed and you are opting for natural birth with no induction, try these classic natural labor inducing techniques: go for a walk, get a massage, stimulate your nipples (to produce oxytocin), have sex if you are cleared for it (sperm contains prostaglandins, which can thin and dilate the cervix), eat spicy food (unless you have terrible heartburn), or try acupuncture or acupressure, if cleared by your doctor.

Organizational tips

• Write an “If I go into labor tonight” plan for work and home. Pre-designate individuals to cover your duties at work, walk your dog, or take care of an older sibling in the middle of the night.
• Make an email list of friends and family. Use this list for an electronic baby announcement. Fill in your baby’s height and weight after birth.
• Email or text yourself a list of companies and phone numbers to call shortly after birth, such as the number for adding baby to your insurance policy, starting maternity leave at work, a dog walking company, etc.
• Finalize baby names with your spouse/partner. The Social Security web site is a favorite source for baby names. Other popular name sites are babynames.com, babynamewizard.com, and behindthename.com (for name etymology and history).
• Keep your baby name a secret until birth, unless you want to hear everyone’s opinions about it.
• Before baby arrives, sit down and write out a rough list of assigned chores and household duties with your spouse or partner. Balance the list until you both feel a sense of equality.
• Before baby arrives, have a discussion about the spiritual or religious direction of your family. If you and your spouse do not share religious beliefs, if one is religious and the other is not, or if you were raised with different religious backgrounds, the subject will come up once you have children, especially if one parent wants the child to be baptized, dedicated, or christened.
• Buy some roomy pajamas or a nursing-friendly nightgown, if you do not want to wear hospital gowns.
• If you do not already own them, buy some large, cotton Granny panties for your postpartum recovery and stock your home with natural maxi-pads. Avoid chemical-heavy pads with odor-lock protection to avoid any possible chemical burns from extended use.
• If you plan to breastfeed, buy some nursing bras, nipple cream, and nursing pads.
• Cook and freeze meals for after delivery. Clean out your fridge to make room for meals delivered after baby.
• Have a friend set up a meal schedule for you on takethemameal.com or a similar website. Email the link to any church groups, service organizations, or close family and friends in the area.
• Look on Groupon, LivingSocial, or other deal sites for a half-price cleaning service to deep clean areas of your home that may not receive attention in the next few months.

Fun tips

• Check out a book at the library that has nothing to do with having a baby.
• Take any older siblings on a “special date” before the baby arrives. Go get ice cream together. Remind them how special they are to you. Have a sibling gift picked out to celebrate baby’s arrival.
• Write a note or make a short video telling your baby how you feel about him or her in the weeks before birth. This could be fun to read when your child is older or watch on your phone when your toddler is screaming in the grocery store.

Baby is considered full term at 37 weeks, so be ready!

Sources

1. Murkoff, H.E., S. Mazel, and C.J. Lockwood, What to expect when you’re expecting. 4th ed. 2008, New York: Workman Pub.
2. Centers for Disease Control and Prevention Unmarried Childbearing. CDC Fast Stats, 2012.
3. American Pregnancy Association Miscarriage. 2011.
4. American College of Obstetricians and Gynecologists (ACOG) Frequently Asked Questions: Pregnancy. 2014.
5. United States Department of Agriculture (USDA) High fructose corn syrup: estimated number of per capita calories consumed daily, by calendar year. 2014.
6. Curtis, G.B. and J. Schuler, Your pregnancy week by week. 6th ed. Lifelong books. 2008, Cambridge, MA: Da Capo/Lifelong Books.
7. Harms, R.W., M. Wick, and Mayo Clinic., Mayo Clinic guide to a healthy pregnancy. 1st ed. 2011, Intercourse, PA: Good Books.
8. Masoni, S., et al., The couvade syndrome. J Psychosom Obstet Gynaecol, 1994. 15(3).
9. American Diabetes Association, How to Treat Gestational Diabetes. 2014.

The post Pregnancy Timeline and To Do List (Tips Collected from Parents for You!) appeared first on UPKiQ.

I will be the first to admit that pregnancy safety can be difficult to discuss with just the right balance. On one hand, no one wants to stress out an expecting mom, causing her to worry about every single thing that she eats, breathes, and puts on to her skin; and truthfully, the individual risks of eating a cold deli sandwich or using a face cream with salicylic acid are probably very low.

On the other hand, this is not your mother’s pregnancy. Today, moms-to-be have to be the EPA, USDA, and FDA, as the laws that regulate over 80,000 new and existing chemicals in our environment are ineffective and out of date. Note: The primary law for chemical safety, the Toxic Substances Control Act (TSCA), called toss-ka by people in the know, was passed in 1976. It provides the U.S. Environmental Protection Agency (EPA) authority to regulate new and existing chemicals used in commerce. When TSCA was enacted, all existing chemicals were grandfathered into the system and considered safe for use.

What does this mean for an expecting couple? It is my opinion that current legislation, government programs and food labels are not protecting your unborn child (rates of autism, asthma, food allergies, etc. are not decreasing), and who knows what these chemicals are doing in combination with one another?  

Over time, we have learned that toxins do pass through the umbilical cord during pregnancy. Just as nutrients and fluids from a mother’s body are transported to baby, everything else from the environment flows there too. In a 2004 umbilical cord study, doctors found a total of 287 industrial chemicals circulating through the bodies of newborn babies (through analysis of cord blood), including mercury, fire retardants, and pesticides. Of the 287 chemicals, 217 were known to be toxic to the brain and nervous system, 180 were identified as cancer-causing, and 208 were cause for birth defects or abnormal results in animal testing.¹¹

Why Babies are so Vulnerable to Toxins

Babies and young children, whether in the womb or swaddled in a blanket, are not little adults. Adults have tight connections between their blood, brain, and cerebrospinal fluid (CSF). This is called the blood-brain barrier. However, embryos and newborns have immature, permeable, and “leaky” connecting points, making them critically susceptible to drugs, toxins, and chemicals in the environment. These chemicals can disrupt and alter the way our genes work together, causing developmental defects.¹² This vulnerable group also does not have the ability to metabolize, detoxify, and get rid of toxins, as an adult does, because the kidney and liver systems are still developing throughout gestation and after birth.

Doubts about Pregnancy Safety

Early in my first pregnancy, I knew that certain foods and chemicals were bad or off-limits, but I didn’t really understand the potential long-term consequences of my choices. Others new to the pregnancy scene may have similar doubts or misgivings, such as:

1. I wasn’t planning on smoking or drinking whiskey, but aren’t modern parents a little bit too paranoid about pregnancy dos and don’ts?
2. I don’t want to be one of those over zealous helicopter parents. I had a childhood full of unsafe things, and we turned out okay.
3. I was born into a world full of chemicals, and my doctor says that I’m healthy.
4. Haven’t they already done away with DDT, lead, and all the really bad stuff?
5. My obstetrician hasn’t said very much about environmental toxins.
6. Isn’t baby wrapped up in a protective bubble called the placenta anyway?

After nearly six years researching these topics, I want to share a few things with you as a mom.

1. Protecting your unborn child from environmental toxins, infections, and diseases should never be confused with paranoia. If someone wants to makes fun of you for being cautious, then so be it. Decisions that you make during pregnancy can have lifetime consequences for your child.
2. Being over-protective of your body while pregnant should not be confused with an over-protective parenting style, such as helicopter parenting. The globalization of food production and the manufacturing of goods that has occurred in the last 10-15 years requires parents to think twice about the food they eat and the products they buy. You’ll have plenty of time to worry about over-parenting later.
3. The world has changed since you were in utero. Due to extraordinarily low production costs in China and other countries, it is cheaper for food to be grown and goods to be shipped halfway around the world than to be grown or made down the street. That’s why a toddler in the middle of Washington State is likely to be sipping on a juice box with apples from China (85% of apple juice in the U.S. is imported with the vast majority from China). That’s why half of the fresh fruit Americans eat comes from outside the country, too. The problem is that a developing fetus or young child cannot process the pesticides and preservatives used on those foods, as adults do, and the developing brain and nervous system are particularly vulnerable.
4. DDT, lead, and other chemicals may have been banned for certain uses in the U.S. However, these substances still linger in the water, soil, and older buildings, and they are readily used overseas. For example, DDT is used today to fight malaria in tropical areas, while paint with higher levels of lead is one-third the cost of paint with lower levels of lead in China. Search “lead paint recalls” to see just how prevalent this neurotoxin is in favorite toys and children’s products on the shelves today.¹³
5. Your obstetrician has probably not discussed a long list of environmental toxins with you for various complicated reasons. Based on a survey examining the subject, she is likely to be limited on time. She may also sense that you are already anxious, and she does not want to cause more anxiety, especially with questions she is not prepared to answer due to uncertainty about the evidence. She likely wants to discuss environmental health more openly with her patients, but does not have extra time to dig into the research. She also tacitly worries what might happen if she starts the conversation about toxins with all of her patients. ¹⁴
6. Not too long ago, scientists thought that the placenta shielded a baby from toxins like a big invincible bubble (the placenta is a blood-filled structure that attaches to the wall of the uterus, while the umbilical cord arises from it and attaches to baby.) Today, we know that alcohol, caffeine, nicotine, medications, and most toxic metals have the ability to readily cross the placenta, enter the fetal bloodstream, and harm unborn babies.¹⁵

In light of loose regulation of toxins used in our food and everyday products and a pandemic of chemicals linked to autism, attention-deficit hyperactivity disorder (ADHD), dyslexia, diabetes, cancers, and other childhood diseases, I recommend a conservative approach to safety in pregnancy. “If there is a doubt, there is no doubt.”

“Is It Safe?”

Alcohol

• No. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) agree that pregnant women should avoid alcohol.
  • If teetotaling is not possible, try a few occasional sips of wine. Bottom line: Don’t waste your time and energy quarreling over whether sips, or even a small glass of wine, will hurt your baby. The underlying issue is that if a respected syndicate of physicians, such as ACOG or AAP, gave the green-light to “very seldom sips of alcohol,” it would likely lead to more ingestion.  

• What if I drank a small amount of alcohol before I knew I was pregnant?
  • Although it is true that no amount of alcohol use is safe during pregnancy, serious harm from this kind of use is unlikely. The important thing is to not drink any alcohol for the rest of the pregnancy.

Coffee/Caffeine 

• Limit to one cup per day or less than 200 mg of caffeine, including coffee, tea, soda and chocolate. ACOG maintains that moderate caffeine use of less than 200 mg per day and miscarriage are not linked.¹⁶
• Calibrate your cup. Not all brews are the same.
  • Starbucks venti 20 oz. cup has 415 mg.
  • Starbucks grande 16 oz. cup has 330 mg.
  • Starbucks tall 12 oz. cup has 260 mg.  
  • 20-oz. bottle of Diet Coke has 78 mg.
  • 8-oz. cup of black tea has 40 mg.
• Consider cutting out caffeine altogether.
  • A study of 60,000 pregnancies in Sweden found that babies’ birth weight decreased 21 to 28 grams and gestation period lengthened by five hours for every 100 mg of caffeine consumed per day.¹⁷

Unpasteurized or Fresh-squeezed Juice

• Do not drink fresh-squeezed juices from restaurants, juice bars, or farm stands. This seems counter-intuitive at first, but fresh juices are not pasteurized to protect against harmful bacteria, such as salmonella and E. coli. Bacterial infections can cause serious illness in those with weakened immune systems, such as pregnant women, the elderly, and young children.¹⁸

Sushi

• Do not eat raw sushi or shellfish, which can harbor parasites or bacteria. You can eat cooked sushi or vegetarian rolls; however, stick to cooked seafood low in mercury, such as wild salmon and occasional shrimp. The tuna used in sushi tends to be very high in mercury.⁴

Fish 

Here’s the dilemma that every pregnant woman must face.

• If you eat too much of the wrong kind of fish, you may end up exposing your unborn baby to excess mercury, a toxin known to impair fetal brain development.

• If you eat too little fish, you might deprive him or her of omega-3 fatty acids, which are highly beneficial to brain development and fetal growth.

For a printable, wallet-sized reference card for eating low-mercury fish, visit The Natural Resources Defense Council link at http://www.nrdc.org/health/effects/mercury/walletcard.pdf.

Fish: A More Conservative Approach

Consumer Reports issued guidance a few years ago for light canned tuna, indicating that while this fish is generally safe, occasional spikes of high levels of mercury have led the non-profit to advise women to skip all canned tuna throughout their pregnancy. After pregnancy, canned light tuna is the better, lower-mercury choice. Canned albacore/white and yellowfin tuna are higher in mercury, but still okay to eat in limited servings. If still in doubt, look for the Safe Catch brand for mercury-tested canned tuna and seafood. Note: Canned tuna is the second most popular seafood in the U.S. (shrimp is first) and is responsible for about 37 percent of the dietary mercury exposure. Canned albacore accounts for almost 20 percent of that.

Overall, Consumer Reports recommends focusing on the 17 fish that are lowest in mercury (see below), which is more conservative than than the government guidelines.

Did You Know?

That Sounds Fishy!

Today, more than 90% of our fish is imported, yet less than 1% is tested for fraud, such as mislabeling and fish substitution. Between 2010 and 2012, the ocean environmental group Oceana conducted one of the largest seafood fraud investigations to date, collecting over 1200 samples in 21 states. DNA testing found that one-third of the U.S. samples were mislabeled: grocery stores mislabeled 18% of samples, restaurants 38%, and sushi venues had a 74% fraud rate. Substitution of seafood is particularly alarming for pregnant women, since tilefish and other species on the “FDA Do Not Eat” list were labeled and sold as halibut and other “Safer to Eat” fish. Bottom line: Avoid eating fish from questionable sushi venues and unknown markets. Stick to seafood found in reputable national chains, such as Whole Foods, or trusted mom-and-pop fish markets with whole fish, which are more difficult to swap.¹⁹

Cheese

Due to a suppressed immune system and other factors, pregnant women are 20 times more likely to contract listeriosis, a bacterial, food-borne illness from eating unpasteurized soft cheeses, unpasteurized dairy products, hotdogs, and lunch meats unless cooked.²⁰

• Safely eat: Most cheese sold in the U.S., including soft cheeses, are made from pasteurized milk (mozzarella, cottage cheese, cheddar, etc.). The pasteurization process kills the listeria organism.
• Do not eat: Imported soft cheese or cheese from raw milk, such as Brie, Camembert, Greek Feta, Montrachet, Neufchatel, goat, and queso fresco, may contain listeria. Listeria can also be found in unpasteurized semi-soft cheeses, such as blue, Asiago, Gorgonzola, Havarti, Muenster, and Roquefort. 

Hot Dogs and Deli Meats

• Thoroughly cook hot dogs or deli meats, or heat to a steaming hot temperature in a microwave, to avoid listeria and other pathogens. This means that if your Costco hot dog just came out of the steamer, it should probably be okay for listeria. A Kirkland Signature hot dog does contain 20% of your daily salt intake and sodium nitrite.
• Avoid nitrates and nitrites. Nitrate is used in inorganic fertilizers, and sodium nitrite is a food preservative found in cured meats, such as ham, bacon, and hot dogs. When cooked with high heat or broken down in the stomach, nitrites form nitrosamines, which cause cancer. Particularly vulnerable groups to nitrates and nitrites are pregnant women and young children.^21-23

Pâté or Meat Spreads

• Do not eat pâté or refrigerated meat spreads to minimize risk of listeria.

Raw Eggs

• Do not eat raw eggs in cookie dough, batter, homemade Caesar dressing, and homemade desserts, including tiramisu, mousse, and meringue, if you want to be completely safe from salmonella.

Peanuts

There is a good reason for the confusion on this issue. The American Academy of Pediatrics (AAP) flip-flopped its position on eating peanuts during pregnancy in recent years. In 2000, the AAP warned that pregnant women should not eat peanuts or tree nuts while pregnant. In 2008, the group reversed its position, explaining there is not enough evidence to prove that avoiding peanuts and other allergenic food products while pregnant reduces allergies, eczema, and asthma. A 2014 study supports the claim that early allergen exposure (eating peanuts while pregnant) increases tolerance and lowers risk of childhood allergy.²⁴

• Talk to your doctor about eating peanuts, especially if food allergies are prevalent in your family.

Leftovers

• Heat leftovers until steaming to kill bacteria. Do not ask for a doggie bag at a restaurant, unless you know that you’re heading straight home.      

Artificial Sweeteners

• Choose foods and beverages without artificial sweeteners. While there isn’t clear evidence linking artificial sweeteners and pregnancy, artificial sweeteners, including saccharin (Sweet ‘N Low), aspartame (Nutrasweet, Equal), sucralose (Splenda), and stevia (Truvia), prime the body for sweet tastes, promoting the consumption of more sweets to satisfy cravings. Opt for water, seltzer, or milk instead.
  • Note: To further clarify the “artificial” nature of these sweeteners, saccharin is derived from coal tar, aspartame is made from methanol and converts to formaldehyde after digestion, sucralose is chlorinated sugar, and even stevia often requires unnatural agents to reduce its bitter taste. Greater consumer awareness of these sweeteners may explain why diet soda sales are in freefall.

Exercise and Pregnancy

• Exercises to do: Swimming, walking outdoors or on a treadmill, cycling on a stationary bike, pregnancy yoga, pregnancy calisthenics, and stretching routines. Stretching on all fours will relieve back pain and pressure, especially during your third trimester.⁷
• Exercises to avoid: Waterskiing, diving/jumping into pools, horseback riding, downhill skiing, cross-country skiing >10,000 feet, scuba diving, bicycling on wet pavement or downhill paths (where a fall is likely), sprinting, or any high impact sports that could cause injury to mom or baby.
• Jogging: Jogging is typically permitted with your doctor’s approval, as long as you are not a high risk pregnancy, such as preeclampsia, placenta previa, bleeding, etc. It is generally recommended that you keep the distance to under two miles per day on level terrain.
• Mountain Biking: It depends. A benign trail ride may be okay early in pregnancy, but avoid bumpy, downhill rides with a risk of falling.
• Weightlifting: Low impact weight training can be a great way to stay fit during pregnancy. However, most doctors recommend that you use lighter weights (5-10 pounds). You may not want to lift while lying flat on your back, as your uterus rests on the vena cava, restricting blood flow.

Practical Tips from Real Parents: Exercise

• Prepare for labor and delivery like you are working up to a big race or big game, and you may be pleasantly surprised how your body reacts. I did this to better prepare for my second birth after the first one kicked my tail.
• My favorite pregnancy exercise was to take my phone outside and do laps around the neighborhood while talking to friends and family. Stay close to home, though, because you may need to make a pit stop.
• Prenatal yoga is the best pregnancy exercise. It helps you stretch, focus, de-stress, and prepare for labor. This is a good time to try yoga for the first time, too, because you don’t have to deal with snooty or super skinny yogis.

Air Travel

Flying is generally considered safe before 36 weeks, if you have a healthy pregnancy. “No later than” flying rules vary from airline to airline, and some domestic and international carriers require a doctor’s certificate or medical clearance between 25 and 35 weeks. Talk to your doctor before traveling.

When you fly,

• Check your airline’s policies for pregnant women.
• Ask for a “pat down” through airport security, especially if you travel frequently or have doubts about scanners.
  • TSA claims that x-ray machines and body scanners are safe for pregnant women since the kind of radiation you are exposed to doesn’t penetrate the body very much. However, there is no guarantee against machine malfunctions, and there is a safer alternative.
• Choose an aisle seat to facilitate frequent bathroom visits. Buckle the seat belt below your abdomen.
• Wear loose clothing and avoid tight pants. Stand and stretch often. Take walks up and down the aisle.
• Drink lots of water. Spending hours in a low humidity cabin without fluid intake is a recipe for dehydration.
• Program your doctor or midwife’s phone number into your cell phone, just in case. Make a contingency plan for obstetric care at your destination.

Seat Belts

• Always wear a seat belt. Put the lap strap under your belly and across the hips. The shoulder strap should go between your breasts and to the side of your belly. 

X-Rays

• Tell your doctor and dentist that you are pregnant, even if it is obvious, and avoid all routine x-rays for dental and diagnostic work.

Smoking and Secondhand Smoke

• Smoking: Most people know that smoking causes cancer, lung disease, heart disease, and other major health problems. Smoking while pregnant adds to the list, potentially causing miscarriage, problems with the placenta, prematurity, increased risk for Sudden Infant Death Syndrome (SIDS), and increased risk for birth defects, such as a cleft palate or cleft lip.²⁵
• Secondhand smoke: Secondhand smoke contains over 7000 chemicals. Hundreds of these chemicals are toxic, and roughly 70 are believed to cause cancer. One study shows that women exposed to secondhand tobacco smoke have an increased risk for adverse pregnancy outcomes, including stillbirth, miscarriage, and ectopic pregnancy.^{25, 26}

Medications (talk to your doctor before taking any medications)

Rule of thumb: do not to take any medications, prescription or OTC, unless you absolutely have to take them to stay healthy during pregnancy with a doctor’s approval. Some medications may be required to prevent harm to you and your baby (i.e., for epilepsy, asthma, high blood pressure, etc.). For some women, OTC or prescription medications may be required to treat infections during pregnancy, such as a yeast infection, urinary tract infection, or sexually transmitted disease.²⁷

•  Acetaminophen (Tylenol) is generally the preferred OTC pain reliever during pregnancy; although, two separate studies in 2014 (one aggregating over 64,000 pregnancies) linked acetaminophen use during pregnancy with ADHD and other behavioral disorders.^{28, 29} 
• Talk to your doctor about medicines for cold and flu symptoms.
• Continue allergy shots with your doctor’s approval, but do not begin new medications.

Household Cleaning Products

• Go green! Phase out toxic cleaners. Make sure there is good ventilation in your cleaning area and wear gloves to protect your skin. Avoid mixing chemicals, such as ammonia and bleach, which can produce toxic fumes.

Household Herbicides, Insecticides, and Pesticides

• Buy organic foods in key food groups, wash food thoroughly, and avoid using chemical sprays to kill insects and rodents inside and outside of your home.³⁰
• Take your shoes off when you enter your home. Place a shoe rack by the door.
• Avoid common household weed killers, such as Monsanto’s Roundup.

Glyphosate

Monsanto’s glyphosate-containing herbicide, RoundUp, has been making headlines, due to with its underestimated toxicity.³¹ RoundUp is a common household weed killer and the most widely used herbicide on wheat and soy crops in the U.S. Farmers use RoundUp not only to kill weeds but also to speed up the dry down process for wheat, such as reaching 20% moisture for harvest. Glyphosate has been strongly linked to birth defects and non-Hodgkin’s lymphoma, in addition to other diseases. Levels of glyphosate are now ten times higher versus decades ago, due to GMO, herbicide-resistant crops.³²

Eat organic or non-GMO foods to minimize exposure to glyphosate.

Changing the Cat’s Litter Box (or gardening in soil with cat feces)

• Have someone else change the litter box, and keep your cat indoors. Cats can become infected with toxoplasmosis as they ingest infected insects, birds, and rodents. Cats transmit this parasitic infection through their feces, which can cause birth defects, especially if contracted in the early stages of pregnancy. Also, garden with gloves if there is a chance of contacting cat feces in the soil.

Skin Care and Skin Care Products

• Know that topical ingredients do get absorbed into the bloodstream. Agents or creams that injure the thick, outer layer of skin called the stratum corneum, such as strong acids, are absorbed quickly and more readily.
• Avoid Retin-A/Retinol/retinoids (found in ROC Retinol Correxion, L’Oreal Revitalift, Neutrogena Age Intensives, and Oil of Olay Pro-x), tetracycline, and products containing salicylic acid and beta hydroxy acid/BHA (most OTC acne washes and creams).
• Avoid prescription acne medications, similar to Accutane (the generic name is isotretinoin, sold under the trade names Amnesteem, Claravis, and Sotret). 

Facials

• Avoid Botox and spa facials that use unknown chemical ingredients, or peeling agents such as glycolic acid.

Manicures and Pedicures

• Bring your own instruments from home if you are serious about reducing infection risk.
• Ask your technician to be gentle or skip these altogether if you are worried about contracting nail fungus, especially with pregnancy pedicures. Pregnancy conditions–such as restricted blood flow to the feet, a suppressed immune system, and increased nail bed damage caused by swollen feet stuffed into small shoes–increase vulnerability to fungus.

Coloring Your Hair

• While the American College of Obstetricians and Gynecologists (ACOG) suggests that minimal hair coloring during pregnancy is probably okay (only small amounts of dye are absorbed through the skin), schedule color appointments after your first trimester. If you must color, consider getting highlights, as opposed to full color, to reduce overall chemical exposure. If you are worried about salon chemicals, but early stray grays are driving you crazy, try a henna-based hair dye found in natural stores.²

Hot Tubs and Saunas

• Avoid hot tubs and saunas while pregnant. Studies show that water >105°F can be damaging to developing cells and embryos. A study of over 1,000 pregnant women in California showed a twofold increased risk of miscarriage associated with the use of a hot tub or whirlpool bath after conception.³³

Hot Baths

• Keep bath water to < 100°F, or around your own body temperature. Avoid baths that raise your body temperature above 102-103 degrees.

Massage

• Request a masseuse trained in prenatal massage, and ask for a special maternity table. If a table is not available, make sure that you are propped up on your left side for circulation.

Alcohol-based Hand Sanitizers        

• Prioritize washing hands with soap and water over hand sanitizers. The use of alcohol-based sanitizers has been questioned for pregnant women since alcohol may be absorbed through the skin. If used sparingly, this should not add up to detectable amounts.

Triclosan/Anti-bacterial Soaps

• Be cautious using too many anti-bacterial soaps and toothpastes with triclosan. Not only is triclosan linked with bacterial resistance to antibiotics, but FDA is also reviewing triclosan for possibly altering endocrine function, hindering an enzyme linked to the metabolism of estrogen. Estrogen plays a critical role in fetal brain development and gene regulation.³⁴

Scented Feminine Hygiene Products and Douches

• Avoid douching, feminine sprays, and scented sanitary napkins because they can irritate the vagina and increase the risk of urinary tract or yeast infections.

Thong Underwear

• Buy cotton underwear that you feel good in and skip the thongs (cue in Sisqó). Thong underwear is linked to a higher risk of urinary tract infections and bacterial vaginosis, and thongs can also irritate hemorrhoids. If you must wear thongs, try a cotton maternity variety and sleep in regular underwear. If you are prone to yeast infections, stick with moisture-absorbing cotton.

Sleep Position

• Try to sleep on your left side to maximize blood flow, and avoid sleeping on your back after four months. Back-sleeping causes your uterus to press against your inferior vena cava, which returns blood from your lower body to the heart. The constriction can lower blood pressure and cause hemorrhoids, varicose veins, and swelling in the feet and ankles. If you wake up “feeling tingly,” simply roll over to your left side.³⁵

Practical Tips from Real Parents: Sleeping While Pregnant

• I had crazy insomnia while I was pregnant, all three trimesters. I would immediately get up to check work emails, or watch Netflix on my iPad, when I should have been listening to soothing music or doing something calming. Try your best to relax and get rest at night.
• Getting up to go to the bathroom several times each night is really annoying. Try to cut back on liquids in the evening, and make sure the path to the bathroom is clear before you go to bed.
• I could not have survived without my Snoogle! My husband was less than thrilled to haul that giant thing with us on vacation, but it kept me comfortable.
• Eat your larger meal in the middle of the day, or else expect heartburn to keep you up at night.
• Stretch before you go to bed if leg cramps are waking you.
• You may want to wear a thin maxi pad to bed, especially in the third trimester. Every time I rolled over my belly pushed on my bladder.

Vaccinations

For pregnant women

Diseases such as rubella and German measles present serious risks to a fetus in the first trimester, and, ideally, women should be up to date with vaccinations prior to becoming pregnant.³⁶  Also, a flu shot may protect your baby after birth. In a 2011 study, babies with mothers who had a flu shot while pregnant were nearly 50% less like to be hospitalized for a flu as infants than babies whose mothers were unvaccinated. ³⁷ If you get the flu shot, be sure to request the shot, not the nasal spray, which is a live virus and not appropriate for pregnant women. 

Environmental Toxins Suspected of Causing Autism and Learning Disabilities

• Lead
• Methylmercury
• Organophosphate pesticides
• Organochlorine pesticides
• Endocrine disruptors (ECDs), such as Phthalates and Bisphenol A (BPA)
• Polychlorinated biphenyls (PCBs) or pre-1979 industrial chemicals
• Automotive exhaust
• Polycyclic aromatic hydrocarbons (PAH) or fossil fuel products
• Brominated flame retardants (polybrominated diphenyl ethers, or PBDEs)
• Perfluorinated compounds (PFCs) or Teflon and Scotchgard
• Arsenic
• Toluene
• Manganese
• Fluoride
• Tetrachloroethylene or dry-cleaning chemicals

How to minimize exposure

• Lead: have your pre-1978 home tested for lead, watch for chipping paint in older homes, don’t remodel while pregnant, filter your water
• Mercury: eat fish and seafood low in mercury
• Pesticides and insecticides: eat organic foods (prioritize The Dirty Dozen fruits and vegetables for buying organic to reduce up to 80% of pesticide exposure), wash fruits and vegetables under running water, scrub with a brush, minimize household weed killers and insect sprays, be mindful if you are living near a golf course, farm, or public space that is frequently sprayed with pesticides.
• BPA: skip canned goods from the grocery store if not labeled BPA-free, use BPA-free plastics, limit drinking bottled water (Note: you can research which brands and which canned or bottled foods are packaged with BPA. For example, here is Trader Joe’s list of BPA-free canned goods and those packaged with BPA. Acidic foods, such as canned tomatoes and mandarin oranges, are likely to have BPA in the lining.)
• Phthalates/Vinyl/PVC-plastics: drink from stainless steel or glass water bottles, use glass to heat and re-heat food, be plastics aware: lose #3, 6, and 7 plastics and choose #2, 4 and 5 plastics. Choose fragrance-free products (avoid the ingredient “fragrance” or synthetic fragrances/phthalates in cleaners, detergents, and personal care products.)
• Brominated fire retardants/ polybrominated diphenyl ethers (PBDEs): throw away ripped items or replace decaying or crumbling furniture with foam padding inside (especially pre-2005), watch for PBDE dust when pulling up old carpet (PBDEs are found in the foam padding beneath carpets), don’t buy baby gear, mattresses, and household products coated in fire retardants
• Polychlorinated biphenyls (PCBs): avoid eating fish skins and animal fat, eat wild salmon (not farmed); Catfish, buffalo, and carp usually have the highest PCB levels among freshwater bottom-feeding fish
• Arsenic: get your water tested if you drink from a well, if you live near metal smelters where metal is made, or if you live near a garbage incinerator
• Toluene: avoid inhaling or sniffing paint, paint thinners, gasoline, rubber cement, nail polish, and other solvents; if you smell fumes, leave the room
• Manganese: check your well water for manganese levels, filter your water, do not feed baby soy or rice milk beverages in place of infant formula
• Perfluorinated compounds (Teflon): keep heat at medium or below for non-stick cookware; opt for iron or stainless steel pots and pans, if possible
• Toxic household cleaners: mix your own cleaning ingredients or use green cleaning products
• Other chemicals brought into the home: use a door mat, take shoes off with a shoe organizer by the door, use a high-efficiency particulate air (HEPA) filter vacuum cleaner, dust with a wet cloth, use sticky pads and crumb cleanup for critters and not indoor sprays

For more information, read:

Exposure to Specific Toxins and Nutrients During Late Pregnancy and Early Life Correlated With Autism Risk: Mount Sinai study uses a unique source—baby teeth—to reveal that both the timing and amount of exposure can affect diagnosis

Sources

11.       Greene, A.R., Raising baby green : the earth-friendly guide to pregnancy, childbirth, and baby care. 1st ed. 2007, San Francisco: Jossey-Bass.

12.       Saunders, N.R., S.A. Liddelow, and K.M. Dziegielewska, Barrier mechanisms in the developing brain. Front Pharmacol, 2012. 3.

13.       Environmental Protection Agency (EPA) DDT – A Brief History and Status: Current Status. 2014.

14.       Stotland, N.E., et al., Counseling patients on preventing prenatal environmental exposures – a mixed-methods study of obstetricians. PLoS One, 2014. 9(6).

15.       Staud, F., L. Cerveny, and M. Ceckova, Pharmacotherapy in pregnancy; effect of ABC and SLC transporters on drug transport across the placenta and fetal drug exposure. J Drug Target, 2012. 20(9).

16.       Morgan, S., G. Koren, and P. Bozzo, Is caffeine consumption safe during pregnancy? Can Fam Physician, 2013. 59(4).

17.       Sengpiel, V., et al., Maternal caffeine intake during pregnancy is associated with birth weight but not with gestational length: results from a large prospective observational cohort study. BMC Med, 2013. 11.

18.       Murkoff, H.E. and S. Mazel, What to expect : eating well when you’re expecting. 2005, New York: Workman Pub.

19.       Oceana, Ocean Study Reveals Seafood Fraud Nationwide. 2014.

20.       American Pregnancy Association, Is It Safe. 2014.

21.       Pogoda, J.M. and S. Preston-Martin, Maternal cured meat consumption during pregnancy and risk of paediatric brain tumour in offspring: potentially harmful levels of intake. Public Health Nutr, 2001. 4(2).

22.       Sarasua, S. and D.A. Savitz, Cured and broiled meat consumption in relation to childhood cancer: Denver, Colorado (United States). Cancer Causes Control, 1994. 5(2).

23.       Griesenbeck, J.S., et al., Development of estimates of dietary nitrates, nitrites, and nitrosamines for use with the Short Willet Food Frequency Questionnaire. Nutr J, 2009. 8.

24.       Frazier, A.L., et al., Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. JAMA Pediatr, 2014. 168(2).

25.       U.S. Department of Health and Human Services, C.f.D.C.a.P., National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health,, Let’s Make the Next Generation Tobacco-Free: Your Guide to the 50th Anniversary Surgeon General’s Report on Smoking and Health. 2014.

26.       Hyland, A., et al., Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: a cross-sectional analysis of historical data from the Women’s Health Initiative. Tob Control, 2014.

27.       U.S. Department of Health and Human Services, O.o.W.s.H., Pregnancy and Medicine. 2014.

28.       Liew, Z., et al., Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr, 2014. 168(4).

29.       Cooper, M., K. Langley, and A. Thapar, Antenatal acetaminophen use and attention-deficit/hyperactivity disorder: an interesting observed association but too early to infer causality. JAMA Pediatr, 2014. 168(4).

30.       Llop, S., et al., Prenatal and postnatal residential usage of insecticides in a multicenter birth cohort in Spain. Sci Total Environ, 2013. 445-446.

31.       Cuhra, M., T. Traavik, and T. Bohn, Clone- and age-dependent toxicity of a glyphosate commercial formulation and its active ingredient in Daphnia magna. Ecotoxicology, 2013. 22(2).

32.       Antoniou, M., et al. Roundup and birth defects: Is the public being kept in the dark? Earth Open Source, 2011.

33.       Li, D.K., et al., Hot tub use during pregnancy and the risk of miscarriage. Am J Epidemiol, 2003. 158(10).

34.       Huang, H., et al., The in Vitro estrogenic activities of triclosan and triclocarban. J Appl Toxicol, 2014.

35.       Dimmitt, B.S., Safest Sleep Positions During Pregnancy in Parenting. 2013.

36.       Harms, R. Is it safe to get a flu shot during pregnancy? 2014.

37.       Poehling, K.A., et al., Impact of maternal immunization on influenza hospitalizations in infants. Am J Obstet Gynecol, 2011. 204(6 Suppl 1).

38.       Akolekar, R., et al., Procedure-related risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2014.

The post Pregnancy: Is It Safe? appeared first on UPKiQ.

For a condensed toxin list and summary of how to minimize exposure, scroll to the end of the post.

Autism, ADHD, and other neurodevelopment disabilities (NDDs) affect about 10 to 15% of births, with only one-third of those cases attributed to genetic causes.³⁹ This means that environmental factors are likely influencing the remaining 60-70%, as toxins and chemicals interact with genetic susceptibilities in children (see Autism Awareness ). To better understand just how prevalent these chemicals are in our bodies, a 2011 nationally representative study of 268 expecting mothers found certain PFCs, PCBs, phenols, PBDEs, phthalates, PAHs, perchlorates, and organochlorine pesticides in 99-100% of women sampled.⁴⁰

Though it can be difficult to prove a cause-and-effect relationship of a single chemical to autism and ADHD, experts have nailed down the major culprits. Here are the top chemicals suspected of causing autism, ADHD, and Neurodevelopment Disabilities (NDDs) from the experts at The Mount Sinai Children’s Environmental Health Center, with the support of the National Institute of Environmental Health Sciences and Autism Speaks.

Note: This list has been expanded to include action items, simple language, and supporting research. ^{41, 42}

Lead

What is it? Lead is a heavy metal and powerful neurotoxin that has been shown to cause brain damage in developing babies and children.

Where do we find it? Lead can be found in the paint in homes, buildings, and day care centers built before 1978 and in old plumbing. Lead dust is the #1 cause of lead poisoning, and it is not always visible to the human eye. Babies and young children get exposed to lead when they put something with lead dust into their mouths.⁴³ Lead can also get into drinking water when plumbing materials that contain lead corrode, especially where the water has high acidity or low mineral content that corrodes pipes and fixtures.

How do I avoid or minimize it? Do not sand, paint, or renovate an old home while pregnant. Consider lead testing if your home was built before 1978. Do a thorough cleanup after all remodeling projects with wet mops, wet cloths, and a HEPA vacuum (a high-efficiency particulate air filter removes very fine particles from the air that pass through the filter.) Use a dust sampling kit to test for lead dust after the cleanup. Drink filtered water if you are concerned about lead leaching from older pipes (pipes without lead were mandated in 1986.) Avoid shopping at bargain stores for baby toys that will go in baby’s mouth, such as dollar-type stores. Researchers note that bargain stores have the highest amounts of lead and arsenic in their toys and toy jewelry.⁴⁴

Methylmercury

What is it? This organic compound is created by coal-powered industrial plants and ends up in our rivers, lakes, and oceans.

Where do we find it? Methylmercury is found in fish and shellfish. A fetus is exposed to mercury in the womb, due to a mother’s consumption of fish. The developing fetal nervous system is significantly more sensitive to mercury, especially during early gestation. Impacts on cognitive thinking, memory, attention, language, and fine motor skills have been seen in children exposed to mercury in the womb.⁴⁵

How do I avoid or minimize it? Avoid seafood with the highest levels of mercury while pregnant. Avoid handling and disposing of mercury-containing products while pregnant, such as thermometers, fluorescent light bulbs, and tilt-switches.  

Polychlorinated biphenyls (PCBs)

What is it? PCBs are older industrial chemicals used in hundreds of products produced before 1979, including electrical products, insulation, adhesives, caulking, paints, carbon copy paper, and engine coolant. The EPA classifies PCBs as probably causing cancer, and they are also linked to endocrine disruption, developmental disabilities, and decreased immune functions.

Where do we find it? PCBs do not break down in the environment. Instead, they filter into the soil and water and slowly accumulate in animal fat and fish skins and ultimately in us.⁴⁶ Most people are exposed to PCBs by eating contaminated fish, meat, and dairy products.

How do I avoid or minimize it? PCBs collect in animal fat and fish skins, so trimming these can reduce exposure. Eat wild salmon. Studies show that PCBs can accumulate in farm-raised salmon, due to smaller feed fish. Steer clear of older fluorescent lights that may still have older transformers or ballasts with PCBs. Keep young children from touching, peeling, and chewing older caulk.⁴⁷

Organophosphate pesticides

What is it? This acutely toxic group of pesticides has a range of problems associated with prenatal and early childhood exposure, such as impaired memory, mental and emotional problems, and higher risk for ADHD. Organophosphate pesticides (OP) disrupt the nervous system by interfering with an enzyme that regulates nerve impulses and acts as an important chemical regulator of brain activity.

Where do we find it? We find organophosphates, such as chlorpyrifos, on conventional fruits and vegetables (the largest market for chlorpyrifos is corn.) Organophosphates are also used to control cockroaches and pests in city apartments.

How do I avoid or minimize it? Prioritize organic fruits and vegetables. Eat a variety of fruits and vegetables from different stores and sources. Wash fruits and vegetables under running water and peel away skins. In homes with pests, clean up food crumbs and seal cracks and crevices as your first defense.

Organochlorine pesticides

What is it? Organochlorine pesticides, solvents, and spray fumigants, known by names such as DDT and chlordane, have largely been banned in the U.S. and Europe, due to health and safety concerns; yet they are widely used in developing countries, especially for fighting malaria. Because of their chemical makeup, organochlorines break down very slowly and remain in soil, water, and ultimately in the fatty tissues of our bodies. Organochlorine pesticide exposure is associated with several chronic diseases and cancers, including Parkinson’s, neurological disorders, birth defects, and abnormal immune function.⁴⁸

Where do we find it? Organochlorine pesticide remnants can still be found in agricultural storage facilities and the environment. Banned in 2010, Endosulfan was one of the last organochlorine pesticides on the market used on vegetables, apples, and melons.⁴⁹

How do I avoid or minimize it? Prioritize organic fruits and vegetables. Eat a variety of fruits and vegetables. Wash fruits and vegetables under running water and peel away skins.

Endocrine disruptors (ECDs), such as phthalates and bisphenol A (BPA)

What is it? ECDs are chemical toxins that act like hormones, tricking the body into over-responding, responding at the wrong time, or blocking natural reactions. Bisphenols are used in the lining of metal cans to prevent corrosion.

Where do we find it? ECDs are found in Bisphenol A/ BPA (food and soda can linings, water bottles, and receipt paper), phthalates (pronounced THAL-ates, which are in plastics, cosmetics, vinyl tile, and air fresheners), and flame retardants (clothing, furniture coverings, computers, and mattresses).⁵⁰

How do I avoid or minimize it? Limit the use of canned goods and water bottles. Always reheat foods in glass, not plastic containers. Avoid plastics, but if you must use them, avoid the 3, 6, and 7 recycle symbols, and look for symbols 2, 4, and 5. Be wary of hand-me-down plastic toys, bottles, teethers, and feeding products made before 2009. Buy cosmetics and personal care products with safer ingredients. Avoid air fresheners and products with “fragrance” as an ingredient (phthalates are used to help to stabilize chemicals and make fragrance oils last longer.) Check for use of flame retardants on clothing, furniture, and baby products.

Automotive exhaust

What is it? Vehicle emissions contain volatile organic compounds (VOCs), oxides of nitrogen, particulate matter, and carbon monoxide. While scientists are only beginning to understand the link between motor vehicle exhaust and brain cell development, evidence for a link between automotive exhaust and brain disorders is growing.⁵¹

Where do we find it? Exhaust levels are highest next to busy highways or in densely populated areas.

How do I avoid or minimize it? Try to avoid living next to a busy highway.

Polycyclic aromatic hydrocarbons (PAHs)

What is it? PAHs are organic compounds that exist naturally in coal, crude oil, and gasoline. They are released into the air as carcinogens by the incomplete burning of fossil fuels.

Where do we find it? PAHs are present in fossil fuel products, and PAH levels may be 10 times greater in urban areas than rural areas. Around the home, PAHs are found in burned meat, anti-dandruff shampoos, cigarette smoke, mothballs, and coal-tar driveway sealants.

How do I avoid or minimize it? Eat less charbroiled meats, avoid cigarette smoke, and use nontoxic alternatives to mothballs, such as cedar chests, vacuuming often, and plant-based deterrents. Remove your shoes before entering your home, especially if you have contact with heavy oils, asphalt, or roofing tar.⁵²

Brominated flame retardants (polybrominated diphenyl ethers or PBDEs)

What is it? These compounds work to inhibit combustible materials, such as a sofa, from igniting (thanks to heavy lobbying by the tobacco industry in the 1970s). PBDEs are transmitted into our lungs through dust and into our blood through ingestion and skin contact. Mothers participating in research studies have been shocked to learn they had PBDEs in their breast milk. PBDEs are linked to cancer, autism, infertility, and other neurological and developmental problems.

Where do we find it? These chemicals are found in mattresses, furniture foam, motor vehicles, TVs and computers, and coatings on fabrics.⁵³ In 2011, a study of 101 widely used baby products found that 80% of them contained flame retardants.⁵⁴ PBDE levels have doubled in people every three to five years for the past three decades.

How do I avoid or minimize it? Throw away ripped items with foam padding inside and watch for PBDE dust when pulling up old carpet. New foam items are not likely to contain PDBEs; however, foam padding or furniture produced before 2005 should be inspected carefully. Use a vacuum fitted with an HEPA filter to reduce PBDE dust.

Perfluorinated compounds (PFCs)

What is it? PFCs, or non-stick chemicals, are widely used to make products resistant to stains, grease, and water. Teflon and Scotchgard are two recognized brand names of PFCs. PFCs break down very slowly in the environment and bind to organic tissue, including those that make up human blood and the brain. PFCs have been linked to several types of cancer.

Where do we find it? PFCs have wide usage in stain-resistant sprays for carpets and upholstery, fire-retarding foams, nonstick cooking surfaces, and grease-proofing of paper and paperboard used in food packaging. We find PFCs in stain-resistant carpets and furniture, grease-resistant food packaging (fast food containers, pizza boxes, and microwave popcorn), non-stick cookware, dental floss, clothing, and shampoo.

How do I avoid or minimize it? Check personal care labels for the words “fluoro” or “perfluoro” (dental floss, cosmetics, moisturizers, and eye makeup). When you start seeing scratches in your cookware, replace it with cast iron or untreated stainless steel. Choose clothing, carpeting, and furniture without stain-resistant treatments.⁵⁵

Additional Neurotoxins

Dr. Philip Landrigan at Mount Sinai School of Medicine in New York and his colleague, Dr. Philippe Grandjean at Harvard School of Public Health, have studied industrial chemicals for over 30 years. As autism and ADHD prevalence rates have increased, these scientists have sounded the alarms calling for the urgent formation of an international clearinghouse for industrial chemicals to fight this “silent, global pandemic.” ³⁹

The list of neurotoxins was also updated to include:

Arsenic

What is it? Arsenic occurs naturally in the environment (in rocks, air, soil, and water) and as a by-product of agricultural and industrial activities. Arsenic is perhaps less known for its neurological nastiness than as one of the most prominent environmental causes of cancer mortality in the world. Arsenic has been linked to lung, skin, and bladder cancers, heart disease, stroke, and diabetes. However, it can also interfere with brain development and cause behavioral problems.

Where do we find it? This odorless, tasteless potent poison is found in small amounts in our food and water.

How do I avoid or minimize it? Widespread high concentrations of arsenic are found in the West, Midwest, parts of Texas, and the Northeast. Get your water tested if you drink from a well, especially in New England (Maine to Massachusetts) or the Midwest (Michigan and Minnesota), which are areas with high natural levels of arsenic in rock, or if you live in an area with mining or big agriculture (central valley California, Western states), if you live near metal smelters where metal is made, or if you live near a garbage incinerator. Dr. Landrigan and Consumer Reports also recommend avoiding or limiting rice consumption, especially rice from Texas and Louisiana, noting that the Gulf Coast areas treated cotton crops a century ago with arsenic pesticides.

Toluene

What is it? Toluene is a colorless, flammable liquid.

Where do we find it? Toluene is added to gasoline to improve octane ratings. It is also used to produce benzene and other household products and solvents, such as paint, paint thinner, gasoline, rubber cement, nail polish, and detergents. Solvents have been linked to hyperactivity and aggressive behavior.

How do I avoid or minimize it? If you smell fumes from these products, leave the room. Don’t deliberately sniff it. Avoid exposure in the workplace, such as printing and painting.

Manganese

What is it? Manganese is a naturally occurring substance used in steel production to improve hardness and strength. Excessive manganese levels are linked with diminished intellectual function (ADHD and reduced IQ) and impaired motor skills (Parkinson’s disease).^{56, 57}

Where do we find it? Manganese is a normal constituent of air, water, soil, and food. As a trace element found in people’s diet, manganese in small amounts is essential to keeping your organs healthy, including the brain. However, high concentrations can be harmful. Pregnant women, infants and children are exposed to manganese mostly through diet (cereals, leafy vegetables, fruit, and fruit juices), including breast milk and formula. Vegetarians who consume foods rich in manganese, such as grains, beans, and nuts, and heavy tea drinkers may have higher than normal manganese levels. Manganese inhalation can also be toxic.

How do I avoid or minimize it? Check your well water for manganese levels, especially if you are pregnant. Filter your water. Avoid soy formulas with high manganese levels.⁵⁸ Do not feed baby soy or rice milk beverages in the place of infant formulas.⁵⁹ Limit exposure to factories with welding or manganese products, mining activities, and automotive exhaust.

Fluoride

What is it? Fluoride compounds are salts that occur when the element fluorine combines with rocks or soil.

Where do we find it? Fluoride is found in toothpaste and drinking water. Although helpful in small doses for dental health, too much fluoride can lead to tooth and bone lesions and other neuro-developmental defects. An analysis of 27 studies on high levels of fluoride (mostly in China) concluded that high concentrations of fluoride can cause adverse effects on the brain.⁶⁰ Another study published in the journal JAMA Pediatrics in August 2019 suggests that fluoride consumed by pregnant women can decrease the IQ of their children. 62

How do I avoid or minimize it? Watch fluoride levels in your water. Keep young children from ingesting toothpaste by smearing small amounts on their toothbrush and keeping tubes out of reach.

Tetrachloroethylene

What is it? This is a chemical used for dry-cleaning and metal degreasing.

Where do we find it? When you bring clothes home from the dry cleaners, tetrachloroethylene (perchloroethylene or PERC) is released in small amounts into the air. It can also be found in drinking water.⁶¹

How do I avoid or minimize it? Dry-clean your clothes without the use of PERC. If you cannot find a PERC alternative, air out recently dry-cleaned clothes. Avoid living in an apartment directly above a dry-cleaning facility.

A Review of the Toxins.

• Lead
• Methylmercury
• Organophosphate pesticides
• Organochlorine pesticides
• Endocrine disruptors (ECDs), such as Phthalates and Bisphenol A (BPA)
• Polychlorinated biphenyls (PCBs) or pre-1979 industrial chemicals
• Automotive exhaust
• Polycyclic aromatic hydrocarbons (PAH) or fossil fuel products
• Brominated flame retardants (polybrominated diphenyl ethers, or PBDEs)
• Perfluorinated compounds (PFCs) or Teflon and Scotchgard
• Arsenic
• Toluene
• Manganese
• Fluoride
• Tetrachloroethylene or dry-cleaning chemicals

Let’s review: how to minimize exposure.

• Lead: have your pre-1978 home tested for lead, watch for chipping paint in older homes, don’t remodel while pregnant, filter your water
• Mercury: eat fish and seafood low in mercury
• Pesticides and insecticides: eat organic foods (prioritize The Dirty Dozen fruits and vegetables for buying organic to reduce up to 80% of pesticide exposure), wash fruits and vegetables under running water, scrub with a brush, minimize household weed killers and insect sprays, be mindful if you are living near a golf course, farm, or public space that is frequently sprayed with pesticides.
• BPA: skip canned goods from the grocery store if not labeled BPA-free, use BPA-free plastics, limit drinking bottled water (Note: you can research which brands and which canned or bottled foods are packaged with BPA. For example, here is Trader Joe’s list of BPA-free canned goods and those packaged with BPA. Acidic foods, such as canned tomatoes and mandarin oranges, are likely to have BPA in the lining.)
• Phthalates/Vinyl/PVC-plastics: drink from stainless steel or glass water bottles, use glass to heat and re-heat food, be plastics aware: lose #3, 6, and 7 plastics and choose #2, 4 and 5 plastics. Choose fragrance-free products (avoid the ingredient “fragrance” or synthetic fragrances/phthalates in cleaners, detergents, and personal care products.)
• Brominated fire retardants/ polybrominated diphenyl ethers (PBDEs): throw away ripped items or replace decaying or crumbling furniture with foam padding inside (especially pre-2005), watch for PBDE dust when pulling up old carpet (PBDEs are found in the foam padding beneath carpets), don’t buy baby gear, mattresses, and household products coated in fire retardants
• Polychlorinated biphenyls (PCBs): avoid eating fish skins and animal fat, eat wild salmon (not farmed); Catfish, buffalo, and carp usually have the highest PCB levels among freshwater bottom-feeding fish
• Arsenic: get your water tested if you drink from a well, if you live near metal smelters where metal is made, or if you live near a garbage incinerator
• Toluene: avoid inhaling or sniffing paint, paint thinners, gasoline, rubber cement, nail polish, and other solvents; if you smell fumes, leave the room
• Manganese: check your well water for manganese levels, filter your water, do not feed baby soy or rice milk beverages in place of infant formula
• Perfluorinated compounds (Teflon): keep heat at medium or below for non-stick cookware; opt for iron or stainless steel pots and pans, if possible
• Toxic household cleaners: mix your own cleaning ingredients or use green cleaning products
• Other chemicals brought into the home: use a door mat, take shoes off with a shoe organizer by the door, use a high-efficiency particulate air (HEPA) filter vacuum cleaner, dust with a wet cloth, use sticky pads and crumb cleanup for critters and not indoor sprays

For those concerned about chemical exposure, minimize potentially problematic foods

• High-mercury fish, such as swordfish, king mackerel, shark, tilefish, marlin, orange roughy, and tuna (bigeye, ahi)
  • The first four fish are labeled as AVOID by FDA and EPA for pregnant women and children.
• Farmed seafood and salmon (may contain PCBs)
• Food from cans and plastics made with BPA
• Processed meats with nitrates/nitrites and other chemicals
• Meat from animals treated with hormones (beef, lamb)
• Non-organic fruits and vegetables
• Non-organic dairy products
• Food additives: artificial sweeteners (e.g., aspartame), stabilizers and preservatives (e.g., sodium benzoate)
• Food dyes: artificial food colors have been linked to hyperactivity in children. In 2010, the European Union required warning labels on foods with artificial dyes stating that they “may have an adverse effect on activity and attention in children.”
  

Notes

• Fish: Advice About Eating Fish (for pregnant women, breastfeeding mothers, and young children). – FDA website
• Farmed seafood and salmon: Mayo Clinic article on fish/salmon and PCBs.
• BPA and pregnancy: journal article
• Steroid Hormone Implants Used for Growth in Food-Producing Animals: FDA website – “Since the 1950s, the Food and Drug Administration (FDA) has approved a number of steroid hormone drugs for use in beef cattle and sheep, including natural estrogen, progesterone, testosterone, and their synthetic versions. These drugs increase the animals’ growth rate and the efficiency by which they convert the feed they eat into meat.”
• Organic Foods: For more information on which organic foods to prioritize on a budget, read our post on Organic Foods.

Graphics permission by Jackie Lay (The Atlantic)

Sources

39.       Grandjean, P. and P.J. Landrigan, Neurobehavioural effects of developmental toxicity. Lancet Neurol, 2014. 13(3).

40.       Woodruff, T.J., A.R. Zota, and J.M. Schwartz, Environmental chemicals in pregnant women in the United States: NHANES 2003-2004. Environ Health Perspect, 2011. 119(6).

41.       Landrigan, P.J., L. Lambertini, and L.S. Birnbaum, A research strategy to discover the environmental causes of autism and neurodevelopmental disabilities. Environ Health Perspect, 2012. 120(7).

42.       Grandjean, P. and P.J. Landrigan, Developmental neurotoxicity of industrial chemicals. Lancet, 2006. 368(9553).

43.       Jusko, T.A., et al., Blood lead concentrations < 10 microg/dL and child intelligence at 6 years of age. Environ Health Perspect, 2008. 116(2).

44.       Hillyer, M.M., et al., Multi-technique quantitative analysis and socioeconomic considerations of lead, cadmium, and arsenic in children’s toys and toy jewelry. Chemosphere, 2014. 108.

45.       Oken, E., et al., Maternal fish intake during pregnancy, blood mercury levels, and child cognition at age 3 years in a US cohort. Am J Epidemiol, 2008. 167(10).

46.       Winneke, G., Developmental aspects of environmental neurotoxicology: lessons from lead and polychlorinated biphenyls. J Neurol Sci, 2011. 308(1-2).

47.       Weaver, D.E., Contaminant levels in farmed salmon. Science, 2004. 305(5683).

48.       Fleming, L., et al., Parkinson’s disease and brain levels of organochlorine pesticides. Ann Neurol, 1994. 36(1).

49.       Eskenazi, B., et al., Pesticide toxicity and the developing brain. Basic Clin Pharmacol Toxicol, 2008. 102(2).

50.       Braun, J.M., et al., Impact of early-life bisphenol A exposure on behavior and executive function in children. Pediatrics, 2011. 128(5).

51.       Volk, H.E., et al., Residential proximity to freeways and autism in the CHARGE study. Environ Health Perspect, 2011. 119(6).

52.       Perera, F.P., et al., Prenatal airborne polycyclic aromatic hydrocarbon exposure and child IQ at age 5 years. Pediatrics, 2009. 124(2).

53.       Herbstman, J.B., et al., Prenatal exposure to PBDEs and neurodevelopment. Environ Health Perspect, 2010. 118(5).

54.       Stapleton, H.M., et al., Identification of flame retardants in polyurethane foam collected from baby products. Environ Sci Technol, 2011. 45(12).

55.       Stein, C.R. and D.A. Savitz, Serum perfluorinated compound concentration and attention deficit/hyperactivity disorder in children 5-18 years of age. Environ Health Perspect, 2011. 119(10).

56.       Woolf, A., et al., A child with chronic manganese exposure from drinking water. Environ Health Perspect, 2002. 110(6).

57.       Wright, R.O., et al., Neuropsychological correlates of hair arsenic, manganese, and cadmium levels in school-age children residing near a hazardous waste site. Neurotoxicology, 2006. 27(2).

58.       Crinella, F.M., Does soy-based infant formula cause ADHD? Update and public policy considerations. Expert Rev Neurother, 2012. 12(4).

59.       Cockell, K.A., G. Bonacci, and B. Belonje, Manganese content of soy or rice beverages is high in comparison to infant formulas. J Am Coll Nutr, 2004. 23(2).

60.       Choi, A.L., et al., Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environ Health Perspect, 2012. 120(10).

61.       Environmental Protection Agency (EPA) Fact Sheet on Perchloroethylene, also known as Tetrachloroethylene. 2012.

62. Green R, Lanphear B, Hornung R, et al. Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatr. Published online August 19, 2019. doi:10.1001/jamapediatrics.2019.1729

The post Top 10 Toxins Suspected of Causing Autism and ADHD appeared first on UPKiQ.

This article is an introduction to some of the ingredients that are commonly found in cosmetics and personal care products. In summary, I would prioritize green beauty and personal care products for pregnant women, but don’t worry, a mixture of products is likely for everyone. There is no expectation to replace your entire makeup bag and medicine cabinet. However, it helps to be aware when you run out of products and have choices to replenish.

Government Regulation of Cosmetics and Personal Care Products

Many consumers might be surprised to discover the FDA does not review the safety of cosmetics and personal care products before they go to market, other than color additives. Instead, the agency has authorized the industry to police itself through a Cosmetics Ingredient Review (CIR) panel. To note, this panel has declared just 11 ingredients as unsafe since it was established in 1976, and its recommendations for restricting personal care ingredients are not binding to companies. In contrast, the European Union has banned over 1,400 ingredients from use in cosmetics and personal care products, primarily for being carcinogenic or toxic to reproduction.

What does this mean for Americans? Well, in the same way that Mars, based in McLean, VA, markets M&M candies with artificial dyes in the U.S. (dyes linked to hyperactivity), while using vegetable and plant-based dyes for M&M’s in Europe, American beauty companies make same-label cosmetics that are safer overseas than the products sold to customers back home. Talk about irritating!

To help you think about some of these issues, here is a list of some of the worst chemical offenders in beauty and personal care.

Antibacterials (triclosan)

What is it? Triclosan is consistently under scrutiny with the FDA over potential long-term health risks, such as unanticipated hormone effects and contributions to increasingly resistant bacteria. Triclosan also may contaminate the environment. After triclosan is washed down drains, it is converted to dioxin when exposed to sunlight and water. It can also combine with chlorine in tap water to make chloroform, a probable carcinogen.³⁴

Where do I find it? Triclosan is found in toothpaste, soaps, and hand sanitizers, such as Colgate Total toothpaste, Softsoap liquid hand soap, Dial liquid soap and bars, Clearasil Daily Face Wash, and Bath & Body Works antibacterial soaps.

How do I minimize or avoid it? Use natural soaps without the antibacterial label. Try a natural toothpaste, such as Tom’s of Maine or The Natural Dentist.

Coal Tar

What is it? Coal tar is a thick brown or black liquid that forms as a by-product when coal is processed. Since coal tar has been used in soaps and shampoos for the treatment of psoriasis and other skin diseases for over a century, it has been grandfathered into the OTC system. Coal tar is known to increase skin sensitivity to sunlight, and it is also found in hair dyes and lotions.

Where do I find it? Dyes with a coal tar base are used in dandruff shampoos (Neutrogena T/Gel Shampoo, Psoriatrax Anti-Dandruff Tar Shampoo), permanent hair dyes (salon and drugstore dyes made by Loreal, Revlon, Clairol, and others), mouthwash (FD&C Green 3), and toothpaste (FD&C Blue). The EU banned coal tar in 2004. Much of the evidence linking hair dyes with cancer has come from studies of salon workers.

How do I avoid or minimize it? Check labels on hair dyes, skin creams, and dandruff shampoos. Look for these ingredients: Coal tar solution, tar, coal, carbo-cort, coal tar solution USP, crude coal tar, estar, impervotar, KC 261, lavatar, picis carbonis, naphtha, high solvent naphtha, naphtha distillate, benzin B70, and petroleum benzin.

Diethanolamine (DEA)

What is it? Diethanolamine (DEA) is a chemical that can adversely affect hormones and cell functioning and development. The EU has banned DEA in cosmetics.

Where do I find it? DEA is used in shampoos and soaps to increase lather. Ethanolamines are also found in lotions, shaving creams, ointments, eyeliners, mascaras, blush, foundations, and sunscreens.

How do I avoid or minimize it? Avoid labels with MEA, TEA, and DEA and anything that ends in–ethanolamine. Worry less about mascaras with DEA and more about lotions that remain on the skin and shampoos lathered in close proximity to your brain.

1,4-Dioxane

What is it? 1,4-dioxane is a carcinogenic byproduct of a process called ethoxylation, which is a shortcut companies take to make soaps and shampoos milder and less irritating to the skin. 1,4-dioxane is on the state of California’s list of chemicals known to cause cancer, and it is banned for use in cosmetics in Canada. The Environmental Working Group (EWG) estimates that 97% of hair relaxers, 57% of baby soaps, and 22% of the more than 25,000 products in the Skin Deep database may be contaminated with 1,4-dioxane.

Where do I find it? 1,4-dioxane is found in products that make suds, like shampoo, bubble bath, and liquid soap.

How do I avoid or minimize it? 1,4-dioxane should not be in cosmetics and personal care products certified under the USDA National Organic program. Avoid labels with sodium laureth sulfate (use a sulfate-free shampoo) and ingredients written as “PEG,” “-xynol,” “ceteareth,” and “oleth.”

Formaldehyde

What is it? Formaldehyde is a probable human carcinogen that can be added to products as an ingredient or released from formaldehyde-releasing preservatives (FRPs).

Where do I find it? Formaldehyde is found in products such as baby bath soap, nail polish, and hair dyes, as a contaminant or a break-down product. Vulnerable groups are infants, salon workers, and nail salon workers.

How do I avoid or minimize it? Avoid labels with formaldehyde, quaternium-15, DMDM hydantoin, imidazolidinyl urea, diazolidinyl urea, sodium hydroxymethylglycinate, and 2-bromo-2-nitropropane-1, 3-diol (bromopol). Look for “toxic-trio-free” nail polish (formaldehyde, toluene, and DBP). Avoid keratin-based hair straighteners in hair salons, such as Brazilian Blowout. These products were found to contain up to 12% formaldehyde.

Fragrance and phthalates

• What is it? These endocrine disruptors mimic the action of our natural hormones, and they can cause reproductive and developmental harm.

• Where do I find it? Phthalates are often hidden under the term “fragrance” in beauty products. Look for phthalates, such as dimethyl phthalate (DMP), diethyl phthalate (DEP), and dibutyl phthalate (DBP), in hair spray, perfumes, deodorant, nail polish, and almost anything with fragrance.

• How do I avoid or minimize it? Use fragrance-free products.

Lead and mercury

What is it? Lead is responsible for making color lipsticks last. The longer it lasts, the more lead it contains. Also, the FDA generally does not allow mercury in drugs or cosmetics; although, mercury has been found in excessive levels in many beauty and skin products made overseas and sold in local ethnic stores.   

Where do I find it? Brands of lipstick or lip-gloss, such as Clinique, Chanel, Christian Dior, and Lancôme, are found to be lead positive. Lead can also show up in products that have hydrated silica, such as toothpaste. Mercury has been found in soaps, cosmetics, and skin care products in stores that tend to cater to Latino, African-American, Asian, and Middle Eastern communities.  

How do I avoid or minimize it? Choose organic or natural cosmetics that do not contain lead and mercury.

Parabens

What is it? Parabens are common preservatives that prevent bacteria growth. Parabens became controversial due to their weak estrogenic effects in animals studies. Estrogen disruption is linked to breast cancer and reproductive issues.

Where do I find it? Parabens are found in about 85% of cosmetics.

How do I avoid or minimize it? Check for methyl-, ethyl-, propyl-, butyl-, and isobutyl- paraben. Choose paraben-free brands, such as Burt’s Bees, Aveda, Dr. Hauschka, and Josie Maran Cosmetics.

Petroleum distillates (PDs)

What is it? Petroleum distillates are hydrocarbon solvents made from crude oil. They are used as inexpensive moisturizers in cosmetics and personal care products. The EU restricts or prohibits petroleum distillates as possible human carcinogens.

Where do I find it? PDs are found in mascara, eye shadow, foundation, wart remover, and foot-odor powder.

How do I avoid or minimize it? Check for the terms “petroleum” or “liquid paraffin” in products.

P-Phenylenediamine (PPD)

• What is it? P-Phenylenediamine is widely used as a dye, and it is associated with allergic reactions.

• Where do I find it? PPD can be found in 307 hair coloring and bleaching products in EWG’s Skin Deep database. PPD can cause irritation and damage to the nervous system and lungs.

• How do I minimize or avoid it? Scan a product’s barcode with the Skin Deep mobile app before purchasing home hair coloring products.

Hydroquinone

• What is it? Hydroquinone, banned from cosmetics in the EU, is one of the most toxic ingredients still used in personal care products today, with links to cancer, organ toxicity, allergies, and immune system toxicity.
• Where do I find it? Hydroquinone is found in skin lighteners, facial and skin cleansers, facial moisturizers (under-eye treatments), hair conditioners, and nail glue.
• How do I minimize or avoid it? Hydroquinone is heavily marketed for spot correction and to women of color in skin lighteners. Avoid labels with hydroquinone, tocopheral acetate, tocopheral, tocopheral linoleate, and other ingredients with the root “toco.”

The post Chemicals in Makeup, Cosmetics, and Personal Care Products appeared first on UPKiQ.

Morning sickness, though typically not harmful to you or your baby, can sincerely affect your quality of life, especially in the first trimester. To start, the term “morning sickness” is often a misnomer, since nausea and vomiting can last the entire day. Morning sickness also typically peaks at a time when many women are trying to hide or remain private with their pregnancy, especially at work. If you find yourself in this position, know that nearly half of all women who experience nausea in pregnancy feel complete relief by 14 weeks. Until then, try a few of these tips and tricks for nausea relief.

• Eat small meals throughout the day. Don’t skip meals.
• Take note of what foods and smells are triggers for queasiness, such as raw meat, garbage, greasy foods, or strong body odor, and avoid them.
• If you can’t avoid an offending smell, pack decoys in your purse: citrus lotion for your hands, a pleasant herb pouch with lavender or mint, or a small washcloth with a dab of lemon oil.
• Keep crackers at your desk at work and by your bed. Eat a few before you get out of bed each morning.
  • Favorite pick: one serving of Trader Joe’s 12 Grain Mini Snack Crackers has 10% of the daily value of iron.
  • For a gluten-free option, try Food Should Taste Good Brown Rice Crackers made from brown rice flour, sesame seeds, flax seeds, amaranth, and quinoa or crackers made from chickpea flour.
• Try acupressure wristbands, such as Sea Bands used for seasickness.
• Put gentle pressure on your wrist (in the groove between the tendons below the top crease of your wrist).
• Put a cool compress on your neck.
• Drink a cold Gatorade or freeze beverages with electrolytes in ice cube trays for hydration. Suck on frozen fruit or a healthy frozen yogurt bar.
• Take a prenatal vitamin daily for adequate vitamin B6, which is linked to relief of pregnancy nausea. If you suspect that the iron in your prenatal vitamin is making you sick, talk to your doctor about a slow-release option.⁶⁴
• If the size of your prenatal vitamin is too big to swallow (calcium is a bulky mineral), talk to your doctor about a smaller pill.
• Avoid sitting in a front of a computer monitor outside of work. Unnoticeable monitor flickering can make some women nauseous.
• Drive rather than riding as a passenger in the car.
• Wear loose clothing. If your pants or skirts are tight around the belly, it may make your nausea worse.
• Finally, if you just need to “let it go” and you want to look chic doing it, don’t leave home without a designer barf bag from morningchicness.com.

Try these food suggestions for nausea:

• Bland foods: chicken soup, broth, plain baked potato, potato chips, pasta
• Whole grains: toast, bagels, brown rice, oatmeal
• Cold foods: sandwiches, raw veggies and hummus, avocados, cheese
• Fruits and vegetables: cold applesauce, pears, citrus, potatoes
• Ginger: ginger ale, ginger tea, ginger snaps, Gin-Gins candy
• Crackers or pretzels, with peanut butter or almond butter for protein
• Lemons: sniff them, slice them and put them in water
• Peppermint: decaf tea, mints
• Popsicles: Italian ice, real fruit bars, frozen fruit, homemade yogurt and fruit pops
• Lollipops or hard candy: Preggie Pops, Preggie Pop drops, B-natal candy
• Beverages: sparkling water, water with electrolytes: SmartWater, Vitamin Water, 365 brand

The post Morning Sickness and Pregnancy Nausea appeared first on UPKiQ.

A healthy diet includes lots of fruits and vegetables, lean proteins, and whole grains (though types and amounts of the latter are debatable). During pregnancy, you can fine-tune a basic healthy diet by adding foods that contain essential nutrients for your developing baby, such as protein, iron, calcium, folate, DHA, and other vitamins and minerals.

If you are vegan or vegetarian, talk to your doctor or midwife, or consult a registered dietician. You may need supplemental protein and supplemental vitamins B12 and D.

Essential Nutrients for Pregnancy

Protein

Your developing baby’s cells are growing at a rapid pace. Every cell in the human body is made up of protein.

Food sources: cottage cheese, boneless/skinless chicken breast, fish, lentils, milk, peanut butter, quinoa (pronounced keen-WAH), beans, and eggs

Iron

Your body needs about 50% more iron when you are pregnant, primarily to make hemoglobin, the protein in red blood cells that carries oxygen to your organs and tissues. Boost iron intake by pairing vitamin C-rich foods with iron-rich foods, such as mandarin oranges with edamame, red peppers with spinach, and tomatoes with broccoli.

Food sources: iron-fortified cereal, beans, spinach, lean beef, duck, poultry, quinoa, pumpkin seeds, tofu, lentils, blackstrap molasses, and edamame (cooked soybeans)

Calcium

Baby needs calcium to build strong bones and teeth. If you do not consume enough calcium, your body will take it from your bones, which can lead to osteoporosis later.

Food sources: milk, yogurt, cheese, ice cream, salmon, spinach, broccoli, edamame, roasted almonds, fortified cereal, and fortified orange juice

Folate

Folate helps prevent neural tube defects, which are serious problems with the brain and spinal cord.

Food sources: fortified cereal, spinach, beans, asparagus, peanut butter, oranges, and dark leafy greens

Vitamin B6

This vitamin helps produce protein for new cells, form new red blood cells, and boost immunity.

Food sources: fortified cereal, garbanzo beans, baked potato with skin, lean beef, and chicken breast

Vitamin B12 (found naturally in animal sources)

This vitamin helps make DNA, the genetic material found in all cells, and it plays a role in healthy brain and nervous function. Vitamin B12 also produces red blood cells and helps your body convert fats and carbohydrates to energy.

Food sources: wild salmon, lean beef, lamb, chicken

Vegetarian sources: milk, yogurt, eggs

Vegan sources: Kellogg’s All-Bran cereal, General Mills Multi-Grain Cheerios, vitamin B12 fortified soy milk and other B12-fortified foods

Vitamin C

Vitamin C is not stored in the body, so you’ll need a fresh supply for your immune system and for baby’s growing body.

Food sources: oranges, kiwi, strawberries, mango, pineapple, grapes, bell peppers, tomatoes, asparagus, broccoli, spinach, and cauliflower

Vitamin D

Vitamin D is essential to building baby’s bones and teeth.

Food sources: milk, low-mercury fish, asparagus, eggs (in the yolk), vitamin D fortified orange juice, and vitamin D fortified soymilk

Docosahexaenoic Acid (DHA) 

Omega-3 fatty acids support healthy brain and eye development.

Food sources: wild salmon and fortified eggs (safest food sources during pregnancy)

What is the “Pregnancy Diet?”  

Several authors have coined variations of the phrase, but if you hear this term, it is more than likely a reference to the pregnancy “daily dozen” diet from What to Expect: Eating Well When You’re Expecting. Please reference the book for more in-depth analysis and recipes.¹⁸

1. Extra calories – You only need on average 300 more calories per day than pre-pregnancy.
2. Protein foods – 3 servings daily – about 75 grams of protein every day.
3. Calcium foods – 4 servings daily – about 1,200 mg a day total.
4. Vitamin C foods – at least 3 servings daily.
5. Green leafy vegetables, yellow vegetables, and yellow fruits – 3-4 servings daily.
6. Other fruits and vegetables – 1-2 servings daily.
7. Whole grains and legumes – 6 or more servings a day.
8. Iron-rich foods – some daily. Small amounts of iron are found in most of the fruits, vegetables, grains, and meats you eat every day.
9. Fats and high-fat foods – approximately four full (about 14 grams each) or eight half (about 7 grams each) servings of fat each day.  
10. Focus on foods with omega-3 fatty acids/DHA.
11. Fluids – at least eight 8-ounce glasses daily.
12. Prenatal vitamin supplements

Some of the Best Foods for Pregnancy

• Lean meat (amino acids in protein are the building blocks of every cell for baby)
• Lentils (loaded with folate, which is good for baby’s brain and nervous system development)
• Yogurt (calcium, protein, folate, and active cultures)
• Wild salmon (loaded with essential omega-3 fatty acids, most importantly DHA)
• Eggs (choline, protein)
• Avocados (folate, potassium, vitamin C and vitamin B6; good fats)
• Oats (fiber, B vitamins, and iron)
• Edamame (protein, calcium, folate and vitamins A and B)
• Nuts (portable snack packed with minerals (copper, manganese, magnesium, selenium, zinc, potassium, and calcium and vitamin E)
• Red peppers, sweet potatoes, and carrots (packed with beta-carotene, which the body converts to vitamin A for baby’s development)
• Dark, leafy greens (Cooked spinach has high levels of folate and iron, and kale and turnip greens are both good calcium sources) 
• Mangos (vitamins A and C)
• Water (delivering nutrients to cells, flushing toxins)

Did You Know?

Pregnant and Gluten-Free

Popular articles and books, such as bestsellers, Wheat Belly by cardiologist William Davis and Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar–Your Brain’s Silent Killers by neurologist David Perlmutter, have helped spearhead a mainstream gluten-free movement, maintaining that gluten and excess carbohydrates lead to inflammation in our bodies and brains. Non-Celiac pregnant women on a gluten-free diet should talk to their doctor or midwife. (Note: Celiac disease is a digestive and autoimmune disorder that can damage the lining of the small intestine.) Many gluten-free products are made with unenriched grains and starches that are loaded with calories and short on vitamins and minerals.

• If you are diagnosed with celiac disease, talk to your doctor. Expect to maintain a healthy gluten-free diet during pregnancy. Strive to breastfeed your infant through baby’s gluten introduction, as it may decrease his or her chance of acquiring celiac disease.  
• If you are on a gluten-free diet “just because”, talk to your doctor. Without proper monitoring, a gluten-free diet can leave you depleted of B vitamins, iron, calcium, zinc, and fiber. For example, breads made with tapioca, rice, and other gluten-free flours are typically not fortified. Fortified breads and cereals are some of the top sources of B vitamins for women in the U.S. This group needs vitamin B_9, also known as folic acid or folate, to prevent birth defects.
• To maintain a gluten-free diet, focus on good sources of gluten-free foods to boost potentially deficient areas.
  • Sources of gluten-free fiber: beans, quinoa, ground flax seeds, berries, sweet potatoes with skin, nuts, kale, chia seeds, broccoli, and prunes
  • Sources of gluten-free iron: beef, poultry, liver, soybeans/edamame, lentils, green peas, spinach, and amaranth    
  • Sources of gluten-free calcium: milk, hard cheese, yogurt, fortified milks (almond, soy, etc.), and green leafy vegetables
  • Sources of gluten-free B vitamins: meats, leafy greens, nuts, seeds, beans, quinoa, GF oatmeal, brown rice, andenriched products (Rice Chex, etc.),
  • Sources of gluten-free zinc: poultry, beef, liver, dark turkey meat, pecans, pumpkin seeds, beans, and brown rice

Tips for Pregnancy Nutrition

• Talk to your doctor before taking any supplements other than a prenatal vitamin. For example, if you don’t drink milk, and you take a calcium supplement, you may not know that calcium supplements from natural sources, such as oyster shell or bone meal, can be high in mercury.
• Take a prescription-level prenatal vitamin with DHA. While popping a gummy bear may seem like an easier option than swallowing a horse pill, some prenatal gummy brands, such as Vitafusion PreNatal, do not contain iron, calcium, thiamin, or riboflavin. DHA and other vitamin and mineral levels are also lower than recommended daily values.
• Take your prenatal vitamin with orange or fruit juice. Vitamin C enhances the absorption of iron into the bloodstream.
• Take your prenatal vitamin at a different time than calcium supplements or TUMS to get the full benefit of each. 
• Drink plenty of water. If plain water is too bland, add slices of lemon, lime, cucumber, or watermelon to enhance flavor. Consider trying an infusing water bottle, such as a BPA-free Infuser bottle, or a stainless steel Aquazinger water bottle.

• Try a breakfast cereal that really packs a punch, containing 100% of the Daily Value for folic acid and iron and vitamin B12, such as General Mills Total and Total Raisin Bran, or Kellogg’s Product 19 and All-Bran Complete.
• If you eat meat, prioritize lean cuts of beef and pork since they contain choline as well as protein.
• If you choose to eat eat canned tuna, choose canned light tuna over white, albacore tuna, which is higher in mercury. FDA limits canned light tuna to 12 ounces per week and albacore to six ounces per week for pregnant women.
• Skip canned goods for tomato sauces in glass bottles or soups in BPA-free Tetra Paks.
• For canned goods, stick to brands without BPA, such as Eden Foods, Amy’s, and some Trader Joe’s canned products.
  • Trader Joe’s Non-BPA Packages:
    ALL Tetra-Pak® Cartons 
    ALL Plastic Bottles, Tubs & Containers 
    ALL Canned Coconut Milk & Coconut Cream
    MOST Canned Beans, Fruits & Vegetables (EXCEPT: Mandarins, Hatch Chilies, Artichokes, and Giant Baked Beans in Tomato Sauce)
    MOST Canned Fish, Chicken & Beef (EXCEPT: Sardines, Crabs, & Cherrystone Clams)
    Organic Vegetarian Chili
    Tunisian Extra Virgin Olive Oil
• For snacks, choose a fruit, vegetable, protein, or calcium food: a hard-boiled egg, an orange, a banana, trail mix, Greek yogurt with flaxseed sprinkles, cottage cheese cup, string cheese, veggie sticks with edamame hummus, a small box of fortified cereal, a Larabar or Kind bar, or apple slices with peanut butter, nuts, or seeds.
• For lunch, try a mashed avocado-chickpea sandwich, leftover slices of lean beef and sliced red peppers, pre-cooked lentils on a bed of quinoa, or hit a local salad bar and load up on vegetables and lean protein.
• For desserts, try a glass of chocolate low-fat milk (using an organic syrup such as Trader Joe’s Organic Midnight Moo), a cored and baked apple with raisins and cinnamon, a frozen fruit and yogurt smoothie, a fresh fruit salad with honey and diced mint leaves, natural ice cream, or a square or two of dark chocolate.  
• For cooking oils and salad dressings, use heart-healthy canola, flaxseed, and olive oils.
• For trips to the supermarket, shop for whole foods around the edges of the store.
• Try a helpful nutrition app. Fooducate and ShopWell both have built-in bar scanners that read ingredient labels and provide nutritional food scores for packaged foods. Fooducate adds funny warnings, such as “Look out! Not 100% whole grain” or “Contains controversial artificial colors,” while ShopWell personalizes and adjusts nutritional scores based on your diet and food preferences, such as gluten intolerance, dairy intolerance, diabetes, etc.  

Pregnancy Nutrition Books

There is perhaps no better time in life to read a book about nutrition than while pregnant. Unlike books on breathing techniques and childbirth, which address a process that could be over in hours, nutritional advice can benefit you and your family for life. Here are some of my picks for the best pregnancy nutrition books:

Best for Easy Reading

• What to Expect: Eating Well When You’re Expecting by Heidi Murkoff and Sharon Mazel

Best for Sample Menus and Recipes

• Eating for Pregnancy: The Essential Nutrition Guide and Cookbook for Today’s Mothers-to-Be by Catherine Jones and Rose Ann Hudson (a culinary school graduate and perinatal nutritionist/registered dietician team)

Best for Nutrition Nuts

• Expect the Best: Your Guide to Healthy Eating Before, During, and After Pregnancy by Elizabeth Ward (spokesperson for the American Dietetic Association)

Best Vegetarian

• Your Vegetarian Pregnancy: A Month-by-Month Guide to Health and Nutrition by Holly Roberts (vegetarian and OB/GYN)

Best Vegan

• The Everything Vegan Pregnancy Book: All you need to know for a healthy pregnancy that fits your lifestyle by Reed Mangels (coauthor of the American Dietetic Association’s position paper on vegetarian diets and food guide for vegetarians)

Practical Tips from Real Parents: Eating and Nutrition

• Don’t be lazy about taking your prenatal vitamin. Take it at the same time each day. Set an alarm on your phone if you tend to forget things.
• If your prenatal vitamin is making you sick, take it with food. You can also cut it in half.
• Be aware that some prenatal vitamins contain stool softeners because of the extra iron. I couldn’t stand having sticky poo all the time (I’d rather be constipated), so you may want to check the label on your prescription before your doctor orders a nine month supply.
• Try not to let pregnancy justify eating junk food or too much food. I kept telling myself “Well, I’m going to get fat anyway,” and guess what? I did.
• Don’t drink too many juices while pregnant. I did this to cut out diet soda however the calories and sugar add up. My doctor attributed much of my 60-pound weight gain to my liquid intake.
• If you get carried away with eating mid-pregnancy, don’t diet to make up for it in the third trimester. Simply eat a healthy diet and work off the extra pounds after baby arrives.
• Don’t eat sugar or bread right before your 28-week, one-hour glucose test (for gestational diabetes), or else risk a “false positive” and a follow-on three-hour test. Talk to your doctor about whether to fast or not. If you do eat, eat eggs for breakfast well before the test.

The post What to Eat While Pregnant appeared first on UPKiQ.

This grocery list has been compiled using multiple nutrition books and online sources. The most nutrient-dense choices for pregnancy are listed at the top of each food group.

Colorful vegetables (select a few and mix them up each week)

• sweet potatoes
• bell peppers
• broccoli  
• avocados
• winter squash
• tomatoes
• artichokes
• carrots
• cauliflower
• beets
• green peas
• asparagus
• brussel sprouts 
• summer squash
• parsley

Dark green, leafy vegetables

• spinach
• kale
• swiss chard or collard greens

Colorful fruits (select a few)

• blueberries
• blackberries
• raspberries
• strawberries
• cantaloupe
• kiwi
• papaya
• mango
• bananas
• oranges
• grapefruit
• apples
• cherries
• pineapple
• watermelon

Dried Fruits

• apricots
• raisins
• figs

Whole grains

• quinoa
• fortified cereal (Total, All-Bran)
• oatmeal
• 100% whole wheat bread
• whole wheat tortillas or pitas
• whole grain or protein-fortified pasta
• brown rice
• whole grain crackers
• baked chips

Beans

• lentils
• soybeans/edamame
• chickpeas/garbanzo
• black beans
• pinto beans
• kidney beans

Lean meats and proteins

• beef (95-98% fat free)
• pork
• chicken breast
• lamb
• *tofu

Dairy products

• low fat Greek yogurt
• skim milk, with vitamin D and DHA
• soy or almond milk (with calcium)
• cottage cheese
• string cheese
• cream cheese

Fish and seafood *Mayo Clinic safe seafood list

8 to 12 ounces, approx. 2 meals per week

• salmon (wild U.S.)
• anchovies
• herring (Atlantic)
• sardines
• trout
• shrimp (wild North American)
• pollock
• canned light tuna
• canned salmon

Eggs

• eggs fortified with omega-3 acids

Nuts, Seeds, and Popcorn

• walnuts
• almonds
• pumpkin seeds
• sunflower seeds
• ground flax seeds
• popcorn
• peanut butter (natural)

Beverages

• calcium-fortified orange juice
• 100% fruit juice
• sparkling water (glass bottle)
• natural or organic ginger ale

Baking and Condiments

• whole wheat flour or almond flour
• organic ketchup
• all fruit, low sugar preserves

The post Pregnancy Grocery List appeared first on UPKiQ.

The following is a checklist to get started in financial planning for the changes that come with baby.

Create a Budget

Babies are expensive! To help you estimate costs for baby in the first year, BabyCenter has an excellent First-Year Baby Costs Calculator.

You can then use these expense estimates to create a budget using budget software or Excel. Don’t forget to factor in any loss of income, due to parental leave. For a free, web-based personal financial tool that plugs into your banks, credit cards, investments, and retirement accounts, try Mint.com or the Mint app.

• Mint: Link to How Mint Works
• Excel Budget Template: Family Monthly Budget Template in Excel

Establish an Emergency Fund

Set aside at least three months living expenses for emergencies and then add three months more, if you can.

Add Your Child to All Health and Life Policies

Add your child to your life or health insurance policies. Typically, you have 30 days to do this with your employer after a major life change.

Determine Your Best Child Care Options (recoup costs with an FSA or by taking the childcare credit at tax time)

Research childcare options based on income and expenses using an online Child Care Cost Calculator. Care.com’s Cost of Child Care calculator provides the average cost of care for a child(ren), depending on type of care and your zip code. Recoup 20% to 35% of the cost by either enrolling in a Flexible Spending Account (FSA) or taking the childcare credit at tax time.

• The Child and Dependent Care Tax Credit: The Child and Dependent Care Credit can get you 20% to 35% of up to $3,000 of child care or similar costs for a child under 13 (up to $6,000 of expenses for two or more dependents).
• Dependent Care FSA (DCFSA): Inquire whether your employer offers a Flexible Savings Account (FSA) to be used for paying for child care with before-tax dollars.

Purchase or Increase Your Life Insurance

Consider purchasing life insurance for you and your spouse or increase current coverage. How much life insurance do you need? Try this calculator on lifehappens.org.

As a younger new parent, I would also consider purchasing a term insurance policy, which is cheaper than permanent insurance and has a death benefit without an investment account attached. A 20- or 30-year premium term policy, which is convertible to permanent insurance in the future, is adequate. With a routine physical and medical questionnaire, you can lock in rates for the next 20 to 30 years.

Check Your Disability Insurance

Consider purchasing disability insurance from your employer. While supporting your child, you will need to guarantee income if you can’t work.

Make a Will

You need a will to appoint a guardian for your child, and you do not need to know the name of your child to make a will.

What happens if I do not have a will?

Dying without a will means that you have no say about who gets your bank accounts, real estate, jewelry, cars, and other property after you die. Without a will, you die “intestate,” meaning that the intestacy laws of the state where you reside will determine how your property is distributed upon your death. Typically, assets will be tied up in what is called “probate,” an expensive and lengthy legal process that could last months or years, depending on the complexity of the estate.

If you and your spouse die without a will, the state will choose a guardian for your child and decide how your money and property is to be divided. If you have family assets that you would like to be passed directly to a child, and not to your spouse, a trust must be established.

Start a College Fund

Get started on college savings. Set up a fund that you, grandparents, and relatives can contribute to early on, if budget allows. For a baby born in 2019, the College Board college cost calculator estimates that in 18 years, the cost of tuition, fees, room, and board for four years of private college will add up to $633,643 (using a 7% cost inflation rate). The cost of out-of-state public college will amount to $509,823, and in-state public college will cost $321,849.

Note: The national average tuition cost has inflated 6-7% each year for the past 30 years. Total cost estimates based on national averages are calculated by the College Board’s Trends in Pricing. To update costs, visit http://www.collegesavings.org/collegeCostCalculator.aspx.

Ask for a Raise

Don’t be afraid to ask for a salary raise. Despite advancements in education for women, female full-time workers still make 77 cents for every dollar earned by men, a wage gap of 23%.⁶⁵ Some of that gap is likely explained by differences in college majors and types of jobs, such as science, technology, engineering, and math vs. lower paying jobs in education and healthcare. Yet outright discrimination in pay, promotions, and hiring is also a likely contributor. When negotiating your salary, consider these tips:

• Keep a detailed record of your specific achievements and accomplishments.
• Build a business case for how you could potentially affect the bottom line of your business.
• Know the market value of your salary for your region.
• Know your company’s compensation policies.
• Make sure the timing is right: you have waited a year or so to prove yourself, don’t time it with your maternity leave discussion, etc.
• Initiate a meeting and then let your employer talk first, or risk naming a price lower than a potential offer.
• Don’t say “yes” immediately to an offer.
• Don’t settle for “no.” If your salary is non-negotiable, perhaps ask for other benefits, such as a bonus, vacation time, flextime at home, etc.  
• Be polite and professional, but be bold. If you really want something, you have to ask.

The post Financial Planning for Baby appeared first on UPKiQ.

Today being green has become decidedly mainstream, thanks to a rising generation of parents and consumers who are informed, Internet-savvy, and seeking eco-friendlier options for everyday life. Being green takes on a whole new meaning when you are pregnant, too, as you strive to protect not only the environment but also your unborn child.

Go Green Mindset

Even if you have never considered “being green” in your entire life, be green now. Stay away from artificial foods and toxins as much as possible while you are pregnant. Your baby is affected by everything that goes into your body, including gases and fumes.¹

Consider a Midwife

If you desire a hospital-free birth and have a low-risk pregnancy, consider using a midwife at a nonhospital birth center. As long as you are in close proximity to emergency support, a birth center may be more open to your requests for a natural labor and delivery.

Let a Doula Help

Let a doula help. Some studies show that having a doula present during birth can reduce invasive or sometimes unnecessary medical interventions, such as pain medications, Pitocin to induce labor, or premature C-sections.⁶⁶

Don’t Worry Excessively About Natural Birth

Worry more about daily green practices and less about natural birth. Strive for a natural birth, if desired. However, everyday activities during pregnancy, such as eating organic foods, minimizing exposure to toxins, using greener products, and avoiding alcohol, cigarettes, and medications, are far more likely to impact your baby than the decision of whether to have an epidural or not.Studies show that baby’s health is about the same whether a mother chooses an epidural or natural birth, with statistically similar blood pH levels, Apgar scores, and meconium levels in the bowels.⁶⁷

Pick a Green-Leaning Pediatrician

Pick a green-leaning pediatrician. How do you treat ear infections? What is your policy for antibiotics? Read the practice website and assess how green your pediatrician may lean.

Reuse Baby Gear and Clothing

Recycle and re-use secondhand baby gear, maternity clothes, and baby clothes that are outgrown quickly.

Eat Organic and Check Food Labels

Check food labels and ingredients carefully. Prioritize organic whole foods during pregnancy, especially meat, eggs, and dairy. Eat ocean-friendly, sustainable seafood (different from mercury in seafood), which can be found in the Monterey Bay Aquarium Seafood Watch Pocket Guide for your region. Read infant formula labels.

Consider Organic Cotton

Consider slowly replacing the family’s linens with organic cotton. Conventionally grown cotton accounts for more than 25% of global insecticide use and 10% of total pesticide use.⁶⁸

Choose Green Beauty Products

Use as many natural beauty and personal care products as possible. Focus your dollars on products that remain on your skin, such as creams and lotions, or may be used on your head, such as shampoo.

Watch Out for Greenwashing (phony green labels)

Beware of personal care products with phony “green” labels.

• Hypoallergenic: Manufacturers can use this word without proving their claim.
• Natural: This word is meaningless and can be applied to any personal care product.
• Organic: This can be used as a label in personal care even if only 1% of the content is organic.
• Fragrance free: This implies that a product has no scent or odor. Even if there is no scent, other substances can be added to mask the odor of other ingredients.
• Unscented: This generally means that no ingredients have been added to mask odors. Confused? Good. Beauty companies want you to be. Bottom line: “fragrance-free” products may still have essential oils or fruit/flower extracts added, which can contain allergens, just like natural and synthetically blended “fragrances.”

Check Personal Care Product Ingredients Online

Check skin and personal care product ingredients online. These databases can help you learn more about the current safety of personal products. 

• The Campaign for Safe Cosmetics at www.safecosmetics.org
• Skin Deep product guide at www.cosmeticsdatabase.com
• NIH Household Products at www.householdproducts.nlm.nih.gov

Skip Home Renovations During Pregnancy

Skip any toxic home renovations that could uncover lead dust in your home. Test old paint with a DIY lead testing kit or have a professional inspection of your home. Older Venetian blinds can also have lead.

Drink Filtered Water

Limit bottled water and install a water filtration system in your home, or use a high-quality filtering carafe. Filtered tap water is your best choice for hydration. Two studies in 2008 found an alarming number of pollutants in bottled water, including industrial chemicals, bacteria, and radioactivity.^{69, 70}

Reduce Indoor Pollutants

Change your sheets once a week, vacuum carpets and furniture, and dust and clean regularly with a wet cloth. For mold, fix leaks and eliminate sources of moisture. Use an exhaust-vent while cooking on a gas stove or range. Have a contractor tune up any furnaces, flues, chimneys, and gas appliances. Install a carbon monoxide detector. Consider an air purifier for your home. Grow air-purifying plants: Areca palm, Lady palm, Bamboo palm, rubber plant, Chinese evergreen, English ivy, Gerbera daisy, and Janet Craig.⁷¹

Make Your Garden Green

Use green gardening and landscaping techniques. Compost garden and household waste. Use natural fertilizers and plant foods, such as TerraCycle or eco-brands at Lowe’s or Home Depot. Plant organic and heirloom seeds. Get green gardening tips from www.joegardener.com or watch recorded episodes of Growing a Greener World, an award-winning public TV program on green living, organic gardening, and farm-to-table cooking.

Reduce Pests While Minimizing Toxic Sprays

Use green methods of indoor pest control. Use a cordless vacuum to sweep up crumbs (Dyson vacuums are worth every penny) and caulk around showers and sinks. Use sticky pads to catch critters indoors rather than using sprays and toxins.

Buy Green Home Goods

If you live in an area with limited access to green products, try online retailers. For natural food, health and beauty, pet, and household products, try Amazon’s Amazon Green category. For sustainable home goods, try: Bambeco, Crate and Barrel, IKEA, and Pottery Barn for sustainable wood furniture and home goods and Fair Trade textiles.

Vote with Your Dollars

Choose organic foods and eco-friendly products. When the competition goes up, prices will come down.

Be Skeptical of Established Green Lines of Products

Be skeptical of established green brands and curious about new labels. Once a brand or product has established a loyal customer base, executives will often scale back the product’s cost by reducing or eliminating the most expensive ingredients. Newer green products and smaller brands must differentiate themselves from the big guys, and they can’t do that with cost. Quite often, they differentiate themselves by offering purer, healthier products.  

Plant a Tree

Plant a tree in honor of your baby. One tree can absorb up to 48 pounds of carbon dioxide per year, which adds up to one ton of by the time your child is 40 years old.

Green Up Your Library

Go green in your library. For more comprehensive green tips, read Raising Baby Green: The Earth-Friendly Guide to Pregnancy, Childbirth, and Baby Care by Alan Greene (author), Jeanette Pavini (contributor), and Theresa Foy DiGeronimo (contributor).

Sources

66.       Wong, C.C., et al., Methylomic analysis of monozygotic twins discordant for autism spectrum disorder and related behavioural traits. Mol Psychiatry, 2014. 19(4): p. 495-503.

67.       LaSalle, J.M., A genomic point-of-view on environmental factors influencing the human brain methylome. Epigenetics, 2011. 6(7): p. 862-9.

68.       Hallmayer, J., et al., Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry, 2011. 68(11): p. 1095-102.

69.       Reichenberg, A., et al., Advancing paternal age and autism. Arch Gen Psychiatry, 2006. 63(9): p. 1026-32.

70.       Idring, S., et al., Parental age and the risk of autism spectrum disorders: findings from a Swedish population-based cohort. Int J Epidemiol, 2014. 43(1): p. 107-15.

71.       Schieve, L.A., et al., Population attributable fractions for three perinatal risk factors for autism spectrum disorders, 2002 and 2008 autism and developmental disabilities monitoring network. Ann Epidemiol, 2014. 24(4): p. 260-6.

The post 20 Tips for a Greener Pregnancy appeared first on UPKiQ.

If you work outside the home, your choice of child care may be one of the most important decisions that you make for your child. This decision should be thought of as a fluid situation that may change, depending on your circumstances. For example, during pregnancy you may select a day care center near your office and register your child for a future time period. However, if your baby is born prematurely or has other health issues, you may want to wait a few months before introducing baby to this center, especially during cold and flu season.

Before we begin with our child care center checklist, let’s discuss some pros and cons of different child care options.

Child Care Center (Day Care)

Pros: state regulated, possibly accredited beyond state requirements (National Association for the Education of Young Children or NAEYC), extra resources for toys and supplies, other children to play with, accountability, additional safety, higher supervision of caregivers

Cons: a strict schedule requires precise drop-off and pickup times (i.e., incurring fees for every minute late), potential overstimulation, lack of peaceful sleeping options, germs and more germs, other children may adversely affect your child

Average Cost: $380 to $1560 a month for babies and toddlers, depending on your location. Costs can be higher in U.S. cities such as New York, Los Angeles, Boston, and San Francisco.

Home Day Care

Pros: usually less expensive than other options, home environment, smaller group than a day care center, other children to play with, usually more flexibility with drop-off and pickup times

Cons: no backup if the care provider gets sick, less stringent accountability and licensing, safety standards may be lower, more germs than a nanny, closed during holidays and vacation time, TV may be used excessively for younger children who can’t tattle

Average Cost: $300 to $1000 a month for babies and toddlers

Nanny

Pros: more convenient than day care, flexibility in scheduling, peaceful sleep in familiar surroundings, consistency with one caregiver, one-on-one attention (interactive conversation with an adult), a nanny may care for a sick child when a day care center would require backup care

Cons: nanny supervision is low, a baby or toddler cannot communicate indiscretions, dependence on one person, need for backup care, the extra expense and paperwork of being an employer (nanny taxes, paying for sick time and vacation time, etc.) 

Average Cost: $2170 to $3030 a month for babies and toddlers

Now let’s proceed with how to choose a child care center, but don’t worry, the Hiring a Nanny checklist is coming up next.

Start Early

• Start researching childcare as early as possible. This process may take time.

Assess Child Care in Your Area

• Begin your search by talking to friends and co-workers in the area.
• Call local experts, such as a local Child Care Resource and Referral agency (CCR and R), if desired.⁷²
• Search “day care” or “child care” and your city online to find centers, or register for an online child-care service such as Care.com or Sittercity.com.
• Assess whether your family qualifies for any child-care financial assistance.
• Obtain information about complaints and licensing violations.

When your list narrows, assess your child-care options with the following questions:

Child-to-Staff Ratio and Group Size

• How many children are being cared for in the child-care program for your age group? Double-check real vs. aspirational numbers. Visit during working hours to crosscheck.
• How many teachers or caregivers are present? State minimums exist for each age group (i.e., one home caregiver is limited to caring for two infants.)
• What is the turnover rate for teachers/staff?

Supervision and Security

• Are children supervised at all times?
• Is supervision consistent during meal time and nap time?
• How do the caregivers discipline children?
• If the center is a home day care, are children taken out of the house? Does the provider walk or drive?
• Are there security cameras at the front desk to monitor visitors coming in and out?
• What is the pick-up and drop-off policy?

Director Qualifications

• Does the director of a child care center have at least a bachelor’s degree in a child-related field?
• How long has the director worked in child care? (At least two years of experience is preferable.)
• Does the director understand children well?
• Is this someone whom you would like to work with on a regular basis?

Lead Teacher Qualifications

• Does the lead teacher in a child care center have a bachelor’s degree in a child-related field?
• Has the teacher worked in child care for at least two years?
• What is the level of interaction between teachers and parents?
• Is there regular communication between teachers and parents?

Hand-washing and Diapering

• Do all caregivers and children wash their hands often (i.e., when children walk into the classroom, before eating, and after using the bathroom or changing diapers)?                                                                                 
• Is hand-washing consistent for older children who may be around your baby?
• Is the place where diapers are changed clean?
• Do caregivers keep a hand on the child while changing their diaper?

Eating and Sleeping

• What is the feeding schedule and meal policy?
• Is the program willing to use and warm breast milk?
• Does the center or home day care provide snacks and meals? At what age? What is the cost?
• If food is brought from home, is the center willing to heat it?
• Is each child able to sleep according to their own rhythms, or is a schedule set by the center?
• Where will my child sleep?

Immunizations

• Is your child up-to-date on all of the required immunizations?
• Does your state have a standard medical entry form for child care centers? What other information do you need to gather from your child’s pediatrician for entry?
• Does the child-care program have records proving that the other children in care are up-to-date on all required immunizations? Ask about the number of exemptions.

Hazardous or Toxic Substances

Emergency Plan

• Are hazardous or toxic substances kept away from children (cleaning supplies, rodent traps, pest sprays, gardening supplies, etc.)?
• Has the building been checked for dangerous substances like radon, lead, carbon monoxide, and asbestos?
• Is poison control information posted? Are teachers trained for poison incidences?

• Does the child-care program have an emergency plan if a child is injured, sick, or lost?
• Does the child-care program have a food allergy plan?
• Does the child-care program have a standard process about who to contact in an emergency?
• Consider leaving your cell number on your child’s check-in sheet each day, in addition to forms filled out for day care entry.

Fire/Emergency Drills

• Does the child-care program have a plan in case of a disaster like a fire, tornado, flood, blizzard, or earthquake? National emergencies?
• Does the child-care program do practice drills once every month?

Child Abuse and Accountability

• Have all caregivers had background checks?
• Can caregivers be seen by others at all times, so a child is never alone with one caregiver?

Medications

• Does the child-care program keep medication out of reach from children?
• What is the medicine policy? Policy for applying diaper cream and sunscreen?
• Are the caregivers trained, and the medications labeled, to make sure the right child gets the right amount of the right medication at the right time?

Staff Training/First Aid

• Have caregivers been trained to keep children healthy and safe from injury and illness?
• Do they know how to do basic first aid and CPR?
• Have they been trained to understand and meet the needs of children of different ages?
• Are all child care staff, volunteers, and substitutes trained on and implementing infant back sleeping and safe sleep policies to reduce the risk of SIDS (Sudden Infant Death Syndrome)?
• When infants are sleeping, are they on their backs with no pillows, quilts, stuffed toys, or other soft bedding in the crib with them?

Playgrounds

• Is the playground regularly inspected for safety?
• Does a fence surround the playground?
• Are the soil and playground surfaces checked often for dangerous substances and hazards?
• How old is the equipment?
• Is the equipment the right size and type for the age of children who use it?

Cost-Benefit Analysis

• If a child care center is significantly more expensive than its competitors, why?
• Do you have a back-up plan if your child is sick? How much will that cost per hour?
• Do you have a list of priorities for your child care needs? What are your child’s health considerations?
• Is it worth paying more to have your child at home with a nanny, or do you prefer the accountability and structure of a day care center?
• Is home day care a better option to balance cost and size of a large day care center?

Other Considerations

• How is TV used in the day care? 
• What is a typical day in the day care center?
• Are you allowed to observe the prospective day care center, or home day care, during working hours? Assess overall impression, happiness of the children, and level of speaking engagement with the children.
• Have you talked with other parents with children currently attending the prospective child care center?
• Do caregivers respect the culture, languages, and values of the families in the center?⁷³

Practical Tips from Real Parents: Day Care and Child Care Centers

• If possible, choose a day care center near your work. Late fees can add up if you have to commute through traffic, or if you are habitually late.
• Make sure that you read the fine print with late fees for pickup. One day care we considered was $5 per minute late (after a five minute grace period). This seemed excessive at first, but now I understand why. The parents, including myself, were always running late.
• Home day care can be good or bad for baby’s first year. In an environment with just a few children, your baby will probably get more attention and more sleep than in a commercial day care center. However, you have to constantly assess how other children coming into the home are affecting your child.
• With home day care, be mindful of males living in and passing through the home. No one wants to think about this stuff, but child sexual abuse offenders are 90 to 95% male. 
• Expect lots of colds the first year in day care. Babies put everything into their mouths, and it is impossible for workers to keep your child from getting sick.
• If your baby has a perpetual diaper rash, put together a rash kit and provide explicit instructions for baby’s diaper care.
• If your child seems unusually unhappy at drop-off or pickup, don’t discount this reaction. There may be a problem.
• Don’t be afraid to speak up or change your child care center if you think something is wrong.

Source for child care costs: National Association of Child Care Resource and Referral Agencies (NACCRRA)

The post Choosing a Child Care Center appeared first on UPKiQ.