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Chandranipapongse W.,Hospital for Sick Children | Koren G.,Motherisk Program
Canadian Family Physician | Year: 2013

Question A healthy woman of reproductive age complained that when she saw me before pregnancy I did not advise her that she could check her varicella immunity and get vaccinated. She contracted chickenpox and endured unnecessary anxiety. This led me to think that it would be useful to have a summary of all the preconception counseling advice we should give to our patients to ensure the best pregnancy outcomes possible. Could Motherisk provide such a summary? Answer Although favourable pregnancy outcomes cannot be guaranteed, when a pregnancy is planned, many risk factors can be reduced and modified to enhance pregnancy outcomes. In the summary provided we will discuss optimization of diet, weight, and exercise; discontinuation of smoking and drinking; controlling chronic medical conditions; starting supplementation with multivitamins and folic acid; and ensuring proper immunization.

Matlow J.,University of Toronto | Koren G.,Motherisk Program | Koren G.,University of Western Ontario
Canadian Family Physician | Year: 2012

Question: Some of my pregnant patients are afraid to take their antiepileptic drugs during pregnancy because of the known risk of malformations and the neurodevelopmental problems associated with valproic acid. Are there similar concerns with carbamazepine? Answer: Similar to valproic acid, carbamazepine increases the risk of neural tube defects; however, it does not increase the risk of other malformations. Carbamazepine is also not associated with an increased risk of developmental delay.

Schoeman K.,University of Western Ontario | Tanaka T.,Motherisk Program | Tanaka T.,The Hospital for Sick Children | Bend J.R.,University of Western Ontario | And 2 more authors.
Journal of Pediatrics | Year: 2010

Objective: To study hair mercury concentrations among women of reproductive age in relation to fish intake in Ontario, Canada. Study design: Three groups were studied: 22 women who had called the Motherisk Program for information on the reproductive safety of consuming fish during pregnancy, a group of Japanese residing in Toronto (n = 23) consuming much larger amounts of fish, and a group of Canadian women of reproductive age (n = 20) not seeking advice, were studied. Mercury concentrations in hair samples were measured using inductively coupled plasma mass spectrometry. Seafood consumption habits were recorded for each participant. Based on the types of fish consumed and consumption frequencies, the estimated monthly intake of mercury was calculated. Hair mercury concentrations were correlated to both the number of monthly seafood servings and the estimated ingested mercury dose. Results: There were significant correlations between fish servings and hair mercury (Spearman r = 0.73, P < .0001) and between amounts of consumed mercury and hair mercury concentrations (Spearman r = 0.81, P < .0001). Nearly two thirds of the Motherisk callers, all of the Japanese women, and 15% of the Canadian women of reproductive age had hair mercury above 0.3 μg/g, which was shown recently to be the lowest observable adverse effect level in a large systematic review of all perinatal studies. Conclusions: Because of very wide variability, general recommendations for a safe number of fish servings may not be sufficient to protect the fetus. Analysis of hair mercury may be warranted before pregnancy in selected groups of women consuming more than 12 ounces of fish per week, as dietary modification can decrease body burden and ensure fetal safety. © 2010.

Koren G.,Motherisk Program | Koren G.,University of Western Ontario
Canadian Family Physician | Year: 2013

Question I just saw for the first time a 7-year-old boy with severe attention deficit hyperactivity disorder and oppositional defiant disorder. He came with his grandmother, who has been his guardian for the past 2 years. His mother is addicted to cocaine and is in rehabilitation. There is no paternal involvement. What is known about the long-term effects of being raised by parents with addictions? Answer Being raised by parents addicted to cocaine, other drugs, or alcohol confers high risk of neglect, physical and mental abuse, poverty, and a long list of psychological and psychiatric disorders. These children must be considered to be at very high risk and should be followed appropriately; both the children and their families must be supported.

Riggin L.,University of Western Ontario | Koren G.,Motherisk Program
Canadian Family Physician | Year: 2015

Question: Some of my male patients who are taking antidepressants are planning to become fathers. Do selective serotonin reuptake inhibitors (SSRIs) affect sperm, causing either decreased fertility or increased risk of congenital anomalies? Answer: There is limited evidence regarding paternal SSRI use before conception and its effects on reproductive outcomes; however, there might be some increased risk of subfertility based on animal studies and sperm-quality studies. There are insufficient data at this time to change prescribing practices of SSRIs in men who are hoping to become fathers. © 2015, College of Family Physicians of Canada. All rights reserved.

Koren G.,Motherisk Program
Canadian Family Physician | Year: 2015

Question: A patient in my practice who takes buprenorphine for chronic pain would like to conceive. Is it safe for her to continue taking her medication? Answer: The literature regarding periconceptional opioid use is conflicted as to whether opioids pose an elevated risk of birth defects. Confounding factors such as socioeconomic status, stress, and alcohol consumption might play a role. The first trimester of pregnancy is the critical period of development for many organ systems in the embryo. A chemical or environmental insult is more likely to produce major congenital malformations such as neural tube defects or mental retardation if it occurs within this window. Medical practitioners should judiciously consider a risk-benefit analysis before making their decisions. © 2015, College of Family Physicians of Canada. All rights reserved.

Chaudhry S.A.,Motherisk Program | Koren G.,Motherisk Program
Canadian Family Physician | Year: 2015

Question: Many of my patients are from Southeast Asia, where hepatitis A virus (HAV) infection is quite common. What precautions can I suggest my pregnant patients take before traveling to these areas and what is the risk of contracting HAV during pregnancy? Answer: Hepatitis A virus is a water-borne pathogen transmitted by the fecal-oral route. To reduce the risk of contracting HAV while traveling to endemic areas, it is important to maintain hygienic practices such as hand washing with safe water, particularly before handling food, avoiding drinking water or using ice cubes of unknown purity, and avoiding eating unpeeled fruits and vegetables. An HAV vaccine is available and can be administered before traveling to endemic countries. Hepatitis A virus infection has a largely favourable expected outcome even during pregnancy. Infection occurring in the second or third trimester has been reported to be associated with preterm labour.

Bozzo P.,Motherisk Program | Narducci A.,University of Toronto | Einarson A.,Motherisk Team
Canadian Family Physician | Year: 2011

Question: One of my patients is studying to become a dental hygienist. Owing to the program requirements, she received several vaccinations last week, including measles-mumps-rubella, varicella, and hepatitis B (HB) vaccines, as well as a tetanus booster. However, today a blood test confirmed that she is currently 6 weeks pregnant. What is known about the safety of these vaccines during pregnancy, and are there any general recommendations for vaccines for women who are planning to become pregnant or who are currently pregnant? Answer: The combination measles-mumps-rubella vaccine and the varicella vaccine are live attenuated vaccines, and are contraindicated during pregnancy owing to theoretical concerns. However, there is no evidence that there are increased risks of malformations, congenital rubella syndrome, or varicella syndrome attributable to these vaccines. The HB and tetanus vaccines are composed of noninfectious particles or toxoids, and theoretically should cause no increased risk to the developing fetus. In addition, limited observational data also support no increased risk of any adverse pregnancy outcomes; consequently, administration of the HB and tetanus vaccines might be, if indicated, considered during pregnancy.

Chaudhry S.A.,Motherisk Program | Vignarajah B.,Motherisk Program | Koren G.,Motherisk Program
Canadian Family Physician | Year: 2012

Question: One of my patients who has been diagnosed with myasthenia gravis (MG) is planning pregnancy. Her MG is controlled with medications. Can her condition or her medications adversely affect her pregnancy? Answer: The course of MG during pregnancy is unpredictable, but there is no evidence that MG can adversely affect pregnancy outcomes. Examination of most of the medications used for symptom control has so far shown reassuring results. Prepregnancy thymectomy might decrease the need for medications during pregnancy. The newborn should be carefully monitored for signs of transitory MG.

Chow C.K.,Motherisk Program
Canadian Family Physician | Year: 2015

Question If a mother takes a sedating drug during breastfeeding, will it cause central nervous system (CNS) depression in her breastfed baby? Answer In some cases (eg, with the use of codeine or oxycodone) sedating drugs will likely cause CNS depression in breastfed infants and in other cases (eg, with the use of benzodiazepines) they will likely not. Mothers using sedating drugs should monitor their breastfed infants for signs of CNS depression (eg, drowsiness; difficulty breathing, feeding, or latching; or cyanosis), paradoxical effects (eg, unusual excitement, irritability), or inadequate weight gain.

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