By Lorrie Harris-Sagaribay, MPH, President of OTIS/MotherToBaby, in collaboration with Joanne Samuel Goldblum, CEO and founder of the National Diaper Bank Network.
MotherToBaby is honored to partner with National Diaper Bank Network (NDBN)an impressive organization that supports families across the country by ensuring access to diapers and other basic material needs. Through our collaboration, we learned that many parents and caregivers, especially those who are pregnant or caring for newborns, often ask the same questions about daily exposures during pregnancy and lactation.
These concerns come straight from the field, as NDBN staff and volunteers who work directly with families hear questions like these every day. To help answer them, MotherToBaby experts look at some of the most common questions families have about exposure in pregnancy and breastfeeding.
First, it’s important to remember that birth defects can occur in any pregnancy for different reasons. Of all babies born each year, about 3 in 100 (3%) will have a birth defect. Pregnancy problems (such as miscarriage) can also happen in any pregnancy. MotherToBaby reviews research studies to understand whether a particular exposure could increase the chance of birth defects or other problems in a pregnancy.
Here are five of the reports NBDN families ask about most often:
1. Caffeine
During pregnancy, it is recommended that you keep your caffeine intake to less than 200 milligrams (mg) per day from all sources, including coffee, tea, energy drinks and chocolate. (For reference, an 8-ounce cup of brewed coffee can contain 70 to 140 mg of caffeine, depending on the type of coffee and how it’s made.) While breastfeeding, it’s recommended to stay below 300 mg per day, although that amount can be too high when the baby is very young (young babies need to process, metabolize much more than adults). Even some older babies may be more sensitive to caffeine than others. If you notice that your baby seems jittery, irritable or awake in the middle of the night after drinking caffeine, you could consider cutting back.
Let’s talk more about energy drinks. Most energy drinks contain not only caffeine, sugar, and B vitamins, but also herbal ingredients that probably haven’t been studied during pregnancy or breastfeeding. This means that there is no information about how much of these ingredients may reach the developing baby during pregnancy or enter breast milk. For this reason, it may be best to hold off on energy drinks until you are no longer pregnant or breastfeeding.
2. Over-the-counter pain relievers
Two of the most common over-the-counter pain relievers are acetaminophen (such as Tylenol®) and ibuprofen (such as Advil®). These pain relievers are also found in multi-symptom products such as cold medicines. During pregnancy, short-term use of acetaminophen, when directed by a health care provider to treat pain or fever, has not been shown to increase pregnancy risks. Acetaminophen should be used as directed and only for as long as you need it to treat your condition. Ibuprofen, on the other hand, is usually not recommended in pregnancy, especially in the second half of pregnancy, unless your doctor has specifically advised against its use.
However, during breastfeeding, acetaminophen and ibuprofen can be used as directed without expected side effects for the baby. The amount of acetaminophen or ibuprofen that enters breast milk is much less than the dose that could be given directly to an infant.
3. Fish and mercury
You may have heard a rumor that eating fish is not a good idea during pregnancy. But this is not the case. While it’s true that most fish could contain some amount of mercury (or more specifically, a form of mercury called methylmercury), these amounts are often too small to increase pregnancy risks as long as you make careful choices about your fish consumption.
The amount of methylmercury in fish increases as fish move up the food chain. Large predatory fish that eat smaller fish usually have higher levels of methylmercury. These large fish include swordfish, marlin, bigeye tuna, and king mackerel, among others. These fish should be avoided during pregnancy and while breastfeeding.
Other types of fish can be enjoyed in moderation (1 to 3 servings per week, depending on the type of fish and where it is caught). The US Food and Drug Administration (FDA) and the United States Environmental Protection Agency (EPA) have developed a helpful guide that lists many types of fish and provides advice on how often they can be eaten by women who are pregnant or breastfeeding and by children ages 1-11: https://www.fda.gov/food/consumers/advice-about-eating-fish.
4. Cleaning Products
Is it better to use natural cleaning products like vinegar during pregnancy or while breastfeeding? What about when you have a small child at home?
How you use a cleaning product is usually more important than what the product is. Although using vinegar as a cleaner is not expected to increase risks during pregnancy or breastfeeding, there may be certain surfaces or situations that require more effective products for sanitizing and disinfecting. In order for a chemical to reach a developing baby during pregnancy or enter breast milk, the chemical must first circulate in your bloodstream. As long as a product is used in a well-ventilated area (open doors or windows, turn on fans) and your skin is protected from direct contact with the cleaner, then using the cleaner as directed is unlikely to result in exposure entering your bloodstream. If you start to feel symptoms, such as nausea, dizziness or headache, increase ventilation in the area and get some fresh air. If you use vinegar to clean, be sure not to mix it with ammonia or other chemicals, as this can create harmful fumes. With any cleaning product, follow the directions on the label for how to use and store it.
As for what types of cleaners are preferred when you have young children at home, this is a great question to discuss with your child’s health care provider.
5. Dandruff/Animal Feces
Common household pets such as dogs, cats and rodents tend to be furry. Although pet dander is not known to be harmful during pregnancy or while breastfeeding, dander can increase the chance of breathing problems if you have significant allergies or asthma. If you experience a worsening of allergy or asthma symptoms during your pregnancy, be sure to discuss this with your healthcare provider. It’s also a good idea to wash your hands after handling any kind of rodent, even sweet, furry, house pets.
What about animal droppings? It is best to avoid direct contact with animal feces during pregnancy. This means you get a free pass to clean the gerbils’ cage or pick up the litter box if possible. Cat feces, in particular, can contain a parasite that is responsible for an infection called toxoplasmosis, especially if the cat is allowed outside or is fed raw meat. A toxoplasmosis infection during pregnancy increases the chance of pregnancy complications and can even be passed on to the fetus. You don’t need to take your cat home or avoid petting her, but you should avoid direct contact with cat feces while you’re pregnant.
Closing Thoughts
Through our partnership with NDBN, MotherToBaby is committed to answering the real questions families ask—accurately, clearly and compassionately. We know that parents want the best for their babies and deserve reliable, evidence-based information to make informed choices.
If you or someone you know has questions about exposures during pregnancy or breastfeeding, you can contact a MotherToBaby expert for free and confidential information by phone, text or chat at MotherToBaby.org.
Together with NDBN, we will continue to listen, learn and support families when it matters most.
More about the National Diaper Bank Network
The National Diaper Bank Network (NDBN) leads a national movement dedicated to helping individuals, children and families access the basic necessities they need to thrive and reach their full potential… including clean, dry diapers, period supplies and other essentials. Launched in 2011 with the support of founding sponsor Huggies®, NDBN is dedicated to raising awareness of diaper need/insecurity and advocating for public policy to end it. The Network consists of more than 300 community banks serving local communities throughout the United States. More information on NDBN and diaper needs is available at nationaldiaperbanknetwork.organd it continues Twitter (@DiaperNetwork), Instagram (@DiaperNetwork) and Facebook (facebook.com/NationalDiaperBankNetwork).
