Posted in Pre-Parenting

Cord Blood Banks: Intro to Pros/Cons and Comparisons

Whether to do a Free Public Cord Bank or Paid Private Cord Bank for your baby’s umbilical cord blood comes up during prenatal care (and should be decided before delivery to guarantee access to desired collection kits).   Here’s a scientific, unbiased review of what it entails:

Free Public Cord banks usually collect only umbilical cord blood. Paid Private Cord Banks vary by company and offer up to 3 different tissue collection/storage: umbilical cord blood, umbilical cord tissue, and placental banking.  Umbilical cord blood contains hematopoietic stem cells that can become any blood cell (red blood cell, white blood cell, etc)-and could help treat blood diseases like leukemia among other things.  The umbilical cord tissue itself also contains mesenchymal cells, which can be isolated and turn into a broader range of cells, which is much more experimental undergoing early testing. (These cell types are slightly different from the “embryonic stem cells” often in the news that can become any cell type- but umbilical collection is less controversial as these limited stem cells are essentially trash if not collected, and do not harm the infant as they are collected after cord clamping from tissue that would otherwise be discarded.) Some private cord banks advertise placental banking– which contains mesenchymal stem cells, doesn’t have standard accreditation for collection methods, and doesn’t add additional advantage since cord tissue mesenchymal cells can be triggered to divide to make additional copies– so at this point appears less relevant.  

The American Academy of Pediatrics (AAP) recommends free public cord banking for all (rather than private banking).  For anyone who needs stem cell treatments, a public bank is the likely source of those cells (rather than a private bank of your own cells- since your cells likely have the same genetic error that caused your disease).   I will include their citations below, but the AAP also summarizes its stance well here:

  • “Public cord blood banks serve patients worldwide by matching individuals in need. Private banks store the cord blood for the donor family’s potential self use, although there is little evidence supporting this use unless a family shares a known genetic defect.
  • Donation to a public cord blood bank is free. Private cord blood banks charge a placement fee of $1,350 to $2,300 and an annual maintenance fee of $100-$175.
  • Public cord blood banks are highly regulated by oversight accrediting institutions. Private cord blood banks may not meet stringent requirements, which can cause cord blood to be of lesser quality.
  • The rate that cord blood stems cells are utilized from a public bank is 30 times higher compared with private cord blood banks. Yet more cord blood donations from ethnic/minority populations are needed to meet increasing need.”

Official AAP Summary: https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Encourages-Use-of-Public-Cord-Blood-Banks.aspx  

Detailed Nov 2017 Statement by AAP: http://pediatrics.aappublications.org/content/140/5/e20172695

Non-Medical Summary of AAP Stance: https://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/Pages/Should-We-Store-Our-Newborns-Cord-Blood.aspx

However, private stem cell banking might be recommended to you by your doctor if you have a rare genetic condition or atypical/unclear diagnosis (neurologic, autoimmune, or other) in yourself or your family that might change the cost/benefit analysis towards private banking (sometimes you may do a private stem cell bank of one child to help another family member as well).   Furthermore, those with more disposable income may consider private stem cell banking a biologic “safe deposit box” that could be useful to that infant or another family member in the future based on their own cost/benefit analysis.  

I’d reiterate that there are very few negatives to public cord banking– if you’re unsure I recommend you go with a public cord bank. Ask your doctor or hospital in advance if they affiliiate public bank, or find out more information to do a mail in donation here in case they do not: https://parentsguidecordblood.org/en/donationspot  or more general public donation information: https://parentsguidecordblood.org/en/donate-cord-blood)  

Picking a Private Cord Bank:

I had a medical reason my doctor recommended that I consider private stem cell banking, so I researched it further…and even being a doctor myself I struggled to wade through the primarily biased company information that surfaced in most Google searches.  (This is an unpaid, unbiased article: I don’t get any kickbacks for any private stem cell companies, nor does this constitute medical advice.) This article is meant to share what I’ve learned to help inform others: if you’ve found other useful links feel free to share with me in the Contact Us page!

Below I attempted to list reputable sources of stem cell science to inform your own cost/benefit analysis of private cord banking for yourself and your family.  This informative non-profit started by an astrophysicist who lost his child to leukemia is a good place to start: https://parentsguidecordblood.org/  Distilling that and other websites, I have references for common questions in the process below:

What diseases can be treated by stem cells?

Umbilical cord blood (hematopoetic) stem cell based treatments are mostly for blood cell cancers (leukemia and related diseases).  Treatment is done via allogenic transplant– meaning the patient is NOT the person who donated the cells; the autologous (self-transplant) supported via private cord donation does NOT occur for most diseases.  (Most private stem cell banks advertise that 80 diseases can be treated, but gloss over the fact your infant is not likely to benefit from their own stem cells in that case.)  This nonprofit link has a very detailed, unbiased chart of what is being treated currently and experimentally via stem cells (the “Autologous” Column of the first charts are what is especially relevant for private umbilical cord blood banking; whereas “Allogeneic” categories are typically from a public stem cell bank):

https://parentsguidecordblood.org/en/diseases

Umbilical TISSUE (mesenchymal) cells are even more experimental than the blood stem cells, and are not used for standard treatments.  Research is investigating their use for a range of diseases along side cord blood referenced at links below.

What areas of research suggest future potential treatments?

Self (autologous) and other (allogeneic) umbilical cord blood treatments are undergoing experimental testing for a range of diseases here (lower in the page at Diseases and Disorders that have been in Clinical Trials with Cord Blood or Cord Tissue Cells) :  

https://parentsguidecordblood.org/en/diseases

Umbilical TISSUE (mesenchymal) cells are even more experimental than the blood stem cells, and are not used for standard treatments, and only researched for non-self (allogeneic) transfers thus far (which is different than the autologous transplant most private blood banks would advertise for your newborn):

https://parentsguidecordblood.org/en/diseases

How do you assess/compare the value of private stem cell banks?

  • Accreditation
  • Availability of cell type storage you desire, and collection options
  • Company viability and long-term durability, storage facility location (free from national disasters, with backup systems etc) and reliability: Better Business Bureau reviews, etc  
  • Number of cell samples stored and number of transplants
  • Pricing (and any hidden fees)
  • Shipping, collection and storage methods
  • Affiliated labs, research, etc
  • Other guarantees

If there is more interest in those topics, I’d be happy to include much more on each of those areas above- please Contact Us if you’d like to hear more.  

I published this article in the meantime to inform/provide a framework for those curious or who might be on a timeline to decide for this topic before delivery!  Many sources say by week 28-34 is recommended to decide/research your wishes.  For private cord banking you need your desired company’s collection kit in hand to bring to the hospital in order to be sure to collect the stem cells (and often have to pay a $100-200 deposit before, which may or may not be refundable if you don’t collect).  If you look into this late like me–many companies will Express mail/Overnight this kit, often if at no cost to you if it is later in pregnancy; however, most hospitals don’t have private cord kits on hand or only limited offerings.  Companies happily staff their phones to answer questions since they want your business- so feel free to call and compare several to find what you want.

This unbiased government website provides more information on the timeline and process of cord collection (particularly for a free public bank): https://bloodcell.transplant.hrsa.gov/cord/options/donating/index.html

 

Posted in Parenting, Pre-Parenting

New AAP Plastic&Chemicals Recs: What to Do?

The AAP recently released a study and new recommendations warning against plastics for children and infants, including not using plastics in the microwave and dishwasher (even BPA-free plastics). They also included other warnings of chemicals in various food packaging and other sources.

As a sleepy new parent with a sleepy 3 month old in my arms, the plastic warning was especially concerning for her baby bottles (and plastic pump parts) and plastic sterilizing kits that used the dishwasher or microwave.  I’d like to delve more into the science, but  below are the actual AAP recommendations and the purchases I made to decrease the risk in the meantime. (These are unpaid, unbiased recs for items I got to keep my own family safe.) Your own research or input is always welcome at the Contact Us section!

AAP recommendations (directly from their source here):

  • Prioritize consumption of fresh or frozen fruits and vegetables when possible, and support that effort by developing a list of low-cost sources for fresh fruits and vegetables.
  • Avoid processed meats, especially maternal consumption during pregnancy.
  • Avoid microwaving food or beverages (including infant formula and pumped human milk) in plastic, if possible.
  • Avoid placing plastics in the dishwasher.
  • Use alternatives to plastic, such as glass or stainless steel, when possible
  • Look at the recycling code on the bottom of products to find the plastic type, and avoid plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless plastics are labeled as “biobased” or “greenware,” indicating that they are made from corn and do not contain bisphenols.
  • Encourage hand-washing before handling foods and/or drinks, and wash all fruits and vegetables that cannot be peeled.

My Purchases and Actions to Decrease Risks:

  • Boil materials to sterilize (?) rather then contaminate be microwave and dishwasher (but I do wonder about plastic contaminating my pots or leaching materials from pot chemicals…or if heating the plastic whatever way is the problem…I didn’t see a quick answer in the AAP report.  Regardless the CDC still recommends sterilizing bottles).  Picking a safe pot type: I use nonstick in general; however, for sterilizing I thought maybe it was safer to follow the Environmental Working Group (EWG) recs that cast-iron or stainless steel may be the safest material (although the $30 Made In China “stainless steel” pot I got from Amazon leached a chemical film on my bottles despite good reviews…paying more or purchasing from a reputable source or store is probably worth it if you’re replacing cookware!) AAP thoughts on non-stick pans:  Chemical PFCs like PFOA/PFOS are warned against by the AAP and can be in nonstick pans, especially before 2015. The chemicals in old nonstick pans and pots meant I replaced them, picking a mostly copper new nonstick pot similar to this from Marshalls…although I do wonder if it might have other variants of PFCs that still can cause harm.  Less scientific sources make claims of the safest cookware here or here, another slightly scientific chemistry-based source says “Overall all cookware made by reputable manufacturers using reputable coating systems is safe. One should only have concerns about low end low cost cookware made by unknown manufacturers.”   It can be tricky to know what is “best” though… Perhaps avoiding nonstick to pick a ‘purer’ boiling pot for sterilizing bottles would be best (like my stainless steel thought) as the AAP specifically says“Because of health and environmental concerns, US production of PFOS was phased out in 2002, and PFOA was phased out in 2015.107 However, these particular compounds are only 2 of more than a dozen members of the parent family. For example, closely related PFNA chiefly replaced PFOA; increasing PFNA concentrations were detected in the 2003–2004 NHANES and have remained stable thereafter.102“…In January 2016, the FDA banned the use of 3 classes of long-chain PFCs as indirect food additives.108 Yet, structurally similar short-chain PFCs, such as PFHxS, may continue to be used.”  In the very least, changing out my plastic bottle parts dishwasher rack for a purely silicone one might help…but I think I’ll avoid the dishwasher all together for sterilizing my plastic bottles and pump parts.  I still use it for the glass bottles and silicone nipples I bought below.  (I’m still in limbo of what seems best for sterilizing plastic parts, however!)
  • Buy glass baby bottles.  Evenflo brand is compatible with Medela pumps (as are Dr. Brown’s, Parent’s Choice at Walmart, and a few others, which I learned from the graphic for this product).  Evenflo glass bottles were relatively inexpensive on Amazon Prime for 4oz or 8oz (6 for ~$16), I purchased them and they’ve seemed durable and were made in Mexico. The nipples were silicone and milk only comes in contact with the silicone rather than the plastic cover and lid they still have.  Dr. Brown’s also sells glass bottles, but apparently only in the wide-neck version now that is not Medela compatible.  I also got a $6 Stainless Steel Parent’s Choice bottle from Walmart (sold in 5oz or 9oz), which still has a plastic lid but silicone nipple–being opaque makes it not as useful for pumping, but it is a non-breakable option for travel.  When I opened it had a heavy plastic/chemical smell (maybe from the packaging-but it made me wonder if such a cheap, Made in China version might have chemical issues and not be as good), but I haven’t noticed the smell as much after using the dishwasher…
  • Glass or Pyrex food storage for myself to avoid contamination of the microwave or dishwasher. After much trial and error I found some slightly more expensive glass&silicone only ‘Ultimate’ sets made by Pyrex (glass made in USA) that worked great and were much cheaper at Target, Williams Sonoma or sources than on Amazon (and less likely for the low-quality/false positive review/bait-and-switch error of other cookware I got from Amazon).  My searching process:  Well many Snap-on lids looked clear like glass and report a silicone seal, they are actually made of PP (polypropylene, #5) plastic–not the high risk#3,6,7 plastics the AAP warns against, but also still has unclear risks. My original compromise was to buy extra silicone lids to try, and not use the plastic lids or at least hand wash it and not microwave or dishwasher it. That opened many options of brands online of glassware storage with plastic lids/  After seeing reviews where even well reviewed ones would break, I originally chose to side with a reputable one like Pyrex; however, there were reports in Amazon of Pyrex breaking too, especially if they are in the cheaper ‘storage’ not the baking category and put in hot environments.  This set from Anchor Hocking is purportedly American made, but the lower quality plastic lids might not be (but in my selection I was less about the lid quality as I would try not to use the plastic lids; however, they arrived chipped and seemed cheaper than Pyrex so I returned them and don’t recommend!). There were also silicone containers that were more expensive but would be plastic free. They reportedly retain taste and smell more than others in reviews, and I’m not sure if low quality ones might have some contamination since silicone isn’t reported by the AAP (and apparently some silicone dyes might have issues). Generally pure silicone is safe for medical use, but I wasn’t sure quality online (it is generally endorsed as safe in not-super-scienc rticles). After much searching and some returns, I was happy with the Ultimate Pyrex Glass&Silicone only sets (available in many sizes and dishwasher safe and plastic free!), plus some extra flexible silicone lids filled the gap replacing old plastic lids I had (bonus those fit over multiple shapes and even foods and were dishwasher safe– replacing Syran wrap too).  
  • Silicone lids for food storage. These reportedly can fit on any container and I did not notice them on the AAP negative list. This could be an alternative to plastic for covering the glassware, and I ordered these to give it a try. They have been good so far and are reportedly dishwasher safe, although they are a Chinese company.
  • Got rid of old Tupperware and cheap baby plates once I knew my replacement worked well. This would help avoid my habit of putting them in the dishwasher or microwave, but others may be happy just keeping them and washing by hand if they are concerned. I wasn’t actually sure if my Tupperware was BPA free on reflection since it was quite old. I also reevaluated whether my current silverware was safe has a left metal marks on my bowls and it was cheap from Marshalls-I may get new stainless steel ones and do the Montessori approach of real glassware instead of plastic for kids &not my bpa-free plastic I got from Ikea once my baby starts on foods.

Lots to think about!  Those were things I ordered after a sleepless night researching and reading the AAP Recommendations.  They have a lot more in the article that is worth looking over the science and safety (I included some more relevant quotes from them below).  Hopefully I can look into more soon!

Summary of Other Chemicals and Risks relevant quotes from the AAP Article:

“The potential for endocrine system disruption is of great concern, especially in early life, when developmental programming of organ systems is susceptible to permanent and lifelong disruption. The international medical and scientific communities have called attention to these issues in several recent landmark reports, including a scientific statement from the Endocrine Society in 2009,42 which was updated in 2015 to reflect rapidly accumulating knowledge3; a joint report from the World Health Organization and United Nations Environment Program in 201343; and a statement from the International Federation of Gynecology and Obstetrics in 2015.44 Chemicals of increasing concern include the following:

  • bisphenols, which are used in the lining of metal cans to prevent corrosion45;

  • phthalates, which are esters of diphthalic acid that are often used in adhesives, lubricants, and plasticizers during the manufacturing process17;

  • nonpersistent pesticides, which have been addressed in a previous policy statement from the American Academy of Pediatrics and, thus, will not be discussed in this statement46;

  • perfluoroalkyl chemicals (PFCs), which are used in grease-proof paper and packaging47; and

  • perchlorate, an antistatic agent used for plastic packaging in contact with dry foods with surfaces that do not contain free fat or oil and also present as a degradation product of bleach used to clean food manufacturing equipment.48

Additional compounds of concern discussed in the accompanying technical report include artificial food colors, nitrates, and nitrites.

Environmentally relevant doses (ie, low nanomolar concentrations that people are likely to encounter in daily life) of bisphenol A (BPA)4 trigger the conversion of cells to adipocytes,9disrupt pancreatic β-cell function in vivo,49 and affect glucose transport in adipocytes.911Phthalates are metabolized to chemicals that influence the expression of master regulators of lipid and carbohydrate metabolism, the peroxisome proliferator-activated receptors,21with specific effects that produce insulin resistance in nonhuman laboratory studies. Some studies have documented similar metabolic effects in human populations.22 Some phthalates are well known to be antiandrogenic and can affect fetal reproductive development.18,19,50 Authors of recent studies have linked perfluoroalkyl chemicals with reduced immune response to vaccine27,28 and thyroid hormone alterations,29,51,52 among other adverse health end points. Perchlorate is known to disrupt thyroid hormone34 and, along with exposures to other food contaminants, such as polybrominated diphenyl ethers,5355 may be contributing to the increase in neonatal hypothyroidism that has been documented in the United States.56 Artificial food colors may be associated with exacerbation of attention-deficit/hyperactivity disorder symptoms.57 Nitrates and nitrites can interfere with thyroid hormone production40 and, under specific endogenous conditions, may result in the increased production of carcinogenic N-nitroso compounds.37,38

Other Resources (often summarizing AAP recs in layman’s terms):

Initial AAP News Release:

https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Says-Some-Common-Food-Additives-May-Pose-Health-Risks-to-Children.aspx

Other related articles:

https://www.simplemost.com/american-academy-of-pediatrics-issues-new-warning-about-putting-baby-bottles-and-bowls-in-the-microwave-and-dishwasher/

Posted in Pre-Parenting

First Trimester Prenatal Screening: Science and False Positives

Around weeks 9-12 in your first trimester, people commonly screen the fetus for extra chromosomes via 1) the standard first trimester screen for maternal blood markers (HCG, PAPP-A), or 2) the relatively new more sensitive NIPT (Non-Invasive Prenatal Test) fetal DNA sample from maternal blood (cell-free DNA). There is a fabulous review of both options by a scientifically minded chemist mom at Infertilechemist.com

Note: These are all screening tests- meaning most patients will have a negative result (and thus low risk of abnormality); however, false positive rates can be 5% or more—so if you test positive, it doesn’t necessarily mean your baby has the abnormality, but that more testing may be needed.  If you happen to get a positive result, there is more information for you at the end of the article.  

(As always, this article does not constitute medical advice, and you should discuss all questions, risks and benefits to make a decision with your personal medical care provider.)

Standard First Trimester Screen (HCG/PAPP-A):

Basically the HCG/PAPP-A maternal blood test will risk stratify you for Down Syndrome (and to a limited degree, Trisomy 18), and is typically drawn around 9-10 weeks gestation (but up to 13weeks 6days).  This blood test may be part of a “combined test”, including an ultrasound of nuchal translucency (around 10.5 to 13.9 weeks) to assess for increased thickness behind the neck (>3-4mm in some studies) which can be associated with Down Syndrome or other birth defects.  ”The combined test detects approximately 85 percent of Down syndrome (ie, detection rate [DR] = sensitivity = 85 percent) with a false positive rate (FPR) of 5 percent” (UptoDate.com)–however this rate of detection varies upon pre-test risks like patient age.  Babies with Down Syndrome have high Beta-HCG (Human Chorionic Gonadotrophin, a common pregnancy marker) and low PAPP-A (Pregnancy-Associated Plasma Protein-A).   Babies with Trisomy 18 (an often fatal defect of three copies of chromosome 18) have very low beta-HCG and very low PAPP-A.  Studies of screening efficacy for Trisomy 18 via first trimester screening are more limited as the condition is more rare (1 in 6,000 births, with many spontaneously dying in utero), suggesting somewhere between 60-91% detection in small studies (NEJM 2003, Lambert-Messerlian et al, 2004).

The ACA: Affordable Care Act (Obamacare) currently requires coverage of most prenatal care (often with no copay- but check with your insurance).  In California, I was told the benefit of doing this test alone is that if it is abnormal there is a state fund to cover your amniocentesis or related prenatal care for free (which might save you money in that case based on your specific insurance).  This test also tends to cost less than NIPT–however, HCG/PAPP-A alone is much less accurate.  If your insurance only covers HCG/PAPP-A, you can see if a nuchal translucency ultrasound (the “combined test”) might be part of your coverage to increase sensitivity.  Those who are higher risk (older moms etc.) might consider any extra cost of the NIPT to be worth it (and insurance may also cover the NIPT for higher risk patients).  Again, check with your current insurance as you might not pay much more for the more sensitive NIPT test.

NIPT (Non-Invasive Prenatal Test) of a fetal DNA sample from maternal blood (cell-free DNA):

NIPT (cell free DNA, cfDNA) is much more sensitive and specific than the traditional first trimester blood screen (cfDNA detects 98-99% of Down Syndrome versus just ~85% with the traditional “combined test”).  Furthermore, cfDNA screens for a wider set of conditions: Trisomy 21 (Down Syndrome), Trisomy 18, Trisomy 13 and Sex Chromosome duplication/deletions.  cfDNA screening works by detecting the small amounts of fetal DNA present in maternal blood, and is typically done via maternal blood draw anytime after weeks 9-10 (with no end date).  Test results come back in about 2 weeks or possibly less depending on your lab.  (Some people enjoy the extra benefit that it tells you fetal sex earlier than ultrasound as well.)

UptoDate Reprint of: Performance of cell-free DNA screening for trisomy 21,18,&13

Disorder Studies Cases DetectionRate (%) False Negative Rate (%) Controls False Positive Rate(%)
Trisomy 21 31 1587 99.4 0.6 146,757 0.1
Trisomy 18 24 444 97.7 2.3 146,496 0.1
Trisomy 13 16 85 90.6 9.4 134,606 0.1
All three* 98.5* 1.5 0.3

DR: detection rate (or sensitivity); FNR: false-negative rate (1-sensitivity); FPR: false-positive rate (or 1-specificity).

* Weighting is by the disorder’s prevalence in the late first trimester of pregnancy (approximately 10:2:1).

Data from the article: Mackie FL, Hemming K, Allen S, et al. The accuracy of cell-free fetal DNA-based non-invasive prenatal testing in singleton pregnancies: a systematic review and bivariate meta-analysis. BJOG 2017; 124:32.

The only downside for this more sensitive NIPT test is that the list price for cfDNA testing is often higher than HCG/PAPP-A–however, do check your specific insurance for coverage and out of pocket costs for this test.  Obamacare requirements might make it covered for you, and especially being 35 or over (AMA: advanced maternal age) might help get this test done for free or little cost.  In my case, my OB/Gyn recommended to the NIPT test alone (without the HCG/PAPP-A test) and added the nuchal translucency ultrasound for more accuracy.  I am 35, but had no co-pays for either test.

If you get an Abnormal cfDNA Screening Test:

Most people will have negative results, thus putting you at low risk for any trisomy or abnormality.  However if you do get a positive result I does not mean your fetus definitely has it. OB/Gyns see positive results rarely, so they may not realize the exact statistics for a positive finding in your case.  If you’re one of the rare people who gets a call with an abnormal results:

  • Ask what brand the cfDNA test was and go to this website for more information of your actual risk: http://www.med.unc.edu/obgyn/Patient_Care/specialty-services/maternal-fetal-medicine/nips_calc.html
    • The relevant calculation for you on this website is the PPV: Positive Predictive Value, which tells you the percent chance your positive result is a “true positive”, aka the fetus actually has the chromosomal abnormality. This can be somewhat reassuring especially for chromosome 18 or 13, where a positive results have just a 11 to 35% chance of actually having the abnormality.   Please note that if your results are negative, this chart is not relevant to you, except to show you your background risk for abnormality based on your age.
  • In addition to that, if you do get a positive result screening from either test:
    • Ask for both a nuchal translucency ultrasound and perinatology consult referral, if this has not been ordered already.  The nuchal translucency ultrasound for a chromosomal or other abnormality is typically done around weeks 10.5-13.9 of the pregnancy and helps further stratify risk. Perinatologists are extra fellowship trained Ob/Gyns who interpret ultrasound results and also tend to get involved if there is a chromosomal abnormality.
    • Ask for a referral to a genetic counselor, who should have more specific information on your specific risks and testing options as well.
    • Talk with your provider about whether a CVS: Chorionic Villus Sampling (~10 to 13 weeks) or Amniocentesis (typically after 14 weeks gestation) can confirm the finding as needed.  Often they can begin the referral process for that now to help minimize the delay of insurance processing for what can be time sensitive procedures.  The cell samples from these invasive procedures can be confirmatory for fetal genetic testing via FISH (a rapid fluorescent probe on chromosomes in ~48hrs-72hrs) and full karyotype analysis (which images and counts all fetal chromosomes, typically taking 2 weeks).  Risks of miscarriage or other complications of these invasive procedures should be discussed by your Ob/Gyn.
    • Based on the results of the follow up testing, your provider can further counsel on the likelihood of the screening test being a true positive and further treatment options.

Screening tests have reached new advances in recent years, particularly with the NIPT cell-free DNA screens.  Sometimes screening can be stressful, but hopefully this helps calm and inform during this process.

Posted in Pre-Parenting

Free Baby Registry Gift Boxes from Amazon and Target

Both Target and Amazon offer free gift boxes when you create a Baby Registry there.  I have yet to find other registries that still do free boxes…and while there are more important reasons to pick a Registry location (ease, it having items you want, relevant discounts)– Free stuff is always fun!  

Below is more info on what you can get (and the relatively low effort ways to qualify).  You can still qualify for the free items even if your registry is still set to private. (This is an unpaid, unbiased review.)

Target Free Baby Registry Gift Bag ($50-60 value with coupons):

Getting a free gift box from Target is pretty easy.  After you sign up for the Baby Registry online, it recommends that you go to the store Customer Service to pick up your welcome bag.  The store I went to was really mellow and didn’t even ask for my name or registry info, and just handed me the nice small bag which they say has about a $50 to $60 value of samples and coupons.  (You can similarly get the bag by doing the registry there in store.) The samples will vary by store, but for me the bag included: 1 Avent baby bottle (4oz, with newborn nipple), 2 different pacifiers,  6 diapers of various brands (size 1), 6 wipes, 2 milk storage bags, 2 disposable breast pads, and some various other small samples of toiletries & lotions.  There are also many useful coupons for the Target store including a buy one get one free Starbucks drink, 10% off certain nursing bras or maternity apparel, and coupons for the samples and other brands. (Detailed list of items at the end of the article for the curious.)

Overall this Target gift bag was very low effort, and had some useful things.  Several coupons are samples could be useful in the during pregnancy too (coupons for maternity clothes, bras, lotions etc) so feel free to get this whenever.  It also doesn’t take up much space, has many items that you might want bringing baby home, and helps you try a few different disposable diapers before buying a larger supply.

20171107_170108Target Baby Registry Free Gift Items & Coupons.20171107_165431

 

Amazon Baby Registry Welcome Box ($35 list value of items):

Getting the Amazon Gift Box takes a few more steps than the Target one, but for me it contained a few bigger items that made it worth it.  Valued at $35, it contained:  1 nice muslin baby swaddle blanket, a onesie (size 3 to 6 months), a Fisher Price teething toy, 4 disposable diapers (various brands), 2 sets of disposable nursing pads, and a few sample baby wipes, toiletries and lotions.  Coupons were more limited, but did include a: $30 coupon for Lolli Living or Living Textile item.  (You’ll see various reviews online that Welcome Box contents can really vary-some people were unlucky and got basically an empty box with a vitamin water- but it seems like the majority of recent reviews reflected a box like mine. Although I wouldn’t recommend paying for it if you didn’t get it for free :P) 

20171114_205259

To qualify for the Amazon Baby Registry Welcome Box, you must:

  1. Be an Amazon Prime Member (Prime Student counts for this).
  2. Sign up for the Baby Registry and complete the “Baby Registry Profile” by either selecting items from each category or, more quickly, just checking the box of each category that suggests it’s complete (you can easily add more items later).
  3. Order $10 worth of stuff from the registry (they do not restrict the Registry to baby-only items, and you can be the one who buys it).  

Once you’ve done all that and your $10 of items ships, your top “Welcome Box” menu section will show all requirements as checked and tell you how to add it to your cart for free (no shipping or other charges).  (Please note, your box will be obviously marked on the outside “Baby Registry”, so if you want it a secret be selective of where you ship it.)

If you have any problems with getting the box, Amazon FAQ has more information here:   https://www.amazon.com/gp/feature.html?docId=1003000081  

This website has some screenshots of the older Amazon version that at least give you some idea:  http://www.mysubscriptionaddiction.com/2016/05/free-amazon-baby-welcome-box.html  

Or for more inspiration, rather than info– here is an article with pictures of the range of items people have gotten in 2017: http://hip2save.com/2017/10/31/free-amazon-baby-welcome-box-filled-w-wipes-diapers-blanket-bottle-more-35-value/ 

Full List of Free Baby Items November 2017 (for the especially curious).

Target Gift Bag (in a small reusable bag to hold it all):

  • 1 Avent baby bottle (4oz, with newborn nipple: level 1 of flow, BPA free)
  • 2 different pacifiers: MAM newborn pacifier (BPA free), & 0-6 month NUK orthodontic pacifier (BPA free)
  • Disposable Diapers (5 total): Pampers cloth diaper holder with 1 diaper (size 1) and 6 sensitive wipes; 2 Honest Company diapers (size 1), 2 Babyganics diapers (size 1)
  • Lansinoh brand: 2 disposable nursing pads and 2 breast milk storage bags
  • Lotion and Toiltries Samples:  
    • Dove baby body wash sampler (1.8 oz)
    • Aveeno Baby daily moisture lotion (1 oz)
    • Palmer’s Cocoa Butter Oil sample packet (for stretch marks)
    • Aquaphor healing ointment skin protectant packet
  • Coupons (valid only at Target):
    • Buy-one-get-one Free Starbucks beverage (only in Target store)
    • 10% off nursing bra: Gilligan and O’Malley, Basics by Bravado designs, or Medela brands
    • 10% off maternity apparel purchase from Isabel Maternity by Ingrid and Isabel, excludes clearance items
    • $5 off one boppy total pillow (maternity pillow only)
    • 20% off Cloud Island baby item (Target’s common brand for nursery items, blankets, etc.)
    • $25 off any Honest Co. product when you spend $50 or more: includes Honest diapers, wipes, diaper cream, infant formula, backpack, lotions or shampoos
    • $10 off when you spend $35 on Honest Co. beauty products including makeup, face gel and cleanser
    • $5 off purchase of any Babyganics Ultraabsorbent diaper box (priced at $24.99 or higher)
    • $5 off your purchase of Step diapers
    • $1.50 off Pampers swaddler diapers (excludes travel size)
    • $1.50 off any one Aquaphor baby ointment
    • $1 off any one Dove baby product (excludes travel sizes)
    • $1 off Palmer’s Cocoa Butter Skin Therapy Oil

Amazon Baby Registry Welcome Box:

  • 1 muslin baby swaddle blanket
  • Onesie (size 3 to 6 months)
  • Fisher Price teething toy
  • 2 Huggies disposable diapers (size 1)
  • Small Seventh Generation pack including: 2 sensitive skin diapers, 2 Free and Clear Laundry Detergent packs, 2 sensitive skin wet wipes, one Coconut care lotion (0.5 oz) and related Coupons.
  • 10 WaterWipes brand baby wipes
  • Baby Dove Body Wash sample (1.8 Oz)
  • Tiny samples of various facial moisturizers and cleansers, 1 additional baby wipe.  
  • Coupon:  $30 coupon for Lolli Living or Living Textiles items (purchase of $50 or more)

Good luck, and enjoy the free goodies!

 

 

Posted in Pre-Parenting

Morning Sickness Mastery: Science & Other Tips to Feel Better

Morning sickness (also known by its medical term “NVP: nausea and vomiting during pregnancy”) affects around 50-75% of pregnancies, particularly during the first trimester.  Typically it begins around six weeks since the last menstrual period, and “…peaks at approximately 9 weeks of gestation. 60% of cases resolved by the end of the first trimester, and 91% resolved by 20 weeks of gestation” (NEJM 2010).

Morning sickness severity varies significantly, but regardless it is usually a very uncomfortable experience (and definitely not confined to the morning).  If you do suffer from it, perhaps you’ll feel slightly better that  research suggests it’s linked to a decrease risk of miscarriage-possibly because of higher pregnancy sustaining HCG hormones (JAMA 2016).   (If you do not have morning sickness though consider yourself lucky and don’t worry!) Realize there are a range of medications that can help, so definitely talk to your health care provider as needed–especially if you fall on the spectrum closer to the 1% of patients with hyperemesis gravidarum with continuous vomiting and significant dehydration!

For those trying to do home remedies- read on!  

First, we’ll discuss the few research driven morning sickness remedies.  Then, as many morning sickness home treatments aren’t studied (NPR)-we’ll also discuss many options for food/behaviors that are low risk but might benefit you to feel better sooner.  

(Please note, none of our articles constitute medical advice:  always confer with your personal health care provider regarding any specific remedies or treatments for your pregnancy.)  

Research Driven Treatments:  

2002 Cochrane Review suggests Vitamin B6 to be effective and acupressure equivocal.  Ginger has been studied more recently, and is shown to lower nausea and have no negative side effects.  (More study details below for the curious.)

  • Vitamin B6 (aka Pyridoxine): Generally considered effective.
    • A 1995 Ob/Gyn RCT (randomized, controlled trial) showed statistically significant reduction of nausea, and a decrease in vomiting (although not statistically significant) with 30mg daily of Vitamin B6.  Future studies have commonly used Vitamin B6 as a positive control to compare other treatments.
    • Talk with your Ob/Gyn for the latest dosing and recommendations- some prenatal vitamins incorporate higher Vitamin B6 dosing, or it can be found in over the counter supplements like Preggie Pop Drops.
  • Ginger:  Likely helps nausea, no evidence of harm.
    • 2005 ObGyn Systematic Review suggests 4 of 6 RCT studies showed ginger superiority over placebo for nausea and vomiting; in 2 of 6 ginger was as effective as reference drug (vitamin B6).  No adverse effects reported.
    • A 2014 systematic review of 12 RCT showed statistically significant improvement of nausea compared with placebo; no statistically significant reduction of vomiting although there was a trend towards improvement.  No increased risk of miscarriage or side effects.  Lower dose of ginger (under 1500mg/day) was possibly more effective.  The study reports:  “Ginger could be considered a harmless and possibly effective alternative option for women suffering from NVP”.
  • Acupressure/Acupuncture: Possibly effective- mixed results, but no obvious harm.
    • Studies focus on the P6 acupuncture region of the wrist, shown in this image.  
    • Acupressure effect on P6 was equivocal in the 2002 Cochrane review.
      • Various nausea bands target the P6 point with acupressure (~$8 or $16 on Amazon) – likely with few risks for most.  (However, I avoided them due to concern for worsening carpal tunnel- a condition pregnancy can already make worse.)
    • Acupuncture might be more effective.  A 2002 RCT shows reductions of nausea or retching with general treatment by an acupuncturist (placebo effect might contribute-but regardless people felt better).  Further details here.  

Morning Sickness Hacks:

 Morning sickness can be hard to deal with–it’s good to have a long list of options.  Considering risks vs benefits, many options for food/behaviors are low risk but might benefit you to feel better sooner.  

Here are some compiled hacks for managing morning sickness on your own (feel free to try and adapt anytime!)  

  1. Eat early and often with small bland meals
  2. Stay hydrated
  3. Time your eating to minimize symptoms
  4. Try ginger, lemon, and other things that help your symptoms
  5. Plus, some extra things I found helped me (feel free to Contact Us to add more!)

More details–

1) Eat early and often with small bland meals.

  • Have a snack pack by your bed of foods that help to eat when you first wake up (crackers, dry cereal like Cheerios, ginger candies, watermelon Jolly Ranchers, etc.).  Ditto for making a similar one for your car, your purse, etc. 
  • If you’re starting to feel early signs of nausea, usually eating a little something helps!  (Really counterintuitive, but it works!)
  • Try combining protein with simple carbs when you eat- like peanut butter and crackers, or cheese and apples, or whatever you can tolerate…
  • Your baby will still get enough nutrients even if your diet is restricted, just try to make sure to get your prenatal vitamins.  (If regular prenatal vitamins are hard on your stomach, talk to your ObGyn for different brand or try gummy ones like this.)

2) Stay hydrated

  • Have ways you can drink while staying in bed- some swear by the Camelbak or just a long straw.
  • Cold things are easier to keep down. I invested in a 40 oz. steel water bottle (with straw lid) that keeps things cold for 24 hours and kept that with me at all times (example here).  Also doing popsicles, particularly lime popsicles worked for me.
  • Generally 1 oz per kilogram per day of water is recommended for pregnant women- about 80 oz for many of us (aiming for two 40oz bottles a day helps keep track).  You have to balance this with how often you have to pee, especially early on. To save bathroom trips, you can also drink earlier in the day and cut back the last two hours before bed.
  • If even water makes you nauseous:  Trying cold water helps, perhaps trying a filter or bottled water. Putting lemon or lime in the water can really help too.  I tended to do fresh lemon or lime only in a bottle or glass I could fully wash to avoid sensitive tastes.  Plus there’s trying flavored drinks or water-rich foods like soup, popsicles, or fruit etc if you can handle it.
  • Avoiding drinking while eating food–sometimes the stomach distension makes you more nauseous, so you can try spacing eating from drinking if needbe.  
  • Try even just one or two sips at a time. This can help even if you’re getting nauseous with water alone.
  • Lemonade or juice can be easier to tolerate if water makes you feel sick. Combining with a salty snacks such as potato chips or crackers also seems to help.
  • Trying Ginger in water or other things, and leaving a pitcher of that mixed in the fridge might be helpful.
  • Certain people like teas or other drinks, however do be careful with some herbal teas that might have a mix of things that aren’t recommended in pregnancy (check with your Ob/Gyn).  Also, make sure to not get over the 200mg/day recommended maximum of caffeine during pregnancy.  

3) Time your eating to minimize symptoms.

  • Symptoms can be worse at certain times for various people, mine were worse in the afternoon or evening. You can try eating certain foods when you’re less sensitive to nausea. (Salads for breakfast became my only way of getting vegetables for awhile.)
  • Getting hungry can make you feel more nauseous, so eating at regular intervals really helps–even if you don’t feel hungry.  (If you’re concerned about eating too much with this snacking, you could measure out chips or snacks in advance so you know how much you’re getting. The Academy of Nutrition and Dietetics suggests you don’t need extra calories in the first trimester, and typically only 340 more calories/day in the second trimester–most people don’t have to watch this too closely though.  Feel free to talk to your doctor for any concerns–many people with bad morning sickness don’t gain weight or even lose weight during that time so it’s not a big concern.  Again, your baby will still get enough nutrients even if your diet is restricted by nausea (especially in the first trimester), just try to make sure to get your prenatal vitamins. 

4)  Try ginger, lemon, or other things that help your symptoms.

  • It can be hard to know what you can eat sometimes–try things in small portion with just one taste at a time. You can try smelling it first and see if it makes you feel bad, and then a slight taste. If your symptoms are mild that’s usually enough to warn you whether it will make you sick to try eating a whole thing.
  • Some common things people say help (compiled from various online resources):
    • Ginger: Ginger, lemon, apple cider is a combo people sometimes swear by.  Or trying ginger candies or ginger-infused drinks.  
    • Lemons or citrus:  mixing lemon with water, or some people swear by lemonade with potato chips.  
    • Vitamin B6 supplements/candies (see research section above).  
    • Ginger or peppermint teas: however do be careful with some herbal teas that might have a mix of things that aren’t recommended in pregnancy (check with your Ob/Gyn), or a few are caffeinated– 200mg/day recommended maximum of caffeine during pregnancy.  
    • Motion sickness bands:  possibly effective, see science section above.  
    • Crackers/saltines
    • Bananas
    • Baby food or applesauce
    • Protein anyway you can get it- scrambled eggs, cheese sticks, etc.
  • Also, first trimester bloating and constipation is real! Mixing in fiber-rich foods can help with some symptoms since constipation can sometimes make nausea worse.  (Oatmeal, chia or flax are especially good bland sources of fiber.)  Talk with your doctor if you need something to help with constipation.

5) Plus, some extra things I found helped me: (Everyone is different, feel free to Contact Us to add more!)

  • Keep things bland and repetitive- it’s ok if you stick with foods you know you can eat for awhile (just keep taking your prenatal vitamin).
  • Avoid strong smells if they make you nauseous– keep windows open for fresh air or consider even taking a walk.  Consider buying fragrance free soaps and lotion if you need to.
  • Taking your prenatal vitamin at night if that helps you feel better (sometimes the iron in it can increase nausea). I also did gummy prenatal vitamins for awhile to lower nausea.
  • You can use an App to track nutrition if you’re really concerned about it (I have some I’ve reviewed in a separate article).  However, for the most part it isn’t necessary and your baby is getting what it needs with the prenatal vitamin.
  • Even if you can’t eat vegetables, trying fruit that sounds good can get you similar nutrients (some easier to eat fruits seemed to be: cantaloupe, kiwis, bananas or apples),
  • Incorporate fiber via chia seeds in juice, or plain oatmeal with some flax added and fruit for breakfast.
  • If brushing your teeth makes you gag, try using mouthwash more often.  (There’s also a recommended mix of baking soda and water to avoid tooth erosion if you vomit a lot too.)  Dental hygiene gets even more important with the changes of pregnancy.
  • If you swim for exercise, but the chlorine smell of the pool makes you sick like me–chlorine reducing shampoo really helps.  Ultraswim brand was inexpensive and worked for me, plus had the benefit of being on Amazon since it was hard to find in local stores.
  • Additional (kind of random) foods that worked for me:
    • Popsicles or Smoothies with frozen fruit.
    • Salty things like potato chips, or Gatorade (but I still didn’t find a good non-dye Gatorade substitute)
    • Ginger ale:  Trader Joe’s version didn’t have many artificial colors or flavors
    • York Peppermint Patties
    • Bagels with cream cheese
    • Cheese sticks
    • Bush’s Baked Beans (also has lots of fiber)
    • Eggs scrambled with cheese and tomatoes only
    • Beans and rice with lime and cilantro (was great, until it absolutely wasn’t)!
  • Foods you like/can eat become highly individual, so feel free to try and keep adapting what works for you!

BEST OF LUCK!!  The aim was for an All-in-One source to help with your morning sickness symptoms.  Feel free to Contact Us with any updates or tips that worked for you.

Additional sources for some of the tips above, plus additional helpful links:

Recipes for nausea: http://www.whattoexpect.com/pregnancy/eating-well-menu/nauseated.aspx

Good all around morning sickness and other hacks: https://www.babylist.com/hello-baby/life-hacks-for-pregnancy

Morning sickness specific remedies: https://www.babble.com/pregnancy/morning-sickness-remedies-nausea-during-pregnancy/

General pregnancy hacks, including clothing, morning sickness, etc: https://www.buzzfeed.com/morganshanahan/pregnancy-hacks-that-will-change-your-life?utm_term=.ou9jnD55Y#.luRGm0NNd

 

 

Posted in Parenting, Pre-Parenting

Lead Risks and Testing

Flint, Michigan brought awareness to the risk of lead exposure–raising the question whether we should be testing for lead?  Lead is an odorless, tasteless material that can be found in paint (before 1978), water or other sources, which can cause serious neurological, behavioral, or health issues in children or adults.  (Breathing or swallowing lead paint dust can provide exposure without you even knowing it.) The American Academy of Pediatrics (AAP) says there is no safe level of lead and calls for stricter regulations and testing.

You’re at high risk for lead exposure effects if: you’re planning to become pregnant, already pregnant or nursing, or have young children at home (under the age of 6).  Young, rapidly growing fetuses or children incorporate lead more readily, but lead can affect everyone depending on its levels.  Lead testing is useful anytime if you are at risk–find out more about risks and testing below.  

Lead in Paint:

Lead paint was banned In 1978, so newer homes are generally safe.  Lead exposure is highest in older homes that have chipping or degrading paint, dust released by opening or closing doors/windows with lead paint, or soil that accumulated lead over time.  (More details of other risks from the EPA here).  For home testing, the EPA approves several lead paint tests kits, including 3M Lead Paint Sticks (8 for ~$24 on Amazon).  If the 3M Lead tests are positive/inconclusive, or your house is high risk: you can check the EPA for certified lead testers or google “lead testing” in your area to find companies that provide testing and hopefully piece of mind (~$250+ depending on your home/location).  

If you find you have lead paint: there are several ways to mitigate risks detailed by the EPA, including regular dusting, wiping areas with wet cloths and avoiding disturbing lead paint etc.  If you have lead paint, doing any renovations requires a certified lead specialist (as it can stir up more lead dust and increase your exposure risks)- find out more on the about renovations from the EPA here.

Lead in Water:

Lead in water is especially high risk when using water to mix infant formula, or for pregnant women or young children (under the age of 6).  The EPA regulates lead levels in tap water to a maximum of 15 parts per billion (ppb) (which is believed not to raise lead levels in adults); however, despite these EPA rules there are several recent cases of high lead levels in Flint Michigan, or even school drinking fountains across San Diego. Even if city systems are tested and regulated, the CDC warns that lead can still get to your tap by water mains connecting to your house or older piping within your house (especially in houses built before 1986).   If you are concerned, you can bring a sample to an EPA certified lab for lead testing (using a certified bottle to collect the first sample in the morning from home sources).  I chose an EPA certified lab that was $25/sample rather than paying ~$15/sample for less accurate home test strips (home test kit reviews aren’t great).  For more testing info check out these links: from the EPA, info about collecting sample tips, San Diego specific testing info here (or find EPA approved laboratories by searching here or googling your own city). 

If you find you have lead in your water: the CDC has detailed tips for lead mitigation here (including running the tap on COLD for certain amounts of time before drinking, etc.)  Some people opt for water filtration systems attached to your faucet (however, I had difficulty finding exactly how much lead was removed by various systems).  Some people opt for bottled water.  The FDA regulates bottled water, setting maximum lead levels to 5ppb in bottled water vs 15ppb EPA regulation for tap water (however, many internet articles suggest FDA bottled water regulation might be more lax than desired–bottled water can be just tap water and might have less regular testing).  The FDA discusses bottled water regulation here, and the CDC has some limited tips here.  Some people bring up concerns about plastic levels (or BPA) in bottled water, which may be addressed in a future blog post.  

Blood Tests for Lead:

Lead is tricky to detect once it gets in the body because it creates an equilibrium of lead storage in bone versus other tissues like blood (and adults may not display obvious symptoms).  Lead blood test levels alone don’t fully rule out lead risk in adults (and environmental testing of lead paint, water etc if indicated is highly encouraged).  

Pregnant or Lactating Women: Beyond present environmental lead exposures, pregnancy or breastfeeding can also release old lead from bones due to increased bone turnover (especially with low calcium or anemia).  Lead is transmitted across the placenta and found in fetal brains as early as the first trimester.  While the American College of Obstetrics and Gynecology (ACOG) doesn’t recommend routine blood lead screening for ALL pregnant/lactating women–  with EVEN ONE lead exposure, ACOG recommends Lead Screening for Pregnant or Breastfeeding women.  (Full EPA lead exposure list here; full ACOG recommendations here for testing and treatment; additional CDC 2010 information here.)

Infants and Children:  Basically if you have known environmental exposure to lead, earlier or more frequent blood testing may be indicated tell your Pediatrician about specific lead exposures/risks to get lead blood testing.   (Age 6-12 months can be marked by rapid lead absorption- and all children under 6 years old are at increased risk for lead effects because of their small body size, higher percentage body water, rapid growth, and increased risk for lead dust/paint ingestions.)   Officially, the American Academy of Pediatrics (AAP) recommends a lead “risk assessment at the following well-child visits: 6 months, 9 months, 12 months, 18 months, 24 months, and at 3, 4, 5 and 6 years of age. The recommendation is to do a risk assessment, and do a blood lead level test only if the risk assessment comes back positive.  According to the AAP and CDC, universal screens or blood lead level tests are not recommended anymore except for high prevalence areas with increased risk factors as described in a 2012 CDC report, such as older housing.”   However, as many Medicaid-eligible patients are higher risk, the AAP may recommend standard screening Blood Lead Level at age 1 and 2 years for all Medicaid patients, depending on your state.  Further AAP lead information hereSummary: bring up any concerns (like older housing) to your Pediatrician to warrant blood lead testing.

If there is lead in the blood lead test:  Blood lead level under 5 micrograms per deciliter is generally considered low-risk; however, because lead is stored in bones and other areas it cannot be fully ruled out.  Known environmental exposures or higher blood levels may require repetitive monitoring, or even treatment (more info from ACOG or AAP).  Adequate intake of calcium, iron, zinc, vitamin C, vitamin D helps decrease lead absorption (ACOG)

Lead Testing Summary:

This article isn’t meant to alarm, but to inform.  If you find you are at risk for any environmental lead exposures, further lead testing AT ANY POINT is beneficial to your pregnancy or children.  Many good resources are linked in the article above.  A few more quality resources can be found below, including an image below from the EPA further detailing the effects of lead.  Many of the negative effects of lead can be treated, mitigated or prevented if you find out early and get tested.

More details of other lead risks from the EPA here: https://www.epa.gov/lead/protect-your-family-exposures-lead)

Consumer Report Review of Lead Test Kits: https://www.consumerreports.org/cro/lead-test-kits/buying-guide

Lead impacts on health: https://www.epa.gov/sites/production/files/2017-06/documents/pyf_color_landscape_format_2017_508.pdf ) (Source of the image below:)

EPA Lead Health Effects

 

Posted in Pre-Parenting

Pre-Parenting: Bras and Pregnancy

The pregnancy hormone progesterone prepares your breasts for milk production very early.  Sore breasts and enlargement can be some of the earliest signs of pregnancy, and support and comfort become high priorities!  On average, you gain 2 to 3 lbs. of breast tissue by the time you give birth.  A well-fitting, supportive bra not only keeps you comfortable, but also prevents sagging and helps avoid future problems with breastfeeding.  While many of us wouldn’t usually think much about our breasts or bras- the Pregnancy-related tips below are very useful!

  1. Help sore breasts (especially in the first trimester) by wearing a comfortable sports bra or built-in bra camisole even when sleeping.  Cotton is best for breathability.  Save money by starting with existing bras you have, or otherwise get a few cotton ones for sleeping at Target or Walmart ($4-12/each).
  2. Extend the use of your current bras by using stretchable sports bras, or buying a bra extender from a craft store or Amazon ($1-3/each) 
  3. Be prepared for rapid changes. (Within 2 months I changed bra size by 4 inches and 2 cup sizes, and needed several different shopping trips since new bras quickly stopped fitting.)  Try buying just just one or two well fitting bras early on, and as things stabilize it might be worth just buying a maternity (nursing) bra too.  (Having bras fit well on the tightest hook in store also means you can loosen it as your body grows.)  
  4. Invest in a bra that fits.  Check the bra fit yourself with these good bra fitting tips at a cheaper store like Target ($12-35 for maternity bras).  Or go to a store where professional staff to help you with a free bra fitting at Nordstrom ($40-75 bras), JC Penney ($20-30) or Dillards ($45-75 but smaller selection than Nordstrom).  Trying on bras in-store beats online shopping since numeric size doesn’t predict fit/comfort well in pregnancy.  
  5. Support is key:  Underwires are a trade off of support versus comfort. You might like a mix of bra types depending on where you are in the pregnancy- underwires can get uncomfortable cutting into your growing baby bump.  Wider shoulder straps, and an adjustable closure on the back are also recommended.  
  6. Nursing (Maternity) Bras are your friend: The shoulder clip that allows you to lower each cup to easily breastfeed is totally worth it (nursing in most regular bras is nearly impossible/very uncomfortable). If you plan to breastfeed, have two or three nursing bras by the time you give birth (including a comfortable cotton one for sleeping). Again you may want slightly different sizes or soft/flexible cups as breast tissue will change over time.
  7. Cool your bra in the freezer if it’s summertime. People on Buzzfeed swear by this hack if you have sore breasts, especially in the heat.
  8. Breast Pumping Bra Hack:  If you are pumping once you give birth, you may want to convert an old sports bra into a hands free breast pump holder (see the image at tip #2 here), or otherwise buy a custom bra for that.  This can free you up and save your wrists too.  For more working mom pumping hacks, click here.

 

Want even more info?

Check out the Consumer Reports Nursing Bra Buying Guide:   https://www.consumerreports.org/cro/nursing-bras/buying-guide

Or get some facts or empathy for Pregnancy Related Breast Changes here:

https://www.webmd.com/baby/tc/breast-changes-during-pregnancy-topic-overview#1

https://www.babycenter.com/0_breast-changes-during-pregnancy_262.bc

https://www.fitpregnancy.com/pregnancy/all-about-boobs-your-crazy-breast-changes-pregnancy

 

Posted in Pre-Parenting

Pre-Parenting: Pregnancy Nutrition Apps

Healthy nutrition in pregnancy is important, and ACOG (American College of Obstetrics and Gynecology) has a list of nutrition recommendations.  Plus daily prenatal vitamins are essential pre-conception or as soon as you know you are pregnant.

Liking data and tech, I was curious to track my own nutrition.  After doing that for a month, here’s what I learned:

  1. Nutrition Apps Reviewed.
  2. Nutritional take-aways (based on my data) that can save you time & effort.

Nutritional Apps Reviewed:

Many pregnancy Apps allow you to record servings of food groups for example (Ovia Pregnancy is one good example of this).  However, I found that not that useful for me as:

  1. Serving sizes vary and aren’t mentioned in the App, so my data recorded is probably not that accurate.
  2. Micronutrients (vitamin A, vitamin C etc.) are ball-parked via this method but not checked accurately.
  3. Caveat: For the most part in a modern, varied diet with fresh foods plus a prenatal vitamin, most pregnant women do get adequate nutrition (so most people don’t have to stress about this).

However, I like data and wanted all the facts behind it.  To get more data I had to look behind traditional Pregnancy Apps (reviewed here) with their limited nutrition settings, and used Nutrition Specific Apps:  MyFitness Pal and Fooducate.  (More information comparing the two upcoming.)

Nutritional Take-Aways:

Tracking my daily food data, I found trends of two important things I was consistently short on.  If you’re like me, focusing on these two elements might be most worth your efforts.

  • Fiber
  • Calcium

More on using this to enhance your nutrition without counting all of your calories coming up!

 

Posted in Pre-Parenting

Pre-Parenting: Pregnancy Apps Reviewed

While Fertility Apps had a clear winner I wrote about here, looking through Google Play for Top-Rated Pregnancy Apps was much tougher.  I easily filled up the memory on my phone, but didn’t find a clear winner that balanced data gathering, usability and education.

My conclusion:  figure out what you want out of a Pregnancy App and go from there.  I gave top reviews based on features below.  (This is my unpaid, unbiased review.)

Top Things I Found Useful (maybe you will too):

  1. Monthly calendar that easily shows weeks gestation.  Bonus if you can put notes ahead of time on certain dates (i.e. I just read recommended testing schedules so I note that at 12 weeks on my calendar I should schedule a prenatal test, etc.) or mark future doctor appointments.
  2. Useful articles.  Many Apps time these articles by gestational age, which is nice so you get educational materials that are time relevant.  I also liked a library of articles within the App so I could read up on things archived in a logical manner.
  3. Tracker.  Keeping track of sleep, activity, mood or other notes can be nice.  Recording symptoms, or especially weight, nutrition, or blood pressure can be medically relevant based on your situation (but if it is, your clinic is likely following it even more closely too).  I have yet to find a good user interface for this though. (And I’ll talk about reviews for getting a good Nutrition Specific App in another article.)  I’m also too early to need the fetal movement tracker (kick-counter) although I could see how that could be useful.
  4. Medication or Food Safety Look Up.  I found this rarely on Apps.  While I didn’t use it that often, I did find it helpful if I wasn’t sure about a food.  (For Medications– my opinion is I’d still want to clear most medications with my OB/Gyn beyond what any App said.)

Items I would have liked:

  1. A Monthly Calendar that also maps typical timing for appointments and testing based on guidelines from ACOG.
  2. Academic leanings on the Articles.  More facts about elective prenatal testing (percentage of risk etc.) would be useful, most information included is pretty general and requires further research outside the APp.
  3. Better Tracker User Interface (UI).  Most Apps were a step down in UI even from the fertility tracker apps (sometimes of the same brand)
  4. Share the App with your Partner.  It could be nice to both have access to the same info.

Things I didn’t find useful (you might disagree, but this helps you understand my rankings):

  1. The online community.  The random posts or surveys of “is this normal?” just made me uncomfortable or needlessly nervous, especially if the App pro-actively listed this information without seeking it out.  It can be nice to check with people, but your own real-life friends or health care providers are probably a safer bet in my mind.
  2. Reminders alerting my phone when I hadn’t logged into the App in a few days.  😛  This gets pretty annoying and awkward when a Baby Bump Icon appears on your phone asking you to check their App when people might see that over your shoulder, especially if it’s too early in the pregnancy to make it public.
  3. Videos.  Most of these Weekly Update Videos were pretty patronizing and done by bad actors.  I prefer to read the info…but if you’re a video person maybe you’d like different Apps than I did.

Top Apps:

Ovia Pregnancy.  Best Features: Calendar showing gestational weeks and allowing you to put notes/appointments on it. Tracks symptoms.  Good Articles and Medical/Food Safety Lookups.  Review:  Begrudgingly it still won, although it changed the smooth data entry UI I liked in its Ovia Fertility Tracker to a much clunkier way to enter the same data.  (Since my initial review, Ovia updated its clunky symptom tracker UI–now it’s easily the #1 App in my mind!) Ovia Pregnancy won for it’s simple good UI Calendar view that overlaid weeks gestation on dates, plus it allowed you to record future notes and doctor visits–this is my most used feature by far.  Its articles were fair– with timely in the newsfeed feature and good curation for reading other articles whenever you wish.  The tracker collected good data, but not as smoothly as before.  It does track trends in weight visually, but not the other metrics like blood pressure, etc.  Ovia has a Medication and Food Safety lookup that was also nice to have when needed as well.  The Videos and Community Features are there for those who like that. I liked the added Notes/Milestones feature in Ovia Pregnancy, although was bummed it is only visible by clicking on the date you recorded the info rather than keeping a running list visible somewhere (like a running list of baby name ideas for example).  With 2 weeks of trying all the Apps, I came back to Ovia the most.

Mayo Clinic Pregnancy.  Best Features:  Limited but more-indepth articles from knowledgeable Mayo source.  Review: Rather streamlined, this App takes your estimated due date and offers weekly updates of 1 to 2 articles.  The articles are more academic than others and can be useful.  Clicking on the Menu shows a Blog with more articles, but those are not curated by topic or weeks gestation.  There are no extra tracking, calendar or note features like in other Apps.  I felt it a little pushy, but 2 of the 3 real tabs under the Menu are a direct link to buying Mayo’s Healthy Pregnancy Book, and Mayo Healthy Baby Book.  I happen to have bought their book separately, but even to me that seemed a little too much.  All-in-all for a free App, it’s worth having on the phone to check every week or so to get a little more detailed information in the articles than other Apps provide.

Meh Apps:

I’m Expecting.  Best Feature: Symptom tracker easily inputs data, has a visual calendar option and compares symptoms with other moms.  Review:  It offers cute baby pics on the landing screen, week by week baby size (today your baby’s 1/16 of an inch!), articles by the week, videos, symptoms manual, a weight or steps graph.  The symptom calendar feature had promise–mapping your symptoms by colored icons daily on the actual calendar.  However, it wasn’t very intuitive to use the calendar with its odd symptom symbols…nor is it that medically relevant since things like morning sickness are there regardless and you don’t have the option to track things that might prevent it.  Symptoms input is relatively simple at least; furthermore, if you wonder if you’re normal or what to expect, it gives a % of women reporting similar symptoms that week.  That can feel reassuring.  I’m Expecting emphasizes the Community Feature with moms in your age bracket, or even a group of moms you’re automatically enrolled in with the same estimated due date– reading any of those things just up my anxiety rather than info though.  Without a weekly calendar or the ability to track other things or notes, I found it rather limited. Its week by week articles were timely but were not possible to read from an archive otherwise.  Its videos had an Ob/Gyn reading you the few sentences of info….but the poor thing looked so uncomfortable the videos are awkward to watch.

What to Expect.  Best Feature: Articles.  Review:  This App is based on the famous book, and has lots of common features of articles, videos and community chat features.  I found their book to be not as academic as Mayo for example, and wasn’t too keen on this App probably because of that.  It offers many standard App features you may like (my husband kept this on his phone…and he’d occasionally update me on things he learned). I must say the thing that most sticks in my mind from it though is that the lady who does their videos is an awkward older lady who is clearly reading from a teleprompter…I’m not sure why they hired her, it’s pretty painful to watch.

Nurture.  (This App also has Fertility and Parenting related Apps called Glow) Best Feature:  Log daily symptoms that are pretty medically relevant (prenatal vitamins, doing kegels, symptoms etc.)    Review:  The opening screen is an embryo pic and this week’s calendar only, plus 3 or 4 daily article that can be useful, plus a Library with all articles but only if you pay for Premium. (It has a “view week” feature that lets you zoom out to see a few weeks and the gestational age, and click on those dates; however, still no calendar view and no way to record things beyond today.)  There is a pretty useful daily Yes/No log for relevant things- spotting, cramps, kegels, taking prenatal vitamins etc (although data entry can still be pretty slow).  It displays streaks of how long you keep doing certain things when you log, but otherwise there’s not any easy way to display trends in the data. Plus I felt it’s % completion of entering all data points was a bit pushy to do it everyday.  For those who like that, it has a Community Feature as well.  Overall though I was turned off by its cluttered interface, and repetitive pushes to pay to join Premium and happy to delete the App.

Pregnancy +.  Best Feature: Timeline feature showing landmarks and testing per week gestation.  Slightly less cluttered UI than Nurture, otherwise very similar and also emphases adding premium feature. Review:   Login shows a fetus pic, current  number of weeks, a time sensitive article or two for the day, plus a sample ultrasound image and baby size guide.  You can enter appointments in advance that sync to a regular calendar.  You can map your weight over time.  There is also a baby kick counter, but it requires payment to use.  This one has videos that are lifelike embryo pictures that scroll by with no talking or education…it’s kind of eery too, and only goes a few weeks unless you pay them $3.99 for 2nd and 3rd trimester.  It does have a the best timeline display I’ve seen, although it’s hard to find:  Click> Baby>Timeline.  Most time time I got lost in a still relatively chaotic UI.  Plus there was no article archives to read up on other information.  Another downside, the widget for this App on your phone is a kind of creepy fetus head.  I was happy to delete it.

BabyBump Pro.  Best Feature: Free Kick Counter or Contraction Timer might be useful later in pregnancy; a few useful checklists.  Fun-Finder display for similar sounding Baby Names has a nice UI.  Review:  Overall this App’s info seems pretty limited, but it does have a few later pregnancy features you might like.  For today it gives you one article or you can scroll through weekly info.  It emphasizes taking weekly baby-bump photos (personally I’m not a fan).  It has Group Community Message boards you can peruse or have friends on.  People might enjoy the Journal feature (but it’s weight and waist, text entry of symptoms that’s not searchable….looks paper based transferred to a phone screen).  It does have Baby Names searchable by origin, popularity and you can mark favorites but not best UI.  There is a free kick counter that runs a stopwatch and you press a button each time you feel a kick.  There’s also a contraction timer that you hit start/stop and it counts duration and interval between contractions.  There’s also a 3D video of a simulated baby being born that is supposed to inspire you to do the Birth Plan Checklist on the same page.  There’s also a one stop Newborn Essentials checklist that might be useful. It might be worth revisiting this App later in pregnancy to see if the kick counter/contraction timers are useful compared to other Apps.

The Bump.  Best Feature:  Snazzy UI, although comparatively few features.  Review:  The UI looks hip at the start with a trendy “How big is baby” prompt (answer, a pea!), and tells you how many weeks along you are.  There are a range of articles, and questions are answered by an expert plus community members (something that seemed better than the standard Community settings on other apps).  It proactively links you to registry options and says what % discount you get by registering at common stores.  You can also enter weekly bump photos or videos.   There aren’t any trackers of symptoms or other things of substance, however- it is nice to look at at least.

Don’t waste your time:  

ACOG Apps.  I was hoping to read the American College of OB/Gyn’s recommendations and information directly from their free App. Unfortunately you have to have a membership (be a practicing OB/Gyn) to access that information from either your App or online.  It did have a feature that can adjust your due dates based on last period and ultrasound findings to a more accurate date which I found interesting, but your doctor will do that anyway.  Many of the reviews said the App was buggy, and I had some issues getting it to open too.  It got quickly deleted.

I’d love to have you add your comments, experience and wisdom in other Apps you may have tried!

Posted in Pre-Parenting

Pre-Parenting: Fertility Tracker Reviews

You like data– and you’re looking to conceive.  There’s an App for that!  But which one?

As a Doc and data-addict, I wanted a usable but data relevant App and compared with other doctor friends doing the same.  (This is an unbiased, unpaid review.)

The clear winner from all of us….

Ovia Fertility available for Free here on Google Play (4.7 star rating).  This user-friendly app easily maps symptoms, basal body temperature, and everything you’d need in a great User Interface (UI).  Plus it has helpful articles and an informative positive daily feedback of the data you enter which makes it a positive experience.  It requires a free login, but then you can set up a quick PIN for privacy so only you will see the data on your phone.  (Note: it does collect a fair amount of data, you might want to read its service agreement closely if that’s a concern for you.)  Ovia Fertility won hands down for being both useful and usable.  (Note, Ovia Pregnancy or Ovia Parenting Apps warrant a separate review as they are very different.)

Other Fertility Apps I checked didn’t even compete (I’d downloaded them but deleted them after I started Ovia):

Glow Ovulation and Fertility (4.6 stars on Google Play): collected similar data as Ovia, but UI was not great and took a lot longer to enter data.  Plus it had an annoying % completion of data feedback that kinda made me bummed each day with its high expectations.  It did have some neat zoomable comprehensive graphs, but required Premium to fully unlock at minimum $3.99/month or more, and frankly the additional data you got wasn’t really clinically relevant or worth the price.  You get much more from Ovia for free with its calendar and summative graphs and you’ll enjoy using it much more.  (The data side of me did like the daily % pregnancy chance it gave…but Ovia’s 1-10 fertility rating is essentially the same and worth it for the overall usability so my vote is that Ovia will still serve you better.)

Flo Period and Ovulation Tracker (4.8 stars on Google Play):  Seemed more geared towards general period tracking.  The UI looks nice at first…but quickly became too Pink and girly and a little too simple for me (big dot covering whole screen).  It’s one week at a time display I didn’t find very helpful vs the monthly calendar used by Ovia or others.   It says neural networks and AI interpret the data which might be great (although I must say the data itself isn’t that complicated so that level of computation).  The summative graphs aren’t as great of UI, but it does analyze other things like sleep and activity separately if you desire.   It didn’t have the useful articles of the Ovia or Glow Apps either or positive reinforcement for data entry.  Overall I didn’t really find it usable.

Fertility Friend Tracker (4.5 stars on Google Play):  OK but its data summary displays were really old school 1990s design and didn’t seem as useful.  Unfortunately didn’t compete with Ovia for UI and usability.

Note: Many of these Apps are also on iPhone (but since I don’t have one I didn’t check that).  Also, signing up for many of these Free Apps might send an awkward “Welcome to Fertility App” email to whatever account you list (make sure that email’s not prominent at work etc. by using a junk email account).  Also, downloading might pop these Apps on your main screen on your phone that anyone can see when you unlock so beware.

Bonus Free App Recommendation: EZPregnancy  (Free on Google Play)  A simple but very usable “Pregnancy Wheel” App that Ob/Gyn doctors use to calculate due date.  If you’re trying to conceive and want a reference when the baby would be due based on first date of last period, this is an easy app to have.

Also, another useful recommendation.   If you’ve used an App for a month or two and want to increase chances of getting pregnant, Ovulation Tests are pretty affordable (especially when you use the App to narrow what dates to test). Ovulation tests give a 12-36hour notice before your most fertile days and can help increase odds of conception. One with the best reviews and reasonable price point I had success with was:  Clearblue Digital Ovulation Test (buying the 20 ovulation test strips supply will prob be all you need for $35.99 at Target, Walmart or cheaper here at Amazon).

Thanks for reading and good luck!