Lead poisoning is rapidly becoming a major environmental health hazard for children and a significant occupational health hazard for adults. Although economically disadvantaged children under the age of six are at the highest risk, the problem can affect those of all ages and socioeconomic status.

Even before a child is born, lead poisoning can cause health problems. Lead can enter a mother’s bloodstream and pass through the placenta. It has been linked to abnormal fatal development, spontaneous abortion, premature membrane rupture and preterm delivery. Lead exposure during pregnancy has also been linked with maternal hypertension.

For children, there are various symptoms of lead toxicity. These symptoms include developmental delays, hyperactivity, regression in motor and/or cognitive skills, growth failure, behavior disorders, hearing loss, anemia, unexplained seizures and abdominal pain.

Children with elevated lead levels in their blood may have lower I.Q. scores and reading levels. In studies, higher lead levels have been linked to poorer performance in tests of motor skills, memory, language, and concentration. In adolescents, higher blood-lead levels can lead to a higher risk of dropping out of high school.

In Massachusetts, recent legislation calls for mandatory lead screening of all children. Children who are considered to be at high risk for lead poisoning must be screened twice a year, starting at the age of six months.

Because lead is widely used in industrial processes, millions of adults are at risk of direct lead exposure.

For adults, occupational exposure to lead is the number one cause of lead poisoning. Occupations involving primary and secondary smelting and refining of lead are associated with the highest risk of exposure.

However, as many as 120 other occupations, including demolition workers, firearms instructors, and bricklayers, are also considered high risk professionals. In addition, numerous cases of lead poisoning have been reported in workers employed in producing batteries, ceramics, glass windows, jewelry, and many other products. Cases of lead poisoning have also been reported in artists and people who work in the printing industry. Even the family members of these workers are at risk of secondary exposure through clothing, skin, and hair.

Children and adults are at risk of exposure to lead from numerous sources, including contaminated soil, water, air, food and some consumer products. Soil is the ultimate depository of lead. Matter containing lead is produced by the burning of discarded newspapers with lead -based inks, food containers and labels with lead-based pigments, and lead-painted wood. The particles eventually return to the ground as sediment carried by rain and snow.

Drinking water is another major source of lead exposure. The environmental Protection Agency states that lead from drinking water accounts for 20 percent of all lead exposure. Poor plumbing is the major source of lead in drinking water, primarily through the corrosion of lead pipes and the use of lead solder in publicly- and privately- owned distribution systems. Lead-contaminated tap water is a serious health threat when it is used in powdered or concentrated infant formula.

Airborne, lead laden dust particles from deteriorated painted surfaces can also pose health hazards. Lead in poorly-glazed foodware is another potential source of exposure. Lead exposure has also been reported in conjunction with the use of herbal medicine, home remedies, and table wines.

Detection of lead poisoning is done through blood sampling. The patient is screened and a blood lead level reading is administered. Although this procedure is now recommended as the primary means of screening, it does not reflect levels of lead in the bone. A new X-ray technique is capable of measuring lifetime lead accumulation in the bone and may eventually become the standard of assessing exposure and evaluating the results of therapy.

Once a case of lead toxicity is detected, the next step is to obtain a detailed history of the person focusing on the identification and elimination of the source of exposure. Evaluation of close family members, friends, and co-workers may be warranted. In some cases, elimination of the lead source is the only necessary measure, but, if the symptoms are severe, additional treatment may be required.

Standard treatment has consisted of chelation with calcium ethylenediamine tetra-acetic acid (CaEDTA), which increases the urinary excretion of lead. This agent is usually given intraveneously in a hospital setting. However, there can be complications with chelation therapy, and it should only be administered by specialists. Penicillamine is used less frequently; it is given orally, but is not yet FDA approved for the treatment of lead poisoning.

The most severe cases of lead poisoning in children are now treated with dimercaptosuccinic acid (DMSA). DMSA is administered orally and is FDA approved. After treatment, patients are monitored for a rebound rise in lead levels at least weekly, because lead may redistribute from bone stores to soft tissues and blood. Adverse side effects caused by DMSA include gastrointestinal symptoms and rashes.

Despite the Occupational Safety and Health Administration regulations limited work-related lead exposure, cases of work-related lead exposure continue to be reported. However, the Council of State and Territorial Epidemiologists is recommending that an elevated blood lead level be made a notifiable condition in every state. U.S. government agencies are monitoring the lead content of foreign and domestic table wines. The Federal Drug Administration is considering tighter standards on lead-glazed ceramic products and prohibiting the use of lead-soldered food cans.

Ultimately, education of the public –especially parents of young children and workers in lead- related jobs—and a high index of suspicion on the part of physicians and other clinicians are essential for prevention and detection of lead poisoning. As the full impact of the problem continues to be defined, awareness is growing that widespread, long term benefits can be achieved from initiatives designed to reduce the incidence of lead poisoning –one of today’s most preventable illnesses.

A maternal blood screening test, the Triple Test identifies pregnancies in which there may be an increased risk of certain birth defects including open neural tube defects, Down syndrome, and Trisomy 18. Early Identification of potential risk factors will enable women to make informed decisions about subsequent diagnostic tests.

A single blood sample is drawn from the mother when she is between 14 to 22 weeks of pregnancy. Three substances are measured, alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG). The AFP level alone is used to estimate the risk of open neural tube defects. A computer analysis provides an estimate of Down syndrome and Trisomy 18 risk using the levels of the three substances in combination with the mother’s age.

Neural tube defects are defects of the central nervous system. During fetal development, the neural tube, comprised of brain and spinal cord tissue, closes completely.

Defects arise if part or all of the neural tube fails to close. "Spina bifida" refers to an opening along the fetal spine which causes varying degrees of paralysis, loss of bowel and bladder control, hydrocephalus ("water on the brain"), and mental retardation. "Anencephaly" occurs when the skull and brain fail to develop properly. Anencephaly is incompatible with life.

A screen positive result is reported when the risk of open neural tube defect is greater than that of the general population (which is 1 in 1,000). If a screen is positive and the gestational age has been confirmed, genetic counseling and a detailed (ultrasound level ll) with or without amniocentesis is offered to look for a possible problem.

A screen negative result means that the pregnancy is not at increased risk for an open neural tube defect, and that the Down syndrome risk is less than 1 in 190 (Triple Test) or 1 in 365 (AFP only). A screen negative result does not rule out all cases of open neural tube defects, Down syndrome, or Trisomy 18. The test will detect:

• Nearly all cases of anencephaly
• 8 out of 10 cases of open spina bifida
• 2 out of 3 cases of Down syndrome (Triple Test)
• 1 out of 2 cases of Trisomy 18 (Triple Test)
• 1 out of 3 cases of Down syndrome (AFP only)

A screen positive result means only that there is an increased risk for a birth defect and that further tests are indicated. If a problem is identified through ultrasound or amniocentesis, genetic counseling is available to aid in understanding the implications of the condition and the options for pregnancy management.

It should be noted that most women with screen positive results have negative follow-up testing and go on to deliver healthy, unaffected babies.

Cost is the primary reason why some physicians elect AFP only screens for their patients. Since the Triple Test was introduced in 1987, many studies have convinced physicians of the validity of the Triple Test. However, insurance companies are slow to act. Many insurance companies will only reimburse the patient for AFP and not the cost of the Triple Test. However, many patients feel the benefits of the Triple Test outweigh the additional cost of the test itself. These benefits include:

• The Triple Test is more effective than AFP alone in detecting Down syndrome
• The Triple Test identifies "wrong dates" more effectively
• The Triple Test provides a Down syndrome screen for women of all ages

Down syndrome is a common form of mental retardation frequently associated with heart abnormalities and other birth defects.

A screen positive result from the Triple Test is reported when there is a greater than 1 in 190 risk for Down syndrome. At this point, your physician may do an ultrasound to check the gestational age-nearly half of all positive screens result from inaccurate conception dates. If the screen is still positive your physician may refer you for genetic counseling and amniocentesis.

At age 35, women have a Down syndrome risk of 1 in 400. This risk continues to increase with age. Women 35 and older make up only 6% to 8% of the entire pregnant population and give birth to only 20% of the babies with Down syndrome each year.

Women under the age of 35 give birth to the remaining 80% of babies with Down syndrome. Since amniocentesis is not possible for the entire pregnant population, screening by Triple Test is a reasonable alternative.

Trisomy 18 is a rare condition involving severe mental retardation and significant physical problems.

Patients who screen positive for Trisomy 18 will be offered genetic counseling, a level ll ultrasound, and amniocentesis.

Amniocentesis is a simple medical procedure used to obtain a small sample of the amniotic fluid surrounding the fetus. It was developed in the 1800’s and has long been used late in pregnancy to assess fetal anemia in Rh disease and to find out if the fetal lungs are mature enough for delivery. Today, amniocentesis is often used in the second trimester of pregnancy to diagnose certain birth defects—or, in most cases, their absence.

Amniocentesis is not routinely offered during pregnancy, because the test itself carries a small risk of infection or miscarriage. Amniocentesis is offered as an optional test when there is an increased risk of chromosomal or genetic birth defects, or certain malformations.

Living cells from the fetus float in the amniotic fluid. These cells from a woman’s fluid sample are grown in the laboratory and then tested for chromosomal abnormalities or various genetic birth defects. Results from the laboratory studies of cells after amniocentesis usually take from one to three weeks.

Alpha-fetoprotein can be directly measured in the amniotic fluid without waiting for cells to grow; results may only take a few days.

Ultrasound is used to see exactly where the fetus and the placenta are located – allowing the physician to choose the safest spot for inserting the amniocentesis needle. Then the abdomen is cleansed, and sometimes a local anesthetic is injected just beneath the skin. A thin needle is then inserted through the abdomen and into the uterus, where a few teaspoons of amniotic fluid are withdrawn. After the sample is taken, an ultrasound check of the babies heart movements is done before the woman leaves the examination room. Some women say the amniocentesis doesn’t hurt at all; others feel cramping when the needle enters the uterus or pressure during the few minutes while the fluid is being withdrawn. Most physicians recommend that a woman take it easy for several hours after amniocentesis, avoiding physical stresses such as lifting and prolonged standing.

Amniocentesis is usually done at about the 15^th week after conception. Now, however, improved ultrasound and laboratory techniques have made it possible to consider doing amniocentesis earlier in pregnancy. To take a closer look at this possibility, several medical centers now offer early amniocentesis at 10 to 12 weeks after conception. The March of Dimes is supporting a multi-center study to assess the safety and accuracy of early amniocentesis.

Prenatal diagnosis by amniocentesis has been used by millions of women. In 1976, after careful study, the National Institutes of Health reported that it found midtrimester amniocentesis for prenatal diagnosis (when guided by ultrasound) to be safe.

More than 95 percent of the high risk women who have prenatal diagnosis receive reassuring news- that their unborn babies do not have the disorders for which they are tested. However, no prenatal tests can guarantee the birth of a healthy baby, since only some birth defects can be ruled out prenatally. Two or three out of every 100 babies born has a significant birth defect.

Amniocentesis test results are more than 99 percent accurate in diagnosing chromosomal abnormalities.

Currently, physicians are able to diagnose many more birth defects than they are able to treat in the womb. However, advances in prenatal therapy now make it possible to treat some birth defects before birth. For example, biotin dependence and MMA (methylmalonic acidemia), two life-threatening inherited birth defects, have been detected by amniocentesis and treated in the womb, resulting in the births of healthy, symptom free babies.

In conditions for which prenatal treatment is not yet possible, parents may desire prenatal diagnosis so that they can be informed. With their physicians, they can then prepare and plan for the safest timing, location, and method of delivery, with the proper specialists available immediately after birth.

Even in the event of abnormal results, genetic counseling can assist couples in dealing with their situation. Special management of such a pregnancy can lesson the burden of a birth defect or genetic disorder for all involved.

Whether or not to have prenatal diagnosis is a matter for individual discussion between parents and health professionals. Genetic counselors, physicians, and informed religious and ethical counselors can be valuable in helping parents make decisions about prenatal diagnosis and other reproductive issues. An early-pregnancy alternative to amniocentesis – chorionic villus sampling, or CVS – now available. Which particular test is best in a given pregnancy depends on the technical expertise available, a woman’s medical history and preferences, and what condition is being diagnosed.

Some diagnostic tests are performed early in pregnancy, and the decision requires thorough discussion. This is just one more reason why it is important that all women get prenatal care, and preferably a visit before conception.

Amniocentesis and other prenatal tests can let a woman know if her baby has certain birth defects or other special risks. Knowing about the problem before birth provides time to plan for the baby’s treatment. There are some basic things that all women can do to reduce their childbearing risk and improve their chances of having a healthy pregnancy and a healthy baby.

• Obtain early and regular prenatal care.
• Eat a variety of nutritious foods.
• Achieve an adequate weight before conception.
• Abstain from all alcoholic beverages throughout pregnancy.
• Do not smoke during pregnancy.
• Do not use any drug, even over-the-counter medications, unless recommended by a doctor who knows you are pregnant.

Chorionic villus sampling (CVS) is a prenatal test that can diagnose some birth defects (or their absence) as early as the seventh week after conception.

CVS is not routinely offered during pregnancy, because the test itself carries a small risk of infection or miscarriage. CVS is offered when there is an increased risk of chromosomal or genetic birth defects and parents would like test results as early in pregnancy as possible.

• A previous child or pregnancy with a birth defect. If a couple has already had a child (or pregnancy) diagnosed with a chromosomal abnormality or other birth defect, the couple may be offered prenatal testing during subsequent pregnancies.

• Other family history. Couples without a previously affected child may also be offered prenatal testing if their family medical histories indicate their children may be at increased risk of inheriting a genetic disorder. One or both perspective parents may be "carriers" of a disorder, or a disorder may "run in the family." Prenatal testing would be done only if the suspected condition can be diagnosed prenatally. Prenatal diagnosis is possible for all chromosomal disorders, but not all genetic ones.

In these cases, amniocentesis may be offered as an alternative prenatal test.

CVS requires a small piece of the chorionic villi, which are wisps of tissue that attach the pregnancy sac to the wall of the uterus. Cells from the villi normally have the same genetic and biochemical makeup as cells from an embryo. Results of most laboratory studies of the cells are available within one to two weeks.

Using ultrasound as a guide, the physician usually inserts a needle into the abdomen to where the villi are located, and uses gentle suction to remove a small sample of the villi. The vagina and cervix are thoroughly cleansed with an antiseptic before the procedure. No anesthetic is required. After the sample is taken, an ultrasound check of the unborn baby’s heartbeat is done before the woman leaves the examination room. Some women say CVS doesn’t hurt at all; others experience cramping or a pinch when the sample is taken.

Depending on the woman’s anatomy, the chorionic villi can also be reached by inserting a needle through the abdomen (trans-obdominal CVS) or the vaginal wall (trans-vaginal CVS). Ongoing studies are comparing the safety and chance of infection involved in the various CVS techniques.

Most physicians recommend that a woman take it easy several hours after CVS, avoiding strenuous physical activity. According to a national study, one in every five women experiences brief cramping following CVS; one in three women have some bleeding or spotting; which ordinarilly stops within a few days.

By 1990, CVS had been performed more than 65,000 times in the United States, with doctors pooling their results so that the safety and accuracy of the procedure could be assessed. The March of Dimes supported a national CVS registry at Jefferson Medical College in Philadelphia, as well as additional study of the test’s risks and potential capabilities.

The National Institute of Child Health and Human Development also conducted a safety study, comparing CVS to amniocentesis. The study, which involved seven hospitals and nearly 3,000 women, concluded that CVS is safe and effective, but is probably slightly more likely than amniocentesis to be followed by miscarriage or to fail to yield conclusive results (meaning that an amniocentesis or second CVS procedure is needed).

After these studies and growing nationwide experience with the technique, the American College of Obstetricians and Gynecologists (ACOG) informed its members in November 1989 that it no longer considered CVS experimental. When performed by properly trained physicians, CVS is "relatively safe and may be considered an acceptable alternative to mid-trimester amniocentesis." ACOG emphasized the importance of thorough genetic counseling, an experienced physician to take the sample, and laboratory expertise in handling and analyzing the samples.

More than 95 percent of the high risk women who have prenatal diagnosis receive reassuring news – that their unborn babies do not have the disorders for which they are tested. However, no prenatal tests can guarantee the birth of a healthy baby, since only some birth defects can be ruled out prenatally. Two or three out of every 100 babies born have a significant birth defect.

CVS test results are very accurate (greater than 99 percent) in ruling out certain chromosomal birth defects and specific genetic problems.

Currently, physicians are able to diagnose many more birth defects than they are able to treat in the womb. However, early prenatal diagnosis using CVS has shown great potential in allowing doctors to intervene and treat some birth defects before fetal development has changed. For example, congenital adrenal hyperplasia (CAH), an inherited birth defect caused by the lack of an important enzyme, can be treated after birth with steroid hormones. But by the 16^th week of pregnancy the female fetus with CAH already will have abnormal genitalia. Now prenatal diagnosis using CVS allows physicians to treat the fetus with hormones during a critical period of development from 10 to 16 weeks of gestation, thus preventing the need for surgery after birth.

In conditions for which prenatal treatment is not yet possible, parents may desire prenatal diagnosis so that they can be informed. With their physicians, they can then prepare and plan for the safest timing, location, andmethod of delivery, with the proper specialists available immediately after birth.

Even in the event of abnormal results, genetic counseling can assist couples in dealing with their situation. Special management of such a pregnancy can lessen the burden of a birth defect or genetic disorder for all involved.

Whether or not to have prenatal diagnosis is a matter for individual discussion between parents and health professionals. Genetic counselors, physicians, and informed religious and ethical counselors can be valuable in helping parents make decisions about prenatal diagnosis and other reproductive issues. CVS is performed early in pregnancy, and the decision requires careful planning and thoughtful discussion. This is just one more reason why it is important that all women get early prenatal care, and preferably a visit before conception.

Which particular diagnostic test – CVS or amniocentesisis – is chosen for prenatal diagnosis depends on the technical expertise available, a woman’s medical history and preferences, and what condition is being diagnosed.

CVS and other prenatal tests can let a woman know if her baby has certain birth defects or other special risks. Knowing about the problem before birth provides time to plan for the baby’s treatment. There are some basic things that all women can do to reduce their childbearing risk and improve their chances of having a healthy pregnancy and a healthy baby.

• Obtain early and regular prenatal care.
• Eat a variety of nutritious foods.
• Achieve an adequate weight before conception.
• Abstain from all alcoholic beverages throughout pregnancy.
• Do not smoke during pregnancy.

Do not use any drug, even over-the-counter medications, unless recommended by a doctor who knows you are pregnant.

We recommend screening of all of our pregnant clients at approximately 28 weeks of pregnancy in order to determine whether they have a diabetic tendency during their present pregnancy. About 10% of all pregnant women have this tendency, and most of the time it can be managed by changes in diet. If we detect any problems we can make pregnancy safer for you and your baby with simple measures. You will be asked to drink a sugar solution, called glucola, and one hour later a blood sample will be taken. We will inform you ahead of time at which visit this will be done.

If the one-hour test should be elevated, you will be asked to complete a three-hour glucola test.

Instructions for this test include having nothing to eat or drink after midnight (except water, black coffee or tea). Report to the OB Clinic, where a fasting blood sample will be taken. You will then drink 10 oz of the glucola solution and have a blood sample taken each hour for three hours. We will then contact you with your lab results as soon as they are available.

The role of ultrasound in pregnancy has received much media attention, and many women and their families have questions about its use in low-risk pregnancies.

Ultrasound is the use of high-frequency sound waves which are reflected or echoed when they meet up with structures of varying densities in the body. These echoes are then transferred into visual images seen on a small screen. Ultrasound is a very useful tool when used appropriately, but until recently, the effects of routine or screening ultrasound on outcomes for low-risk women and their babies was unknown.

The routine use of ultrasound does not impact preterm delivery, birth weight, induction of labor, Cesarean section rate or length of hospital stay.

In a study of over 15,000 pregnancies, routine ultrasound screening identified only 35% of pregnancies with severe birth defects before the babies were born, and most of these birth defects were found after 24 weeks of pregnancy, the time when it is still legal in most states to have an abortion. Blood tests and medically indicated ultrasounds found 11% of the babies with severe birth defects in the group of women not routinely screened. The screening did not significantly change the management or outcome of these pregnancies. The frequency of planned abortions for severely affected pregnancies was not different between the two groups. The survival rate for babies born with severe birth defects did not differ between the groups, even though there may have been an opportunity to take measures such as delivery at a hospital equipped with specialized care for these babies.

Because of these and other research findings, the American College of Obstetricians and Gynecologists, the American Institute of Ultrasound in Medicine and the National Institutes of Health have compiled lists of indications for the use of ultrasound in pregnancy. They do not recommend routine screening.

Current research has been unable to show harmful effects of ultrasound when used appropriately. We do not currently have information on long-term effects of ultrasound. A position paper by the International Childbirth Education Association (1983) states that pregnant women should avoid ultrasound exposure unless there is a documented medical reason for its use and/or disease is expected, and adds that pregnancy is a normal physiological process which does not, by itself, constitute a medical reason for ultrasound exposure.

Ultrasound has proven itself an excellent tool when used for sound medical reasons, especially in high-risk pregnancies. A policy of routine ultrasound in pregnancy, however, would cost over $1 billion a year in this country with no known improvements in outcomes for low-risk women and their babies. As the authors of one study stated, the current research has caused much interest where concern about unnecessary testing, overtreatment, and healthcare costs are growing.

Based on our current knowledge, routine screening ultrasounds "just to see if the baby is O.K." do not appear to change outcomes for most pregnant women. Those families who wish to pursue ultrasound where a medical reason is not present may be asked to pay "out of pocket," since many insurers will not cover this expense. Every pregnant woman should discuss these issues with her healthcare provider.

Hepatitis is the name for several diseases that affect the liver. A healthy liver performs many important jobs in the body, but hepatitis stops it from doing its work properly.

Although there are several types of hepatitis, the one caused by the hepatitis B virus may be especially dangerous for the babies of women who have the disease or are carriers of the virus.

In New York State, every pregnant woman must have a blood test to determine if she is carrying the hepatitis B virus. If so, her baby can be protected from the disease by immunization.

Hepatitis B is caused by a virus. In general, the virus is not very contagious and cannot be spread by casual contact. However, it can be passed from one person to another through exchanged blood and other body fluids, such as during sexual intercourse.

Hepatitis B can also be spread by sharing needles to shoot drugs. A pregnant woman who has the disease can pass it to her baby through her body fluids that come in contact with the baby during birth.

Anyone could have hepatitis B, but some people are more likely to be infected than others. If you are of Asian, Caribbean, Pacific Island, American Indian, native Alaskan, or South American origin, you have a much higher chance of having been infected and of being a carrier of the disease. This is because hepatitis is more common among these groups of people. You may also be at a higher risk if:

• You have had a number of sexual partners
• You have had a sexually transmitted disease
• You have shared needles to shoot drugs
• You have worked in a health care-related field
• You have lived with someone on kidney dialysis or who had hepatitis

Anyone of the above puts you at risk by increasing your chances of coming into contact with body fluids infected by hepatitis B.

Babies who are infected at birth and not treated have a chance of developing severe hepatitis, which could be fatal. Even more likely, if not treated, these babies will become carriers of the disease. A carrier is a person who may not be sick, but who can pass the hepatitis virus on to others. Babies infected at birth may also suffer liver problems or develop liver cancer late in life.

The symptoms of hepatitis B usually include yellowing of the skin and eyes (jaundice), dark urine, and fever. Many people lose their appetites, feel tired, or feel like they have a flu. Many people are severely ill for months. (If you have these symptoms, check with your doctor. He or she will be able to tell if you have hepatitis B.) However, there are some people who are carriers of the infection but never feel sick.

If you have ever had hepatitis B, it is possible that you did not fully recover and are now a carrier. Your doctor can give you a simple blood test to find out for sure if you have hepatitis or are a carrier.

Yes. If you have the hepatitis B virus in your blood, you can give your baby the virus whether you feel sick or not.

If you are pregnant, it is important to find out if you carry the hepatitis B virus. Ask your doctor for the results of the blood test to show if you have the virus and could pass the disease to your baby. If the test is positive, you make sure that your baby gets all the necessary shots on time.

If your doctor finds that you are carrying the hepatitis B virus in your blood, he or she will immunize your baby at birth. Your baby should also receive immunization shots at approximately one and six months of age. These are all to protect your child against hepatitis B. When your baby is one year old, a blood test should be done to be sure he or she is protected against hepatitis B.

Yes. The only precaution is that you should temporarily stop breastfeeding if you develop open sores on your nipples.

No. People who live with someone who has hepatitis B or who are sexual partners of someone with the virus should be immunized – after a blood test to be sure they are not already infected.

Even if you don’t think you are at risk of having hepatitis B, make sure. If you are pregnant, ask your doctor to give you the simple blood test for hepatitis B virus. It’s quick, easy, and can help you be certain that your baby is protected against this dangerous infection.

Not too long ago, many pregnant women with Rh negative (Rh-) blood often had miscarriages, stillbirths, or babies with birth defects.

Since 1968, there has been a vaccine that can help such women have babies free from Rh disease. Even so, not all women who need the vaccine get it, and a small number of women cannot benefit from it. As a result, some 6,000 infants are born each year with Rh blood disease.

Rh- blood has no Rh factor. The Rh factor is found on the red blood cells of 85 percent of white people and 95 percent of black people. Those who have the Rh factor are called Rh positive (Rh+). It makes no difference to a person’s own health if he or she has the Rh factor or not.

A simple blood test can tell if you are Rh-. This can be done in a doctor’s office, clinic or hospital. A woman of childbearing age should be tested before pregnancy. If she becomes pregnant and doesn’t know her Rh blood type, she should be tested during or shortly after pregnancy, whether the pregnancy ends in birth, miscarriage or abortion.

An Rh-negative mother and an Rh+ father may conceive a baby who inherits the father’s Rh+ blood. Some of the baby’s blood may then get into the mother’s bloodstream when she’s pregnant. Her body then tries to fight off the Rh+ blood cells with natural fighters called "antibodies."

In first pregnancies, there is little danger from these antibodies to the unborn Rh+ baby, because the mother hasn’t made enough of them by the time the pregnancy ends. But in each later pregnancy there’s a larger chance that these Rh-fighting antibodies may cross the placenta and kill some of the unborn baby’s red blood cells. That can lead to blood disease, brain damage or death before birth.

No. Although a woman will stay as healthy as ever, the antibodies become part of her blood supply, and any future Rh+ babies may be harmed.

Blood tests done on the Rh- mother’s blood during pregnancy will tell if the baby has Rh disease. It may be necessary to perform amniocentesis, a method for taking fluid through a needle from around an unborn baby. The fluid is tested and can show how severely your baby is affected.

In some cases, defects can be lessened or prevented by giving a blood transfusion to the baby before it is born, or right after. Sometimes, medicine is given to a mother to make her have the baby ahead of time (induced delivery) so it can get away from the damaging blood and start getting blood transfusions, if needed.

Yes. It usually can be prevented by giving a vaccine called Rh immune globulin to the woman with Rh- blood within 72 hours of the birth of any baby with Rh+ blood. The same is true after a miscarriage or abortion—in other words, any time it has become possible for Rh+ blood to get into the bloodstream of an Rh- woman. Some doctors give a small dose of the vaccine during pregnancy, and another one after the pregnancy ends.

The vaccine contains anti-Rh antibodies (substances that react against Rh+ cells). These antibodies destroy the Rh+ red blood cells coming from the fetus, thus removing the cause of permanent anti-Rh antibodies. In her next pregnancy, it will be as if the Rh- negative mother were having a first baby again, as far as Rh blood differences are concerned.

If an Rh- woman’s pregnancy ends at 12 weeks or less, the doctor may choose to give her a smaller dose of the vaccine, rather than the full dose needed after a full-term pregnancy. This small dose sometimes is enough to stop the dangerous antibodies from forming, and costs less than the vaccine needed after a full-term pregnancy.

The vaccine may not work for woman who have already had pregnancies, miscarriages, abortions, or transfusions that left them with antibodies that could harm their future Rh+ babies. Scientists are finding new treatments for such women.

There will be no danger of Rh blood disease to the baby, and the mother will not need the vaccine.

If both parents are Rh-, the baby will be negative. Even if the father is Rh+, he may also carry the gene for Rh- blood. This means the baby has a 50 percent chance of inheriting the father’s Rh blood.

Many people still do not know about the vaccine. Every woman of childbearing age should find our if she is Rh positive or negative. Another reason is that some patients are overlooked for the blood test that has to be done before the vaccine is given. Shorter hospital stays after childbirth are part of the problem. Also, the cost of the vaccine may pose a problem.

The march of Dimes wants every couple to know that Rh blood disease usually can be prevented by the use of the vaccine and has urged the government to help pay for immunization programs.

Many scientists are doing research on blood diseases and immunity in general. The March of Dimes supports research on the immune mechanisms that recognize and destroy germs and cells not normally found in your body. Increasing understanding of the immune system will advance our ability to treat and, perhaps, eventually prevent a wide variety of diseases.

Two infections have special meaning for pregnant women: toxoplasmosis and chlamydia. Toxoplasmosis poses a serious threat to an infant’s health. If a woman becomes infected during pregnancy, she risks miscarriage, stillbirth or infant death soon after birth. An infected baby may even appear normal at birth but later develop a defect such as blindness, heart disease or mental retardation. The danger is real, but by taking a few simple precautions, you can minimize your chances of infection.

Toxoplasmosis is a parasitic infection that is widespread in cats and also found in some meats. After animals are slaughtered for food, the parasite (Toxoplasma gondii) can live in the raw meat until it is killed by cooking, drying or prolonged freezing.

Cat feces are also a source of infection because of oocysts (pronounced "oh-oh-cysts"), an infective stage of the parasite, which develop in the cat’s intestines and are excreted into a litter box or onto the ground. These oocysts become infectious within as little as one day and resist most types of disinfectants. Under the right temperature and humidity conditions, they may live for more than a year in soil. Other suspected sources of infection include goat’s milk, raw eggs, and insects such as flies and cockroaches that may have been in contact with cat feces.

If you’re pregnant or planning to become pregnant, it’s important that you ask your doctor to give you a blood test for toxoplasma antibodies. If you are immune to the infection, there is no danger of passing it along to your baby. If you are not, then you need to follow safeguards, which I will mention later, about cat litter, and handling and eating food.

Unfortunately, the disease can only be controlled through a combination of drugs that may cause adverse side effects. Infants who are born with toxoplasmosis, whether they have birth defects or not, should be treated with the drug combination.

Damage that has already occurred in the eye, brain or nervous system cannot be reversed, but treatment can prevent further damage. Although there is currently no vaccine for toxoplasmosis, it is an important area of research of the March of Dimes Birth Defects Foundation.

If you don’t know your immune status, or if you’ve had a negative test for toxoplasma antibody, there is no need for panic. Toxoplasmosis can be prevented if you avoid the known sources of infection. Here is a list of safeguards:

• Don’t eat raw or undercooked meat, especially lamb or pork. Meat should be cooked at 140° throughout for at least 15 minutes.
• After handling raw meat, wash your hands before touching anything that you might put in or near your mouth.
• Clean any fresh fruits and fresh vegetables before eating them.
• Don’t feed your cat raw meat or table scraps of undercooked meat. Keep an eye on your cat. Once outdoors, a cat might hunt birds or rodents and increase the risk of spreading toxoplasmosis.
• Don’t empty the litter box. Have someone else do this, and tell them to wear gloves that can be discarded or washed immediately after use. The litter box should be cleaned daily.
• Since outdoor soil may contain oocysts from cats, it is equally important to wear gloves when doing any work in the garden. Avoid close contact with outdoor cats, and don’t take in any new cat whose health history and eating habits you don’t know.
• If you have a cat, ask your veterinarian about testing it for toxoplasmosis. If the test is positive or if your cat has been outdoors hunting and eating raw or undercooked meat, avoid contact with it until you are assured that you are immune.
• Keep sandboxes covered when children are not using them for play. If cats use the sandbox, it can become a source of infection.

Chlamydial infection, unlike toxoplasmosis, is a sexually transmitted disease that is twice as common as gonorrhea and affects more pregnant women than toxoplasmosis. The March of Dimes Birth Defects Foundation is concerned about chlamydial infection because it endangers a healthy pregnancy and is linked with miscarriage, low birthweight and infant death.

Chlamydia is a bacteria-like organism that was once believed to be a virus. The organism is the major cause of urethral infection in men and pelvic inflammatory disease in women. Women infected with chlamydia often go undiagnosed because they have no symptoms.

Until recently, chlamydial infection could only be diagnosed by the process of taking a culture during a pelvic examination and isolating and identifying the infection in laboratory testing. This procedure is difficult and costly because of technically demanding laboratory procedures and the time involved. Medical journals now report on two new tests that have streamlined the previous laboratory method and, as a result, may lead to more widely available screening programs. Both tests work with specimens taken directly from the cervix and involve procedures frequently used in research laboratories.

If a pregnant woman with chlamydial infection is untreated, she can infect her baby during a vaginal delivery. A baby infected at birth risks conjunctivitis and pneumonia and should be given prompt, careful treatment to prevent severe eye infections and prolonged, troublesome lung disorders. Research also suggests that stillbirth and premature birth are higher among babies whose mothers have untreated chlamydial infections.

The antibiotic tetracycline usually eradicates the infection within a week. Infected pregnant woman should be treated with erythromycin, however, in a dosage of 500 milligrams, four times daily, for seven to ten days. Babies of infected mothers should be carefully monitored as a matter of routine.

Since chlamydial infection is sexually transmitted, the patient’s sexual partner should be treated at the same time. Otherwise, the disease can be passed back and forth between the partners.

If you have any concerns about chlamydial infection, be sure to consult with a physician or other healthcare professional.

Low birthweight affects one in every 15 babies born each year in the United States. It is related to some 60 percent of infant deaths. Low birthweight babies may face serious health problems during the newborn period, and are at increased risk of long-term disabilities.

Advances in newborn medical care have greatly reduced the number of infant deaths that result from low birthweight, as well as the disabilities that survivors of low birthweight experience. Still, a small percentage of survivors are left with problems such as mental retardation, cerebral palsy and impaired lung function, sight and hearing.

Low birthweight is a weight of 5 pounds, 8 ounces (2,500 grams) or less at birth. Very low birthweight is a weight of 3 pounds, 5 ounces (1,500 grams) or less.

There are two categories of low birthweight:

• Preterm births (also called premature births) occur before the 38th week of pregnancy. Most low birthweight babies are preterm. The earlier a baby is born, the less it is likely to weigh, and the greater its risk for many problems.
• Small-for-date babies (also called "small for gestational age" or "growth retarded") may be full-term but are underweight. Their low birthweight results, at least partly, from a slowing or temporary halting of growth in the womb.

Some babies are both premature and growth-retarded. They are at highest risk of experiencing the many problems linked to low birthweight.

We know some, but not all, of the reasons babies are born too small, too soon, or both. Fetal defects that result from inherited diseases or environmental factors may limit normal development. Babies born from multifetal pregnancies (twins, triplets, etc.) often are low birthweight, even at term. If the placenta is not normal, a fetus may not grow as well as it should. The mother’s medical problems influence birthweight, especially if she has high blood pressure, diabetes, certain infections, or heart, kidney, or lung problems. An abnormal uterus or cervix can increase the mother’s risk of having a low-birthweight baby.

The mother’s behavior during pregnancy may affect birthweight, especially if she doesn’t:

• Receive early, regular prenatal care – the most important controllable factor that prevents low birthweight.
• Eat a balanced diet. Since a fetus is nourished by what a mother eats it can suffer if the mother eats poorly.
• Gain enough weight. Doctors recommend that a woman of normal weight gain 25 to 35 pounds.
• Avoid smoking, drinking alcohol, or using unprescribed drugs. Smokers have smaller babies than nonsmokers. Drug or alcohol use limits fetal growth.

Socioeconomic factors such as low income and lack of education may place mothers at increased risk of having a low-birthweight baby. Low income mothers may be unable to afford proper health care and nutrition. Women under 17 years old or over 35, or who have had many children, are at increased risk of having low-birthweight babies. Teenagers may not know about good health habits. Unmarried women, who are likely to experience stress and other social, economic and psychological disadvantages, also are at increased risk of having a low-birthweight baby.

The most important prevention is early and regular prenatal care. Women who receive this care can learn good health habits and ways to reduce the risk of having a low-birthweight baby. They can learn the basics of good nutrition, as well as the importance of avoid behavior that can cause low birthweight, especially smoking drinking alcohol, and taking unprescribed drugs.

Low birthweight babies are more likely than babies of normal weight to have medical complications. The smaller the baby, the larger the risk. Some common problems:

A premature baby may have breathing problems. Up to 75 percent of babies born before the 30th week of pregnancy suffer from respiratory distress syndrome (RDS), a leading cause of death and disability among premature babies. These tiny babies lack a chemical called surfactant, which normally keeps the small air sacs in the lungs from collapsing. Without special medical care, these babies do not get enough oxygen into their blood or enough carbon dioxide out of it.

Some low-birthweight babies have salt or water imbalances or low blood sugar (hypoglycemia), which can cause brain damage. A baby who turns yellow because of jaundice may have a liver that is slow to start functioning on its own. If the problem is severe, the baby can develop brain damage.

A premature baby may be anemic (not have enough red blood cells). Normally, a fetus stores iron during the latter months of pregnancy and uses it after birth to make red blood cells. Infant born too soon may not have had enough time to store iron.

Low-birthweight babies may not have enough fat to maintain a healthy body temperature. Low body temperature can cause blood chemistry changes and slow growth.

Bleeding in the brain, which can be one of the most severe results of low birthweight, happens in 40 to 45 percent of very low-birthweight infants. The bleeding may result in brain damage or death. Newborns who survive may have learning difficulties and behavior problems later in childhood.

Premature babies often have a potentially dangerous heart problem. Before birth, an large artery called the ductus arteriosus lets blood bypass the baby’s nonfunctioning lungs. In premature babies, the artery may fail to close properly after birth, which can result in heart failure.

Some premature babies have necrotizing enterocolitis a severe inflammation of the intestine that can result in death. Retinopathy of prematurity, an abnormal growth of blood vessels in the eye, can result in poor vision or blindness.

Special life-saving equipment in intensive care nurseries help sustain low-birthweight babies who otherwise might not survive. Babies who have trouble breathing may need additional oxygen and mechanical assistance to keep their lungs expanded. Sometimes doctors insert a small tube that carries air through the baby’s nose or mouth down into the trachea (windpipe). The tube helps the babies breathe better but does not breathe for them.

Some babies need the temporary help of a respirator. During treatment for breathing problems, doctors and nurses watch babies’ oxygen levels very carefully because high levels help cause retinopathy of prematurity.

The Food and Drug Administration recently approved the sale of a synthetic surfactant that may save the lives of many more babies suffering from respiratory distress syndrome. The substance, which is given through a tube into the windpipe, goes to the lungs and helps the infants breathe more easily.

Babies with low blood sugar are given glucose through a tube that goes into their veins. As they begin to recover, they may be fed breast milk by tube. Babies with water and salt imbalances may be given specially formulated fluids by mouth or vein. Jaundiced infants may be treated with special blue lights in a process called phototherapy. Anemic infants may be treated with dietary iron supplements or, in severe cases, blood transfusions. Babies with low body temperature are kept in open beds that have overhead heaters or in closed incubators to regulate body temperature.

Doctors cannot correct the sort of bleeding in the brain that is typical in very premature babies, but they can treat some of its secondary effects, to reduce the risk and extent of brain damage. They can examine the brain by ultrasound or CAT scan. If the brain’s fluid-filled spaces (ventricles) expand rapidly, surgeons may insert a tube into the brain to drain the fluid and reduce the risk of brain damage. A baby whose ductus arteriosus does close on its own may need to be treated with oxygen and given a drug that helps close the ductus. Surgery may be necessary. Necrotizing enterocolitis is treated with intravenous fluids and antibiotics to prevent further injury to the intestines. Damaged intestines may have to be removed.

The March of Dimes Birth Defects Foundation supports may areas of research related to the cause, prevention and treatment of low birthweight and its consequences. Some researchers, for example, are studying how infections, even symptomless ones, can trigger preterm labor, in an effort to develop better methods of preventing or halting premature labor. Others are looking for better ways to treat breathing problems to prevent damage to the lungs and eyes.

March of Dimes-supported researchers also study home care of low-birthweight babies to find ways to prevent intellectual and behavioral problems that may appear later in childhood.

To learn more about low birthweight or to obtain additional copies of this fact sheet, contact your local March of Dimes chapter.

Individual women experience an extremely wide range of sexual responses during pregnancy. Attitudes toward sex and pregnancy are influenced by a number of factors, including: attitudes about themselves, attitudes towards sex, physical changes during pregnancy, and prior information about sex during pregnancy.

The most common reason for women to become disinterested in sex during pregnancy is the fear of miscarriage. Some spotting can result from deep penetration during sexual intercourse. The majority of physicians agree women should refrain from sex during the first trimester only if they experience both bleeding and cramps.

The majority of women find their interest in sex will be normal or increased during the first trimester. However, women who experience significant nausea or fatigue are less likely to be interested in sex during the first trimester.

The second trimester, for most women, is the time when they feel best during pregnancy. Problems of nausea and fatigue have resolved, but the size of the baby has not become so big that they feel uncomfortable. Increased blood flow to the pelvic region and other physical factors tend to enhance a woman’s sexual pleasure during this part of her pregnancy.

Adapting to the increasing size of the abdomen can make third trimester intercourse more uncomfortable. It is helpful if partners can communicate about their sexual needs and be flexible about making changes. Oral sex may be one alternative, but air should never be blown into the vagina of a pregnant woman. Air or emboli could enter the mother’s blood stream and cause serious complications. As women get closer to their due dates, many will find themselves increasingly tired and uncomfortable. This does not mean couples need necessarily become estranged. Physical needs can be met by snuggling, massaging, or walking arm-in-arm.

Pregnancy requires many couples to make adjustments in their lovemaking. Furthermore, responses to sex during pregnancy depend on the individual mother, her sense of well-being, and her stage of pregnancy. Overall, most obstetricians and nurse-midwives feel making love is safe for the mother and baby throughout pregnancy, unless there is a specific medical problem.

In order to maintain balance and decrease fatigue and backache, a pregnant woman must learn to adapt her posture and body movement to the changes in weight and increased pressure which result.