Risks and Benefits
For many women, pregnancy will be a routine exercise in risks and benefits analysis – making mostly minor (and some major) decisions throughout their day that could potentially positively or negatively affect their pregnancy.
Sometimes pregnant women conduct this thought process very quickly and without even realizing it (ordering lunch, swimming in a lake, getting on an airplane). Other women may agonize over every decision they need to make, and this site aims to help women avoid this anxiety-ridden process and any associated guilt that comes with it.
First, women need to make their own decisions based on the amount of risk they are willing to accept and they should not compare themselves to others. An acceptable level of risk is going to be different for every woman based on her specific pregnancy, lifestyle factors, and overall health.
While some decisions are much easier than others, more complex decisions, such as using certain medications or undergoing labor induction, may require lengthier and more detailed conversations with an HCP.
Women should read as much evidence-based information they can so they understand what is currently known and unknown about any particular topic. HCPs can fill in gaps and make recommendations based on their expertise and clinical experience.
Women can also read about the experiences of other pregnant woman to help them gain additional perspective, clearly recognizing however that all women experience different circumstances, have different medical backgrounds, and may not provide all information necessary for the reasons behind their decision or their HCP’s recommendation.
When women follow this process, they will realize that in deciding to have a procedure or take a medication, they made the best decision possible for their pregnancy (not the worst one) and can subsequently feel less guilt and anxiety.
Background
Pregnancy does not have to be full of anxiety regarding whether a woman can eat cheese, fish, or soft serve ice cream, or use her favorite makeup or hair dye without feeling worried or guilty. It is more of a matter of understanding if certain risks exist and how to mitigate those risks to feel more comfortable with every decision.
Unfortunately, because safety-related research during pregnancy is slow, women end up having to make decisions – that affect not only their health, but the health of their baby – with little to no scientific data to help guide them (or their HCP).
While HCPs make recommendations regarding women’s healthcare so women do not have to consider these various aspects of risk, many women want to actively participate in these decisions and conversations as much as possible.
Further, women who actively engage in their own medical care have more confidence in their decisions, feel less guilt, cope better with possible side effects of complications (because they were prepared), and in general, feel more in control of their own pregnancies.
Level of Risk
The actual question women should ask is not necessarily whether something is safe – but what is the level of risk (think how safe). The benefit is usually always known as it is significantly easier to detect than the risk. However, the benefit may not always be achieved which then becomes another consideration of risk.
Scenario example: if a woman is debating whether to take ginger capsules for her severe nausea and vomiting of pregnancy (NVP), the benefit is easy to detect: the ginger capsules could relieve her nausea.
However, the risks are slightly harder. Currently, there are unanswered safety-related questions regarding theoretical bleeding risks associated with ginger, as well as the possibility it could make acid reflux/heartburn much worse in the first trimester, which would also worsen NVP.
After reading quality information regarding ginger capsules and pregnancy, the woman learns ginger capsules have a safety profile strong enough to be formally recommended as a first-line agent for NVP, despite other unknowns; further, the woman’s symptoms are quite severe. Note: Women always need to take into account the risks of not taking or using a medication/supplement.
Additional risks also include difficulty in swallowing the pills (four times per day, as recommended) and the fact they may not work on severe NVP, as first-line agents work better when they are taken almost as soon as symptoms begin.
However, the woman wants to avoid prescription medications, and if the capsules start to bother her, she can immediately discontinue their use, with no major lasting effects. She and her HCP can then determine a potential plan B. Therefore, she and her HCP determine she should give ginger capsules a try.
Of note, there are certain additional considerations that may have made another woman and her HCP decide ginger capsules should not be tried. For example, in women who vomit frequently, ginger can be incredibly painful to throw up. Further, for women with severe acid reflux or evening/nighttime nausea, ginger capsules would almost certainly make these symptoms worse.
Process
The first step women should do when attempting to determine level of risk for any particular agent is to get informed; this includes what is currently both known and unknown about the agent during pregnancy (see our Topics page).
After women learn about current evidence-based information regarding that agent during pregnancy, they can begin to formulate what type of risk that agent could have on their individual pregnancy. Women must remember how research is conducted during pregnancy in order to correctly interpret this data.
Experiences from other women can then be a valuable next step. Once women are informed on current evidence-based research, side effects, possible risks, what is currently unknown about the agent, and have some knowledge regarding the experiences of other women regarding that topic, women then need to talk to their HCP regarding their HCP’s expertise and clinical experience.
Women are now fully prepared to participate in this discussion and decision with their HCP. Note: This site is not meant to replace a discussion with an HCP, it is meant to complement it.
Note: Women should have a complete understanding of their medical history, any potential underlying conditions, and other aspects of their health that could present as risk factors. All these aspects need to be considered in any medical decision and need to be shared with the woman's HCP.
Although some women may go into an appointment with a decision already made, they should not discount the opinion and recommendation of their HCP. While the decision is ultimately their own, women should ask as many questions as possible to better understand their HCP's recommendation and the reasons and experience behind that recommendation.
It is also completely normal for some women to go through the above process, have an HCP confirm an activity is safe, but for some women to still choose to avoid that particular activity, food, or medication:
For example, even though there is currently no evidence that exercise in the first trimester leads to miscarriage, some women may determine they are going to avoid exercising completely until at least the second trimester.
Regarding the risk of listeriosis (Listeria) infection during pregnancy, some women may avoid certain cheeses, soft serve ice cream, and deli meat, even though there are steps they can take to mitigate and even eliminate risk. Other women may determine the overall risk for infection is so low, they will continue to eat in the same manner they did prior to pregnancy.
Women can vary widely on what they feel is too much risk, and women should make their own decisions based on what they feel is an acceptable level of risk for their own pregnancy.
Additional Examples
Many women may require medical imaging during pregnancy that may use ionizing radiation (x-ray, CT scan).
For any imaging request during pregnancy, women need to have a risks and benefits discussion with their HCP regarding their general concerns, evidence-based information regarding radiation and fetal development, the necessity of the test, risks in performing the scan, if there are ways to mitigate risk, as well the risks in not performing the scan.
Medical imaging may be necessary for women who require diagnostic information; this benefit could outweigh any associated risk (read Radiation).
It is currently estimated that up to 30% of pregnant woman will experience severe nausea and vomiting as a result of NVP . Many of these women may have an interest in using medication to control their symptoms.
Women need to read about all medications currently recommended for NVP, the risks associated with each, the safety-data available for each, and which medication may fit their individualized needs, medical history, and comfort level. Women must also take into consideration the impact of their symptoms on their quality of life as well as their physical, mental, and emotional health.
Decisions with a Lack of Data
Women may also face many decisions in which there is very limited to no safety-related information regarding a particular environmental factor (cosmetics, beauty-related products, most medications).
For example, there is no direct safety or risk-related information regarding the use of bath bombs during pregnancy. To determine this, women can read additional pages on this to understand how indirect aspects of pregnancy can help answer this question.
For bath bombs, this could mean heat exposure, cervix, vagina, and skin.
The benefit of using these products during pregnancy could include aromatherapy, much needed relaxation, and soft and smooth skin that could help relieve women of certain pregnancy-related discomforts.
Regarding risk, women must look at what is currently known about other aspects of pregnancy, such as baths and hot water in general, as well as changes to the vagina and skin. This indirect information could provide them with enough data to decide.
Women would learn they should keep the bath water warm, not hot (or less than 10 minutes when hot) (read Heat Exposure). Women would also learn that the cervix forms a plug during pregnancy to prevent pathogens of the lower genital tract from infecting the uterus (which is a good thing), but it does not prevent all infections.
Additionally, the microbiome of the vagina changes dramatically during pregnancy and favors potential infection. Further, these changes could also lead to greater irritation and dryness from bath products that otherwise did not irritate the vagina or vulva prior to pregnancy – symptoms that could be very uncomfortable during pregnancy.
Further, although the chemicals in bath bombs can be assessed to potentially be safe overall, there are no studies to assess absorption in the skin of these chemicals or potential passage to the fetus. (Note: this risk could be very low or even non-existent; however, this is currently unknown).
Some women will decide the above data shows the benefit of much needed relaxation may be worth the possible and theoretical risks above, while other women may choose to avoid bath bombs while pregnant.
Action
It is important that pregnant women make their own decisions based on the amount of risk they are willing to accept. They should also be informed and well-counseled by their HCP. While some decisions are much easier than others, more complex decisions such as taking certain medications or undergoing labor induction, may require lengthier and more detailed conversations with an HCP.
Resources
Shared decision-making and decision support: their role in obstetrics and gynecology (Curr Opin Obstet Gynecol. December 2014)
Which potential harms and benefits of using ginger in the management of nausea and vomiting of pregnancy should be addressed? a consensual study among pregnant women and gynecologists (BMC Complementary and Alternative Medicine; April 2017)