Category Archives: Our Blog

Get Your Flu Shot!

  • Pregnant and postpartum women are at higher risk for severe illness and complications from influenza than women who are not pregnant because of changes in the immune system, heart, and lungs during pregnancy…. Influenza vaccination can be administered at any time during pregnancy, before and during the influenza season. Women who are or will be pregnant during influenza season should receive inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV).
  • Flu shots have been given to millions of pregnant women over several decades with a good safety record.
  • Pregnant women should get a flu shot; NOT the live attenuated vaccine (LAIV or nasal spray).
  • Postpartum women, even if they are breastfeeding, can receive either type of vaccine.
  • There is a lot of evidence to show that flu shots can be safely given to women during pregnancy. CDC and ACIP recommend that pregnant women get vaccinated during any trimester of their pregnancy.
  • Pregnant women should receive a seasonal flu shot.
    • Influenza is more likely to cause severe illness in pregnant and postpartum women than in women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women more prone to severe illness from influenza.
    • Vaccination has been shown to reduce the risk of flu-associated acute respiratory infection in pregnant women by about one-half.
    • Getting a flu shot can reduce a pregnant woman’s risk of being hospitalized with flu by an average of 40 percent.
    • Pregnant women who get a flu shot are also helping to protect their babies from flu illness for the first several months after their birth, when they are too young to get vaccinated.

-Dr. Jennifer Jagoe, courtesy of CDC

Headaches during Pregnancy

More than 40 million people suffer from headaches. Headaches interfere with leisure activities, mood, concentration and daily function. The National Headache Foundation suggests that understanding the type and triggers of a headache can not only guide potential treatment options but also help people make lifestyle changes and efforts to try to  prevent them. 

Headaches during pregnancy can be common in each of the 3 trimesters.  The causes are multiple and need to be evaluated carefully as the causes are varied.  The most common headaches include tension, cluster or migraines. Common triggers include exertion, foods, stress, hunger, anxiety, dehydration, neck strain and poor sleep habits.  Other causes of headaches include medication side effects, changes in hormones and underlying medical conditions such as high blood pressure or hypertension.  

First trimester is often a time of altered eating due to hormonal changes which accompany food aversions, heightened sense of smell, nausea and vomiting. It is important for pregnant ladies to avoid long periods of fasting and to limit the risk of dehydration. Pregnant woman who abruptly stop caffeinated beverages may experience headaches as well.  In second trimester, higher levels progesterone, a normal female hormone, can lead to an increase in headaches and are typically self -resolving as the pregnancy progresses.  Viral illness, seasonal allergies sinus congestion, tooth pain, infections and other medical problems may also lead to a headache.

Stretching, reduced computer time, eyeglasses, sunglasses, sleep, rest, massage and exercise all may improve quality of life and lower frequency of head pain.

Acetominophen is the generic name for Tylenol which is both safe and effective as first line treatment for both pain and fever in pregnancy. The maximum amount that adults can take is 4000mg or 4gm orally in divided doses in a hour period. For example:  325mg tabs, taking 2 by mouth with water every 6 hours.

Water alternatives include products such as Gatorade, Propel, Powerade, lemonade, carbonation, decaffeinated tea, shakes, popcicles, smoothies, sugar water, ginger, lemon and lime additives to water may help increase fluid intake so headaches resolve and IV fluids in the acute care setting is not required.

Home remedies are appropriate to try initially; however, if not improved please be sure to seek advice and /or evaluation from your primary care provider or obstetrical medical team.  The first consideration in third trimester of pregnancy is hypertension or high blood pressure.  Pre- eclampsia is more common in the first pregnancy. Prenatal visits are more often in the third trimester so that if problems occur close follow up and early intervention is possible.

You are advised to call our office at 301 468-4900 for headaches or if not feeling well so that blood pressure and symptoms can be evaluated promptly.

-Dr. Jennifer Jagoe

Travel during Pregnancy

Expecting a baby is an exciting and special time. Women feel energized and empowered when they observe miraculous body changes. The body knows exactly what to do and healthy personal choices help support this amazing natural process. Travel is sometimes considered a way to celebrate, however safety and comfort needs can be prioritized if you plan to travel during pregnancy.

The American College of Obstetrics and Gynecology (ACOG) suggests the best time to travel is between 14-28 weeks. Cruise lines and airplanes caution about having pregnant ladies aboard. Traveling can sometimes cause problems. Be careful about standing too long waiting in line as you may feel faint. If you do feel so, sitting down and having a cold sweet drink can help. Try to avoid carrying too much weight. Travel to other countries later in third trimester can lead to hospitalization or delivery far from home. Seatbelts, of course, are always advised. Long car trips can become complicated when women need to frequently make trips to the bathroom. Water intake requirements increase to approximately a gallon of water a day, preferably from bottles. Once you arrive, try to avoid doing too much physical activity right away. Your skin may be more sensitive to the sun, so wearing a large hat and putting on sunscreen can help. Anticipating hunger and the need for frequent snacks and healthy meals is essential so planning ahead is important. Travel is not always easy. Preparing ahead of time with food, water bottles, sensible footwear and thoughtful creative ideas are required, appropriate and fun.

American popular culture shows us professional athletes competing while pregnant such as the LPGA star golfing at top level tournament in third trimester and the performing artists at the Super Bowl halftime show demonstrate how a woman with an enlarging abdomen and a healthy fetus can gracefully do just about anything. However, sometimes activity modification to prevent a fall, accident or injury in pregnancy is not only medically recommended to optimize outcome but also may be more comfortable. Being able to anticipate common discomforts and to minimize potential complications in pregnancy needs to be carefully considered and is something to discuss with both family and the health care team. If you have an urgent question, you are able to reach us by calling our office even while away from home.

-Dr. Jennifer Jagoe

We Recommend You get Vaccinated!

We recently have received communications from the Maryland Department of Health and from the American College of Obstetricians and Gynecologists regarding whether pregnant women should become vaccinated:

ACOG stated that “pregnant patients with COVID-19 are at increased risk of more severe illness compared with non pregnant peers.”
“These data indicate an increased risk of ICU admission, need for mechanical ventilation and ventilatory support (ECMO), and death reported in pregnant women with symptomatic COVID-19 infection, when compared with symptomatic non-pregnant women.” “ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination.”

Considering the relative safety of the vaccine compared with the much greater short-term and unknown long term risks of the virus, we recommend you do what we did, Get Vaccinated!

We are working to be able to provide the vaccine in our office. Until that is available, we recommend you get the vaccine as it becomes available wherever you can.

Covid-19 Update

You Can Make a Difference!

In Montgomery County, Maryland we are heading into an expected surge in infections with the Covid-19 virus. We are trying to make everyone safer by following these precautions:

  1. If you are having symptoms such as fever, cough, shortness of breath:
    1. Call your primary care physician
    1. Stay home except for medical care
    1. Limit contact with others in your home
    1. Practice good hygiene with frequent had washing, cleaning common surfaces, and covering your cough or sneeze with your elbow, not your hands
    1. Manage symptoms at home with over the counter medications for fever and cough. Currently Nsaids such as ibuprofen are not recommended.
    1. Get plenty of rest
    1. Stay well hydrated
  2. If you are sick, keep in touch with your doctor. Most cases of Covid-19 are mild and do not require a trip to the ER or hospital. If your symptoms worsen to high fever an difficulty breathing, call your doctor or health facility before you go there. This can help them to prepare for your visit.
  3. If you are in Labor, Shady Grove Adventist Hospital remains open, but there are changes in procedures:
    1. In order to minimize exposure, only ONE visitor will be allowed in Labor and Delivery.
    1. Only the ER entrance should be used from 8pm to 5am.
    1. Visitors will be screened for flu like symptoms and will not be permitted to enter if positive.
    1. Visitors who have traveled internationally will not be permitted to enter.
    1. No visitors under age 18 unless they are a parent of a child in the hospital.
    1. Hospital Tours and Childbirth classes are suspended. We recommend as a substitute online classes such as www.mybirthly.com
  4. Our office remains open, but we have suspended routine gyn visits. We continue to encourage prenatal visits as long as you have no symptoms of the virus. If you have questions about whether or not to come, please call us first. 
  5. Unfortunately, we also must limit visitors to our office. We request that you do not bring visitors to our office including husbands, partners and children until this crisis has passed unless they need to be present for translation.

Are Hormones for Menopause Safe?

I recently attended the American Congress of Obstetricians and Gynecologists Annual Clinical Meeting and heard an excellent talk from one of George Washington University’s Professors, James Simon MD. The talk was inspirational! He spoke about a very important topic, “The Status of Hormone Replacement Therapy.”

By way of background, in the past many women were treated for symptoms of menopause with hormones, but in 2002 a report came out, called the “Women’s Health Initiative,” which changed everything by painting a very negative picture about the harm that hormones could cause. As a result, many women, all over the world, were scared into stopping hormones, and some of that fear persists to this day, despite much evidence to the contrary. Years later we have gradually discovered that the study was deeply flawed.

Dr Simon described this as an example of a  “Zombie Idea,” an idea that should have been killed by evidence, but refuses to die! This actually is similar to the current situation involving fear of vaccines, which was originally based on a fraudulent and discredited study, but still lingers on despite overwhelming evidence of vaccine safety.

Similarly, the WHI Study from 2002 was also flawed and following its recommendations has caused harm.

We now know about the “timing hypothesis” that the safety of starting hormone replacement therapy depends on when it is started in relation to menopause. Studies show a much decreased risk of complications such as stroke or heart attack if the woman starts treatment within 10 years of menopause.

Transdermal patches as a way of receiving hormones appear to decrease the risk even further, according to an extensive French study.

Re-analysis of the old WHI data shows no effect of hormones on causing breast cancer.

A Finnish nationwide study showed a decreased chance of death from breast cancer if hormone therapy with either estrogen or estrogen with progesterone was used.

To make it even more definite, a review of 17 studies looking at the risk of recurrence of breast cancer in women who had previous breast cancer, showed that 16 of the 17 studies had either no change or a reduction in recurrence of cancer if they were on hormone therapy.

Another review showed women lived longer if they received hormones starting at age 50-59. This looked at death from all causes, death from cancer, and death from stroke or heart attack.

The risk of Alzheimer’s disease or dementia was decreased by use of hormones.

How do hormones compare with other medications? Surprisingly, recent  studies found an increased risk of breast cancer from taking statins, which are often prescribed for high cholesterol levels. Medicines prescribed for improvement of bone density such as Pioglitazone showed an increased risk of breast cancer of 88 per 10,000.

Surprisingly, analysis showed one of the most dangerous medications causing breast cancer is Vitamin D, which caused 70 per 10,000 additional cases of breast cancer.

What was the aftermath of stopping hormonal therapy based on the WHI report when it came out in 2002? A study in 2009 showed a significantly increased number of bone fractures. Another study in 2011 shows more hip fractures in women who stopped hormonal therapy compared with those who continued it.

Was there an increased risk of death from stopping estrogen therapy? A study in 2013 showed over a 10 year span, starting in 2002, a minimum of 18,000 and as many as 91,000 US women died prematurely because of the avoidance of estrogen therapy.

The conclusions are that hormone therapy risks are rare, and even more rare when started in women who are less than 60 years old and/or within 10 years of beginning menopause. Starting it at a younger age does decrease the risk and increase the benefit.

The degree of risk, when it does occur, is similar to that of many commonly used medications or vitamin supplements. Hormone therapy significantly reduced the risk of bone fractures and is the most effective treatment for reducing the worst symptoms of menopause including hot flashes and atrophy of the vulva and vagina. If you have any symptoms of menopause, talk with us about being treated for it!

Introducing Dr. Jennifer Jagoe!

Ournewdr

We are very pleased to announce that our practice has grown. As you can see in the picture, we now have four doctors in our practice!

Dr. Jennifer Jagoe, pictured on the left in the above image,  has joined our practice. She has a strong background in Obstetrics and Gynecology. She served as an OBGYN physician at the Naval Medical Center San Diego, the Naval Hospital Guam, the Naval Hospital Bremerton, Washington, the Madigan Army Medical Center, Tacoma, Washington, and the Walter Reed National Military Medical Center in Bethesda, MD.

She recently worked as an Assistant Clinical Professor of Obstetrics and Gynecology at the University of Maryland School of Medicine. Her work included being a preceptor for medical students, being a member of the Perinatal Advisory Council, and a member of the Maryland Patient Safety Center.

We are very fortunate to have her joining our group!

Dr. Jagoe is available to see patients at our Rockville office on Tuesday, Thursdays and Fridays, and at our Germantown office on Mondays and Wednesdays.

Getting Pregnant!

Fertility FriendBecoming pregnant can be fun, happy, exciting, or sometimes unplanned. Knowing how it happens is very useful information to make it easier to achieve when desired, and to be avoided if that is the goal.

 
The average menstrual cycle lasts for 28 days and can range from 21 to 35 days. In an average cycle ovulation occurs on day 14. Signs may include a cramp in the lower abdomen or back, breast tenderness, increase in a clear vaginal discharge, or an increase in sexual desire.

 
SpermFor pregnancy to happen, sperm must be present in the fallopian tubes and meet with an egg. When a man climaxes during sex millions of sperm go into the vagina and some can make their way through the cervical mucus and into the uterus and from there into the fallopian tubes. Sperm can live inside a woman’s body for 3 days or more, but an egg’s life is much shorter, only 1 day. So pregnancy can occur if an egg is already present when you have sex, or if you ovulate within a day or two after you have sex. This means that your fertility time is limited. You are fertile from 3-5 days before ovulation to 1 day after ovulation. Trying to time intercourse so that you have sex just before ovulation seems to be a good way of thinking about it. There is also a new theory that ovulation is not just a random event. Research has discovered a special protein in semen that can actually cause ovulation.

 
Knowing when you are fertile can be a challenge. There are different methods to predict it. For planning purposes, there are phone apps that can be helpful such as Fertility Friend or My Days. These apps calculate your expected next period and make predictions based upon it. The predictions are less accurate if your cycles are less regular. You can also go to the drug store and purchase an ovulation predictor test kit such as Ovutime or Ovutest. These urine tests indicate when the hormone LH becomes present. When LH rises in your circulation it causes ovulation and this hormone can be detected in your urine. When the ovulation test turns positive, this means you should have intercourse that day and the next day for best results. You may also notice changes in your cervical mucus where it becomes increased in amount and more clear and watery in quality. To promote pregnancy you should time intercourse to be daily or every other day when good quality cervical mucus is present. It should not be less often than every other day or more frequent than once a day for the best fertility results. You can also track your temperature with a special thermometer to measure your basal body temperature. Your temperature rises after you ovulate and stays up by a small amount for 2 weeks. This method is not that useful in that by the time you discover you have ovulated, it’s already too late for timing of sex.

 
You can start trying for pregnancy soon after you stop using a birth control method, but not too soon. If you are using the pill or a similar hormonal birth control method, it is a good idea to wait at least a month or two to allow your body to return to normal. If you get pregnant in the first cycle after stopping the pill you will have double the chance of having twins. While that may sound exciting, having one baby at a time is a much safer way to go, and much more manageable for taking care of children later on. We recommend stopping the birth control method, waiting 1-2 months before trying for pregnancy, and being on vitamins that contain iron, folic acid and DHA. In a given cycle the chance of success is only 20%, and it is normal to take months for pregnancy to happen. Do not be discouraged if it does not happen right away. With normal fertility you will become pregnant within 1 year, and 85% of couples will be successful in having this happen. 15% of couples will take longer than a year (that is called infertility), but only 1% of couples are unable to conceive. If you are trying for pregnancy and it seems to be taking too long, don’t worry about it. Sometimes you can be trying too hard for pregnancy. Increasing your anxiety about it is not helpful for fertility. Relaxing and having a good time is usually the best recipe for success.

 
First signs of pregnancy include feeling very tired, feeling nauseous, having breast tenderness, and your period being late. If you think you may be pregnant, doing a home test is helpful. If positive, these tests are usually reliable. If a test is negative it may be accurate or not. Sometimes the level of pregnancy hormone is elevated by too little to be detected by the urine method. If you really need to know (for example when a tubal pregnancy is suspected), then a blood test is much more reliable to detect an early pregnancy. Blood tests and ultrasound are also very helpful if you are bleeding and concerned about a possible miscarriage.

 

 

When you have a positive test, call us to make an appointment to come in and confirm your pregnancy. If you are at least six weeks and one day from the first day of your last period, we should be able to see the fetus and its heart beat by ultrasound. Once we see the fetal heartbeat the chance of successfully having a baby goes up to 85%! Then you are on your way to having a new life in your family. Good luck!

 
This article is partially based on information in ACOG’s book, Your Pregnancy and Childbirth, Month to Month.Your Pregnancy and Childbirth

Menopause and Hormone Therapy – What’s New?

estrogen replacementIt was only about 100 years ago that the average woman’s life expectancy increased to the extent she would live past the time of menopause. Now with the average life expectancy into the 80’s, a woman may live more than 1/3 of her life in the menopause. The number of women in the menopause is increasing and expected to go up even more. The consequences of menopause include hot flashes, night sweats, insomnia, skin changes, mood changes, depression, anxiety, irritability, loss of libido, vaginal atrophy, cardiovascular disease and weakened bones. How can hormone therapy be safely used to help treat this problem affecting so many women?

We need to put hormone therapy in perspective, and also consider risks and benefits of treatment. Although there is a lot of controversy in the media, patients look to their doctors to be their advocates and give good advice about treatment. It’s our duty as doctors to be informed and advocate for our patients. We need to treat disease in a preventive way, rather than wait for the damage to be done. Disease often starts off in a pre-clinical way, and with some diseases it can be difficult to detect early on. Many diseases that occur have their roots decades before they can be detected, and similarly their treatment may take time to demonstrate a benefit.

Menopausal symptoms

Hot flashes are one of the most bothersome symptoms of menopause. 50% of women have them longer than 4 years, 23% more than 13 years. Temperature regulation helps your body maintain the proper temperature by causing sweating when you are hot and chills when you are cold, thus maintaining a neutral zone of comfort. Hot flashes are a disturbance of this system which are thought to be due to a change in the temperature regulatory system where a decrease in estrogen causes a decrease in the size of the normal thermo-neutral zone in-between sweating and shivering. The end result can interfere with your sleep and your comfort.

Benefits and risks of treatment

Combination estrogen and progestin therapy is FDA approved to treat menopausal hot flashes, prevent osteoporosis, treat vaginal atrophy, and provide other benefits to reduce insomnia, irritability and short-term memory loss. Hormone therapy is highly effective to relieve hot flashes, both their amount and intensity. In women who have a uterus, estrogen alone therapy can increase the risk of uterine cancer, but the increased risk is removed once progesterone therapy is added to estrogen. In 2002 the Women’s Health Initiative study came out and revealed risks of this treatment, including an increased risk of heart disease, stroke, blood clots and breast cancer when both estrogen with progesterone are taken. This had the effect of scaring women into avoiding estrogen therapy even though the absolute risk was only 8 per 10,000 women and the study was based on doses higher than are in use today. This risk is roughly equivalent to the risk of dying in a car accident, and is relatively rare. Rather than being misled by percentages of change, it’s more scientific to consider the absolute risk, and when the risk is less than 1 per 1000 you must weigh that small risk against the improvement in relieving symptoms you get with the right treatment. Other variables to consider include age and method of treatment. Women receiving hormones in the age group of 50-59 have a much less risk of coronary heart disease, stroke, and breast cancer than those in the 70-79 age group. Also women who receive estrogen through a transdermal patch have a significantly reduced risk of a blood clot compared with oral treatment, possibly due to a more stable delivery system and avoiding metabolism by the liver where clotting proteins are made.

Having a uterus makes a difference

Having had a hysterectomy means that hormone replacement therapy need only include estrogen, which is the hormone that conveys most all of the benefits and very little risk. This good hormone decreases the risk of heart disease, protects against breast cancer, and reduces damage to blood vessels with benefits in the brain leading to less risk of Alzheimer’s disease. Women who don’t have a uterus are in a much better position because the only major risks to consider are those related to blood clots and much of this risk can be reduced by getting estrogen through transdermal medications that don’t affect the liver where clotting proteins are made. There are benefits in vaginal lubrication, increased vaginal thickness, better sexual function, better support of the bladder, improved bone strength and decreased cancer of the colon.

Having a uterus makes treatment more complex, because an progestin needs to be added to treatment to decrease the risk of uterine cancer. But what if there were a medication available that can still provide estrogen benefits without the progesterone risk? Well, there is a new type of estrogen now available called a SERM, or selective estrogen receptor modulator, and when combined with a traditional estrogen, its called a TSEC, or tissue selective estrogen complex. The new estrogen has been designed to have some progesterone-like beneficial effects on the uterus (but without a progestin) and also when combined with a traditional estrogen conveys an improved quality of life, more satisfaction with treatment, improved vaginal health, improved sleep, improved bone density, significantly less hot flashes, with less breast pain and less bleeding. The new medication, Duavee, combines an estrogen with a synthetic “designer” estrogen called Bazedoxifene and represents an improved hormone therapy for those women who have a uterus.

While combined traditional hormone replacement therapy can still be used for the majority of women being treated, there are groups of women who are particularly good candidates for this new approach, including women with a family history of breast cancer, women who have had a problem with combined therapy such as tender breasts, those with increased breast density, or if they have had bleeding issues.

Conclusions 

We need safe and effective treatment for menopausal symptoms. The risk of breast cancer is slightly increased with hormone therapies that combine estrogen with progesterone, but not with estrogen alone or in combination with a new estrogen (called a SERM). TSECS combine an estrogen with a SERM to provide relief of menopausal symptoms without the increased risks caused by progestins and offer a new, safer treatment for menopause. These new developments in hormone therapy are just the beginning of designing new safe treatments that provide more benefit at less risk.

This information is from a course “Menopause and Hormone Therapy” given at the 2015 ACOG Annual Clinical Meeting and was presented by Drs Hugh Taylor and JoAnn Pinkerton.

Apps for Pregnancy, 2015

Apps can be useful and fun. I’m always asking my patients which apps they like for pregnancy. These are some apps that have been recommended to me:

  1. My Days – Period and OvulationIMG_3685

This free, accurate app has is very helpful for determining the best days of fertility and improving your chances of becoming pregnant more quickly. It tracks periods and uses this information to predict fertility in the upcoming month.

Or… it can be used as a birth control rhythm method by knowing which are the most important fertile days and avoiding intercourse at that time.

  1. Perfect OB WheelIMG_3686

Comprehensive pregnancy wheel contains information about conception, length of pregnancy, due date.   It’s simple, fast, free, and has input flexibility, allowing you to put in the last menstrual period, the conception date, the estimated date of confinement, or the number of weeks and days of gestation based on ultrasound dating.

 

 

  1. IMG_3678What to Expect Pregnancy

This very popular app includes a due date calculator, week-by-week details on your baby’s development, weekly baby illustrations, updates on your changing body, and countdown to your due date. You get daily tidbits of advice and it also includes helpful information for dads. It’s from the popular book “What to Expect When You’re Expecting” and works on the iPhone, iPad and even the Apple Watch!

 

  1. IMG_3679Contraction Timer by iBirth

The value of a contraction timer is in its simplicity and ease of use. This app makes timing of contractions during labor easy. It has a simple interface, tracks the duration of each contraction, tracks the intervals between contractions, and has a history report for tracking labor progress over time. It’s great for tracking information that your doctor will want to know in assessing if labor has begun.

  1. IMG_3680Baby Names!!

For people who would like some help in choosing a name, this app will show you the name’s meaning, pronunciation, gender and origin. It also includes graphs of a name’s popularity over time. For example, the most popular girls names now are Sophia, Isabella, Emma, Olivia, Ava and Emily! You can search by name, gender, origin or initial. It links to Wikipedia and gives you oodles of information of more than 30,000 names. It also has a feature that chooses names that fit with those of the parents.

  1. IMG_3684Sex Life – 100+ Positions

This fun guide to sex positions may add some variety to your life!   This app has a contemporary style and can help you try different positions, rate them, keep track of what you have tried, and choose favorites. You can unlock one position free every day and over time build up your amount of visual illustrations.

A score board gives you an overview of your progress.

 

  1. IMG_3681First Aid.                                                                 A useful guide to quick treatment of many different medical emergencies from the American Red Cross, including allergic reaction, burns, poisoning, broken bones, choking, heart attack, heat stroke, seizures, shock, insect bites, unconscious and not breathing.                                                         The app has much useful information that can help you take care of an emergency by yourself or while waiting for help to come. It helps you to be prepared for the unexpected problem.
  2. Lactmed.IMG_3682

LactMed is part of the National Library of Medicine (NLM) Toxicology Data Network and is a database of drugs and dietary supplements that may affect breastfeeding. It includes information of the levels of substances in breast milk and how they could adversely affect the nursing infant. This app can help you know which medicines are safe to take when you are breastfeeding your baby.

 

 

These apps can be very helpful.  But you have to be careful when getting health related apps because some of them may superficially appear reliable but actually are not based on medicine or science. A recent article “Identification of iPhone and iPad applications for obstetrics and gynecology providers” performed a scientific search for quality ob/gyn apps with results described as “finding a needle in a haystack.”

The good news is that more apps are being written every day. As time goes on, I’ll report back on other apps I have found useful and based on reliable information.