Is it safe to take medication when you’re pregnant?

Just because you are pregnant doesn’t mean you won’t get ordinary aches and pains, like headaches or a cold. I rarely have pain other than the occasional headache, but when I was pregnant I had a lot of back pain, frequent headaches, a stuffy nose and De Quervain syndrome (also known as mother’s wrist—pain and swelling on the thumb side of the wrist). I knew what I would take if I wasn’t pregnant, but wasn’t sure it would be safe for my baby. So I asked my doctor.

It is important to talk to your doctor or pharmacist before you begin taking any medications, vitamins or herbs. Even “natural” products like herbs, minerals or amino acids are not necessarily safe. Drug companies can’t test medications on pregnant women, so in many cases we don’t have much information on how they can affect a women and her baby.

If you are pregnant and want to take a medication, talk to your doctor. Ask if there are any known safe alternatives. For example, maybe an ice pack would work for pain instead of medication. Ginger root or frequent eating and drinking may relieve nausea.

For some women, ongoing health conditions like high blood pressure and diabetes can actually get worse during pregnancy. There are several pregnancy exposure registries to help you learn which medications for these conditions are safe to take while pregnant. These registries are not run by the U.S. Food and Drug Administration, but the FDA does keep a list of all of them, where you can look for your medication or medical condition.

Just recently the FDA released a warning that pregnant mothers should not take certain migraine medications because they can lower children’s IQ scores. This warning was a result of the findings from the antiepileptic drug pregnancy registry.

If you are pregnant or thinking of becoming pregnant and take medication for an ongoing medical condition, contact a pregnancy exposure registry to learn more about your risks and options.

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Poisonings at work: An interview with Dr. Karla Armenti

Dr. Karla ArmentiFor North American Occupational Safety and Health Week, we spoke with Dr. Karla Armenti, the principal investigator for the Occupational Health Surveillance Program within the New Hampshire Department of Health and Human Services. She has been analyzing poison center data to look for trends in workplace poisonings.

What are the main occupational safety and health issues for New Hampshire employees today?

Karla Armenti: Actually we are continuing to see a steady number of occupational poisoning exposures as reported to the poison center. The numbers have remained consistent for most substances, however upon analysis, we see an increase in exposures involving cleaning substances used in industrial or janitorial (cleaning industry) environments.

Other issues of concern involve ergonomic-related, or musculoskeletal injuries involving upper extremities and low back.

Our work-related fatality rate has increased, especially in 2012, where we had 14 fatalities.  Of these, 4 involved tree-cutting activities.

You recently did a survey of immigrants in New Hampshire to better understand the occupational health of this working population. What was the most important thing you learned in your research?

KA: 62% of those surveyed had never heard of workers’ compensation and did not understand what their rights were when injured at work.

Many of our immigrants (including refugees settled in New Hampshire) were highly educated in their home country, but the only job they could get here was in cleaning or home health care. They reported that they knew when conditions at work were not safe but were fearful of losing their job. They often reported no knowledge of OSHA or workplace safety regulations. There is a critical lack of understanding about their employer’s responsibilities in this country with regard to keeping them safe at work.

The NNEPC manages approximately 150 occupational poisonings a year in New Hampshire. You have been analyzing our data to better understand this issue. What are some interesting findings? How has this data been useful to your work?

KA: Yes, our New Hampshire poison center data are critical to our surveillance efforts. We recently completed a study looking at data from 2009 to 2011 and found that chemicals, household and industrial cleaning substances, fumes/gases/vapors, heavy metals, and hydrocarbons are among the top contributors to occupational exposures in New Hampshire. We also see that among all age groups, the number of cases was greater for males than for females and the most common age group for both genders was the 20s. The highest percent for exposure route was inhalation, with dermal and ocular exposures evenly distributed, while ingestion was the lowest.

Despite existing intervention and education efforts, reported occupational exposure rates have remained relatively steady since 2005. The substances involved in the most exposures are widely used in workplace environments, and should be a focus of public health injury prevention efforts. While safety training, better enforcement of safe practices, and improved preventive maintenance of equipment are important interventions for these risks, ultimately the most effective intervention would be to limit the use of potential poisons in the workplace.

It is noteworthy that a number of the poisonings in our study occurred during a cleaning activity, performed across different types of businesses. While cleaning is often necessary in many industrial sectors, specific cleaning chemicals are not essential per se to the production process or final product. Thus, cleaning could be targeted as a high priority for substituting toxic substances with less hazardous ones to prevent workplace poisonings.

What do you hope to see happen to improve occupational safety and health in Northern New England and the U.S. in the next 5-10 years?

I would like to see an increased focus on primary prevention that includes stronger efforts to eliminate hazards in the workplace through design and chemical substitution.

There is a lot of promise in workplace wellness and health promotion activities; however, there must be a concerted effort to integrate workplace safety and health into these strategies for a more holistic and successful approach. We often spend more than 8 hours a day at work.  We need to understand that what we do at work influences our health just as much as anything else we do–and maybe more!

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Suicide and poisoning: Prevention strategies

Suicide is a complex issue involving multiple factors. According to the Surgeon General’s 2012 National Strategy for Suicide Prevention, “There is no single path that will lead to suicide. Rather, throughout life, a combination of factors, such as a serious mental illness, alcohol abuse, a painful loss, exposure to violence, or social isolation may increase the risk of suicidal thoughts and behaviors.”

Preventing suicides requires programs that reduce these negative factors and promote resilience and supportive relationships during difficult times. On a personal level, we need to be able to recognize warning signs of suicide and keep the person safe until they get help from a trained professional.

Warning signs of suicide include:

  • Talking about wanting to die; feeling hopeless, trapped, or in unbearable pain; feeling like a burden to others
  • Looking for a way to kill oneself
  • Increasing the use of alcohol or drugs
  • Acting anxious, agitated, or reckless
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more warning signs a person has, the greater the risk of suicide. If you think someone is at risk, do not leave them alone. Be sure to remove firearms and poisons (such as medications), call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), and take the person to the emergency department or connect them with a medical or mental health clinic.

If you live with someone who has a history of substance abuse or suicidal behavior, always keep firearms and other lethal items in a locked cabinet, and buy only small quantities of medications you need and store them in a locked box. Dispose of unwanted medications frequently – participate in local medication take back events.

To learn more about suicide prevention programs and recommendations read the 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action.

If you have questions about a possible poisoning, call the poison center at 1-800-222-1222 or chat online.

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Suicide and poisoning: Current statistics

According to the CDC, suicide was the 10th leading cause of death [PDF] in the U.S. in 2010 with 38,364 suicides, a rate of 12.4 per 100,000. Northern New England states rates were all above the national average [PDF] with Vermont ranked 12th (16.9 per 100,000), New Hampshire 18th (14.9) and Maine 26th (14.0).

Nationally, males account for 79% of all suicides and are more likely to use a firearm. The rates are highest for males among those 75 years and older. Females are more likely to use poisoning and the rate of suicide is highest among those 45-54 years of age.

In 2010, there were an estimated 465,000 people with self-inflicted injuries treated in the emergency department, up from 374,500 in 2009.

According to the American Association of Poison Control Centers, in 2010 nearly 220,000 [PDF] suspected suicide attempt poisoning cases were managed by U.S. poison centers. The Northern New England Poison Center managed nearly 3,300 of these. Patients under 20 were more likely to use readily-available substances such as over-the-counter pain relievers, while patients 20 and older were more likely to use prescription medications, including benzodiazepines and painkillers.

Suicide is preventable. If you feel you are in a crisis or know someone who is, call the National Suicide Prevention Lifeline at 1-800-800-273-TALK (8255).

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Mr. Yuk: A retired poison prevention icon

Do you remember Mr. Yuk?

Mr. Yuk

Mr. Yuk: No longer used

Many poison centers used to give parents Mr. Yuk stickers to put on poisonous things. The idea was that kids would learn to stay away from products that had the Mr. Yuk sticker on them. It was a good concept and very popular tool.

However, studies showed that Mr. Yuk wasn’t effective. Parents couldn’t realistically put stickers on every possible poison, so even if their child was really well trained to stay away from things with the sticker, they might think it was OK to play with products that didn’t have it. Some kids may have been attracted to the sticker, too.

Maybe more importantly, the kids targeted with the campaign—young school-aged kids—are not the real high-risk group. Children ages 13 months to 2 years are the most at risk for poisoning. In fact, they accounted for nearly 25% of all poisoning calls to the NNEPC in 2012.

Given all of this, most poison centers phased out using Mr. Yuk over a decade ago.

The sticker also couldn’t always help for medication. Medication is the most common cause of poisoning among young children, and they frequently get loose pills that have fallen to the floor. A study released this year by Safe Kids Worldwide found that among children treated for medication-related poisonings in an emergency room in 2011, 27% had found the medicine on the ground or misplaced. The next most common places they found medication were in a purse, bag or wallet (20%), on a counter, dresser, table or nightstand (20%), and in a bag of pills or pillbox (15%). The medications most often belonged to a grandparent (38%).

This report is a reminder to keep all medications in child-resistant packaging and out of the reach of children, and to be careful to not leave loose pills lying around. And programming your cell phone with the poison center phone number, 1-800-222-1222, is the best way to be prepared in case a child does get into some medication.

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