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gastric\treflux.\tRinsing\twith\ta\tbaking\tsoda\tsolution\t(1\ttsp\tbaking\tsoda\tin\t1\tcup\twater)\tmay\thelp\nneutralize\tthe\tacid\t(\nACOG,\t2013a\n)\tand\ttooth\tbrushing\tshould\tbe\tavoided\tfor\tat\tleast\tan\thour\tafter\nvomiting\tto\tallow\n\tthe\tenamel\tto\treharden\t(\nDragan\tet\tal,\t2018\n).\nPreexisting\tmedical\tconditions
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Dragan\tet\tal,\t2018\n).\nPreexisting\tmedical\tconditions\nMany\twomen\tbegin\tpregnancy\twith\tpreexisting\tconditions\tthat\tcan\tcomplicate\tthe\tpregnancy\tand\nmodify\tnutrient\trequirements\tand\tappropriate\tfood\tsources,\tas\twell\tas\tthe\tsupplementation\tthat\tis\nnecessary.\tAs\tan\texample,\tceliac\tdisease\tadversely\taffects\tfertility\tfor\tmen\tand\twomen,\tand\tthe
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] |
absorption\tof\tnutrients\toften\n\tis\timpaired\t(\nFreeman,\t2010\n).\tWomen\twith\tceliac\tdisease\thave\nincreased\trisk\tof\tmiscarriages\tand\tpreterm\tdeliveries.\tSome\tprenatal\tsupplements\tmay\tcontain\ngluten\tor\twheat\tbinders\tand\tshould\tbe\tavoided.\tWomen\twith\tphenylketonuria\t(PKU)\tmust\tbe
|
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] |
following\tthe\tdietary\trestrictions\tmonths\tprior\tto\tconception\tto\tminimize\tdamage\tto\tthe\tfetal\tbrain\n(see\t\nChapter\t42\n).\tWomen\twith\tinflammatory\tbowel\tdisease\n\tmay\thave\tlow\tserum\tvitamin\tB\n12\n\tlevels\tif\nthere\tis\tdamage\tto\tthe\tintestines.\tWomen\twith\tHIV\tinfection\tmay\thave\thigher\tenergy\tneeds\tand\tthe
|
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interaction\tof\tnutrients\twith\tmedications\tmay\thave\tto\tbe\tconsidered.\tImmigrant\twomen\tmay\tsuffer\nwith\tactive\tmalaria,\twhich\tinvades\tthe\tplacenta,\tor\tGI\tparasites,\twhich\tcan\tboth\tdecrease\tnutrient\nintakes\tand\tincrease\tnutrient\tlosses.\tWomen\twith\tpreexisting\tdepression\n\tare\tat\trisk\tfor\tpoor
|
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are\tat\trisk\tfor\tpoor\npregnancy\toutcome\tand\tpostpartum\tdepression,\tputting\tthe\tmother\tand\ther\tnewborn\tat\trisk\tif\tshe\tis\nunable\tto\tfunction\toptimally.\nWomen\talso\tmay\tdevelop\tconditions\tresulting\tfrom\tthe\tpregnancy\tthat\tneed\tparticular\tattention,\nincluding\tHG,\tgallstones,\tor\tintrahepatic\tcholestasis\tof\tpregnancy.\tThey\talso\tmay\tbe\tinvolved\tin\ta
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motor\tvehicle\taccident\tor\tother\ttrauma\tthat\trequires\n\tspecial\tcare\tor\teven\ttime\tin\tan\tintensive\tcare\nunit\t(ICU).\tIn\tall\tcases,\tthe\tneeds\tof\tthe\tmother\tand\tthe\tfetus\tmust\tremain\tparamount.\tAlthough\nguidance\tis\tavailable\tfor\tsome\tconditions\t(\nCrozier,\t2017\n),\tstrong\tevidence-based\trecommendations\nare\tlacking.\nFood\tsafety\tduring\tpregnancy
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are\tlacking.\nFood\tsafety\tduring\tpregnancy\nAlthough\ta\tpregnant\twoman\tis\tno\tmore\tlikely\tto\tbe\texposed\tto\tpathogens\tthan\ta\tnonpregnant\nwoman,\tshe\tand\ther\n\tfetus\tmay\tbe\tat\thigher\trisk\tof\tsuffering\tnegative\tconsequences\tfrom\tfoodborne\nillnesses.\tIn\taddition,\tbecause\tmetabolically\tactive\ttissues\tmay\tbe\tmore\tsusceptible\tto\tthe\taction\tof
|
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0.03796349838376045,
0.11392192542552948,
-0.010218803770840168
] |
toxins,\talong\twith\tthe\tpotential\tlong-term\teffects\tof\tfetal\texposure\tto\tsuboptimal\tconditions,\ta\npregnant\twoman\toften\thas\tquestions\tregarding\tthe\tsafety\tof\tcommon\tfoods\tand\tnonnutritive\nsubstances.\tThose\tfood\tsafety\tissues\n\tof\tmost\tconcern\tvary\tbetween\tpopulations.\t\nBox\t14.5
|
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] |
summarizes\tgeneral\tfood\tsafety\tguidelines.\nBOX\t14.5\nGeneral\tFood\tSafety\tGuidelines\nClean\n•\t\nWash\thands\tthoroughly\twith\tsoap\tand\twater,\tespecially\tbefore\tand\tafter\thandling\tfood,\tand\nafter\tusing\tthe\tbathroom,\tchanging\tdiapers,\n\tor\thandling\tpets.\tDo\tnot\ttouch\tmucous\nmembranes\tafter\thandling\tmeats.\n•
|
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] |
membranes\tafter\thandling\tmeats.\n•\t\nWash\tcutting\tboards,\tdishes,\tutensils,\tand\tcountertops\twith\thot\twater\tand\tsoap.\tWashing\nutensils,\tincluding\tcutting\tboards,\tin\tthe\tdishwasher\tis\tpreferable.\n•\t\nWash\traw\tfruits\tand\tvegetables\tthoroughly\tunder\trunning\twater,\teven\tif\tthe\tskin\twill\n\tnot\tbe\neaten.\n•\t\nDo\tnot\twash\tor\trinse\tmeat\tand\tpoultry.
|
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] |
not\tbe\neaten.\n•\t\nDo\tnot\twash\tor\trinse\tmeat\tand\tpoultry.\nSeparate\tto\tavoid\tcross\tcontamination\n•\t\nSeparate\traw\tmeat,\tpoultry,\tand\tseafood\tfrom\tready-to-eat\tfoods\twhen\tshopping,\tpreparing,\nand\tstoring\tfoods.\n•\t\nUse\tone\tcutting\tboard\tfor\traw\tmeat,\tpoultry,\tand\tseafood\tand\tanother\tone\tfor\tfresh\tfruits\nand\tvegetables.\n•
|
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] |
and\tvegetables.\n•\t\nPlace\tcooked\tfood\ton\ta\tclean\tplate.\tThe\tunwashed\tplate\tthat\theld\traw\tmeat,\tpoultry,\tor\nseafood,\tmay\tbe\tcontaminated.\nCook\tto\tproper\ttemperature\n•\t\nCook\tfoods\tthoroughly.\tUse\ta\tfood\tthermometer\tto\tcheck\tthe\ttemperature.\t(Color\tis\tnot\ta\nreliable\tindicator\tof\tmeat\tdoneness.)\tExamples\tinclude\tthe\tfollowing:\n•
|
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] |
•\t\nBeef,\tpork,\tveal,\tlamb,\tlarge\n\tcuts\t(steaks,\troasts,\tand\tchops):\t145°\tF\t+\t3-minute\trest\n•\t\nFish:\t145°\tF\n•\t\nBeef,\tpork,\tveal,\tlamb,\tground\tmeats:\t160°\tF\n•\t\nEgg\tdishes:\t160°\tF\n•\t\nTurkey,\tchicken,\tduck\t(whole\tanimal,\tpieces,\tground):\t165°\tF\n•\t\nCook\teggs\tuntil\tfirm.\n•\t\nReheat\tleftovers\tto\tat\tleast\t165°\tF\tand\tsauces,\tgravies,\tand\tsoups\tshould
|
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] |
be\tboiled.\nChill\tto\tavoid\tthe\tdanger\tzone\n•\t\nRefrigerator\tshould\tregister\tat\t40°\tF\tor\tbelow\tand\n\tthe\tfreezer\tat\t0°\tF.\tCheck\tthe\ntemperature\tperiodically\twith\tan\tappliance\tthermometer.\n•\t\nLimit\tthe\ttime\tfoods\tare\tin\tthe\tdanger\tzone,\tthe\trange\tof\ttemperatures\tat\twhich\tbacteria\tcan\ngrow\tquickly,\tusually\tbetween\t40°\tF\tand\t140°\tF.\n•
|
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] |
grow\tquickly,\tusually\tbetween\t40°\tF\tand\t140°\tF.\n•\t\nDefrost\t(and\tmarinate)\tfoods\tin\n\tthe\trefrigerator,\tnot\ton\tthe\tkitchen\tcounter.\n•\t\nRefrigerate\tor\tfreeze\tperishables\t(foods\tthat\tcan\tspoil\tor\tbecome\tcontaminated\tby\tbacteria\tif\nleft\tunrefrigerated)\tpromptly.\n•\t\nUse\tready-to-eat,\tperishable\tfoods\t(dairy,\tmeat,\tpoultry,\tseafood,\tproduce)\tas\tsoon\tas
|
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0.0639231950044632,
0.03820899873971939,
-0.035795919597148895,
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0.10719969868659973,
0.02143886685371399,
-0.005161378998309374,
0.015747105702757835,
0.04973840340971947,
0.04608316347002983,
-0.027622345834970474,
-0.04880106449127197,
0.012954609468579292,
0.09946808964014053,
-0.0494321808218956,
0.04783434793353081,
0.040463998913764954,
-0.00941170658916235,
0.015120706520974636,
0.03336179628968239,
-0.029058676213026047
] |
possible.\n•\t\n2-hour\trule:\tdiscard\tperishable\tfoods\tleft\tout\tat\troom\ttemperature\tfor\tmore\tthan\t2\thours.\tIf\nit\tis\ta\thot\tday\t(more\tthan\t90°\tF),\tshorten\tthe\ttime\tto\t1\thour.\nAvoid\thigh-risk\tfoods\n•\t\nAvoid\tunpasteurized\tmilks,\tincluding\tgoat\tmilk,\tand\tfoods\tmade\tof\tunpasteurized\tmilks.\nEven\tif\tsoft\tcheeses\tare\tpasteurized,\thard\tcheeses\tare\tsafer.\n•
|
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] |
Even\tif\tsoft\tcheeses\tare\tpasteurized,\thard\tcheeses\tare\tsafer.\n•\t\nAvoid\traw\tor\tundercooked\tmeats,\tpoultry,\teggs,\tfish,\tor\tseafood.\n•\t\nAvoid\tunpasteurized\tfruit\tor\tvegetable\tjuices.\tUnpasteurized\tjuice,\tincluding\tcider,\tmust\tbe\nboiled\t(full\trolling\tboil)\tfor\tat\tleast\t1\tminute.\n•
|
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boiled\t(full\trolling\tboil)\tfor\tat\tleast\t1\tminute.\n•\t\nAvoid\traw\tor\tundercooked\tsprouts,\tincluding\talfalfa,\tclover,\tmung\tbean,\tand\tradish.\tCooked\nsprouts\tare\tlower\trisk.\n•\t\nDo\tnot\topen\tbulging\tcans.\n•\t\nBoil\thome-canned\tfoods\tfor\t20\tminutes.\n•\t\nPay\tattention\tto\tnational\tfood\trecalls,\tas\twell\tas\tcautions\tissued\tlocally.\tPregnancy\tis\tnot\tthe
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] |
time\tto\tgamble.\nAdapted\tfrom\tCox\tJT,\tPhelan\tST:\tFood\tsafety\tin\tpregnancy,\tpart\t1:\tputting\trisks\tinto\tperspective,\nContemporary\tOb/Gyn\n\t54:44,\t2009a;\tUnited\tStates\tDepartment\tof\tHealth\tand\tHuman\tServices\n(USDHHS):\t\nKeep\tFood\tSafe:\tCheck\tyour\tSteps\n\t(website):\nhttps://www.foodsafety.gov/keep/basics/index.html\n,\t2018.
|
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] |
However,\tcaution\tis\tadvised\tto\tnot\toverestimate\tthe\trisk\tof\tfood\tcontamination\tin\tpregnancy\tor\tthe\namount\tof\tcontrol\tthat\tan\tindividual\thas\tin\tlowering\tthat\trisk.\tIt\tis\tcritical\tto\tavoid\tthe\timpression\nthat\ta\thealthy\tbaby\tis\tguaranteed\tif\tparents\tdo\teverything\tright\tand\tthat\tthe\tmother\tis\tto\tblame\tif\nanything\tgoes\twrong.\tIn\taddition,
|
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] |
anything\tgoes\twrong.\tIn\taddition,\n\tit\tis\tbecoming\tincreasingly\tapparent\tthat\tmaternal\tpsychological\nstress\tis\talso\tharmful\tto\tthe\tpregnancy\t(see\t\nClinical\tInsight:\n\tStress\tDuring\tPregnancy\n).\nCLINICAL\tINSIGHT\nStress\tDuring\tPregnancy\nPrenatal\tpsychological\tstress\tis\tassociated\twith\tshorter\tgestations\tand\tlower\tbirth\tweights.\tStress
|
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] |
also\tappears\tto\tinteract\twith\tpoor\tnutrition\tto\tnegatively\taffect\tfetal\tneurocognitive\tdevelopment,\nespecially\tthe\thippocampus\tand\tmemory\tfunctioning,\tusing\tthe\tsame\tmechanisms\tas\tinfectious\nstress\t(\nMonk\tet\tal,\t2013\n).\nAll\tnutrients\tare\timportant\tfor\tneuronal\tand\tglial\tcell\tgrowth\tand\tdevelopment.\tStress\tappears
|
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] |
to\talter\tthe\tmetabolism\tof\tmany\tnutrients\t(protein,\tglucose,\tzinc,\tiron,\tchromium,\tcholine,\tfolate,\nvitamin\tD,\tB\tvitamins),\tbut\tnot\tothers\t(LCPUFA,\tcopper,\tiodine,\tvitamin\tA),\tand\tsome\n\tnutrients\n(LCPUFA,\tprotein,\tzinc,\tiron,\tcholine)\tmay\thave\ta\trole\tin\tthe\tstress\tresponse\t(\nMonk\tet\tal,\t2013\n;\nMcCabe\tet\tal,\t2017\n;\t\nLindsay\tet\tal,\t2019\n).
|
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Monk\tet\tal,\t2013\n;\nMcCabe\tet\tal,\t2017\n;\t\nLindsay\tet\tal,\t2019\n).\nDistress\tcan\tinduce\tinsulin\tresistance\tand\tproinflammatory\tcytokines,\tdiverting\tamino\tacids\tto\ngluconeogenesis\tand\tenergy\tproduction\trather\tthan\tprotein\tproduction\t(\nMonk\tet\tal,\t2013\n).\tStress\nalso\traises\tthe\trisk\tof\thypertension,\tincreasing\tuterine
|
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).\tStress\nalso\traises\tthe\trisk\tof\thypertension,\tincreasing\tuterine\n\tartery\tresistance\tand\tlowering\tnutrient\ndelivery\tto\tthe\tfetus.\tRisk\tof\tautism\tand\tschizophrenia\tmay\tincrease,\tbut\tthe\ttiming\tof\tthe\tinsult\nmay\taffect\tthe\tresponse\t(\nMarques\tet\tal,\t2013\n).\tPrenatal\tstress\talso\taffects\tplacental\tdevelopment
|
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] |
).\tPrenatal\tstress\talso\taffects\tplacental\tdevelopment\nand\tplacental\tresponse\tto\tfetal\tdevelopment\tin\ta\tsex-specific\tmanner\t(\nCao-Lei\tet\tal,\t2017\n),\tas\twell\nas\tfetal\tprogramming,\tincluding\taffecting\tthe\tproduction\tof\n\tgenes\tthat\taffect\tthe\tability\tto\nregulate\tstress\tas\tan\tadult\t(\nGeorgieff\tet\tal,\t2015\n).
|
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] |
regulate\tstress\tas\tan\tadult\t(\nGeorgieff\tet\tal,\t2015\n).\nMaternal\tand\tfetal\timmune\tsystems\tcommunicate\tbidirectionally,\tand\tthe\tfetal\timmune\tsystem\n(innate\tand\tadaptive)\tcan\tbe\tdisrupted\twith\tmaternal\tstress,\tas\twell\tas\tby\texposure\tto\ttoxins\tand\nmalnutrition.\tThis\tdisruption\tmay\tbe\tsufficient\tto\taffect\ta\tchild’s\tresponse\tto\tvaccines\tbut\tthere\tis
|
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no\tconsensus\ton\tthe\n\ttimeframe\tof\tvulnerability\tor\ton\tthe\tmechanisms\t(\nMarques\tet\tal,\t2013\n).\nWhen\tstudying\tinfant\tneurocognitive\tdevelopment,\tpsychological\tstress\tand\tnutritional\tstatus\nmust\tbe\tstudied\ttogether\tto\texamine\ttheir\tbidirectional\tand\tsynergistic\teffects,\tbut\tthe\teffects\nappear\tto\tdiffer\twith\trace\tand\toffspring\tsex\t(
|
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] |
appear\tto\tdiffer\twith\trace\tand\toffspring\tsex\t(\nLindsay\tet\tal,\t2019\n).\tMaternal\tdepression\tand\nanxiety,\tas\twell\tas\tmaternal\tmalnutrition,\n\tare\tassociated\twith\taltered\toffspring\tbrain\tanatomy,\ncognitive\timpairments,\tand\tneurodevelopmental\tdisorders.\nWhen\tstudying\tintervention\tstrategies,\tstress\tand\tnutrition\talso\tneed\tto\tbe\tstudied\ttogether\n(
|
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] |
(\nLindsay\tet\tal,\t2019\n).\tHigh\tfat\tdiets\tappear\tto\tbe\tneuroprotective\tin\tthe\tcontext\tof\tmaternal\tstress\nexposure.\tThe\ttype\tof\tfat,\tspecifically\ta\tlow\tn3:n6\tratio,\tmay\tbe\tof\tconcern,\tbut\tthe\teffect\n\tappears\nto\tvary\tby\trace\tand\tethnicity.\tPrenatal\tsupplementation\twith\tantioxidants\tor\t1-carbon\tnutrients
|
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may\tlower\tthe\tanxiogenic\teffects\tof\tperinatal\tstress\tin\tthe\tadult\toffspring,\tat\tleast\tin\tthe\trodent\nmodel.\tMany\tnutrients,\tincluding\tcholine,\tlutein,\tB\n6\n,\tB\n12\n,\tfolate,\tmethionine,\tand\tbetaine,\tare\nbeing\tstudied,\tbut\tthe\tbeneficial\teffects\tappear\tto\tbe\tsex-specific.\tCurrent\tevidence\tis\tinsufficient
|
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to\trecommend\tany\tspecific\tdiet\tor\tnutrient\tcomponents\tto\tmitigate\tthe\teffect\tof\tprenatal\tstress\ton\nneurodevelopmental\toutcomes\tin\tthe\toffspring.\nOften\tissues\tof\tpsychological\tstress\tarise\tin\tthe\tcourse\tof\tdiscussing\tfood\tintake\tand\tweight\ngain.\tThey\twould\tinclude,\tbut\tare\tnot\tlimited\tto,\tcatastrophic\tlife\tevents,\tverbal\tor\tphysical\tabuse,
|
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unemployment,\tand\tfood\tinsecurity,\tas\twell\tas\tanxiety\n\tabout\tthe\tpregnancy\titself.\tIn\taddition,\ta\nhistory\tof\tadverse\tchildhood\texperiences\t(ACEs)\tis\talso\tassociated\twith\tlower\tbirthweights\tand\nshorter\tgestational\tage\t(\nSmith\tet\tal,\t2016\n),\tas\twell\tas\tincreased\trisk\tin\tthe\tperinatal\tand\tpostnatal\nperiods\t(\nMadigan\tet\tal,\t2017
|
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] |
periods\t(\nMadigan\tet\tal,\t2017\n).\tPaternal\tstress\tand\ttrauma\tappear\tto\taffect\tsperm\tdevelopment,\nnegatively\taffecting\toffspring\tneurodevelopment\t(\nChan\tet\tal,\t2018\n).\tWhether\tor\tnot\tany\tof\tthese\nhistoric\texposures\tto\tstress\tare\tmediated,\tor\tcan\tbe\taltered,\tby\tnutritional\tinterventions\tis
|
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] |
unknown.\tA\treferral\tto\ta\tmental\thealth\tprofessional\tfor\tevaluation\tand\ttreatment\tis\twarranted\nand\tgood\tsupport\tsystems\tappear\tto\tbe\thelpful\t(\nMadigan\tet\tal,\t2017\n).\tSee\t\nChapter\t30\n\tfor\tmore\ninformation.\nAlcohol\nAbundant\tevidence\tfrom\tanimal\tstudies\tand\thuman\texperience\n\tassociates\tmaternal\talcohol
|
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associates\tmaternal\talcohol\nconsumption\twith\tteratogenicity,\tcausing\ta\tvariety\tof\tproblems\tcollectively\tknown\tas\tFetal\tAlcohol\nSpectrum\tDisorders\t(FASDs).\t\nFetal\talcohol\tsyndrome\t(FAS)\n,\tthe\tmost\tinvolved\tof\tthese\tconditions,\nis\tthe\tleading\tcause\tof\tpreventable\tbirth\tdefects,\tpotentially\taffecting\t5%\tto\t10%\tof\tpregnancies\nworldwide\t(
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] |
worldwide\t(\nHarris\tet\tal,\t2017\n)\t(see\t\nChapter\t43\n).\nUse\tof\tany\talcohol\tduring\n\tpregnancy\tis\tassociated\twith\tan\tincreased\trate\tof\tmiscarriage,\tplacenta\nabruption,\tLBW\t(five-fold\tincreased\trisk\twith\tat\tleast\t1\tdrink/day),\tpreterm\tdelivery\t(twofold\nincreased\trisk),\tand\tcognitive\tcompromise\t(\nCox\tand\tPhelan,\t2009b\n).\tEpigenetic\teffects\thave\talso
|
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] |
Cox\tand\tPhelan,\t2009b\n).\tEpigenetic\teffects\thave\talso\nbeen\tdocumented\t(\nGupta\tet\tal,\t2016\n)\tand\tboth\tmaternal\tand\tpaternal\tgene\texpression\tmay\taffect\ta\nfetus’\tsusceptibility\tto\tFAS.\tHowever,\n\tthe\teffects\ton\tan\tindividual\tare\tdifficult\tto\tpredict\tand\teven\ndizygotic\ttwins\tcan\tbe\taffected\tdifferently\t(\nSarman,\t2018\n).
|
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dizygotic\ttwins\tcan\tbe\taffected\tdifferently\t(\nSarman,\t2018\n).\nPoor\tnutrition\tcan\texacerbate\tthe\tdevelopment\tof\tFAS.\tHigh\tblood\talcohol\tconcentrations\tcan\ndisplace\tor\treduce\tthe\ttransfer\tof\tnutrients\tacross\tthe\tplacenta.\tWhile\tprenatal\tinterventions\tto\nprevent\tor\treverse\talcohol’s\tteratogenicity\tare\tbeing\texplored,\tincluding\tthe\tuse
|
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] |
of\tantioxidants\tand\nother\tnutrients,\tresults\tare\tnot\tconsistent\tand\tnone\tare\tapproved\tfor\tclinical\tuse\t(\nGupta\tet\tal,\t2016\n).\nACOG,\tthe\tAmerican\tAcademy\tof\tPediatrics\t(AAP),\tand\tthe\tMarch\tof\tDimes\trecommend\tthat\nalcohol\tnot\tbe\tused\tduring\tpregnancy\tbecause\tno\tsafe\tthreshold\thas\tbeen\tidentified.\tReduced-
|
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] |
alcohol\twines\tand\tbeers\tcontain\tsmall\tamounts\tof\talcohol\tand\talso\tare\tcontraindicated.\tDespite\n\tthe\nmultiple\twarnings\tof\tfetal\tinjury\tcaused\tby\talcohol,\tsome\twomen\tcontinue\tto\tdrink\tin\tpregnancy\tand\nthey\tshould\tbe\toffered\tassistance.\tHowever,\tfor\tthose\twomen\twho\tare\tfearful\tof\tthe\talcohol\tthey
|
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consumed\tearly\tin\tpregnancy,\tpossibly\tbefore\trealizing\tthey\twere\tpregnant,\treassurance\tis\tadvised.\nAllergens\nRestriction\tof\tthe\tmaternal\tdiet\tduring\tpregnancy\tand\tlactation\tis\tnot\tadvised\tas\ta\n\tstrategy\tto\tlower\nthe\trisk\tof\tinfant\tfood\tallergies\tand\tmay\tbe\tcounterproductive\t(\nRenz\tet\tal,\t2018\n).\tMaternal\tdietary
|
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Renz\tet\tal,\t2018\n).\tMaternal\tdietary\nproteins\tfound\tin\tamniotic\tfluid\tand\tcord\tblood\thave\tbeen\thypothesized\tto\tsupport\tthe\tdevelopment\nof\ttolerance\tbut\tthe\tissue\tis\tstill\tbeing\tdebated\t(\nJeurink\tet\tal,\t2018\n).\tThe\tmother\tshould\tavoid\ther\nown\tallergens\tduring\tpregnancy\tand\tlactation\tbut\tshould\teat\ta\tvariety\tof\tother\n\tfoods,\tincluding\tthe
|
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foods,\tincluding\tthe\nfather’s\tallergenic\tfoods.\tRegarding\tpeanuts,\tstudies\thave\tshown\tthe\tchild\thas\ta\tslightly\tincreased\nrisk\tof\tdeveloping\tpeanut\tsensitization\tif\ta\tmother\teats\tpeanuts\tmore\tthan\ttwice\ta\tweek,\tbut\navoidance\tby\tthe\tmother\tappears\tto\tbe\tassociated\twith\teven\thigher\trisk\t(\nFleischer\tet\tal,\t2013\n).\tThe
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Fleischer\tet\tal,\t2013\n).\tThe\nmother\tis\tencouraged\tto\tbreastfeed\texclusively\tfor\tthe\tfirst\tfew\tmonths.\tFoods\tshould\n\tbe\tadded\tto\nthe\tinfant’s\tdiet\tcarefully\twhile\tstill\treceiving\tbreastmilk,\tbut\tdelaying\tintroduction\tof\tsolid\tfoods\npast\t6\tmonths\tprovides\tno\tbenefit.\tUse\tof\tprobiotics\tby\tthe\tmother\tor\tchild\tmay\tbe\tbeneficial,\tbut
|
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] |
type,\ttiming,\tand\tdose\tare\tunknown.\tThe\troles\tof\tmaternal\tfish\toil\tconsumption\tand\tvitamin\tD\ndeficiency\tare\talso\tbeing\tstudied\tbut\tcurrent\tdata\tare\tconflicting\tand\tno\tdefinite\tdietary\n\tguidance\ncan\tbe\tgiven\t(\nGarcia-Larsen\tet\tal,\t2018\n).\nArtificial\tsweeteners
|
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] |
can\tbe\tgiven\t(\nGarcia-Larsen\tet\tal,\t2018\n).\nArtificial\tsweeteners\nResearch\ton\tthe\tsafety\tof\tartificial\tsweeteners\tis\tlimited,\tbut\tthe\tFDA\thas\tdeemed\tthe\tfollowing\tsafe\nfor\tuse\tin\tmoderation,\tincluding\tduring\tpregnancy\tand\tlactation:\tsaccharin,\tacesulfame-K,\tsucralose,
|
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aspartame,\tneotame,\tadvantame,\tsteviol\tglycosides\tfrom\tstevia\tleaves,\tand\textracts\tfrom\tmonk\tfruit.\nFood\tadditives,\n\tincluding\tartificial\tsweeteners,\tare\ttested\tfor\tshort-\tand\tlong-term\ttoxicity;\nreproductive\teffects,\tincluding\tteratogenicity;\tand\tany\tadverse\teffects\ton\tan\tanimal’s\treproductive
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organs\tor\tsystems,\tany\tbirth\tdefects,\tand\tgenetic\ttoxicity\t(\nRulis\tand\tLevitt,\t2009\n).\tFrom\tthat\tdata,\ta\nsafety\tfactor\tis\tapplied;\tusually\t1/100th\tof\tthe\tdose\tin\twhich\tany\tproblems\thave\tbeen\tseen.\tThe\nresulting\tvalue\tis\n\tthe\tacceptable\tdaily\tintake\t(ADI),\tdefined\tas\tthe\testimated\tamount\tof\ta\tfood
|
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additive\tthat\tsomeone\tcan\tsafely\tconsume\ton\taverage\tevery\tday\tover\ta\tlifetime\twithout\tany\nappreciable\thealth\trisk.\tMonk\tfruit\tis\ttoo\tnew\tfor\tan\tADI\tto\thave\tbeen\tdetermined.\tCurrent\tintakes\nof\tthe\tother\tsweeteners\tlisted\there,\texcept\tfor\tstevia,\tare\twell\tbelow\tthese\tADI\tlevels\t(\nShankar\tet\tal,\n2013\n;\tsee\t\nChapter\t29\n).\nSaccharin
|
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0.0331045500934124,
0.022144926711916924,
0.08169533312320709,
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] |
Shankar\tet\tal,\n2013\n;\tsee\t\nChapter\t29\n).\nSaccharin\n\t(Sweet’N\tLow,\tSweet\tTwin,\tSugar\tTwin,\tNecta\tSweet)\tcrosses\tthe\tplacenta\t(\nCohen-\nAddad\tet\tal,\t1986\n)\tand\tmay\taccumulate\tin\tthe\tfetus\tand\tin\tbreastmilk,\tbut\tadverse\teffects\ton\tthe\nfetus\tand\tinfant\thave\tnot\tbeen\tdocumented\t(\nPope\tet\tal,\t2014\n).\tIt\thas\tbeen\tdelisted\tas\ta\thuman\ncarcinogen\t(
|
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] |
Pope\tet\tal,\t2014\n).\tIt\thas\tbeen\tdelisted\tas\ta\thuman\ncarcinogen\t(\nKroger\tet\tal,\t2006\n;\t\nShankar\tet\tal,\t2013\n).\nAcesulfame-K\t(Sunett,\tSweet\tOne)\tconsumption\tby\tpregnant\twomen\tis\tclassified\n\tas\tsafe,\teven\nwithout\tlong-term\tstudies\tduring\thuman\tpregnancy.\tIt\toften\tis\tused\tin\tconjunction\twith\tother
|
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] |
artificial\tsweeteners.\tIt\tis\tsaid\tto\tnot\tbe\tmetabolized\tin\thumans\t(\nKroger\tet\tal,\t2006\n).\tHowever,\tin\nmice\tit\tcan\tappear\tin\tthe\tamniotic\tfluid\tand\tbreastmilk\tafter\tan\toral\tinfusion\t(\nZhang\tet\tal,\t2011\n)\tand\nanimal\tmodels\thave\tshown\tit\tcan\tcross\tthe\tplacenta\tand\tincrease\tthe\tpreference\tfor\tsweets\n\tas\tadults\n(\nPope\tet\tal,\t2014\n).
|
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] |
as\tadults\n(\nPope\tet\tal,\t2014\n).\nSucralose\t(Splenda,\tNevella),\ta\tcarbohydrate\tderived\tfrom\tsucrose,\tappears\tto\tpass\tthrough\tthe\tGI\ntract\trelatively\tunchanged,\tis\tnot\tbioreactive,\tand\tdoes\tnot\tbioaccumulate\t(\nMagnuson\tet\tal,\t2017\n).\nThere\tis\tno\tevidence\tof\tharm\twhen\tused\tduring\tpregnancy\tand\tlactation\t(\nPope\tet\tal,\t2014\n).\tIt\thas
|
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] |
Pope\tet\tal,\t2014\n).\tIt\thas\nnot\tbeen\tfound\tto\tbe\tteratogenic\tin\tanimal\tstudies.\nAspartame\t(Equal,\n\tNutraSweet,\tNatra\tTaste)\tis\tmetabolized\tto\tphenylalanine,\taspartic\tacid,\tand\nmethanol\tin\tthe\tGI\ttract.\tStudies\thave\tshown\tno\tsignificant\teffect\ton\tfertility,\tconception\trates,
|
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embryo\ttoxicity,\tfetotoxicity,\tor\tteratogenesis\tat\tthe\tlevels\ttested\tin\tanimals\t(\nLondon,\t1988\n).\tIts\tuse\nduring\tpregnancy\tand\tlactation\thas\tnot\tbeen\tfound\tto\tincrease\trisk\tof\tbrain\ttumors\tin\tchildren\n(\nShankar\tet\tal,\t2013\n).\tThe\taspartic\tacid\tdoes\tnot\tcross\tthe\tplacenta\tin\tmonkeys,\tand\tthe\tmethanol\ncontent\tis\tless\tthan\tthat\tof\tmany\tfruit\tjuices\t(
|
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content\tis\tless\tthan\tthat\tof\tmany\tfruit\tjuices\t(\nKroger\tet\tal,\t2006\n;\t\nLondon,\t1988\n;\t\nPope\tet\tal,\t2014\n).\nAlthough\tit\tis\tnot\tabsolutely\tcontraindicated\tfor\twomen\twith\tPKU\tor\tfor\twomen\tbreastfeeding\tan\ninfant\twith\tPKU,\tit\tmust\tbe\tcounted\tas\ta\tphenylalanine\tsource.\tHigh\tcirculating\tconcentrations\tof\nphenylalanine\tare\tknown\tto
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phenylalanine\tare\tknown\tto\n\tdamage\tthe\tfetal\tbrain\t(see\t\nChapter\t42\n).\tNeotame\t(Newtame)\tis\talso\ta\nsource\tof\tphenylalanine\tand\taspartic\tacid\tbut,\tbecause\tit\tis\tmuch\tsweeter,\tthe\tamounts\tconsumed\nare\tnegligible\tand\tdo\tnot\thave\tto\tbe\tcounted\t(\nKroger\tet\tal,\t2006\n).\tAdvantame\tis\talso\ta\tsource\tof
|
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] |
Kroger\tet\tal,\t2006\n).\tAdvantame\tis\talso\ta\tsource\tof\nphenylalanine\tbut\tat\tsuch\tlow\tconcentrations\tthat\tit\talso\tdoes\tnot\tneed\tto\tbe\tcounted\t(\nFDA,\t2014\n).\nThere\tare\tno\thuman\treproductive\tstudies\n\ton\tadvantame,\tbut\tit\tis\tsweeter\tthan\tneotame,\tso\tvery\nsmall\tamounts\twould\tlikely\tbe\tconsumed.
|
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] |
small\tamounts\twould\tlikely\tbe\tconsumed.\nBoth\tstevia\tand\tmonk\tfruit\tare\tplant-derived\tsweeteners\tconsidered\tgenerally\trecognized\tas\tsafe\n(GRAS)\tin\ttheir\tpurified\tforms.\tStevia\t(Pure\tVia,\tTruvia,\tSweetLeaf)\thas\tnot\tbeen\tfound\tto\taffect\tfetal\ndevelopment,\tat\tleast\twith\tshort-term\tuse.\t\nStevia\trebaudiana\n\ttraditionally\thas\tbeen\tused\tby\tthe\nindigenous
|
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] |
Stevia\trebaudiana\n\ttraditionally\thas\tbeen\tused\tby\tthe\nindigenous\n\tpopulations\tof\tParaguay\tfor\tfertility\tcontrol\t(\nUlbricht\tet\tal,\t2010\n).\tAnimal\tstudies\thave\nsuggested\tthat\tsteviol\tglycosides\tmay\thave\tadverse\teffects\ton\tthe\tmale\treproductive\tsystem,\tbut\nthere\tare\tno\tconfirming\tstudies\tin\thumans\t(\nKroger\tet\tal,\t2006\n;\t\nUlbricht\tet\tal,\t2010
|
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] |
Kroger\tet\tal,\t2006\n;\t\nUlbricht\tet\tal,\t2010\n).\tCaution\tis\nadvised\twhen\tused\tby\tpregnant\tor\tlactating\twomen,\tor\tfor\tuse\tlonger\tthan\t2\tyears,\tbecause\tof\ninsufficient\tevidence\n\tof\tsafety\t(\nUlbricht\tet\tal,\t2010\n;\t\nPope\tet\tal,\t2014\n).\tThere\tis\tlittle\tinformation\ton
|
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;\t\nPope\tet\tal,\t2014\n).\tThere\tis\tlittle\tinformation\ton\nthe\texcretion\tof\tRebaudioside\tA\t(the\trefined\tpreparation\tof\tthe\tactive\tingredient,\tnow\tconsidered\nGRAS)\tand\tthe\tother\tplant\tcomponents,\tincluding\tsteviol\tglycosides,\tinto\tbreastmilk,\tso\tcaution\tis\nadvised\twhen\tnursing\ta\tnewborn\tor\ta\tpreterm\tinfant.\tThe\tADI\tfor\tstevia\tis\tthe\tequivalent\tof\tonly\t9
|
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] |
sweetener\tpackets/day\n\tfor\tsomeone\tweighing\t60\tkg.\tFor\tthe\textracts\tof\t\nSiraitia\tgrosvenorii\n,\tknown\nas\tSwingle\tfruit,\tLuo\tHan\tGuo,\tor\tmonk\tfruit,\tthere\tis\tno\tinformation\tavailable\tfor\tpregnancy\tor
|
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] |
lactation.\nSugar\talcohols\t(polyols)\tand\tpolydextrose,\ta\ttype\tof\tdietary\tfiber,\tare\tboth\tlikely\tsafe\tfor\tuse\tduring\npregnancy.\tOther\tsweeteners\tare\tavailable\tinternationally,\tincluding\tthaumatin\t(\nThaumatococcus\ndaniellii\n),\n\tderived\tfrom\tthe\tKatemfe\tfruit.\tThe\teffect\ton\tpregnancy\tis\tunknown\tbut\tis\tnot\texpected\tto\nbe\tof\tconcern\t(\nPope\tet\tal,\t2014\n).
|
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be\tof\tconcern\t(\nPope\tet\tal,\t2014\n).\nArtificial\tsweeteners\toften\tare\tfound\tin\tfoods\twith\tlow\tnutrient\tcontent.\tIntakes\tmay\thave\tto\tbe\nlimited\tso\tas\tnot\tto\tdisplace\tthe\tmore\tvaluable,\tnutrient-dense\tfoods.\tAlthough\taverage\tintakes\tare\nwell\tbelow\tthe\tADI,\tan\tassessment\tof\tthe\tdiet\tis\twarranted\tto\tidentify\tthose\n\twomen\twho\tmay\tbe
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women\twho\tmay\tbe\ningesting\tmultiple\tsources\tof\tartificial\tsweeteners.\tIf\tintakes\tare\thigh,\talternatives\tshould\tbe\toffered.\nBisphenol-A,\tphthalates,\tand\tother\tenvironmental\ttoxins\nBisphenol-A\t(BPA),\tan\tendocrine\tdisruptor,\tis\tassociated\twith\trecurrent\tmiscarriages\tand\tmay\taffect
|
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] |
thyroid\tfunction\tin\thumans,\tespecially\tin\tthe\tfetus.\tIts\tfunction\tat\tthe\tcellular\tlevel\tis\tstill\tbeing\ninvestigated\n\tbut\tthere\tis\tevidence\tin\tmice\tthat\tit\tacts\tsimilar\tto\tdiethylstilbestrol\t(DES)\t(\nACOG,\n2013b\n).\tPhthalates\tare\tassociated\twith\tshortened\tgestational\tlength\tand\tdevelopmental\tdisruptions.
|
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] |
BPA\tand\tphthalates,\talong\twith\t20\tother\tchemicals,\tare\tassociated\twith\tincreased\trisk\tof\tweight\ngain,\tinsulin\tresistance,\tand\ttype\t2\tdiabetes\tlater\tin\tlife\tafter\tdevelopmental\texposure\t(\nBarouki\tet\tal,\n2012\n).\tSee\t\nTable\t14.2\n\tfor\tmore\texamples.\nThere\tare\tcalls\tto\tlimit\tthe\tuse\tof\tBPA,\tphthalates,\tand\tother\tenvironmental\ttoxins.\tAlthough
|
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] |
recommendations\tcan\tbe\tmade\tto\tavoid\tspecific\tplastics\tand\tcanned\tfoods\t(BPA\tis\tused\tas\ta\tlining\nmaterial),\tmost\tpeople\talso\thave\thigh\texposure\tthrough\tair,\tdust,\tand\tpersonal\tcare\tproducts\n(\nSathyanarayana\tet\tal,\t2013\n),\tand\tchanging\tbehavior\tdoes\tnot\tnecessarily\treduce\trisk.\tIn\taddition,
|
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] |
having\ta\tplastic\tlabeled\t“BPA\tfree”\tdoes\tnot\tensure\tsafety.\tMost\tplastics\tunder\tstress\t(exposure\tto\nboiling\twater,\tultraviolet\trays\tin\tsunlight,\tor\tmicrowaving)\trelease\testrogenic\tchemicals\tthat\tmay\tbe\nof\tmore\tconcern\tthan\tthose\tplastics\tcontaining\tBPA\t(\nYang\tet\tal,\t2011\n).
|
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] |
Yang\tet\tal,\t2011\n).\nAlthough\tit\tis\tknown\tthat\texposure\tto\tenvironmental\ttoxins\tcan\thave\tlong-term\teffects,\tit\tis\nunknown\twhether\tor\thow\tthe\teffects\n\tvary\tby\tgender\tor\tlife\tstage.\tIt\tis\talso\tunknown\thow\tthe\nplacenta\tmediates\texposure\tto\ttoxins\t(\nACOG,\t2013b\n;\t\nBloomfield,\t2011\n).\tThe\teffects\tmay\tbe\tnonlinear
|
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] |
ACOG,\t2013b\n;\t\nBloomfield,\t2011\n).\tThe\teffects\tmay\tbe\tnonlinear\n(i.e.,\tlow\tdoses\tcan\tbe\tmore\tharmful\tthan\thigh\tdoses)\t(\nBarouki\tet\tal,\t2012\n).\tThere\tare\talso\tpotential\neffects\ton\tgene\texpression.\tACOG\tis\tcalling\tfor\tbetter\tresearch\ton\tthe\treproductive\teffects\tof\nenvironmental\ttoxins\tand\tsocietal\tchange\tregarding\n\texposure\tto\tthese\ttoxins\t(
|
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exposure\tto\tthese\ttoxins\t(\nACOG,\t2013b\n).\nMuch\tof\tthe\teffect\tof\tthese\tchemicals\tmay\tbe\tduring\torganogenesis,\tso\treducing\tpreconceptual\nexposure\tis\tlikely\tto\tbe\tmost\tproductive.\tRaising\tconcerns\twith\ta\tmother\tlater\tin\tpregnancy\twithout\nactually\tbeing\table\tto\tchange\toutcomes\twould\tnot\tbe\thelpful.\nCaffeine\tand\tenergy\tdrinks
|
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] |
Caffeine\tand\tenergy\tdrinks\nCaffeine\tcrosses\tthe\tplacenta\tand\tincreases\tmaternal\tcatecholamines,\tbut\n\tit\tappears\tthat\tintakes\tof\nless\tthan\t200\tmg/day\tare\tnot\tassociated\twith\tincreased\trisk\tof\tmiscarriages,\tlow\tbirthweight,\tor\npreterm\tbirth\t(\nPractice\tCommittee,\t2017\n).\tIt\tdoes\tnot\tdecrease\tuterine\tblood\tflow\tor\toxygenation.
|
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] |
).\tIt\tdoes\tnot\tdecrease\tuterine\tblood\tflow\tor\toxygenation.\nHowever,\talthough\tthere\tis\tno\tclear\tevidence\tof\tharm,\tthe\tevidence\talso\tdoes\tnot\tfollow\tthe\texpected\ndose-response\tcurve,\tso\tthe\teffect\tcannot\tbe\tdetermined\tdefinitively.\tThe\n\thalf-life\tof\tcaffeine
|
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] |
half-life\tof\tcaffeine\nincreases\tduring\tpregnancy\t(8.3\thours\tlonger\ton\taverage,\tbut\tcan\tbe\tup\tto\t16\thours\tlonger)\tso\tthe\neffect\ton\tthe\tfetal\tbrain\tis\tpotentially\tincreased\t(\nTemple\tet\tal,\t2017\n).\tSmoking\tdoubles\tthe\tclearance\nrate\tbut\talcohol\tconsumption\tdecreases\tit.
|
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] |
rate\tbut\talcohol\tconsumption\tdecreases\tit.\nCaffeinated\tbeverages\tare\tnot\tconsidered\tto\tbe\tof\thigh\tnutritional\tquality,\tand\tmoderation\tis\nencouraged.\tSee\t\nAppendix\t25\n\tfor\tcaffeine\n\tfood\tsources.\tEnergy\tdrinks\tand\tenergy\tshots\tare\tnot\nrecommended\tduring\tpregnancy.\tThey\tmay\tcontain\tvery\thigh\tcaffeine\tlevels\t(>\t500\tmg)\tand\talso\tcan
|
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] |
be\thighly\tsweetened\t(\nTemple\tet\tal,\t2017\n).\tIn\taddition,\tthese\tdrinks\toften\thave\thigh\tlevels\tof\tadded\nnutrients\tand\therbal\tproducts\tthat\thave\tnot\tbeen\tevaluated\tfor\tsafety\tduring\tpregnancy\t(\nProcter\tand\nCampbell,\t2014\n).\nLead\tand\tcadmium\nContaminants\n\tin\tfood\tare\tthe\texception\trather\tthan\tthe\trule\tin\tthe\tUnited\tStates,\tbut\tthey\tdo\toccur.
|
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] |
In\thigh\tconcentrations,\tthey\tcan\tpass\tacross\tthe\tplacenta\tto\tthe\tfetus\t(\nFig.\t14.7\n).\tHeavy\tmetals\tare\nof\tparticular\tconcern.
|
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] |
FIG.\t14.7\nTransfer\tof\tsubstances\tacross\tthe\tplacental\tmembrane.\t\nIg\n,\tImmunoglobulin.\nLead\tcontamination\tis\tassociated\twith\tincreased\trisk\tof\tmiscarriage,\tgestational\thypertension,\nIUGR,\tpreterm\tdelivery,\tand\timpaired\tneurobehavioral\tdevelopment.\tIt\teasily\tcrosses\tthe\tplacenta\tby\npassive\tdiffusion\t(\nCaserta\tet\tal,\t2013\n).
|
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] |
passive\tdiffusion\t(\nCaserta\tet\tal,\t2013\n).\nIn\taddition\tto\told\tpaint\tchips,\tpoorly\tglazed\tdishware\t(often\timported)\n\tand\tleaded\tcrystal\ndecanters\tmay\tcontain\thigh\tamounts\tof\tlead.\tPregnant\twomen\tshould\tavoid\tusing\tdolomite\tas\ta\ncalcium\tsupplement\tbecause\tthe\tseashells\tor\tsea\tcoral\toften\tcontain\theavy\tmetals,\tincluding\tlead,\tas
|
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0.0882715955376625,
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0.029522689059376717,
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0.02156890369951725,
0.06218087673187256,
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0.11429381370544434,
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0.05694582685828209,
0.07678844034671783,
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-0.016125064343214035,
0.05061554163694382,
0.010575258173048496,
-0.0716259703040123,
0.0151644516736269,
0.07634720951318741,
-0.00848425179719925,
-0.03214948996901512,
-0.054116617888212204,
0.03787580877542496,
0.08742449432611465,
0.060434240847826004,
-0.018471309915184975,
-0.010473711416125298,
0.07499396055936813,
0.11048643290996552,
0.049479298293590546,
0.002706997562199831
] |
a\tresult\tof\tdumping\tindustrial\twastes\tin\tthe\toceans.\tImported\tcandies\tfrom\tmany\tareas,\tincluding\nMexico,\tChina,\tand\tIndia,\thave\talso\tbeen\tfound\tto\tcontain\tlead\t(\nHandley\tet\tal,\t2017\n)\tSpices\n\tand\nherbs,\tnotably\tground\tturmeric,\thave\tbeen\tfound\tto\tbe\tadulterated\twith\tlead\tchromate\t(\nCowell\tet\tal,\n2017
|
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] |
Cowell\tet\tal,\n2017\n).\tLead\tcan\talso\tbe\tfound\tin\timported\tcosmetics,\tceremonial\tpowders,\tand\tmedications,\nincluding\tkohl,\thenna,\tsindoor,\tayurvedic\tmedicines,\tand\tMexican\tdigestive\tmedicines\t(\nLin\tet\tal,\n2010\n).\tIt\thas\talso\tbeen\tfound\tin\tmaca\troot\tpowder\t(\nLepidium\tmeyenii\n),\toften\ttaken\tas\ta\tfertility\nenhancer\t(\nJohnson-Arbor\tet\tal,\t2018\n).
|
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),\toften\ttaken\tas\ta\tfertility\nenhancer\t(\nJohnson-Arbor\tet\tal,\t2018\n).\nCadmium\texposure\tis\tassociated\twith\tpoor\tfetal\tgrowth\t(\nCaserta\tet\tal,\t2013\n).\tIt\taccumulates\tin\tthe\nplacenta\trather\tthan\tin\tthe\tfetus,\taffecting\tzinc\ttransport\tto\tthe\tfetus\tand\taltering\tboth\tthe
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production\tof\tplacental\thormones\tand\ttrophoblast\tcell\tmigration.\tOne\tsource\tof\tcadmium\tand\tother\nheavy\tmetals\tmay\tbe\tseaweeds\tgrown\tin\tcontaminated\twaters\t(\nDesideri\tet\tal,\t2016\n).\nOther\tpotential\tcontaminants,\n\tor\tsources\tof\tcontamination,\tmay\tbe\timportant\tas\twell,\tso\tlocal\nissues\tshould\tbe\tinvestigated\tand\tappropriate\tguidance\tgiven.
|
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issues\tshould\tbe\tinvestigated\tand\tappropriate\tguidance\tgiven.\nListeria\tmonocytogenes\nListeria\tmonocytogenes\n\taffects\t1600\tAmericans\teach\tyear,\tkilling\t260\tof\tthem,\tmaking\tit\tthe\tthird\nleading\tcause\tof\tdeath\tresulting\tfrom\tfood\tpoisoning\t(\nCDC,\t2018d\n).\tPregnant\twomen\tare\t10\ttimes\nmore\tlikely\tthan\tother\thealthy\tadults\tto\tbecome\tinfected\n\twith
|
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] |
more\tlikely\tthan\tother\thealthy\tadults\tto\tbecome\tinfected\n\twith\t\nListeria\n\tspp.\tand\trates\tamong\tU.S.\nHispanic\twomen\tare\t24\ttimes\tthat\tof\tthe\tgeneral\tpopulation,\tbut\tthe\treasons\tfor\tthe\tincreased\nsusceptibility\tare\tunclear.\tAlthough\tthe\tincidence\tof\tlisteriosis\tdeclined\t42%\tbetween\t1996\tand\t2012
|
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] |
because\tof\tbetter\tfood\tsafety\tmeasures,\tit\thas\tplateaued\tsince\tthen\tand\ta\tbetter\tunderstanding\tof\nthe\teffect\tof\tdifferent\tstrains,\tdoses,\tgenetic\tsusceptibility,\n\tand\tother\tunknown\tfactors\tis\tneeded\n(\nWadhwa\tDesai\tand\tSmith,\t2017\n).\nIn\tstudies\tof\twomen\twho\tdeveloped\tlisteriosis\tduring\tpregnancy,\t10%\tto\t20%\tsuffered\ta
|
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miscarriage,\t11%\thad\ta\tstillbirth,\tand\t50%\tof\tthem\thad\ta\tpreterm\tdelivery\t(\nAdams\tWaldorf\tand\nMcAdams,\t2013\n).\tListeria\tcan\talso\tcause\tneonatal\tmeningitis,\tsepsis,\tand\tpneumonia.\tIt\tmay\tonly\ncause\tflu-like\tsymptoms\tin\tthe\tmother\tand\tcan\tmimic\n\ta\turinary\ttract\tinfection,\tbut\tmany\twomen
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a\turinary\ttract\tinfection,\tbut\tmany\twomen\nhave\tno\tsymptoms\tand\tthe\tlack\tof\tmaternal\tsymptoms\tis\tnot\ta\treliable\tmarker\tfor\tfetal\trisk.\tFetal\ntransmission\tis\tnot\tinevitable.\tInfections\tare\tmuch\tmore\tlikely\tduring\tthe\tthird\ttrimester\t(96%)\tthan\nin\tthe\tfirst\t(3%),\tbut\tthe\tconsequences\tare\tmore\tserious\twith\tthe\tearlier\tinfections.\tWith\tbetter
|
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surveillance\tand\tmore\tfood\trecalls,\tthere\tis\tnow\tmore\tof\tan\n\tawareness\tof\tan\texposure,\tbut\tthere\tis\nlittle\tguidance\ton\thow\tto\tprevent\tthe\tdevastating\teffects\tif\tthe\tmother\tis\tasymptomatic\t(\nWadhwa\nDesai\tand\tSmith,\t2017\n).\nListeria\n\tis\ta\tsoilborne\tbacteria\tand\tinfection\tresults\tfrom\teating\tcontaminated\tfoods\tof\tanimal
|
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origin\tor\traw\tproduce.\tBecause\tit\tcan\talso\tbe\tairborne,\tcan\ttolerate\thigh\tsalt\tenvironments,\tand\ngrows\tin\tmoist\tenvironments\tat\trefrigeration\n\ttemperatures,\traw\tmilk,\tsmoked\tseafood,\tfrankfurters,\npté,\tsoft\tcheeses\t(especially\tif\tmade\twith\tunpasteurized\tmilk),\tand\tuncooked\tmeats\tare\tlikely
|
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] |
sources.\tMost\tcases\tof\tlisteriosis\tare\tassociated\twith\tsporadic\tcontamination\trather\tthan\tepidemics\n(\nCDC,\t2018d\n).\tBecause\tof\timprovements\tin\tprocessing,\tthe\trisk\tof\tcontamination\tin\tpackaged\tcold\ncuts\tis\tnow\tone\tfifth\tthat\tof\tretail-sliced\tmeats\t(\nBatz\tet\tal,\t2011\n).\tRecommendations\tto\treduce\trisk
|
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] |
Batz\tet\tal,\t2011\n).\tRecommendations\tto\treduce\trisk\ninclude\tusing\tonly\tpasteurized\tfood\tproducts\tand\theating\tprecooked\tmeat\tproducts\tto\tsteaming\t(\nBox\n14.6\n).\nBOX\t14.6\nListeria\n\t\nGuidelines\nFollow\tthe\tgeneral\tsafety\tguidelines\tin\n\t\nBox\t14.5\n,\tincluding\tthe\tfollowing:\n•\t\nAvoid\tcross\tcontamination\twith\tthe\tfluid\tfrom\thot\tdog\tpackages.
|
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] |
•\t\nKeep\traw\tmeats\tseparated\tfrom\tvegetables,\tcooked\tfoods,\tand\tready-to-eat\n\tfoods.\n•\t\nWash\tfruits\tand\tvegetables\tthoroughly.\n•\t\nEat\tperishable\tand\tready-to-eat\tfoods\t(dairy,\tmeat,\tpoultry,\tseafood,\tproduce)\tas\tsoon\nas\tpossible.\tCheck\tfor\t“use\tby”\tdates\tonce/week\tand\tthrow\tout\tfood\tthat\thas\tpassed.\nFollow\trecommended\tstorage\ttimes\tfor\tfoods.\n•
|
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] |
Follow\trecommended\tstorage\ttimes\tfor\tfoods.\n•\t\nWipe\tup\tspills\timmediately.\tClean\tthe\trefrigerator\tregularly\twith\thot\twater\tand\tmild\nliquid\tdetergent,\trinse.\nChoose\tlower\trisk\n\tfoods.\n•\t\nAvoid\tunpasteurized\tmilk\tor\tany\tfoods\tmade\tfrom\traw\tmilks.\n•\t\nMake\tsure\tsoft\tcheeses\t(feta,\tBrie,\tCamembert,\tblue-veined,\tor\tMexican\tstyle\t“queso
|
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blanco,”\t“queso\tfresco,”\tor\tPanela)\tare\tmade\twith\tpasteurized\tmilk.\n•\t\nDo\tnot\teat\thot\tdogs,\tluncheon\tmeats,\tor\tdeli\tmeats\tunless\treheated\tto\tsteaming\t(165°\nF).\tMeats\tmay\tbe\tchilled\tafterward.\tAs\tan\talternative,\tcooked\tmeats\tor\tcanned\tmeats\n(salmon,\tchicken,\ttuna)\tmay\tbe\tused\tfor\tsandwiches.\n•
|
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] |
(salmon,\tchicken,\ttuna)\tmay\tbe\tused\tfor\tsandwiches.\n•\t\nDo\tnot\teat\trefrigerated\tptés\tor\tmeat\tspreads.\tCanned\tor\tshelf-stable\tversions\tmay\tbe\neaten.\n•\t\nDo\tnot\teat\tham\tsalad,\tchicken\tsalad,\tor\tseafood\tsalad\tmade\tat\tthe\tstore.\tInstead,\tmake\nthem\tat\thome\tfollowing\tgeneral\tfood\tsafety\tguidelines.\n•
|
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] |
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