Supporting Optimal Immunity In Pregnancy

Motherhood is a lifelong role during which there will be no shortage of opportunities to worry. Even before you give birth, your mama-bear radar is engaged, and you’re suddenly motivated to do all you can to protect this precious being growing inside of you. So as hard as it is to manage these worries while we're pregnant, it's also an ideal time to start developing inner practices to help us cope with these worries, both in order to protect ourselves and our little ones.

On today’s first official Let’s Chat About That episode of On Health, I’ll be addressing some of these worries head on by answering a voicemail from an expecting mama who is concerned about optimal immunity in pregnancy, and dealing with the very real feelings of anxiety and fear about getting sick during this time. My goal today is to ease some of these overwhelming worries by providing you with the honest facts so that you can make the most informed decisions to keep yourself and baby healthy now and for the long run.

On this episode, I discuss:

• The likelihood of developing respiratory illness while pregnant
• Non-respiratory infections to be aware of: herpes, toxoplasmosis, and Listeria
• What you need to know about the cold, the Flu, COVID, and RSV while pregnant, including prevention and what to do about common respiratory symptoms and fever
• Universal symptoms, that tell you it's time to get medical care
• How to minimize exposure and boost immunity safely in pregnancy

I hope this episode brings you the peace of mind, reassurance, and ease to carry you through your pregnancy and into your journey through motherhood. I look forward to connecting with you and answering more of your women’s health-related questions in future episodes of this series! Remember, you can call me at (413) 889-4549 and leave a voicemail for a chance to be featured on the next one!

Thank you so much for taking the time to tune in to your body, yourself, and this podcast! Please share the love by sending this to someone in your life who could benefit from the kinds of things we talk about in this space. Make sure to follow me on Instagram @dr.avivaromm to join the conversation.

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Let's Chat About That: Supporting Optimal Immunity In Pregnancy

Hi everyone, and welcome to the first official “Let’s Chat About That” episode, where you get to call in a question and I answer it. Sophia, and all you pregnant mamas out there: congratulations on your pregnancies

Sophia, thank you for your question; I’m sure so many mamas listening will relate to it! If you’re not pregnant but you want to know about immunity, and this is the first time you’re tuning in, what I share today will be relevant. However, I recently did another episode specifically about boosting immunity.This is definitely relevant if you’re planning to conceive soon, so bookmark it and have a listen. Grandmommas, aunties, birth workers: in this episode, you’ll all find something to share with the pregnant mamas in your life.

Before we dive in, I want to give a CONTENT WARNING. We are going to talk about some of the possible complications of common seasonal infections when they occur in pregnancy. While these are rare (and I’m going to continue to remind you of that), they are still important to know about. As a mama and a midwife myself, I know how tender we feel and how big our emotions are when it comes to hearing some of the pregnancy risks. I’ll also be telling you all the things you can do to prevent infection and stay healthy throughout the season. 

Anxiety about Getting Sick in Pregnancy

Sophia, I hear you. You’re feeling super anxious about getting sick – of course! First trimester is such an important time for a baby’s growth, and we’ve all heard how careful we have to be in the first trimester. It’s natural to be anxious! You’re not alone or weird! There’s a lot going on in there that we can’t see; even with a second or subsequent pregnancy, we feel so responsible for our baby’s well-being. It can feel like a lot of pressure. 

It is an especially rough year for all things infection related. Anxiety about getting sick was naturally heightened by COVID, and now there’s the “tripledemic” (RSV, flu, colds) in kids, as it’s being called. COVID isn’t just a thing of the past, and we're all susceptible, with more or less risk depending on our age, immunity, genetics and other factors. It's really important, with everything that’s going on in the world, that you be really easy and gentle on yourself about having pregnancy worries. Who wouldn't have worries?

I’m just gonna say it: as a mama of 4, pregnancy is the start of wearing your heart on your sleeve. As mothers, most of us feel we’re doing it for the rest of our lives. My kids are 28 to 37 at the time of this recording. On some level, the worry doesn’t stop. There will be no shortage of opportunities to worry about things. So as hard as it is, being pregnant is the ideal time to develop inner practices to help us cope with these worries. We have to protect ourselves and our littles, but also have to learn to release the worry over what we can’t control. There’s a saying that goes, ‘if you worry about a problem, you have it twice.’ Most of the things we worry about never happen, so we end up spending a lot of time worrying and feeling miserable unnecessarily. Worry doesn’t help you think clearly, which is another reason to learn to use your breath, meditation, journaling, mindfulness, and resilience tools to learn to transform worry into proactive practices. Trust that you’re doing what you need to in order to support your immunity, to protect yourself, and to protect your children. 

Prenatal Anxiety

That said, I don’t want to dismiss the very important and too often overlooked condition of prenatal anxiety. If anxiety is preoccupying or overwhelming your thoughts, this could be prenatal anxiety. If it's a constant distraction, if it is incapacitating you, if it is waking you up at night and you can't go back to sleep, this could be prenatal anxiety. It’s very important to discuss it with your midwife or other care provider so that they can help you get the care that you need.  I have a wonderful podcast on perinatal mood challenges with the founders of the Motherhood Center, Catherine Birndorf MD, and Paige Bellenbaum LCSW, as well as other resources on my website and podcast. Again, just having worries doesn’t mean you have prenatal anxiety! But if you do feel that you're having unusually high levels of anxiety, and if the worries are getting in the way of your wellbeing, it’s important to talk to someone. Nobody should have to live miserably with worries all the time. 

The Realities of Getting Sick with a Common Infection During Pregnancy

I’ve been doing this work as a midwife and midwife-MD for a combined 37 years now. I can tell you from my experience in both of those professions – as well as statistically – that about two-thirds of women do develop some type of respiratory illness (aka cold and flu) if they’re pregnant through the winter season. However, most pregnant women do not get severely sick, even when they have littles who are coming home with the entire germ bank of your town, for example. Even women who are working in healthcare and are exposed to these illnesses don't usually get severely sick. Most simply get a cold – or if it is a flu, it's a mild case. Fewer than 2% of pregnant women require admission to an intensive care unit (ICU) during pregnancy, or in the first few weeks postpartum; acute respiratory failure that requires mechanical ventilation affects only 0.1% to 0.2% of pregnant women.

 Any woman could become very sick, but it’s much more likely in women who are already at higher risk of acquiring an infection because of comorbidities (asthma, diabetes, heart disease, immunocompromised, being a smoker); occupation (nurses, military, possibly teachers); travel plans; and medical beliefs and practices. If you're not vaccinated for something and you're exposed to it, you're statistically more likely to get it than somebody who is vaccinated. It’s important to maintain good health, to know your personal risks, and to minimize exposures whenever possible. 

Today we’re going to focus on the common seasonal infections that appear during cold and flu season, but there are some non-respiratory infections that we want to follow precautions for avoiding, and your midwife or medical provider should be talking to you about them. One of these is experiencing a primary herpes outbreak in the first trimester. Half to three quarters of people have herpes and have been exposed to it at some point in their life. Many of you, if you do have herpes, either get cold sores or genital sores. Your risk of herpes outbreaks in pregnancy doesn't increase risks to the baby, but if you get herpes for the first time during pregnancy, then there is a very high risk of infection. If you have new sexual partners during pregnancy, make sure that you're asking them questions about their history with herpes, using protection, etc. 

Exposure to toxoplasmosis and Listeria are also risks. For toxoplasmosis, two big exposures to avoid are kitty litter, gardening in places where cats have used the soil as kitty litter, and raw fish (i.e. in sushi). The most common risk for Listeria exposure is raw dairy products.

All of the common respiratory infections involve universal symptoms to look out for:

• Inability to retain fluids
• Signs of dehydration
• Shortness of breath
• Chest pain or pressure
• Altered mental status
• Comorbidities (eg, human immunodeficiency virus [HIV], asthma)
• Obstetric complications (eg, preterm labor)
• Worsening symptoms after previous improvement
• Inability to care for self

Hopefully, you wouldn't ever get that sick. But if you have asthma, poorly controlled diabetes, if you have immunodeficiency or are immunosuppressed due to being treated for an autoimmune condition – make sure to seek medical help if you begin to experience any of the above symptoms.  

COVID, Flu, Colds, and RSV in Pregnancy

The seasonal infections that are most common in the late fall, winter, and into early spring  (depending on the hemisphere you live in) are influenza (flu), colds, and RSV. Now we can add COVID to that mix (though it’s not fully seasonal – it’s still all year ‘round).

These are the infections a pregnant woman is likeliest to be exposed to in the winter season. Everyone was so sequestered during the COVID lockdown that we’re seeing higher rebound rates of flu and RSV. We probably will continue to see these higher rates into early spring; patterns show that some of these infections are starting earlier and lasting later into the season. 

With some of these infections, respiratory consequences are the biggest risk for mama. Fever is one of the greatest concerns – especially with flu, in which temperatures often run high. Dehydration is also a risk. COVID may increase other risks, such as preeclampsia, but in most women it doesn’t. With RSV, and possibly with COVID, vertical transmission, mama passing things onto the baby in utero, is a concern. 

Let’s start by talking about these infections, and then what you can do to protect yourself and your baby. A caveat here is that, while most pregnant women who get respiratory infections in pregnancy will be just fine, it’s impossible to talk about some of these infections without bringing up some scary data. It’s important to know the honest facts so that you can make the most informed decision for yourself – a decision you’re also making for your baby while you're pregnant, and which can also influence baby’s immunity and health after birth.

Colds

Colds are a nuisance, but for otherwise healthy pregnant women, rarely ever more than that. The biggest issues with colds in pregnancy is maintaining adequate hydration and keeping fever from getting high. Stay hydrated, rest, and if you have fever (depending on how high it is), you can start with natural remedies. You may need to use Tylenol short-term; I talk about the safety profile of Tylenol in pregnancy in an article and podcast. The bottom line with short-term use for high fever in pregnancy is that the benefits outweigh the risks. Aspirin and nonsteroidal anti-inflammatory drugs [NSAIDs]) like ibuprofen should be avoided, as they may be associated with adverse pregnancy and infant outcomes. Low-dose aspirin for other medical conditions in pregnancy can be used. 

Flu

As with colds, it’s important to manage fever and stay hydrated when you have the flu. However, influenza infections in pregnancy are potentially more complicated than infections from a common cold. Again, while most women will simply experience discomfort, a percentage of women will become moderately ill. A smaller but significant percentage may become very ill. When compared with the rest of the population, pregnant women are about 5 times more likely to be hospitalized for flu. Some of this may be due to legal issues that cause healthcare professionals to treat pregnant women with so much caution medically. But it is also true that pregnant women are much more susceptible to respiratory problems as a result. 

Transplacental transmission of influenza virus appears to be rare, but maternal influenza during pregnancy may have adverse effects on the fetus, even in the absence of transplacental transmission. Influenza during pregnancy can also be associated with an increased risk for pregnancy loss, preterm birth, low birth weight, birth of a small-for-gestational-age (SGA) infant, and fetal death.

What’s a mama to do? Of course, do all of the common sense things to prevent exposure. Also consider the supportive herbs and supplements that I’ll tell you about. This is also one area where I do feel vaccination is worth the peace of mind. Vaccination is really important if you have medical comorbidities that put you at greater risk for flu complications in pregnancy, such as asthma or diabetes. Only the inactivated flu vaccine should be used during pregnancy, never the live vaccine. If you want to reduce any possible exposure to thimerosal, request that the vaccine come from a preloaded syringe, not from a multi-dose vial.

The vaccine isn’t fully protective against flu, so you still need to do all the common sense things and immune support I talk about later in this article, though being vaccinated against the flu can help lessen flu severity if you do get sick. Getting vaccinated also provides some protection for your baby against flu during those early months after birth; if you’re having visitors, or when siblings want to hold the baby in those early months you can breathe easier.

For many years, ACOG and the CDC have recommended that every pregnant woman receive a flu shot in any trimester. Multiple published studies, as well as clinical experience, have all supported the belief that the flu vaccine is safe and effective during pregnancy. In a new development, a recent article reported concerns about influenza vaccination when given very early in the first trimester, finding that there is an increased risk of a pregnancy loss within the first 28 days following vaccination. Scientifically, it is unclear why this would occur; the same study stated that when vaccination was given either later in the first trimester or in the second or third trimester, there was no association seen with pregnancy loss, or any other adverse pregnancy outcomes. 

So, what to do? Consider waiting until late first trimester to get your flu vaccine. If you do get sick, Tamiflu is an option in the first 48 hours, though not well-studied in pregnancy. You can talk with your provider about trying natural approaches like elderberry, as long as your symptoms are mild to moderate and you and baby are safe and stable. You can learn more about those remedies on my website and in the Natural Pregnancy Book and The Mama Pathway.

RSV

Respiratory syncytial virus (RSV) is a respiratory infection that can affect people of all ages, but it is the most serious when it occurs in babies. Babies’ airways aren’t developed, so they can’t cough up mucus like older children and adults. Their airways are also smaller, which can cause blockage, making it more difficult to breathe. In many adults and older children, RSV can result in cold-like symptoms, and it is often associated with a cough. 

Limited studies suggest that RSV infection is generally uncommon in pregnant women, occurring in 2% to 10% of pregnancies, and it’s most likely so mild that it’s never recognized as RSV. This also means that we don’t fully have the data we need on RSV, but it’s thought that most cases are mild. In severity, some may fall somewhere between a common cold and  the flu. Complication risk is higher in women with baseline pulmonary diseases, such as asthma, and in women who use tobacco. It is more likely to lead to hospitalization if you have the flu at the same time, which can happen. 

There’s currently no vaccine for RSV, though there is one in research stages, so following the common sense prevention methods I’ll share with you is essential! 

COVID

In the early months of COVID, I reported a lot of good news: pregnant women seemed to be protected from getting COVID, and from getting severe COVID. Many of us in maternal health breathed huge sighs of relief, and the phrase ‘it’s a miracle’ was used more than once – even by those of us who aren’t particularly religious. What we now know is that pregnant women do get COVID just like anyone else, and like with flu, there are risks of severe respiratory consequences, preterm labor, and some scarier potential consequences (such as an increased risk of preeclampsia which, left untreated, is exceptionally dangerous for mom and baby) that can happen fast. We also know that you can become reinfected with COVID, whether the same or a new strain – so prior exposure and illness may provide some protection, but it’s not fully protective. And yes, as with flu, I quickly went from skeptical to fully supportive of pregnant women being vaccinated against COVID to prevent vertical transmission, transmission to your newborn, and to protect the mama from potentially severe illness from infection in pregnancy.

Optimizing Your Immunity in Pregnancy 

Should You Isolate Socially?

Sophia asked in her question that her daughter's in preschool and they go to social events and they're worried about all the bugs going around. And Sophia, you asked if you should completely avoid kind of social settings. Avoiding social settings when you don't have to is not a great idea. The incidence of postpartum depression went up 70% during the pandemic. Pregnancy is meant to be something we do in a village of our sisters, our friends, our mothers, our aunties, our nieces, our families, our tribes. Yes, we learned in Covid that we can do amazing things solo, socially sequestering. But  now, there's nothing data wise that's saying you should isolate. 

While I don't recommend isolating, I do recommend narrowing your social bubble. I do recommend that you consider, especially if you're going to be in crowded or enclosed places, I would wear a mask. It gives you that extra measure of protection. Stay socially distanced from people to the extent that you can in bigger public places. If you're in a supermarket, a shopping mall, you can still observe the six-foot rule. And obviously if somebody's coughing or sneezing, stay away from them and back up from them because you get these viruses primarily through coughing, sneezing, droplets in your eyes, nose or mouth. 

Humidifiers

One thing that you might not think of and then you might not heard much about is keeping the air in your home moist. When our respiratory passages are dry, when we're breathing in dry air, it makes our respiratory passages and our lungs more irritated, more inflamed, and more susceptible to us getting sick. If you have dry heat, if you have a wood stove especially, but if you have any dry heat going throughout the colder weather – during cold, flu, RSV season, etc., keep a humidifier on in your room and in your kids' rooms. Be  sure to keep the humidifier clean, to protect bacteria and molds from growing. I don't recommend using essential oils, unless on an infrequent basis. In large, frequent contact, even through breathing them in, they can act as endocrine disruptors. Now and then you want to do your aromatherapy for your bath?  Beautiful, even once a week, but don't keep that going.

Get Adequate Rest

Getting enough rest is critical for immune function. Now, waking up to pee once or twice a night may interrupt your sleep.  Do what you can to have comforting, supportive things that help you fall back to sleep easily. If you need an app like Mind Space or Calm, play that to go back to sleep or have some soothing music – try  Carlos Nikai, George Winston, or something like that’s meditative, beautiful music. When we're not getting enough sleep, our immune systems get out of whack. And this is really important to consider. If you are a midwife or a night shift worker, make sure that if you're a midwife, you have somebody spotting you at night so that you can get those hours that you need. You don't get exempt from the immune effects of poor sleep because you're out there doing good work in the world. 

Healthy DIet

Studies show that getting three servings a day of fruits and vegetables, fresh fruits and vegetables; just doing that massively reduces your risks of getting respiratory infections. You should really be getting a minimum of six, ideally eight to 10, to get all the nutrients that you need.  I talk about how to do this in my books and in other resources on my podcast. I talk about that with a number of different guests, including Robynne Chutkan when we're talking about gut health. I also talk about it with Jessie Inchauspé (the Glucose Goddess).

Our blood sugar balance is really important for our immunity. One of the ways we do that is by avoiding processed sugars and empty carbs, which in and of themselves deplete our immunity. They deplete our nutrients because our body has to work against the inflammation that those things cause. If you're not sure about nutrition in pregnancy, Lily Nichols‘ website has wonderful resources. Her book, Real Food in Pregnancy is a wonderful one to use. And also What to Eat When You're Expecting is a great resource for meal plans and menus. 

Often if you're a mama with toddlers, you're eating toddler lunch, toddler dinner. Don't do that. Eat real food, even if you eat the tofu nuggets or the chicken nuggets. Make sure you're getting the kale or the collards or the broccoli or the big salad with all of that and all the other things that you need. 

Exercise

This is nuts, but walking 30 minutes a day or even a few times a week, ideally up to an hour, a few times a week is super important. It doesn't even have to be a massively brisk walk, but just getting out there and taking a walk. I actually heard it described as a super weapon the other day in one of my medical feeds. I don't love that terminology, but it’s one of the most important things we can do to prevent getting COVID and severe COVID. 

We also know from other studies, and I talk about this much more at length in my podcast on how to boost your immunity for cold and flu season, that the data is substantial. Now it's really easy to say ‘ my back hurts and my belly's too big.’ Mm-hmm. Walking and exercise are important for good bowel movements and elimination. Who doesn't want that when they're pregnant – especially when you’re big and pregnant – for a healthier, easier labor. If you're not sure what to do, check in with your midwife, your MD, or find local mamas that are in a prenatal class. Some form of exercise is really important, ideally every day or at least three to four times a week. One study found that even walking just 30 minutes or an hour even one time a week still decreases your risk, but again, it's not enough. 

Natural Approaches to Support Immunity that are Safe in Pregnancy

In my recent podcast, How to Boost Your Immunity for Cold and Flu Season, I go into detail on the natural approaches you can take to support and enhance immunity. But what’s safe in pregnancy? Let’s take a look at that. 

First, here’s a reminder of the common sense approaches:.  

• Get enough rest: Getting enough sleep and keeping immunity healthy go hand-in-hand so do what you can with sleep pillows, aromatherapy, gentle support like magnesium for sleep if needed. You can learn more in the resources I shared earlier – The Natural Pregnancy Book, Mama Pathway, and articles on my website.
• Healthy diet: Studies show that 3 servings/day of fruits and veggies decreases risk – that’s not too hard to get – and can really make a tremendous difference. 
• Exercise – walking 30 minutes daily, or even a few times/week, and ideally up to an hour. It doesn’t have to be super brisk, either. 

In addition, you might want to know whether – and what – supplements and botanicals can be used safely in pregnancy. Now remember, we're not talking about treatment here. We're talking about things you can do to boost immunity for prevention. 

Which ones are safe in pregnancy? Well, that's a really interesting question. We just don't have data on a lot of herbs and supplements; many of them we could presume are not safe and appropriate for pregnancy. But the good news is that there are many you can use safely during pregnancy. Here are a few of my favorites.

Vitamin C (★) aids in the formation of immune cells, supports their function, and supports the health of the lining of your respiratory passages. While studies are limited in humans, a 2018 meta-analysis that included 9 clinical studies supported the idea that vitamin C can shorten colds and lessen symptoms, particularly in athletes. Daily use of Vitamin C (ascorbic acid) has been shown to reduce the likelihood of colds and flu, reduce antibiotic use, and school absences in children. People who take vitamin C regularly can expect shorter colds (by 8% in adults and 14% in children) with slightly less severe symptoms. It only seems to be beneficial if taken daily and preventatively, so I recommend starting it at the beginning of the season, or when you read this, and continue until the end of cold/flu season.

Anywhere you are in your pregnancy now, or if you're not pregnant yet and you're planning to get pregnant, start taking it. The main thing you need to know about supplementing with Vitamin C in pregnancy is that the upper limit of safety is 4,000 milligrams a day, not including what you're getting in your diet. Most prenatal vitamins have some vitamin C in them, although usually not much. What I recommend is not exceeding 2000 milligrams a day during pregnancy, plus whatever's in your prenatal vitamin. Since Vitamin C is a water soluble vitamin, meaning that if you take it and you're getting more than your body needs at any one time, guess what happens? You pee the rest out. Optimally you want to break it up through the day. I usually recommend a 500 milligram dose at a time because in some studies that appears to be the max that you'll absorb at one time – so take 500 in the morning, 500 midday, and then you can take a thousand in the evening, something like that. It’s safe to take throughout pregnancy. 

Vitamin D3 (★) is critical for optimal immune function, Epidemiologic studies have shown that low levels of serum vitamin D are associated with increased risk of getting upper respiratory infections. It’s also important for your baby's bone formation and for healthy teeth, and for healthy blood sugar balance. According to a 2017 large systematic review and meta-analysis, supplementing vitamin D reduces the likelihood of upper respiratory infections, as well as asthma. If you have asthma, it's important to talk with your provider about taking vitamin D. Studies have shown that low vitamin D actually is associated with increased risk of COVID and COVID severity. 

It’s often hard to get enough from food or sunlight alone, especially in the winter. But Vitamin D3 is safe to take during pregnancy. The dose for adults is 1000-2000 units daily; for kids is 400-800 units/day, depending on age.

Zinc (★) is intimately involved with many aspects of immune function, and with maintaining resistance to upper respiratory infections. Zinc lozenges are the preferred form for preventing infection in the sinuses and respiratory tract, where they may also reduce inflammation. They can also be taken within 24 hours of the onset of symptoms, sucked throughout the day, to reduce cold symptoms.. Zinc acetate, the more common form may be more effective, but not all studies show that the form makes a difference. 

Typically, you start taking them, if you do have the onset of an upper respiratory infection, you can start taking them within 24 hours of the onset of symptoms. The adult max dose is about 40 milligrams a day. I don't recommend taking that much for prevention during pregnancy because I don't feel like the data is strong enough, so I usually recommend up to 20 milligrams a day, including what's in your prenatal vitamin. 

Be forewarned – Zinc is horribly nauseating, so I would not take it during the first trimester. Really, I wouldn't, and don't take it on an empty stomach ever!

Probiotics (★): A healthy immune system depends on a healthy gut, which in turn depends on the health of both your microbiome and your intestinal lining. Your intestinal lining forms a major immune barrier in your body that may in turn help protect you from upper respiratory infections. Various probiotics have been shown to interact with immune system cells, and while a 2015 Cochrane review found no evidence that probiotics prevent cold and flu, another systematic review and meta-analysis of 23 randomized controlled trials (RCTs) has found that probiotics appear to decrease the incidence of respiratory tract infections (RTIs) in children, athletes, and the elderly, and an interesting study, this one in healthy older adults, found that taking probiotics and/or prebiotics helped improve the efficacy of the flu vaccine when supplemented around the time of vaccination.

When it comes to cold and flu prevention, while the data is mixed, probiotics are safe enough and the data is promising enough that I do recommend a probiotic that contains a mix of Lactobacillus and Bifidobacterium strains and at least 10 million colony forming units. That's how the dose is described. The concentration is described, and then just follow what's on the package. 

Echinacea (★) is traditionally used to support immunity, has been the subject of many studies, and while the results have been mixed, there is evidence that taken daily, it may reduce the risk of upper respiratory infections. One large study that was done in Canada  about 15 years ago, retroactively looked at a large database of pregnant women who were surveyed throughout their pregnancy and then after, and asked whether they had used echinacea during pregnancy and for how long and during which trimesters. The study concluded that echinacea taken during any trimester and for any length during pregnancy is considered safe. 

Because echinacea can interact with certain medications, particularly immunosuppressive drugs, discuss daily use with your medical provider first.

You might notice that I'm not mentioning a few botanicals commonly thought of with colds and the flu. Elderberry, for example, is used much more for the onset of symptoms than for prevention. There's also just not enough solid data to say that it's safe for long-term use in pregnancy; we know that it can have some impacts on the immune system that may or may not be advisable during pregnancy. If someone has flu symptoms, they're starting to get sick, they're in that first couple of days, absolutely it can be used. But for prevention, I don't recommend using it long-term.

Similarly with adaptogens and medicinal mushrooms. Look, if you want to have a cup of reishi hot cocoa or you want to have a chaga chai once in a while as a beverage during pregnancy, that's fine. It's like having a cup of coffee during pregnancy. You can do that. I don't recommend daily regular use of adaptogens or medicinal mushrooms, which are also adaptogens. They can be phenomenally immune boosting, but we just don't know enough about the data on their safety in pregnancy. And they do some things to the immune system, to cortisol and to blood sugar regulation that when we're not pregnant can be beneficial, but when we're pregnant may actually be counterproductive. 

Alright, I know that we talked about some big scary stuff here. I want to come back to where I started at the beginning. Congratulations on being pregnant. If you're trying to conceive, it's a beautiful, wonderful time. Motherhood is a lifelong role during which there will be no shortage of opportunities to worry. Even before you give birth, your mama-bear radar is engaged, and you’re suddenly motivated to do all you can to protect this precious being growing inside of you. So as hard as it is to manage these worries while we're pregnant, it's also an ideal time to start developing inner practices to help us cope with these worries, both in order to protect ourselves and our little ones.