Overview

With warmer weather comes more insects and the potential for bug bites. As with any topic, pregnancy adds an additional layer of concern about bug bites. When you are pregnant, increased skin sensitivity can make itchy or painful bug bites more bothersome. Some illnesses spread by insects, like the Zika virus, pose additional dangers during pregnancy. Plus, you need to be cautious about exposure to chemical ingredients found in many insect repellants. The good news is there is a lot you can do to mitigate your risk of insect bites during pregnancy, and there are repellants that are safe to use when you are expecting.

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We are about to start summer in the United States. With warmer weather comes more insects and the potential for bug bites. Insects bite humans and animals for survival. Some insects feed on blood, which contains essential nutrients they need for development. Some bugs, like mosquitos, require a blood meal to reproduce. In other cases, insects like wasps or bees bite as a defense mechanism if they are threatened.

Mosquitos

Mosquitos are small flying insects found worldwide, especially prevalent in tropical and subtropical regions. Most mosquitos are active at dawn or dusk and tend to live in warm, humid environments. Male mosquitos don’t bite and live off sugary fluids like nectar. Female mosquitos need a blood meal from a host to produce viable eggs. When a mosquito bites, its saliva contains an anticoagulant, and the proteins in its saliva cause a raised bump called a wheal. The bump is a reaction caused by histamines to fight off the proteins left in your skin from the mosquito. Mosquito bites irritate your skin and itch like crazy.

Mosquito Bites and Pregnancy

Changes during pregnancy make you more attractive to mosquitos. A study found that pregnant women attracted twice as many mosquitos as non-pregnant women. Mosquitos utilize the smell of CO2 and thermal sensory information to detect body heat, which is how they find a person or animal to bite. Later in pregnancy, you exhale about 20% more, and the additional CO2 and moisture you exhale can attract mosquitos. Also, your body temperature tends to be slightly elevated during pregnancy, making you more likely to attract mosquitos.

Mosquito-Borne Illnesses

A mosquito bite can be irritating, but the diseases spread by mosquitos make them the deadliest animal in the world. Diseases carried by mosquitos include yellow fever, dengue fever, malaria, West Nile virus, eastern equine encephalitis, tularemia, chikungunya, and Zika. These are known as vector-borne diseases,  human illnesses caused by parasites, viruses, and bacteria transmitted by vectors. In this case, the vectors are mosquitos. According to the World Health Organization, vector-borne diseases account for more than 17% of all infectious diseases, causing more than 700,000 deaths annually.

Malaria is a parasitic infection transmitted by Anopheline mosquitoes. It causes 219 million cases globally and results in more than 400,000 deaths every year. Dengue is the most prevalent viral infection transmitted by Aedes mosquitoes. More than 3.9 billion people in over 129 countries are at risk of contracting dengue, with an estimated 96 million symptomatic cases and an estimated 40,000 deaths every year. 95% of malaria cases occur in sub-Saharan Africa. Dengue is now endemic in more than 100 countries in the WHO Regions of Africa, the Americas, the Eastern Mediterranean, Southeast Asia, and the Western Pacific. About 70% of cases are in Asia. Thankfully, diseases like malaria and dengue are less common in first-world countries.

Zika

The infection caused by the Zika virus is known as Zika fever or Zika virus disease. Many Zika cases are asymptomatic or have mild symptoms, including fever, conjunctivitis or pink eye, joint pain, headache, or a rash. These mild symptoms usually only last about 2-7 days. Unfortunately, Zika is especially dangerous during pregnancy. Zika started getting media attention in 2015 when it was reported that the spread of the virus in Brazil was accompanied by an unprecedented number of cases of babies being born with microcephaly. This is a condition in which the baby has an unusually small head, which affects brain development and a whole host of other things. Many other countries also reported a significant increase in cases of Guillain-Barré syndrome, which is a neurological disorder. Zika has also been linked to other problems in infants, including eye defects, hearing loss, and impaired growth.

Thankfully, there were no cases of Zika in the United States, Canada, or Australia. As of the time of this article, no travel notices have been issued by the CDC about Zika. You can view travel notices here. If you live in an area with an outbreak of Zika, it would likely be headline news. If you travel to an area where Zika is present, you should take additional precautions. Your partner should also avoid Zika because it can be sexually transmitted. You can learn more about the Zika virus in pregnancy in this episode.

Treating Mosquito Bites

If you get a mosquito bite, try not to scratch it. I know it can be difficult because bites are very itchy. Scratching bites only make it worse, plus that opens you up to the possibility of an infection. A cold pack or ice can help reduce swelling. You can apply aloe vera or calamine lotion, which may help with the itching. I am a big fan of the mosquito bite patches from Moskinto. These are shaped like a grid; you peel it off and stick it on your skin. They are chemical-free, and they help alleviate itching a lot. These are also amazing for kids and are my go-to solution if one of my children gets a big bite.

Many of the illnesses transmitted by mosquitos cause a fever. If you get a mosquito bite and have other symptoms, especially a fever, please contact your doctor or midwife.

Fleas

Another bothersome pest that bites is fleas. Fleas bite because their sole food source is blood. Similar to mosquitos, female fleas require blood to reproduce. There are over 2,500 species of fleas worldwide. While they cannot fly, they can jump 50 times their body length and can jump vertically about 7 inches or horizontally about 13 inches. That may not sound far, but it is pretty impressive, considering how small they are. Fleas are most problematic when you have a pet, especially in the warmer months. Although they are far less dangerous than mosquitos, fleas can also carry diseases. A flea bite causes a raised bump that is very itchy. Sometimes, these bites can last for weeks. If you get a flea bite, the same remedies for mosquito bites apply.

Fleas and Pets

Fleas can be a big problem for your pets, especially dogs and cats. There are many different types of flea treatments for pets that you can discuss with your veterinarian. If you apply a topical medication to your pet, you may want to ask someone else to apply it or wear gloves when you do it. I have had a veterinarian tell me that topical flea medications are almost pointless in the summer months. While it may not eliminate them, it should help reduce them. Fleas can be a nuisance to your pet, but they can be an even bigger problem if your whole house gets infested.

Ticks

Different kinds of ticks are found worldwide, and different types can transmit different diseases. These are around throughout the year, and bites are most common in the summer, from April through September. They prefer warm, humid weather and live in areas with grass, bushes, or trees. Ticks are found throughout the United States. You can check the CDC website for maps and more information about your area.

Ticks inhabit grasses or leaves and wait for an animal or person to come by so they can attach. Once a tick finds a host, it will attach itself. Depending on the type of tick and what stage of life it is in, it can take anywhere from ten minutes to two hours from when a tick lands on a host until it attaches itself. Ticks have four life stages and require blood from a host to go from one stage to the next. Ticks attach themselves and feed off blood from the host for days or longer if not removed. Like mosquitos, ticks can transmit diseases with their saliva.

Checking for Ticks and Removing Them

Anytime you return from being in an area that could have ticks, you should check your clothing, backpacks, pets, or any other items with you. Ticks like to hide in warm, moist areas. Check in and around your hair, ears, under your arms, in your belly button, between your legs, and the back of your knees. A full-length mirror or another person is the best tool for checking your whole body. To kill ticks, throw clothes in the dryer for ten minutes (or longer if clothes are damp) or wash clothing in hot water.

Removing ticks as soon as possible is essential for you and your pets. You can use tweezers to grab it as close to your skin as possible and pull it out with even pressure. The goal is to get the whole tick, not just part of it. Once it is off, you should clean the area with soap and water or rubbing alcohol. Do not smash it with your fingers. Place the tick in rubbing alcohol, flush it down the toilet, and put it in a sealed bag or container or wrap it tightly in tape. You may want to put it in a sealed container and freeze it if it has been attached in the event you need to identify the type of tick it is since different ticks carry different diseases. 

Lyme Disease and Tick-Borne Illnesses

Lyme disease is the most common illness caused by tick bites. The bacterium that causes Lyme disease is found in the gut of infected ticks. It takes time for the bacterium to move from the tick’s gut to its salivary glands and into the host’s bloodstream. For an infected tick to transmit Lyme disease, it has to be attached for 36-48 hours, which gives you a lot of time to find and remove a tick. If Lyme disease goes untreated, it can cause brain, nerve, spinal cord, and heart problems. Untreated during pregnancy, it can cause an infection in your placenta, stillbirth, congenital heart defects, urinary tract defects, or blood problems.

Ticks can also carry tularemia, Rocky Mountain spotted fever, anaplasmosis, heartland virus, and Colorado tick fever. Common symptoms that are red flags are fever, chills, aches and pains, and a rash. If you get a rash or a fever within a few weeks of a tick bite, please get in touch with your doctor or midwife.

Most tick-borne illnesses can be treated with antibiotics. While you do not want to take antibiotics unnecessarily, they can be lifesaving if needed. There are antibiotics that are safe during pregnancy.

Preventing Bug Bites

The good news is that you can do many simple things to prevent bug bites.

Avoiding Bugs

The best way to protect yourself from bugs and bites is to avoid them in the first place. Avoid wooded or brushy areas with high grass and leaf litter where ticks are found, and stay in the center of trails on hikes. Mosquitos are most active around dawn and dusk. You may consider spending those times inside or in screened areas.

Covering Your Skin

A simple way to avoid any bug bite is to cover as much skin as possible. Wear pants and long sleeves. You can even tuck your pants into your socks. Clothing should be loose fitting since mosquitos can bite through clothing that is tight against your skin. If you are somewhere with ticks, consider light-colored clothing to make it easier to spot a tick.

Limiting Risks at Home

Your next step in avoiding bugs and limiting risks is around your pet or home. If you have a dog or cat that spends time outdoors, you should check them frequently for ticks and give them some treatment to minimize fleas and ticks.

If your pet brings fleas into your home and your house gets infested, that is a different problem. Vacuuming often may help since fleas can breed in your carpet. Empty your vacuum after each use since eggs could hatch in there. If you choose to use any chemicals in your home, the first option is to have someone else, like your partner, do it while you are away and ensure your place is well-ventilated. Overall, the less you are exposed to flea-fighting chemicals, the better. If your home gets infested with fleas and you have trouble getting rid of them, consider contacting a pest control company to discuss your options.

You can do many things to reduce the risk of ticks on your property. Clear any leaf litter, tall grasses, or brush around your yard. Mow your lawn regularly and use wood chips or gravel between your lawn and wooded areas to limit tick migration. Keep any wood stacked neatly in a dry location to discourage rodents, which can be a host for ticks. Other host animals, like deer, can be kept out with a fence around your property. Lastly, remove old furniture, trash, or other unnecessary things on your property that would give ticks a good place to hide.

To make your home environment mosquito-safe, use screens on windows and doors and air conditioning when available. You could put a mosquito net over your bed if you don’t have A/C or screened rooms. Ensure no areas around your home collect water, which can be breeding grounds for mosquitos. Some areas and neighborhoods spray insecticides to kill mosquitos. If these are used in your area, you should avoid being outside when these products are applied.

Insect Repellant

You want to limit your exposure to potentially harmful chemicals during pregnancy, and the last line of defense is insect repellant. Effective mosquito and tick repellants contain DEET, IR3535, KBR3023 (AKA Picaridin or Icaridin), and oil of lemon eucalyptus.

The WHO states that there is no evidence of any restriction on the use of these repellents by pregnant women if they are used in accordance with the instructions on the product label. There are several useful resources for selecting the right insect repellant.

• The Environmental Working Group has an informative article examining these repellents’ differences.
• The Environmental Protection Agency has a tool that you can use to select the duration of time you need repellant to work and what bugs you want to protect against, and you can narrow down results with specific ingredients or brand names.
• Consumer Reports has a helpful insect repellant buying guide.

DEET

Deet is short for diethyltoluamide, which protects against mosquitoes, ticks, fleas, chiggers, leeches, and many biting insects. This is generally the most effective repellant when compared to alternatives. Consumer Reports found that 15-30% DEET products provided long-lasting protection. Studies have found concentrations of 30% to be safe for use during pregnancy. DEET is not recommended for babies younger than two months old. Deet has a strong smell and can damage plastic, vinyl, and rubber, which could be an issue if you plan to spray repellant on gear you are taking on a hike. It can irritate your eyes, and in strong doses, it can cause neurological damage.

KBR3023 (AKA Picaridin and Icaridin)

KBR3023 (also known as Picaridin and Icaridin) is a synthetic repellent modeled after a compound that occurs naturally in the black pepper plant. It is nearly colorless and odorless and protects against a wide array of insects. It does not dissolve plastics, like DEET does. Consumer Reports recommends a concentration of 20% and notes that the sprays perform best. Picaridin is deemed safe, even for use on infants who are at least two months old and during pregnancy. It can irritate your skin and eyes, so use it carefully. This may be a good alternative if you are concerned about Deet’s risks.

IR3535

IR3535 is a man-made compound structurally similar to a naturally occurring amino acid. Like Picaridin, it is nearly colorless and odorless and helps repel mosquitos, ticks, lice, and other bugs. Consumer Reports found this less effective than Deet, Picaridin, and Oil of Lemon Eucalyptus. IR3535 can be irritating to your eyes.

Oil of Lemon Eucalyptus

Oil of lemon eucalyptus is an oil from the eucalyptus tree native to Australia. It is colorless, smells similar to menthol, and has a cooling effect on your skin. Refined oil of lemon eucalyptus contains up to 65-70% PMD (which is short for p-methane-3,8 diol), which is the compound that actually repels bugs. Consumer Reports found this worked well, but other essential oils tested, like cedar, cinnamon, lemongrass, rosemary, and peppermint, failed tests within a half-hour. Also, natural lemon eucalyptus oil is not the same as oil of lemon eucalyptus. A concentration of 30% worked for 7 hours in tests performed by Consumer Reports.

While some people prefer this because it is more of a natural repellant, there is less research on it than Deet and Picaridin, and it is not recommended for use on kids under the age of 3. See this episode for more information on the safety of essential oils during pregnancy.

Tips for Using Insect Repellant

Some essential tips can limit your chemical exposure if you choose to use an insect repellant. First, follow the instructions on the label and do not apply more than you need to or more frequently than suggested. Avoid products that contain a combination of sunscreen and bug repellants. Sunscreen should be reapplied every two hours, which could overexpose you to chemicals in repellents. Another way to limit your exposure to unnecessary chemicals is to avoid repellants with added fragrances. Do not apply repellants under clothing; only apply it to exposed skin or clothing as directed on the product label). Never put it on under your clothing. Clothes first, then bug repellant.

Insect repellents can be irritating. If you are concerned about reacting to a new product, you can always test it on a small area before applying it all over. Avoid applying repellants to cuts, wounds, or irritated skin. Avoid your eyes and mouth, and use it sparingly around your ears. If you need to apply repellants to your face, spray it on your hands first, then rub it on your face. Don’t spray it near food; wash your hands after applying it and before eating. Wash treated skin with soap and water before bed and wash any treated clothing in a separate wash before wearing it again.

Insect Repellants and Your Baby

Talk to your pediatrician about the risks where you live and their recommendations for protecting your baby or children. There are some additional tips for kids. If mosquitos are problematic where you live, you could use a mosquito net over your child’s bed or even get a net for your stroller or baby carrier. Never let your child apply insect repellant. Rather than spraying it on, you can spray your hands and rub it on. You should limit repellants on your child’s hands because they constantly put their hands in their eyes and mouths. If you have any questions, please get in touch with your pediatrician.

Talk to Your Doctor or Midwife

As with any topic, please bring up questions with your doctor or midwife. While you may want to limit chemical exposure during pregnancy, the benefit of using an insect repellant may outweigh the risks. You need to consider many factors, including where you live, the time of year, and your risk of exposure to bites or diseases from insects. If you get a bite and have other symptoms like a fever or rash or have any concerns, please get in touch with your care provider.

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