(1) How Does Pregnancy Tend to Affect the Hands and Specifically the Fingernails

(1) How does pregnancy tend to affect the hands and specifically the fingernails? Why does this happen?

For most women, pregnancy causes fingernails to grow faster. No one can say why with certainty, however an increase in mom’s blood volume (increased circulation) and a dramatic increase in the circulation of hormones likely plays a role. Also, most pregnant women take prenatal vitamins, while during other times in their lives vitamins might not be a part of their routine. Use of vitamins improves overall hair and nail health. Pregnant women may notice that their nails grow more quickly, are longer and stronger than ever before, and this may lead to more frequent visits to the nail salon! As I believe I mentioned, I have several nail professionals as patients who say they are at their happiest when pregnant because their own nails look so healthy! Some women will notice changes in both fingernails and toenails that are not as positive. Dry, brittle nails can be seen as well as pigmented streaks in the nail beds (melanonychia). Sometimes, transverse grooves will be seen in the nails, as well. These problems are easy to understand if you consider pregnancy a state of controlled malnutrition. We know that sick, malnourished people tend to have weak, “sick” nails. Nail growth can be a direct reflection of overall physical well-being. The unborn baby has no way to get vitamins, growth factors and nourishment except to “steal” from mom. So, mom’s circulating nutrients decrease as mom’s body is trying to support the baby. Mom makes up for the loss by taking vitamins, eating healthy and trying to stay in shape. Generally speaking, most women in our culture end up on the positive side of the ledger, as true maternal malnutrition is fortunately rare. But on a cellular level, parts of the body may still think they are malnourished, and these changes can sometimes be reflected in the nails.

One other thing to mention in the hands: carpal tunnel syndrome. An increase in tissue swelling (see below) can lead to compression of the nerve that runs through the wrist, known as the Median nerve. This can result in weakness, pain and altered sensation in the hands.

(2) How does pregnancy tend to affect the feet and specifically the toenails? Why does this happen?

Swelling is usually much more pronounced in the feet and legs. Mom’s volume of blood increases by about 50% over that from when she is not pregnant. Blood cells themselves stay in the blood vessels, but the fluid component tends to leak out. The effect of gravity is to pull that extra fluid down into dependent areas. Pregnant women who sit a lot often have edema around their tailbones. The lower extremities are the most dependent areas for people who stand, so every pregnant woman who walks will generally have some edema in the legs and feet. Swelling can be very substantial in some women, but is usually just a sign of normal pregnancy. If associated with high blood pressure or certain other abnormalities identified in blood tests, swelling can be a sign of toxemia of pregnancy, a potentially serious medical problem. This edema can be uncomfortable as it compresses nerves, and often forces pregnant women to wear slip-on open-toed sandals. Toenails tend not to grow as quickly as fingernails in pregnant women, because circulation may not be as robust due to the collection of edema. Since toenails are thicker anyway, they may be more brittle and more likely to have the issues with abnormal growth as discussed above. Nail salons may see more women asking for pedicures due to the fact that self-grooming of the feet becomes physically difficult with a pregnant belly. I asked one patient about this, and she told me “I can hardly even see my toenails, no less paint them!!”

(3) Are there specific procedures or services that nail techs should NOT do with pregnant women? If so, what are they and why? (i.e.certain chemicals)

I must profess that I am not a wealth of knowledge on the myriad of services offered in a nail salon! However, I can tell you about some controversy. There are some chemicals used in nail products that are believed to be dangerous. Pthalates, methyl methacrylate (MMA) and acetonitrile are 3 such compounds. In addition to nail polish, pthalates are found in a variety of personal care products (i.e. hair mousse, deodorant), and have been linked to developmental anomalies in the male reproductive tract. Acetonitrile is broken down into cyanide when ingested, and can cause skin problems. MMA has been prohibited for use since the 1970s. The nailbeds are not so richly supplied with blood vessels that they serve as a common source for absorbing toxins. Truthfully, very little (if any) of these substances are absorbed into the body from nail polish applied during pregnancy. The quantity absorbed would be so miniscule that it likely would be broken down in the body, and would not cross the placenta to harm the baby. However, one study from North Carolina showed that cosmetologists performing a large number of chemical services were at an increased risk for miscarriage, suggesting a link. It raises the question about the safety of exposure to chemicals, though no study has ever shown that standard nail treatments are associated with danger to a pregnancy. Because of concerns over potential liability, we will not likely ever see such a study done. I tell my pregnant patients that they can certainly ask for “natural” products, or perhaps even just have their nails buffed instead of painted. If they are worried about chemicals from acrylics or appliqués, take a few months off from artificial nails and enjoy what your own nails can do.

Many women are also concerned about inhaling fumes in a nail salon. It stands to reason that good ventilation is important (to every one… not just pregnant clients!), but it is unlikely that short term episodic exposure to fumes has an impact on a developing pregnancy. More likely, as any nail professional can describe, exposure to toxins in a nail salon can cause allergic reactions and sensitivities! These are generally associated with chronic, long-term exposures such as that seen in nail salon employees! There is a simple solution to concerns over these fumes: wear a mask. They are cheap and readily available in any drug store!

As with all salon clients, sterilization of instruments is critical, whether by autoclave or chemical soaking. Infections of the cuticle (paronychia) are rarely more than annoying, but bloodborne diseases such as Hepatitis B & C and HIV have far greater significance when contracted during pregnancy.

Finally, it is often recommended that the pressure points located between the toes and around the Achilles tendon be avoided during foot massage. There is data in the naturopathic literature suggesting that correct manipulation of these points can induce labor. I think it would be very difficult to induce labor from a simple foot massage associated with a pedicure, as it is extremely difficult even for a trained therapist to induce labor by this means. It is controversial as to whether this is even true! Many labor nurses actually provide their laboring patients with foot massage to ease the pains of labor. However, be aware that controversy exists and it might be best to avoid these areas.

In summary: is it safe to visit the nail salon during pregnancy? Yes! Are there any dangers that lurk within those walls? Probably. There is danger in every thing we do! Many of the specifics have never been studied, but to put things in perspective, you are orders of magnitude more likely to be involved in a motor vehicle accident driving to the nail salon (or for that matter to the hospital when in labor) than you are to have an adverse safety event arise from a nail salon incident.

(4) Are there specific procedures or services that nail techs SHOULD do with pregnant women? If so, what are they and why? (i.e. foot massage?)

There is no recommendation on this, I am afraid, but see below…

(5) What else should nail techs know about working with pregnant clients?

I often tell people that “pregnancy is not a disease!” Pregnancy is a natural part of life and need not be feared. There is little that a nail professional can do to harm a pregnant client or her unborn child, while there is much that can be done to help. A pregnant client may have anxieties about nail treatments but can generally be reassured that nail treatments remain a good way to relax and to feel more attractive. Her specific anxieties can be addressed by simply taking this approach: If you’re nervous about it, let’s not do it. No pregnant woman – and more importantly – no nail professional can ever be faulted for this conservative approach.

The nail professional has the unique opportunity to help a client feel special, beautiful and well groomed. Pregnancy is a time of stress for many women where their own body image changes and self-esteem can falter. It goes far beyond cleaning up the cuticles, removing dead skin, or shining up nails. What an important opportunity the nail tech has to bolster her confidence and help to eradicate some of the negative images she may have of herself and her changing body. This is the crux of what nail professionals can do for pregnant women.

Be sure to tell me about yourself as well!

Randy A. Fink, MD, FACOG, is a private practice obstetrician/gynecologist in Miami, Florida. Trained at Brown University/Women & InfantsHospital, he is an internationally sought after lecturer on topics of women’s health. He is a Diplomate of the American Board of Obstetrics and Gynecology, and a Fellow of the AmericanCollege of Obstetricians and Gynecologists.