(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 & Infants Hospital, 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 American College of
Obstetricians and Gynecologists.