Selected References:

• Alembic Pharmaceuticals Inc. 2017. Metoprolol tartrate product labeling. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=24837d82-0f3f-4482-9af0-31e5f675c30f. Accessed 27 Jan 2026. 
• Bateman BT, et al. 2016. Late pregnancy β blocker exposure and risks of neonatal hypoglycemia and bradycardia. Pediatrics; 138(3). pii:e20160731.  
• Battarbee AN, et al. 2020. Chronic hypertension in pregnancy. Am J Obstet Gynecol; 222(6):532-541. 
• Davis RL, et al. 2011. Risks of congenital malformations and perinatal events among infants exposed to calcium channel and beta-blockers during pregnancy. Pharmacoepidemiol Drug Saf. 20(2):138-145. 
• Duan L, et al. 2017. b-Blocker exposure in pregnancy and risk of fetal cardiac anomalies. JAMA Intern Med. 177(6): 885-887. 
• Duan L, et al. 2018. Beta-blocker subtypes and risk of low birth weight in newborns. J Clin Hypertens 20(11):1603-1609. 
• Firoz T, et al. 2014. Community Level Interventions for Pre-Eclampsia (CLIP) Working Group. Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review. BJOG. 121(10):1210-1218. 
• Kulas J et al. 1984. Atenolol and metoprolol.  A comparison of their excretion into human breast milk.  Acta Obstet Gynecol Scand Suppl. 118: 65-69. 
• Lindeberg S et al. 1984. Disposition of the adrenergic blocker metoprolol in the late-pregnant woman, the amniotic fluid, the cord blood and the neonate. Acta Obstet Gynecol Scand Suppl. 118: 61-64. 
• Ruys TP, et al. 2014. Cardiac medication during pregnancy, data from the ROPAC. Int J Cardiol. 15. 177(1):124-8. 
• Sandstrom B, Regardh CG. 1980. Metoprolol excretion in breast milk. Br J Clin Pharmacol. 9: 518-519.  
• Tamirisa KP, et al. 2022. Arrhythmias in Pregnancy. JACC Clin Electrophysiol. 8(1):120-135. 
• Tanaka K, 2016. Beta-blockers and fetal growth restriction in pregnant women with cardiovascular disease. Circ J. 80(10):2221-2226.  
• Welzel T, et al. 2021.Intrauterine Growth Retardation in Pregnant Women with Long QT Syndrome Treated with Beta-Receptor Blockers. Neonatology. 118(4):406-415.  
• Wichman K et al. 1984. A placebo controlled trial of metoprolol in the treatment of hypertension in pregnancy. Scand J Clin Lab Invest Suppl. 169: 90-95. 
• Xie RH, et al. 2014. Beta-blockers increase the risk of being born small for gestational age or of being institutionalised during infancy. BJOG. 121(9):1090-1096. 
• Yakoob MY, et al. 2013. The risk of congenital malformations associated with exposure to β-blockers in pregnancy: a meta-analysis. Hypertension 62(2):375-381. 

Selected References: 

• AlHarthi A, et al. 2023. Investigating behavioral and neuronal changes in adolescent mice following prenatal exposure to electronic cigarette (e-cigarette) vapor containing nicotine. Brain Sci, 13(10): 1417. 
• Archie S, et al. 2023. Maternal e-cigarette use can disrupt postnatal blood-brain barrier (BBB) integrity and deteriorates motor, learning and memory function: influence of sex and age. Fluids Barriers CNS, 20. 
• Baez-Loya S, et al. 2014. Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bull Menninger Clin. 78(3):243-52.  
• Bednarczuk N, et al. 2022. Nicotine replacement therapy and e-cigarettes in pregnancy and infant respiratory outcomes. Early Hum Dev, 164:105509. 
• Bell L, et al. 2023. Use of e-cigarettes in pregnancy: a systematic review of evidence published from 2020-2022. Journal of Public Health, 33: 315-328 
• Bolumen-Lopez A, et al. 2025. Neonatal nicotine withdrawal in a newborn exposed to maternal e-cigarette use. J Neonatal Perinatal Med. Published online October 9, 2025.  
• Cardenas VM, et al. 2019. Use of Electronic Nicotine Delivery Systems (ENDS) by pregnant women I: Risk of small-for-gestational-age birth. Tobacco induced diseases, 17:44. 
• Centers for Disease Control and Prevention (CDC). 2018. Electronic Cigarettes. https://www.cdc.gov/tobacco/e-cigarettes/?CDC_AAref_Val=https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm [Accessed 4/2025]. 
• Centers for Disease Control and Prevention (CDC). 2023: General Information About Secondhand Smoke. https://www.cdc.gov/tobacco/secondhand-smoke/?CDC_AAref_Val=https://www.cdc.gov/tobacco/secondhand-smoke/about.html [Accessed 4/2025]. 
• Çetin T & Durmaz Ö. 2024. An assessment of the impact of smoking and vaping during pregnancy on placental dysfunction using shear-wave elastography. Arch Basic Clin Res, 6(3): 188-194.  
• Chen T, et al. 2023. Ovarian toxicity of e-cigarette liquids: effects of components and high and low nicotine concentration e-cigarette liquid in vitro. Tobacco Induced Diseases, 21:128. 
• Deprato A, et al.2025. Associations between vaping during pregnancy and perinatal outcomes: A systematic review and meta-analysis. J Hazard Mater.;486:137028.  
• Froggatt S, et al. 2020. The effects of prenatal cigarette and e-cigarette exposure on infant neurobehavior: A comparison to a control group. EClinicalMedicine, 28:10062.  
• Hahn J, et al. 2014. Electronic cigarettes: overview of chemical composition and exposure estimation. Tob Induc Dis, 12(1):23. 
• Galanti F, et al. 2023. Impact of different typologies of smoking on ovarian reserve and oocyte quality in women performing ICSI cycles: an observational prospective study. Eur Rev Med Pharmacol Sci. 27(11):5190-5199.  
• Holmboe SA, et al. 2020. Use of e-cigarettes associates with lower sperm counts in a cross-sectional study of young men from the general population. Hum Reprod, 35(7):1693-1701. 
• Kahr MK, et al. 2015. A qualitative assessment of the perceived risks of electronic cigarette and hookah use in pregnancy. BMC Public Health. 15(1):1273.  
• Kim S, Oancea SC. 2020. Electronic cigarettes may not be a “safer alternative” of conventional cigarettes during pregnancy: Evidence from the nationally representative PRAMS data. BMC Pregnancy Childbirth, 20(1):557.  
• Kim HK, et al. 2025. Impact of conventional cigarette and electronic cigarette use on sperm quality and IVF/ICSI outcomes. Sci Rep. ;15(1):23714.  
• Kopa-Stojak PN & Pawliczak R. 2024. Disposable electronic cigarettes – chemical composition and health effects of their use. A systematic review. Toxicology Mechanisms and Methods, 35(3): 250-261. 
• Le AD, et al. 2025. A Preconception Cohort Study of Nicotine Vaping and Incidence of Spontaneous Abortion. Nicotine Tob Res. Published online July 3, 2025.  
• Lin S, et al. 2023. E-cigarette use during pregnancy and its association with adverse birth outcomes in the US. Prev Med, 166:107375. 
• McDonnell BP, et al. 2020. Electronic cigarettes and obstetric outcomes: A prospective observational study. BJOG, 127(6):750-756.Nanninga EK et al. 2023. Adverse maternal and infant outcomes of women who differ in smoking status: e-cigarette and tobacco cigarette users. Int. J. Environ. Res. Public Health, 20(3): 2632. 
• Nguyen T, et al. 2018. Maternal e-cigarette exposure results in cognitive and epigenetic alterations in offspring in a mouse model. Chemical research in toxicology, 31(7): 601-611. 
• Noël A, et al. 2020. In utero exposures to electronic-cigarette aerosols impair the Wnt signaling during mouse lung development. American journal of psychology. Lung cellular and molecular physiology, 318(4):L705-L722. 
• O’Connell, A., et al. 2025. Vaping and Smoking in Pregnancy-A Meta-Analysis of Neurobehavioural Development in Prenatally Exposed Offspring. Acta paediatrica (Oslo, Norway : 1992), 114(12), 3108–3121.  
• Orzabal MR, et al. 2019. Chronic exposure to e-cig aerosols during early development causes vascular dysfunction and offspring growth deficits. Translational research: the journal of laboratory and clinical medicine, 207:70-82. 
• Popham K & Kandasamy Y. 2023. The impact of smoking and nicotine exposure during pregnancy on fetal nephrogenesis: a systematic review. Journal of Developmental Origins of Health and Disease, 14(5): 559-569. 
• Phillips L et al. 2023. Developing a taxonomy to describe offspring outcomes in studies involving pregnant mammals’ exposure to non-tobacco nicotine: a systematic scoping review. Plos One, 18(2).  
• Sana M et al. 2023. Maternal cigarette and electronic cigarette use before pregnancy associated with the risk of hypertension and gestational hypertension. Obstetrics & Gynecology, 141(5S): 83S-83S. 
• Sukhato K, et al. 2025. Comparative effects of electronic cigarettes and dual use of electronic and conventional cigarettes on adverse pregnancy outcomes: a systematic review and meta-analysis. BMC Public Health. Published online November 28, 2025.  
• Suter MA, et al. 2015. Is there evidence for potential harm of electronic cigarette use in pregnancy? Birth Defects Res A Clin Mol Teratol,103(3):186-95. 
• Trapphoff T,et al. 2024. Consumption of hookahs, e-cigarettes, and classic cigarettes and the impact on medically assisted reproduction treatment. Sci Rep.;14(1):9597.  
• Vallée A, et al. 2025. Maternal vaping and pregnancy adverse outcomes: A systematic review and meta-analysis. Women Birth ;38(5):101951.  
• Walayat A et al. 2024. Maternal e-cigarette exposure alters DNA methylome, site-specific CpG and CH methylation, and transcriptomic signatures in the neonatal brain. Sci Rep, 14. 
• Wang X, et al. 2020. Smoking and use of electronic cigarettes (vaping) in relation to preterm birth and small-for-gestational age in a 2016 U.S. national sample. Preventative medicine, 134:106041. 

Selected References:

• Bateman BT, et al. 2016. Late pregnancy β blocker exposure and risks of neonatal hypoglycemia and bradycardia. Pediatrics 138(3) pii:e20160731. 
• Bauer et al. 1979. Propranolol in human plasma and breast milk. Am J Cardiol 43(4):860-862. 
• Bratton S, et al. 2024. Does atenolol use during pregnancy cause small for gestational age neonates? A meta-analysis. Journal of Perinatal Medicine. 52.8: 858-862. 
• Davis RL, et al. 2011. Risks of congenital malformations and perinatal events among infants exposed to calcium channel and beta-blockers during pregnancy. Pharmacoepidemiol Drug Saf. 20(2):138-45.  Duan L, et al. 2017. b-Blocker exposure in pregnancy and risk of fetal cardiac anomalies. JAMA Intern Med
• 177(6):885-887.  
• Duan L, et al. 2018. Beta-blocker subtypes and risk of low birth weight in newborns. J Clin Hypertens 20(11):1603-1609. 
• Firoz T, et al. 2014. Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review. BJOG 121(10):1210-1218. 
• Fischer AJ, et al. 2021. Antiarrhythmic drugs – safety and efficacy during pregnancy. Herzschrittmacherther Elektrophysiol 32(2): 145-151. 
• Freppel R, et al. 2024. Beta-blockers and breastfeeding: a real-life prospective study. Eur J Clin Pharmacol. 80(12):1937-1943.  
• Halpern DG, et al. 2019. Use of medication for cardiovascular disease during pregnancy: JACC state-of-the-art review. Journal of the American College of Cardiology. 73.4: 457-476. 
• Hutchinson S, et al. 2013. Use of common migraine treatments in breast-feeding women: A summary of recommendations. Headache 53(4):614-627.  
• Joglar JA, et al. 2023. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm. 20.10: e175-e264. Karlberg B, et al.
• 1974. Excretion of propranolol in human breast milk. Aceta Pharmacol Toxicol 34(3):222-224. 
• Lennestal R, et al. 2009. Maternal use of antihypertensive drugs in early pregnancy and delivery outcome, notably the presence of congenital heart defects in the infants. Eru J Clin Pharmacol 65(6):615-625. 
• Manolis TA, et al. 2020. Cardiac arrhythmias in pregnant women: need for mother and offspring protection. Curr Med Res Opin 36(7)1225-1243. 
• Moss HB, Procci WRR. 1982. Sexual dysfunction associated with oral antihypertensive medication: a critical survey of the literature. Gen Hosp Psych 4(2):121-129. 
• Riant P, et al. 1986. High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol 35(24):4579-4581. 
• Rosen RC, et al. 1988. Beta-blocker effects on sexual function in normal males. Arch Sex Behav. 17(3):241-255. Ruys TP, et al. 2014. Cardiac medication during
• pregnancy, data from the ROPAC. Int J Cardiol. 177(1):124-128.  
• Salman M, et al. 2016. Erectile dysfunction: prevalence, risk factors, and involvement of antihypertensive drugs intervention. Trop J Pharm Res 15(4)869-876. 
• Smith MT et al. 1983. Propranolol, propranolol glucuronide, and naphthoxylactic acid in breast milk and plasma. Ther Drug Monit. 5(1):87-93. 
• Tanaka K, et al. 2016. Beta-blockers and fetal growth restriction in pregnant women with cardiovascular disease. Circ J 80(10):2221-2226. Taylor EA, Turner P. 1981. Anti-hypertensive therapy with propranolol during pregnancy and lactation.  Postgrad Med J 57(669):427-430. 
• Thorley KJ, McAinish J. 1983. Levels of the beta-blockers atenolol and propranolol in the breast milk of women treated for hypertension in pregnancy.  Biopharm Drug Dispos. 4(3):299-301. 
• Turnstall ME. 1969. The effect of propranolol on the onset of breathing at birth. Br J Anaesth 41(9):792. 
• Welzel T, et al. 2021. Intrauterine growth retardation in pregnant women with Long QT syndrome treated with beta-receptor blockers. Neonatology 118(4)406-415. 
• Xie RH, et al. 2014. Association between labetalol use for hypertension in pregnancy and adverse infant outcomes. Eur J Obstet Gynecol Reprod Biol 175:124-128. 
• Xie RH, et al. 2014. Beta-blockers increase the risk of being born small for gestational age or of being institutionalized during infancy. BJOG. 121(9):1090-1096. 
• Yakoob MY, et al. 2013. The risk of congenital malformations associated with exposure to β-blockers in pregnancy: a meta-analysis. Hypertension 62(2):375-381. 

Selected References:

• Abdellatif M, et al. 2019. Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Eur J Pediatr 178(3):301-314. 
• Adair CD, Gunter M, Stovall TG et al. 1998. Chlamydia in pregnancy: A randomized trial of azithromycin and erythromycin. Obstet Gynecol 91:165-168. 
• Andersson NW, Olsen RH, Andersen JT. 2021. Association between use of macrolides in pregnancy and risk of major birth defects: nationwide, register based cohort study. BMJ. 372:n107.  
• Bahat Dinur A, et al. 2013. Fetal safety of macrolides. Antimicrob Agents Chemother 57(7):3307-11. 
• Berard A, et al. 2015. Use of macrolides during pregnancy and the risk of birth defects: a population-based study. Pharmacoepidemiol Drug Saf 24(12):1241-1248.  
• Cohen I, et al. 1990. Improved pregnancy outcome following successful treatment of chlamydial infection. JAMA 263:3160-3163. 
• Committee on Drugs, American Academy of Pediatrics. 2001. The transfer of drugs and other chemicals into human breast milk. Pediatrics 108:776-89. 
• Damkier P, et al. 2019. In utero exposure to antibiotics and risk of congenital malformations: A population-based study. Am J Obstet Gynecol 221:648.e1-15.  
• Fan H, et al. 2020. Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort study. BMJ 368:m331. 
• Flenady V, et al. 2013. Prophylactic antibiotics for inhibiting preterm labour with intact membranes. Cochrane Database Syst Rev 5;12:CD000246. 
• FitzSimmons J et al. 1990. Chlamydial infections in pregnancy. J Reprod Med 31:19-22, 1986. 
• Goldstein LH, et al. 2009. The safety of macrolides during lactation. Breastfed Med 4:157-200  
• Källén B, Danielsson BR, 2014. Fetal safety of erythromycin. An update of Swedish data. Eur J Clin Pharmacol 70(3):355-60.  
• Keskin-Arslan E, et al. 2023. Pregnancy outcomes following maternal macrolide use: A systematic review and meta-analysis. Reprod Toxicol; 115:124-146. 
• Lin KJ, et al. 2013. Safety of macrolides during pregnancy. Am J Obstet Gynecol 208(3):221.e1-8.  
• Lund M, et al. 2014. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ 11;348:g1908. 
• Marlow N, et al. 2017. The ORACLE Children Study: educational outcomes at 11 years of age following antenatal prescription of erythromycin or co-amoxiclav. Arch Dis Child Fetal Neonatal Ed 102(2):F131-F135. 
• McCormack WM et al. 1987. Effect on birth weight of erythromycin treatment of pregnant women. Obstet Gynecol 69:202-207. 
• McGregor JA et al. 1986. Adjunctive erythromycin treatment for idiopathic preterm labor: Results of a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol 154:98-103. 
• Romøren M, et al. 2012. Pregnancy outcome after gestational exposure to erythromycin – a population-based register study from Norway. Br J Clin Pharmacol 74(6):1053-62. 
• Ryan GM Jr, et al. 1990. Chlamydia trachomatis infection in pregnancy and effect of treatment on outcome. Am J Obstet Gynecol 162:34-39. 
• Schachter J, et al. 1986. Experience with the routine use of erythromycin for chlamydial infections in pregnancy. N Engl J Med 314:276-9Sorensen, HT et al. 2003. Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis 35:104-6 
• Shen Q, et al. 2025. Associations between urinary antibiotic exposure and semen parameters among adult men: a biomonitoring-based cross-sectional study. Environmental Pollution 375: 126335  
• WHO Working Group, Bennet PN (ed). 1988. Drugs and Human Lactation. Elsevier, Amsterdam, New York, Oxford, pp. 253-4. 

Selected References:

• Cheema R, et al. 2023. Protecting Breastfeeding during the COVID-19 Pandemic. Am J Perinatol. 40(3):260-266.  
• Dernoncourt A, et al. 2023. Fetal and Neonatal Adverse Drug Reactions Associated with Biologics Taken During Pregnancy by Women with Autoimmune Diseases: Insights from an Analysis of the World Health Organization Pharmacovigilance Database (VigiBase®). BioDrugs.37(1):73-87.  
• Food and Drug Administration. 2025. Kevzara® (sarilumab) Prescribing Information. Available at: https://www.accessdata.fda.gov>label. 
• Khiali S, et al. 2021. A comprehensive review on sarilumab in COVID-19. Expert Opinion on Biological Therapy; 21(5):615-626.  
• Krysko KM, et al. 2023. Family planning considerations in people with multiple sclerosis. Lancet Neurol. 22 (4):350-366.  
• Garcia-Vicuña R, et al. 2020. Subcutaneous Sarilumab in hospitalized patients with moderate-severe COVID-19 infection compared to the standard of care (SARCOVID): a structured summary of a study protocol for a randomized controlled trial. Trials; 21(1):772.  
• McCarty D, Robinson A. 2018. Efficacy and safety of sarilumab in patients with active rheumatoid arthritis. Ther Adv Musculoskelet Dis; 10(3):61-67.  
• Mizutani Set al. 2023. A Woman with Rheumatoid Arthritis Who Successfully Delivered a Healthy Child with Continuous Administration of Sarilumab Throughout Pregnancy. Intern Med.62(4):633-636. 
• Nana M, et al. 2024. Use of interleukin-6 receptor antibodies in the second and third trimester of pregnancy: a retrospective cohort study. Lancet Rheumatol. 6(9):e625-e635.  
• Prieto-Peña D, et al. 2021. Biologic agents and small-molecule inhibitors in systemic autoimmune conditions: an update. Pol Arch Intern Med; 131(2):171-181.  
• Raimondo et al. 2017. Profile of sarilumab and its potential in the treatment of rheumatoid arthritis. Drugs Des Devel Ther. 11:1593-1603. 
• Rüegg L, et al. 2025. EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis.84(6):910-926.  
• Saito J, et al. 2023 Establishment of a measurement system to evaluate breast milk transfer of biological agents using dry filter paper: A multi-institutional study. Br J Clin Pharmacol.