Selected References:

• Aichhorn, Wolfgang et al. 2014. Mirtazapine and breast-feeding. The American journal of psychiatry vol. 161,12 (2004): 2325. 
• Biswas PN, et al. 2003. The pharmacovigilance of mirtazapine: results of a prescription event monitoring study on 13,554 patients in England. J Psychopharmacol 17:121-6. 
• Carvalho, André F et al. 2016. The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychotherapy and psychosomatics vol. 85,5 (2016): 270-88. 
• Djulus J, et al. 2006. Exposure to mirtazapine during pregnancy: a prospective, comparative study of birth outcomes. J Clin Psychiatry 67(8):1280-4. 
• Einarson A, et al. 2009. Incidence of major malformations in infants following antidepressant exposure in pregnancy: results of a large prospective cohort study. Can J Psychiatry 54(4): 242-246. 
• Grigoriadis S, et al. 2013. The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta-analysis. J Clin Psychiatry. 74(4):e309-20. 
• Goracci, Arianna et al. 2015. Benefici e potenziali rischi dell’utilizzo di antidepressivi in gravidanza: una revisione della letteratura [Antidepressant use in pregnancy: a critical review of the risk and benefits]. Rivista di psichiatria vol. 50,3 (2015): 118-26.     
• Guclu S, et al. 2005. Mirtazapine use in resistant hyperemesis gravidarum: report of three cases and review of the literature. Arch Gynecol Obstet 272(4):298-300 
• Kieviet N, et al. 2015. Risk factors for poor neonatal adaptation after exposure to antidepressants in utero. Acta Paediatr 104(4):384-91.   
• Kjaersgaard MI, et al. 2013. Prenatal antidepressant exposure and risk of spontaneous abortion – a population-based study. PLoS One 8(8):e72095.   
• Klier C, et al. 2007. Mirtazapine and breastfeeding: maternal and infant plasma levels. Am J Psychiatry 164:2: 348-349. 
• Kristensen JH, et al. 2007. Transfer of the antidepressant mirtazapine into breast milk. Br J Clin Pharmacol 63:322-7. 
• Lennestal R. 2007. Delivery outcome in relation to maternal use of some recently introduced antidepressants. J Clin Psychopharmacology 27(6):607-613. 
• Milosavljević, Jovana Z et al. 2022. The effects of selective serotonin reuptake inhibitors on male and female fertility: a brief literature review. International journal of psychiatry in clinical practice vol. 26(1): 43-49. 
• Ostenfeld, Anne et al. 2022. Mirtazapine exposure in pregnancy and fetal safety: A nationwide cohort study. Acta Psychiatr Scand 145(6): 557-567. 
• Ostenfeld A, et al. 2025. Mirtazapine in pregnancy and lactation: A systematic review of adverse outcomes. Acta Psychiatr Scand 151(1):6-32.  
• Saks BR. 2001. Mirtazapine: treatment of depression, anxiety, and hyperemesis gravidarum in the pregnant patient:  A report of 7 cases. Arch Womens Ment Health 3(4):165-170. 
• Schwarzer V, et al. 2008. Treatment resistant hyperemesis gravidarum in a patient with type I diabetes mellitus: neonatal withdrawal symptoms after successful antiemetic therapy with mirtazapine. Arch Gynecol Obstet 277:67-69. 
• Smit M, et al. 2016. Mirtazapine in pregnancy and lactation: A systemic review. European Neuropsychopharmacology 26:126-135.   
• Smit M, et al. 2015 Mirtazapine in pregnancy and lactation: Data from a case series. J Clin Psychopharmacol 35:163-7.  
• Sokolover N, et al. 2008. Neonatal recurrent prolonged hypothermia associated with maternal mirtazapine treatment during pregnancy. Can J Clin Pharmacol 15(2):e188-190. 
• Sołek, Przemysław et al. 2021. Molecular Consequences of Depression Treatment: A Potential In Vitro Mechanism for Antidepressants-Induced Reprotoxic Side Effects. International journal of molecular sciences. 22(21):11855. 
• Solek, P et al. 2021. Toxic effect of antidepressants on male reproductive system cells: evaluation of possible fertility reduction mechanism. J Physiol Pharmacol; 72(3). 
• Tonn P, et al. 2009. High mirtazapine plasma levels in infant after breastfeeding: case report and review of the literature. J Clin Psychopharmacol; 29(2):191-192. 
• Winterfeld U, et al. 2015. Pregnancy outcome following maternal exposure to mirtazapine: a multicenter, prospective study. J Clin Psychopharmacol; 35(3):25.  

Selected References:

• Broussard CS, et al. 2011. National Birth Defects Prevention Study: Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol. 204(4):314.e1–11.
• Cohen RS. 2009. Fentanyl transdermal analgesia during pregnancy and lactation. J Hum Lact. 25(3):359-361.
• Fishman B, et al. 2019. Pregnancy outcome following opioid exposure: A cohort study. PLoS One 14(7): e0219061.
• Fleet JA, et al. 2020. Fentanyl concentration in maternal and umbilical cord plasma following intranasal or subcutaneous administration in labour. Int J Obstet Anesth. 42:34-38.
• Larson JJ, et al. 2019. Cognitive and behavioral impact on children exposed to opioids during pregnancy. Pediatrics. 144(2): e20190514.
• Lind JN, et al. 2017. Maternal use of opioids during pregnancy and congenital malformations: A systemic review. Pediatrics. 139(6):e20164131.
• Mahomed K, et al. 2019. Does fentanyl epidural analgesia affect breastfeeding: A prospective cohort study. Aust N Z J Obstet Gynaecol. 59(6):819-824.
• Moore A, et al. 2016. Maternal Epidural Fentanyl Administered for Labor Analgesia Is Found in Neonatal Urine 24 Hours After Birth. Breastfeed Med. 11(1):40-1.
• Nitsun M, et al. 2006. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther. 79(6):549-557.
• Rana D, et al. 2025. Illicit Fentanyl in the Prenatal Period: A Significant Emerging Risk for Neonatal Opioid Withdrawal Syndrome. American journal of perinatology, 42(7):891–898. 
• Regan J, et al. 2000. Neonatal abstinence syndrome due to prolonged administration of fentanyl in pregnancy. Br J Obstet Gynecol. 107:570-572.
• Väänänen A, et al. 2019. Spinal and epidural sufentanil and fentanyl in early labour. Acta Anaesthesiol Scand. 63(10):1413-1418.
• Wadman E, et al. 2023. A novel syndrome associated with prenatal fentanyl exposure. Genetics in Medicine Open; 1, 100834.
• Yazdy MM, et al. 2013. Periconceptional use of opioids and the risk of neural tube defects. Obstetrics and Gynecology. 122(4):838–844.

Selected References

• American College of Obstetricians and Gynecologists (ACOG). 2017 (Reaffirmed 2021). Marijuana Use During Pregnancy and Lactation. ACOG Committee Opinion Number. 722. Obstetrics & Gynecology 130(4).
• Arora M, et al. 2025. Cannabis use & female infertility: A cross sectional analysis of the National Health and Nutrition Examination Survey, 2013-2018. Ann Epidemiol. 104:1-7.
• Astley SJ, Little RE. 1990. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol 12:161–8.
• Avalos LA, et al. 2024. Early maternal prenatal cannabis use and child developmental delays. JAMA Netw Open. 7(10):e2440295.
• Avalos LA, et al. 2024. Neonatal outcomes associated with in utero cannabis exposure: a population-based retrospective cohort study. Am J Obstet Gynecol. 231(1):132.e1-132.e13.
• Bandoli G, et al. Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes. Drug Alcohol Depend 225:108757.
• Bertrand KA, et al. 2018. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics 142:e20181076.
• Brik M, et al. 2024. Cannabis exposure during pregnancy and perinatal outcomes: a cohort study. Acta Obstet Gynecol Scand. 103(6):1083-1091.
• Carroll K, et al. 2020. Marijuana use and its influence on sperm morphology and motility: identified risk for fertility among Jamaican men. Andrology 8(1):136-142.
• Chabarria KC, et al. 2016. Marijuana use and its effects in pregnancy. Am J Obstet Gynecol 215(4):506.e1-7.
• Cioffredi LA, et al. 2022. Prenatal cannabis exposure predicts attention problems, without changes on fMRI in adolescents. Neurotoxicology and teratology 91, 107089.
• Coleman-Cowger V, et al. 2018. Prevalence and associated birth outcomes of co-use of cannabis and tobacco cigarettes during pregnancy. Neurotoxicity and Teratology 68:84-90
• Committee on Drugs, American Academy of Pediatrics. 2001. The transfer of drugs and other chemicals into human breast milk. Pediatrics 108:776-89.
• Corsi DJ, et. al. 2020. Maternal cannabis use in pregnancy and child neurodevelopmental outcomes. Nat Med; 26, 1536-1540.
• Davis, E, et al. 2020. Cannabis use in pregnancy and breastfeeding: The pharmacist’s role. Can Pharm J 153(2):95-100.
• Delker E, et al. 2022. Prenatal exposure to cannabis and risk of major structural birth defects: A systematic review and meta-analysis. Ob Gyn 142(2):269-283
• Delker E, et al. 2024. Prenatal cannabis use disorder and gastroschisis in California, 2007-19. Int J Epidemiol. 53(2):dyae042.
• ElSohly MA, et al. 2016. Changes in cannabis potency over the last 2 decades (1995-2014): Analysis of current data in the united states. biol psychiatry. 79(7):613-9.
• Feinshtein V, et al. 2013. Cannabidiol changes P-gp and BCRP expression in trophoblast cell lines. PeerJ 1:e153.
• Fried PA, Smith AM. 2001. A lit review of the consequences of prenatal marihuana exposure. An emerging theme of a deficiency in aspects of executive function. Neurotoxicol Teratol 23:1-11.
• Fronczak CM, et al. 2012. The insults of illicit drug use on male fertility. J Androl 33(4): 515-528.
• Goldschmidt L, et al. 2004. Prenatal marijuana and alcohol exposure and academic achievement at age 10. Neurotoxicol Teratol 26(4):521-32.
• Goldschmidt L, et al. 2008. Prenatal marijuana and intelligence test performance at age 6. J Am Acad Child Adolesc Psychiatry 47(3):254-263.
• Goldschmidt L, et al. 2016. Early marijuana initiation: Link between prenatal marijuana exposure, early childhood behavior, and negative adult roles. Neurotoxicol Teratol 58:40-45.
• Gray T, et al. 2010. Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth. Clin Chem 56(9):1442-1450.
• Gundersen TD, et al. 2015. Association between use of marijuana and male reproductive hormones and semen quality: A study among 1,215 healthy young men. Am J Epidemiol.;182(6):473-481.
• Hale D, Phillips W. 2022. Cannabis withdrawal in two newborns. Abstract published at SHM Converge 2022. Abstract G24 Journal of Hospital Medicine. https://shmabstracts.org/abstract/cannabis-withdrawal-in-two-newborns/.
• Harhangi MS, et al. 2025. Placental endocannabinoid system: focus on preeclampsia and cannabis use. Hypertension. 82(5):804-815.
• Harris M, et al. 2023. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med. 18(10):715-733.
• Hayatbakhsh MR, et al. 2012. Birth outcomes associated with cannabis use before and during pregnancy. Pediatric Res 71(2): 215-219.
• Hehemann MC, et al. 2021. Evaluation of the impact of marijuana use on semen quality: a prospective analysis. Therapeutic Advances in Urology 13:17562872211032484.
• Huizink A. 2009. Moderate use of alcohol, tobacco, and cannabis during pregnancy: New approaches and update on research findings. Reprod Toxicol 28:143-151.
• Jones MJ, et al. 2022. Prenatal marijuana exposure and neonatal outcomes: a retrospective cohort study. BMJ open, 12(9), e061167.
• Karatayev O, et al. 2024. Neurological disorders induced by drug use: effects of adolescent and embryonic drug exposure on behavioral neurodevelopment. Int J Mol Sci. 25(15):8341.
• Keim SA, et al. 2024. Prenatal cannabis exposure and executive function and aggressive behavior at age 5 years. JAMA Pediatr. 178(12):1316-1325.
• Lam PK and Torfs CP. 2006. Interaction between maternal smoking and malnutrition in infant risk of gastroschisis. Birth Defects Res 76:182-186.
• Leech SL, et al. 1999. Prenatal substance exposure: effects on attention and impulsivity of 6-year-olds. Neurotoxicol Teratol 21(2):109-18.
• Leemaqz SY, et al, SCOPE Consortium. 2016. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common later pregnancy complications. Reprod Toxicol 62:77-86.
• Liston J. 1998. Breastfeeding and the use of recreational drugs alcohol, caffeine, nicotine and marijuana. Breastfeed Rev 6(2):27-30.
• Matrin GI. 2020. Marijuana: The effects on pregnancy, the fetus, and the newborn. J Perinatology; 40, 1470-1476.
• Metz TD, et al. 2017. Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. Am J Obstet Gynecol; 217:478.e1-8.
• Moore BF, et al. 2025. Impact of prenatal exposure to delta 9-tetrahydrocannabinol and cannabidiol on birth size and postnatal growth trajectories. Pediatr Obes. 20(1):e13187.
• Moss MJ, et al. 2021. Cannabis use and measurement of cannabinoids in plasma and breast milk of breastfeeding mothers. Pediatric research, 90(4), 861–868.
• Narayanan P, et al. 2025. The effect of cannabis consumption during lactation on the macronutrient concentrations in breast milk. Breastfeeding Medicine. 20(1):33–41.
• Neradugomma NK, et al. 2019. Marijuana-derived cannabinoids inhibit uterine endometrial stromal cell decidualization and compromise trophoblast-endometrium cross-talk. Reprod Toxicol; 87:100-107.
• Nguyen VH, Harley KG. 2022. Prenatal cannabis use and infant birth outcomes in the Pregnancy Risk Assessment Monitoring System. The Journal of pediatrics, 240, 87–93.
• Petersen JM, et al. 2025. An exploration of potential risk factors for gastroschisis using decision tree learning. Ann Epidemiol. 101:19-26.
• Pleau J, et al. 2025. Longitudinal associations between cannabis use during pregnancy and child cognitive, motor, and language development at 2 years old. Matern Child Health J 29(4):549-562.
• Roca A, et al. 2021. Clinical features and risk factors associated with prenatal exposure to drugs of abuse. Anales de pediatria, 95(5), 307–320.
• Ryan SA, et al. 2018. . Marijuana use during pregnancy and breastfeeding: implications for neonatal and childhood outcomes, Pediatrics. 142(3):e20181889.
• Sarrafpour S, et. al. 2020. Considerations and Implications of cannabidiol use during pregnancy. Curr Pain Headache Rep; 24, 38.
• Sasso EB, et al. 2021. Marijuana use and perinatal outcomes in obstetric patients at a safety net hospital. European journal of obstetrics, gynecology, and reproductive biology, 266, 36–41.
• Smith AM, et al. 2004. Effects of prenatal marijuana on response inhibition: an MRI study of young adults Neurotoxicol Teratol 26(4):533-42.
• Sonon, KE, et al. 2014. Prenatal marijuana exposure predicts marijuana use in young adulthood. Neurotoxicol Teratol. 47:10–15.
• Tadesse AW, et al. 2025. Maternal cannabis use disorder and neonatal health outcomes: a data linkage study. BJOG. 132(4):529-538.
• Tadesse AW, et al. 2025. Maternal cannabis use disorder and offspring behavioral outcomes: findings from a linked data cohort study. Psychiatry Res. 346:116404.
• Thompson R, et al. 2019. Marijuana use in pregnancy: A review. Obstet Gynecol Surv. 74(7):415-428.
• S. Food and Drug Administration (FDA). 2019. What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding: Available at: https://www.fda.gov/consumers/consumer-updates/what-you-should-know-about-using-cannabis-including-cbd-when-pregnant-or-breastfeeding [Accessed 10/2022].
• Varner MW, et al. 2014. Association between stillbirth and illicit drug use and smoking during pregnancy. Obstet Gynecol; 123(1):113-25.
• Weinsheimer RL, et al. 2008. Impact of maternal substance abuse and smoking on children with gastroschisis. J Pediatr Surg 43:879-883.
• Williams LJ, et al. 2004. Maternal lifestyle factors and risk for ventricular septal defects. Birth Defects Res A Clin Mol Teratol 70:59-64.
• Young-Wolff KC, et al. 2024. Prenatal cannabis use and maternal pregnancy outcomes. JAMA Intern Med. 184(9):1083–1093.
• Young-Wolff KC, et al. 2025. Prenatal cannabis use and offspring attention deficit hyperactivity disorder and disruptive behavior disorders: a retrospective cohort study. J Dev Behav Pediatr. 46(1):e25-e32.

Selected References:

• Adkoli A, et al. 2022. Access to Family Planning Services Following Natural Disasters and Pandemics: A Review of the English Literature. Cureus. 14(7):e26926.
• Atkin K, et al. 2024. Climate-Related Emergencies in Pregnancy. AACN Adv Crit Care. 35(4):343-352.
• Ha S. 2022. The Changing Climate and Pregnancy Health. Curr Environ Health Rep. 9(2):263-275.
• Pashaei-Asl Y, et al. Consequences of Natural and Man-made Disasters on Pregnancy Outcomes and Complications: A Systematic Review. Arch Acad Emerg Med. 12(1):e61.
• Severson E, et al. 2023. Experiencing Trauma During or Before Pregnancy: Qualitative Secondary Analysis After Two Disasters. Matern Child Health J. 27(5):944-953.
• Suter MA, et al. 2023. Natural disasters resulting from climate change: The impact of hurricanes and flooding on perinatal outcomes. Semin Perinatol. 47(8):151840.

Selected References:  

• Bowman, J. D., Kim, H., & Bustamante, J. J. 2012. Drug‐Induced gynecomastia. Pharmacotherapy the Journal of Human Pharmacology and Drug Therapy, 32(12), 1123–1140. 
• Carone, L., Oxberry, S. G., Twycross, R., Charlesworth, S., Mihalyo, M., & Wilcock, A. 2016. Spironolactone. Journal of Pain and Symptom Management, 53(2), 288–292. 
• de Arriba G, Sanchez-Heras M, Basterrechea MA. 2009. Gitelman syndrome during pregnancy: a therapeutic challenge. Arch Gynecol Obstet 280(5):807-809.  
• Delgado, D., Stellwagen, L., McCune, S., Sejane, K., & Bode, L. 2023. Experience of induced lactation in a transgender woman: analysis of human milk and a suggested protocol. Breastfeeding Medicine, 18(11), 888–893.  
• Forestiero, V., Sconfienza, E., Mulatero, P., & Monticone, S. 2022. Primary aldosteronism in pregnancy. Reviews in Endocrine and Metabolic Disorders, 24(1), 39–48.  
• Groves TD, Corenblum B. 1995. Spironolactone therapy during human pregnancy. Am J Obstet Gynecol 172(5):1655-1656.  
• Liszewski W, Boull C. Lack of evidence for feminization of males exposed to spironolactone in utero: A systematic review. J Am Acad Dermatol. 2019;80(4):1147-8. 
• Loriaux, D. L. 1976. Spironolactone and endocrine dysfunction. Annals of Internal Medicine, 85(5), 630.  
• Nagi, S., & Virgo, B. B. 1982. The effects of spironolactone on reproductive functions in female rats and mice.
• Toxicology and Applied Pharmacology, 66(2), 221–228.  
• Phelps, D. L., & Karim, A. 1977. Spironolactone: Relationship between Concentrations of Dethioacetylated
• Metabolite in Human Serum and Milk. Journal of Pharmaceutical Sciences, 66(8), 1203.  
• Pugashetti, R., & Shinkai, K. 2013. Treatment of acne vulgaris in pregnant patients. Dermatologic Therapy, 26(4), 302–311. https://doi.org/10.1111/dth.12077.
• Reisman, T., & Goldstein, Z. 2018. Case report: Induced lactation in a transgender woman. Transgender Health, 3(1), 24–26.  
• Rigo J Jr, Glaz E, Papp Z/ 1986. Low or high doses of spironolactone for treatment of maternal Bartter’s syndrome. Am J Obstet Gynecol 174(1 Pt 1):297, 1996.  
• Spironolactone Product Label. 2022. Retrieved February 2025 from https://labeling.pfizer.com/ShowLabeling.aspx?id=12861%20.   
• U.S. Food and Drug Administration. 2018. Spironolactone. Retrieved February 2025 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/012151s075lbl.pdf.