Sulfamethoxazole/Trimethoprim (Bactrim® or Septra®)

Selected References: 

  • American College of Obstetricians and Gynecologists. Urinary tract infections in pregnant individuals. Clinical Consensus No. 4. Obstet Gynecol;142:435–45.
  • Ailes EC, et al. 2018. Antibiotics dispensed to privately insured pregnant women with urinary tract infections – United States, 2014. MMWR Morb Mortal Wkly Rep, 67(1):18-22.
  • Andersen JT et al. 2013. Trimethoprim use in early pregnancy and the risk of miscarriage: a register-based nationwide cohort study. Epidemiol Infect, 141:1749-1755. 
  • Cooper M, et al. 2014. Clinical Inquiry: how best to treat UTIs in women who breastfeed? J Fam Pract, 63(2):102-3. 
  • Crider KS, et al. 2009. Antibacterial medication use during pregnancy and risk of birth defects. Arch Pediatr Adolesc Med,163:978-985. 
  • Crowe HM, et al. 2021. Antibiotics and fecundability among female pregnancy planners: a prospective cohort study. Hum Reprod, 18;36(10):2761-2768.
  • Czeizel AE, et al. 2001. The teratogenic risk of trimethoprim-sulfonamides: a population-based case-control study. Reprod Toxicol,15:637-646. 
  • Czeizel AE, et al. 2004. Possible association between different congenital abnormalities and use of different sulfonamides during pregnancy. Congenital Abnormalities, 44:79-86. 
  • Ford N, et al. 2014. Safety of co-trimoxazole in pregnancy: a systematic review and meta-analysis. J Acquir Immune Defic Syndr, 66(5): 512-521.
  • Hansen C, et al. 2016. Trimethoprim-sulfonamide use during the first trimester of pregnancy and the risk of congenital anomalies. Pharmacoepidemiol Drug Saf, 25(2):170-8.
  • Hernandez S, et al. 2000. Folic acid antagonists during pregnancy and the risk of birth defects. N Engl J Med, 343:1608-1614. 
  • Hernandez-Diaz S, et al. 2001. Neural tube defects in relation to use of folic acid antagonists during pregnancy. Am J Epidemiol, 153:961-968. 
  • Klarskov P et al. 2013. Short-acting sulfonamides near term and neonatal jaundice. Obstet Gynecol, 122:105-110. 
  • Li P, et al. 2020. Maternal exposure to sulfonamides and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One, 15(12):e 
  • Molgaard-Nielsen D, Hviid A. 2012. Maternal use of antibiotics and the risk of orofacial clefts: a nationwide cohort Pharmacoepidemiol Drug Saf, 21:246-253. 
  • Murdia A, et al. 1978. Sulpha-trimethoprim combinations and male fertility. Lancet, 2:375-376. 
  • Muanda FT et al. 2018. Use of trimethoprim-sulfamethoxazole during pregnancy and risk of spontaneous abortion: a nested case control study. BJCP, 84(6):1198-1205.
  • NIH-U.S. National Library of Medicine (2021). LABEL: BACTRIM DS- sulfamethoxazole and trimethoprim tablet. (nih.gov) Available at DailyMed https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm. Accessed November 14, 2024
  • Santos F et al. 2011. Exposure to anti-infective drugs during pregnancy and the risk of small-for-gestational-age newborns: a case-control study. BJOG, 118:1374-1382. 
  • Wen SW, et al. 2008. Maternal exposure to folic acid antagonists and placenta-mediated adverse pregnancy outcomes. CMAJ, 179:1263-1268. 
  • Yang J et al. 2011. Exposure to trimethoprim/sulfamethoxazole but not other FDA category C and D anti-infectives is associated with increased risks of preterm birth and low birth weight. Int J Infect Dis, 15:e336- 341. 
  • Yu PA, et al. 2020. Safety of antimicrobials during pregnancy: a systematic review of antimicrobials considered for treatment and postexposure prophylaxis of p Clin Infect Dis, 70(70 Suppl 1):S37-S50. 


Sulfamethoxazole/Trimethoprim (Bactrim® or Septra®)

Selected References:

  • Bauer RL, et al. 2017. Use of transdermal selegiline in pregnancy and lactation: a case report. Psychosomatics, 58(4):450-452.
  • Hagell P, et al. 1998. Pregnancy in Parkinson’s disease: a review of the literature and a case report. Mov Disord, 13(1):34-38.
  • Kupsch A, Oertel WH. 1998. Selegiline, pregnancy, and Parkinson’s disease. Mov Disord, 13(1):175-176.
  • Selegiline Drug Labels. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021479s010lbl.pdf and https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b891bd9f-fdb8-4862-89c5-ecdd700398a3&audience=consumer.
  • Shimazu H, et al. 1995. [Study on oral administration of FPF 1100 prior to pregnancy, pregnancy, and lactation period in rats.] Yakuri To Chiryo, 23(1):57-70.
  • Whitaker-Azmitia PM, et al. 1994. Effects of gestational exposure to monoamine oxidase inhibitors in rats: preliminary behavioral and neurochemical studies. Neuropsychopharmacology, 11(2):125-132.


Sulfamethoxazole/Trimethoprim (Bactrim® or Septra®)

Selected References:

  • Bravi F, et al. 2016. Impact of maternal nutrition on breast-milk composition: a systematic review. Am J Clin Nutr, 104(3):646-662.
  • Bsoul SA, Terezhalmy GT. 2004. Vitamin C in health and disease. J Contemp Dent Pract, 5(2):1-13.
  • Carmichael SL, et al. 2010. National Birth Defects Prevention Study: Craniosynostosis and nutrient intake during pregnancy. Birth Defects Res A Clin Mol Teratol, 88(12):1032-1039.
  • Cochrane W. 1965. Overnutrition in prenatal and neonatal life: a problem? Can Med Assoc J, 93:893-899.
  • Conde-Agudelo A, et al. 2011. Supplementation with vitamins C and E during pregnancy for the prevention of preeclampsia and other adverse maternal and perinatal outcomes: A systematic review and metaanalysis. Am J Obstet Gynecol, 204:503.e1-12.
  • Cyrus A, et al. 2015. The effect of adjuvant vitamin C after varicocele surgery on sperm quality and quantity in infertile men: a double blind placebo controlled clinical trial. Int Braz J Urol, 41(2):230-238.
  • Dror DK & Allen LH. 2018. Overview of nutrients in human milk. Adv Nutr, 9 Suppl 1:278S–294S.
  • Gunabalasingam S, et al. 2023. Micronutrient supplementation interventions in preconception and pregnant women at increased risk of developing pre-eclampsia: a systematic review and meta-analysis. European journal of clinical nutrition, 77(7):710–730.
  • Hamidian S, et al. 2000. The effect of vitamin C on the gene expression profile of sperm protamines in the male partners of couples with recurrent pregnancy loss: A randomized clinical trial. Clin Exp Reprod Med, 47(1):68-76.
  • Institute of Medicine. 2000. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: The National Academies Press. https://ods.od.nih.gov/HealthInformation/Dietary_Reference_Intakes.aspx [Accessed 01/2021].
  • Ji X, et al. 2023. Association between nutrient intake and female infertility: a study based on NHANES database. Journal of obstetrics and gynaecology, 43(2):2285025.
  • Kabodmehri R, et al. 2023. Female infertility and dietary antioxidant index (DAI); a case-control study. BMC women’s health, 23(1):608.
  • Martysiak-Żurowska D, et al. 2016. Higher absorption of vitamin C from food than from supplements by breastfeeding mothers at early stages of lactation. Int J Vitam Nutr Res, 86:81–87.
  • National Institutes of Health (NIH) Office of Dietary Supplements. 2021. Vitamin C Fact Sheet. Available at: https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/ and https://ods.od.nih.gov/factsheets/VitaminC-Consumer/ [Accessed 01/2023].
  • Nelson MM & Forfar JO. 1971. Associations between drugs administered during pregnancy and congenital abnormalities of the fetus. Br Med J, 1(5748):523-527.
  • Rahimi R, et al. 2009. A meta-analysis on the efficacy and safety of combined vitamin C and E supplementation in preeclamptic women. Hypertens Pregnancy, 28(4):417-434.
  • Rumbold AR, et al. 2006. ACTS Study Group: Vitamins C and E and the risks of preeclampsia and perinatal complications. N Engl J Med, 354:1796-1806.
  • Steiner AZ, et al.; Reproductive Medicine Network. 2020. The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial. Fertil Steril, 113(3):552-560.e3.
  • 2015. National Nutrient Database for Standard Reference, Release 28. Nutrients: Vitamin C, total ascorbic acid (mg). https://ods.od.nih.gov/pubs/usdandb/VitaminC-Food.pdf [Accessed 01/2021].


Sulfamethoxazole/Trimethoprim (Bactrim® or Septra®)

Selected References:

  • Bailey A, Sapra A. MMR Vaccine. [Updated 2022 Jun 12]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554450/
  • Bouthry E, et al. 2014. Rubella and pregnancy: diagnosis, management and outcomes. Prenatal Diagnosis. 34(13).
  • Centers for Disease Control and Prevention. 2001. Notice to Readers: Revised ACIP Recommendation for Avoiding Pregnancy After Receiving a Rubella–Containing Vaccine. MMWR 50(49):1117.
  • Centers for Disease Control and Prevention. 2016. CDC Advisory Committee on Immunization Practices (ACIP): Guidelines for Vaccinating Pregnant Women. https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html.
  • Center for Disease Control and Prevention. 2017. Rubella (German Measles, Three-Day Measles). https://www.cdc.gov/rubella/about/index.html.
  • Centers for Disease Control and Prevention. 2019. Measles (Rubeola). https://www.cdc.gov/measles/.
  • Centers for Disease Control and Prevention. 2019. Mumps. https://www.cdc.gov/mumps/.
  • Center for Disease Control and Prevention. 2021. Vaccination Safety for Breastfeeding Mothers. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/vaccinations.html
  • Chen, W, et al. 2004. No evidence for links between autism, MMR, and measles virus. Psychol Med 34:543-553.
  • Enders M, et al. 2005. [Frequency of spontaneous abortion and premature birth after acute mumps infection in pregnancy]. Gynakol Geburtshilfliche Rundsch;45(1):39-43.
  • Hisano M, et al. 2016. Evaluation of measles-rubella vaccination for mothers in early puerperal phase. Vaccine 34(9):1208-1214.
  • Immunization Action Coalition. 2019. Measles, Mumps and Rubella. http://www.immunize.org/askexperts/experts_mmr.asp.
  • Merck, Sharp & Dohme. MMR II. 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a9e384f-e717-436b-b9a0-15e53cef0862
  • Moss WJ. 2017. Measles. Lancet. 390(10111):2490-2502.
  • Mohrbacher N, et al (eds.) 2003. The Breastfeeding Answer Book. La Leche League International, Inc., p. 607.
  • Pickering LK (ed.) 2000 Red Book: Report of the Committee on Infectious Diseases. American Academy of Pediatrics, pp. 389-395, 406-408, 497-500.
  • Schulz J, et al. 2023. Dissecting rubella placental infection in an in vitro trophoblast model. Int. J. Mol. Sci, 24(9): 7894
  • Taparelli F, et al. 1988. Isolation of mumps virus from vaginal secretions in association with oophoritis. J Infect 17:255-8.
  • Taylor LE, et al. 2014. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine 32(29):3623-3629.


Sulfamethoxazole/Trimethoprim (Bactrim® or Septra®)

Selected References:

  • Albrecht M, et al. 2022. Infant immunity against viral infections is advanced by the placenta-dependent vertical transfer of maternal antibodies. Vaccine, 40(11): 1563-1571.
  • Bailey A, Sapra A. MMR Vaccine. [Updated 2022 Jun 12]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554450/
  • Bouthry E, et al. 2023. Congenital rubella syndrome following rubella vaccination during pregnancy. Pediatrics, 152(3): e2022057627.
  • Centers for Disease Control and Prevention. 2001. Notice to Readers: Revised ACIP Recommendation for Avoiding Pregnancy After Receiving a Rubella–Containing Vaccine. MMWR 50(49):1117.
  • Centers for Disease Control and Prevention. 2016. CDC Advisory Committee on Immunization Practices (ACIP): Guidelines for Vaccinating Pregnant Women. https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html.
  • Center for Disease Control and Prevention. 2017. Rubella (German Measles, Three-Day Measles). https://www.cdc.gov/rubella/about/index.html.
  • Center for Disease Control and Prevention. 2021. Vaccination Safety for Breastfeeding Mothers. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/vaccinations.html
  • Chen, W, et al. 2004. No evidence for links between autism, MMR, and measles virus. Psychol Med 34:543-553.
  • Gao B-G, et al. 2024. Effectiveness and safety of a mumps containing vaccine in preventing laboratory-confirmed mumps cases from 2002 to 2017: a meta-analysis. Open Life Sciences, 19(1): 20220820.
  • Hisano M, et al. 2016. Evaluation of measles-rubella vaccination for mothers in early puerperal phase. Vaccine 34(9):1208-1214.
  • Immunization Action Coalition. 2019. Measles, Mumps and Rubella. http://www.immunize.org/askexperts/experts_mmr.asp.
  • Merck, Sharp & Dohme. MMR II. 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a9e384f-e717-436b-b9a0-15e53cef0862
  • Mohrbacher N, et al (eds.) 2003. The Breastfeeding Answer Book. La Leche League International, Inc., p. 607.
  • Pickering LK (ed.) 2000 Red Book: Report of the Committee on Infectious Diseases. American Academy of Pediatrics, pp. 389-395, 406-408, 497-500.
  • Rodriguez-Cartes SA, et al. 2024. Evaluating the potential impact of rubella-containing vaccine introduction on congenital rubella syndrome in Afghanistan, Dem. Republic of Congo, Ethiopia, Nigeria, and Pakistan: a mathematical modeling study. PLOS Global Public Health, 4(1): e0002656.
  • Taylor LE, et al. 2014. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine 32(29):3623-3629