This sheet is about exposure to remdesivir in pregnancy and while breastfeeding. This information is based on available research studies. It should not take the place of medical care and advice from your healthcare provider.

What is remdesivir?

Remdesivir is an antiviral medication that has been approved to treat SARS-CoV-2 virus, which causes COVID-19. It has also been used to treat Ebola virus infections. Remdesivir is sold under the brand name Veklury®.

Having a COVID-19 infection during pregnancy can increase the chance of having severe symptoms and pregnancy-related problems. For more information about COVID-19, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/covid-19/.

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.

I take remdesivir. Can it make it harder for me to get pregnant?

It is not known if remdesivir can make it harder to get pregnant.

Does taking remdesivir increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if remdesivir can increase the chance of miscarriage. In studies with a total of 150 pregnancies, no increased chance of miscarriage was reported.

Does taking remdesivir increase the chance of birth defects?

Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like remdesivir, can increase the chance of birth defects in a pregnancy. There are no human studies looking at the chance of birth defects with remdesivir use in pregnancy. Animal studies have not shown an increased chance of birth defects.

Does taking remdesivir in pregnancy increase the chance of other pregnancy-related problems?

Reports of 70 women who were treated with remdesivir for COVID-19 infections in the second and third trimesters of pregnancy found a higher chance for preterm delivery (birth before week 37), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), and cesarean section. However, these women were very sick with COVID-19. Also, preterm delivery has been associated with COVID-19 infection in pregnancy. It is not known if these outcomes were due to the COVID-19 illness, the medication, or other factors. Another small study did not find an increased chance of preterm delivery with the use of remdesivir.

Does taking remdesivir in pregnancy affect future behavior or learning for the child?

Studies have not been done to see if remdesivir can increase the chance of behavior or learning issues for the child.

Breastfeeding while taking remdesivir:

Remdesivir passes into breast milk in small amounts. Nursing infants are not likely to absorb large amounts of the medication from milk. Remdesivir is approved to be given to children older than 28 days to treat Ebola and COVID-19 infections. No side effects have been reported in the children prescribed remdesivir or in the reports of children exposed to remdesivir through breast milk. If you suspect the baby has symptoms (such as diarrhea, rash, decreased urination, or dizziness), contact the child’s healthcare provider.

The virus that causes COVID-19 has not been found to pass through breast milk. There are no reported cases of infants getting COVID-19 through breast milk. The Centers for Disease Control and Prevention (CDC) encourages women to continue to breastfeed or provide breast milk for their babies even if they have a viral infection like COVID-19. There are antibodies in breast milk that might help prevent a baby from getting sick with COVID-19.

Women with COVID-19 might feel too sick to breastfeed. The CDC recommends continuing to express milk when possible.

While sick, it is important to try to protect the baby from getting sick. Wash your hands with soap and water before holding your baby. Avoid coughing or sneezing on your baby. Cover your mouth/nose with a tissue when you cough or sneeze, then throw away the tissue and wash your hands. While you are ill, you might want to consider having someone who is not sick help you care for your baby. If you think your baby has symptoms of COVID-19, contact your child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a man takes remdesivir, could it affect fertility or increase the chance of birth defects?

Studies have not been done to see if remdesivir could affect a man’s fertility (ability to get a woman pregnant) or increase the chance of birth defects. In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/

Please click here for references.

This sheet is about exposure to nirmatrelvir/ritonavir in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare providers. 

What is nirmatrelvir/ritonavir? 

Nirmatrelvir and ritonavir are medications that have been used together to treat COVID-19 (the illness caused by the SARS-CoV-2 virus). The combination of nirmatrelvir and ritonavir is sold under the brand name Paxlovid®. To be most effective, nirmatrelvir/ritonavir treatment should be started as soon as possible after a diagnosis of COVID-19 and within 5 days of the start of symptoms. For more information on COVID-19, please the fact sheet at https://mothertobaby.org/fact-sheets/covid-19/. 

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

I need to take nirmatrelvir/ritonavir. Can it make it harder for me to get pregnant?  

Studies have not been done in humans to see if nirmatrelvir/ritonavir can make it harder to get pregnant. Animal studies on ritonavir have not shown effects on the ability to get pregnant (fertility). 

Does taking nirmatrelvir/ritonavir increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done in humans to see if nirmatrelvir/ritonavir can increase the chance of miscarriage.  

Does taking nirmatrelvir/ritonavir increase the chance of birth defects?  

Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like nirmatrelvir/ritonavir, might increase the chance of birth defects in a pregnancy.  Studies have not been done in humans to see if the combination of nirmatrelvir/ritonavir can increase the chance of birth defects. Case reports of use in human pregnancy have not suggested an increased chance of birth defects.  

The National Institutes of Health (NIH) recommends that nirmatrelvir/ritonavir not be withheld from women who are pregnant and have COVID-19 if they otherwise qualify to receive this medication. The American College of Obstetricians and Gynecologists (ACOG) states that nirmatrelvir/ritonavir is the preferred treatment for women who are pregnant and have COVID-19 that does not require hospitalization. If you have COVID-19, your healthcare providers can talk with you about what treatment is best for you.  

Does taking nirmatrelvir/ritonavir in pregnancy increase the chance of other pregnancy-related problems? 

Small studies looking at women who took nirmatrelvir/ritonavir for COVID-19 infection during pregnancy have not reported an increased chance of pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Among the women who had gone on to deliver at the time of these reports, no side effects related to nirmatrelvir/ritonavir were reported in their infants at the time of delivery. Most of the women who had delivered were vaccinated against COVID-19 and received nirmatrelvir/ritonavir in the third trimester.  

Having a COVID-19 infection in pregnancy can increase the chance of pregnancy problems such as stillbirth and preterm delivery.  

Does taking nirmatrelvir/ritonavir in pregnancy affect future behavior or learning for the child?   

Studies have not been done to see if nirmatrelvir/ritonavir can increase the chance of behavior or learning issues for the child.  

Breastfeeding while taking nirmatrelvir/ritonavir: 

Information on the use of nirmatrelvir/ritonavir during breastfeeding is limited. Nirmatrelvir/ritonavir passes into breast milk in small amounts. No adverse effects were reported in a few case reports on nursing infants. More information is available about ritonavir used by itself during breastfeeding.  

Since the amount of nirmatrelvir/ritonavir in the milk is expected to be low, it is not expected to cause side effects in nursing infants. However, if you suspect the baby has any symptoms (such as diarrhea or irritability), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

If a man takes nirmatrelvir/ritonavir, could it affect his fertility or increase the chance of birth defects? 

Studies have not been done in humans to see if nirmatrelvir/ritonavir could affect male fertility (ability to make healthy sperm) or increase the chance of birth defects. Animal studies on ritonavir have not shown an effect on male fertility. In general, exposures that men have are unlikely to increase the risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.  

Please click here for references. 

This sheet is about exposure to molnupiravir in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider.

What is molnupiravir?

Molnupiravir is an antiviral medication that has been given emergency permission by the U.S. Food and Drug Administration (FDA) to treat mild to moderate COVID-19 in certain patients. Molnupiravir must be started within 5 days of having symptoms of COVID-19 in order to be effective. A brand name for molnupiravir is Lagevrio®.

The FDA emergency use guidelines for molnupiravir recommend that women who are pregnant not use this medication unless there are no other treatment options and treatment is clearly needed. This is because there is not enough information available on the use of molnupiravir to know if/how it could affect a pregnancy. However, the benefit of using molnupiravir may outweigh possible risks. Your healthcare provider can talk with you about using molnupiravir and what treatment is best for you. For more information about COVID-19, please the see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/covid-19/.

I am taking molnupiravir, but I would like to get pregnant after taking it. How long does the drug stay in my body?

People eliminate medication at different rates. In non-pregnant adults, it takes up to 1 day, on average, for most of the molnupiravir to be gone from the body. The FDA emergency use guidelines recommend that women avoid trying to get pregnant while they are taking molnupiravir and for 4 days after the last dose.

I take molnupiravir. Can it make it harder for me to get pregnant?

It is not known if molnupiravir can make it harder to get pregnant. The FDA emergency use guidelines recommend that women who can get pregnant use effective contraception correctly and consistently while they are taking molnupiravir and for 4 days after the last dose.

Does taking molnupiravir increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done in women to see if molnupiravir can increase the chance of miscarriage.

Does taking molnupiravir increase the chance of birth defects?

Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Studies have not been done in women to see if molnupiravir can increase the chance of birth defects above the background risk.

Does taking molnupiravir in pregnancy increase the chance of other pregnancy-related problems?

Studies have not been done in women to see if molnupiravir can increase the chance of pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Having COVID-19 during pregnancy can increase the chance of preterm delivery, stillbirth, and other pregnancy complications.

Does taking molnupiravir in pregnancy affect future behavior or learning for the child?

Studies have not been done to see if molnupiravir can cause behavior or learning issues for the child.

Breastfeeding while taking molnupiravir:

The FDA emergency use guidelines for molnupiravir recommend that women who are breastfeeding not use this medication unless there are no other treatment options and treatment is clearly needed. But the benefit of using molnupiravir along with the benefits of breastfeeding your baby may outweigh possible risks. Women who are breastfeeding can consider pumping and discarding breast milk during treatment with molnupiravir and for 4 days after the last dose. Your healthcare providers can talk with you about using molnupiravir and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a man takes molnupiravir, could it affect fertility or increase the chance of birth defects?

Studies have not been done to see if molnupiravir could affect a man’s fertility (ability to get a woman pregnant) or increase the chance of birth defects above the background risk. The FDA emergency use guidelines recommend that men use a reliable method of contraception correctly and consistently during treatment and for at least 3 months after the last dose of molnupiravir. In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

This sheet is about exposure to tofacitinib in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare provider. 

What is tofacitinib? 

Tofacitinib is a medication that has been used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and ulcerative colitis. Some brand names for tofacitinib are Xeljanz® and Xeljanz XR®. 

MotherToBaby has fact sheets on rheumatoid arthritis here: https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/, psoriasis here: https://mothertobaby.org/fact-sheets/psoriasis-and-pregnancy/, ankylosing spondylitis here: https://mothertobaby.org/fact-sheets/ankylosing-spondylitis/ and inflammatory bowel disease here:  https://mothertobaby.org/fact-sheets/inflammatory-bowel-disease-pregnancy/.  

Tofacitinib has been studied in treating severe COVID-19. Since there is little information about tofacitinib in pregnancy and breastfeeding, it is not currently recommended for treatment of COVID-19 in women who are pregnant or breastfeeding if other recommended treatment options are available. However, the National Institutes of Health (NIH) also states that necessary COVID-19 treatments should not be withheld from women just because they are pregnant or breastfeeding. More information on COVID-19 can be found in our fact sheet here: https://mothertobaby.org/fact-sheets/covid-19/.  

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

I take tofacitinib. Can it make it harder for me to get pregnant?  

It is not known if tofacitinib can make it harder to get pregnant. 

Does taking tofacitinib increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done to see if tofacitinib increases the chance of miscarriage. Reports of tofacitinib use during early pregnancy have not suggested an increased chance of miscarriage. 

Does taking tofacitinib increase the chance of birth defects?  

Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like tofacitinib, might increase the chance of birth defects in a pregnancy. 

There are limited studies on the use of tofacitinib in pregnancy. No increased chance of birth defects has been reported when tofacitinib was used during early pregnancy.  

Does taking tofacitinib in pregnancy increase the chance of other pregnancy-related problems? 

Studies have not been done to see if tofacitinib can increase the chance of pregnancy-related problems, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). 

Does taking tofacitinib in pregnancy affect future behavior or learning for the child?   

Studies have not been done to see if tofacitinib can increase the chance of behavior or learning issues for the child. 

Breastfeeding while taking tofacitinib: 

Tofacitinib has not been well studied for use during breastfeeding. In 2 reports of tofacitinib use while breastfeeding, the amount that was found in breast milk was low. Additionally, no side effects were reported in either breastfed infant. There have been no large research studies on the use of tofacitinib in breastfeeding.  

The product label for tofacitinib and an expert panel recommends women who are breastfeeding not use this medication during breastfeeding, and that breastfeeding should not resume until 18 hours after the last dose. For the extended release form (Xeljanz® XR), they recommend waiting 36 hours after the last dose before breastfeeding again. This is because there is not enough information available on the use of tofacitinib to know if/how it could affect breastfeeding or a breastfed child. But the benefits of using tofacitinib and breastfeeding might outweigh possible risks. Your healthcare providers can talk with you about using tofacitinib and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

If a man takes tofacitinib, could it affect his fertility or increase the chance of birth defects? 

Studies have not been done to see if tofacitinib could affect male fertility (ability to get make healthy sperm) or increase the chance of birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.  

Please click here for references.