This sheet is about having gestational diabetes in a pregnancy and while breastfeeding. This information is based on published research. It should not take the place of medical care and advice from your healthcare provider. 

What are diabetes and gestational diabetes? 

Diabetes is a medical condition in which the body either does not make enough insulin or cannot use insulin correctly. Insulin is a hormone that helps sugar (glucose) move from the bloodstream into the cells of the body, giving the cells energy to function. When glucose cannot enter the cells, it builds up in the blood (high blood sugar, or hyperglycemia). MotherToBaby has a separate fact sheet about type 1 and type 2 diabetes at: https://mothertobaby.org/fact-sheets/type-1-and-type-2-diabetes/.  

Gestational diabetes is diabetes diagnosed for the first time during pregnancy. Gestational diabetes can develop in women who did not have diabetes before pregnancy. It has also been diagnosed in women who have type 2 diabetes before becoming pregnant, but they do not know they have it. If the diabetes is not diagnosed until later in pregnancy, it is called gestational diabetes. Since type 2 diabetes is becoming more common in the general population, it has been suggested that all women who want to become pregnant talk with their healthcare providers about being checked for diabetes before becoming pregnant.  

Well-controlled glucose levels are levels in the range that works best for a person. Uncontrolled or poorly-controlled glucose levels mean blood sugar levels are too high, even if the condition is being treated. What are considered well-controlled, poorly-controlled and uncontrolled glucose levels can vary from person to person. According to the American Diabetes Association, the goals for blood glucose levels for people with gestational diabetes are:  

• Before a meal (preprandial) ≤95 mg/dL (5.3 mmol/L) 
• 1-hour post-meal ≤140 mg/dL (7.8 mmol/L) 
• 2-hours post-meal ≤120 mg/dL (6.7 mmol/L)

However, because every person and every pregnancy are different, it is important to work with your healthcare team to determine what your own blood glucose goals are and how to meet them during pregnancy.  

How are women screened for gestational diabetes?

Most women are screened for gestational diabetes around 24 to 28 weeks of pregnancy by drinking a glucose solution and having their blood glucose level tested 1 hour later. If this test result is abnormal, a longer test may be done to confirm a diagnosis of gestational diabetes.  

Women who have had gestational diabetes in a previous pregnancy have a greater chance of having it again in later pregnancies. If you have had gestational diabetes in a previous pregnancy, your healthcare provider may want you to take the glucose screening test earlier in pregnancy. Talk to your healthcare provider about the screening or testing options that are right for you.  

Does having gestational diabetes increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. When glucose levels are not well-controlled during pregnancy, there is an increased chance of miscarriage.  

Does having gestational diabetes 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 gestational diabetes, might increase the chance of birth defects in a pregnancy.  

Gestational diabetes has not been associated with birth defects in most studies, but some studies do suggest an increased chance of birth defects. It is possible that these birth defects are due to undiagnosed type 2 diabetes in the first trimester or other causes, such as obesity. Obesity can cause gestational diabetes, and can also increase the chance of birth defects. For more information on obesity, please see the MotherToBaby fact sheet: https://mothertobaby.org/fact-sheets/obesity-pregnancy/.  

Would having gestational diabetes increase the chance of other pregnancy related problems? 

When glucose levels are not well-controlled during pregnancy, there is a higher chance of stillbirth, pre-eclampsia (high blood pressure and problems with organs, such as the kidneys), too much amniotic fluid around the baby (polyhydramnios), and preterm delivery (delivery before week 37). At birth, the baby can have trouble breathing, low blood sugar (hypoglycemia), and jaundice (yellowing of the skin and the whites of the eyes). In addition, having gestational diabetes increases the chance of having large babies (called macrosomia), some weighing over 10 pounds. When glucose levels are well-controlled during pregnancy, these problems are less likely to happen.  

Does having gestational diabetesin pregnancy cause long-term problems or affect future behavior or learning for the child?   

Infants born to women with gestational diabetes have higher chances of childhood obesity and developing diabetes later in life. These outcomes are thought to be influenced by both genetics and blood sugar levels during pregnancy. Some studies suggest that poorly-controlled diabetes during pregnancy could affect development of the central nervous system (CNS) in the fetus. If this happens, it could increase the chance of problems with learning, behavior, and development for the child later in life. However, data from these studies are limited.  

How is gestational diabetes treated?

In most cases of gestational diabetes, blood glucose levels can be controlled with dietary changes and exercise. Some women need to take medication. You can discuss questions about specific medications with your healthcare provider or with a MotherToBaby specialist.  

What kinds of tests are recommended during pregnancy for people with gestational diabetes? 

Your healthcare providers will follow you and your developing baby’s health closely during the pregnancy. They will talk with you about the correct tests for your pregnancy.  

Does gestational diabetes go away after I deliver my baby?

For most women, gestational diabetes goes away soon after delivery. If it does not go away, it is called type 2 diabetes. About 50% (1 in 2) of all women who had gestational diabetes develop type 2 diabetes later in life. It is suggested that women who had gestational diabetes get tested for diabetes 6 to 12 weeks after their baby is born, and then every 1 to 3 years. It is important for women who had gestational diabetes to continue to exercise and eat a healthy diet after pregnancy to prevent or delay getting type 2 diabetes.  

Breastfeeding while I have gestational diabetes: 

Having gestational diabetes is not considered a reason to discourage breastfeeding. Keeping glucose levels well-controlled is important when breastfeeding. Some research has found that high glucose levels in the mother’s blood can overflow into the breast milk as sugar. This could cause hypoglycemia (low blood sugar) in the infant. If you take medication to control your diabetes, you can contact a MotherToBaby specialist to learn more about your specific medication(s) during breastfeeding. Be sure to talk to your healthcare provider about all of your breastfeeding questions. 

Please click here to view references.

This sheet is about exposure to quetiapine in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare providers.

What is quetiapine?

Quetiapine is a medication that has been used to treat schizophrenia, bipolar disorder, and major depression. Some brand names are Seroquel® and Seroquel XR®. Some women need to adjust their quetiapine doses during pregnancy to keep the medication working well for them. Discuss how to monitor this with your healthcare providers.

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 this medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. MotherToBaby has a fact sheet on depression at https://mothertobaby.org/fact-sheets/depression-pregnancy/.

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

Maybe, but women still get pregnant while taking this medication. Quetiapine might increase the level of a hormone called prolactin in some people who take this medication (called hyperprolactinemia). Hyperprolactinemia can make it harder to get pregnant. However, quetiapine is less likely to cause hyperprolactinemia than other similar medications. If there is concern about fertility, a healthcare provider can check the level of prolactin with a blood test. Untreated psychiatric disorders and symptoms can also affect fertility.

Does taking quetiapine increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Most studies have found that the chance of miscarriage is not different between women who take quetiapine and women who use similar medications. One study reported an increased chance of miscarriage in women taking quetiapine or similar medications during pregnancy when compared with groups that were not taking such medications. However, the authors of the study noted that their findings may be due to the person’s underlying condition rather than the medication used as treatment. Studies have shown that untreated or poorly treated depression can increase the chance for miscarriage. This makes it difficult to determine if it is the medication, poorly treated depression. or other factors that increased the chance for miscarriage.

Does taking quetiapine 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. Based on studies reviewed, quetiapine is not thought to increase the chance of birth defects.

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

Quetiapine might increase the chance for gestational diabetes. Your healthcare provider can monitor your blood sugar levels in pregnancy. MTB has a fact sheet on Diabetes and Gestational Diabetes at https://mothertobaby.org/fact-sheets/diabetes-pregnancy/.

Quetiapine use in pregnancy might also increase the chance for low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). However, research has also shown that when depression and other psychiatric conditions are left untreated during pregnancy, there could be an increased chance for pregnancy complications, including low birth weight. This makes it hard to know if it is the medication, the untreated depression or other factors that are increasing the chance for these problems.

I need to take quetiapine throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth?

The use of quetiapine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. There is limited information about the use of quetiapine during late pregnancy and how a newborn adjusts after delivery. It has been suggested that babies exposed to quetiapine during late pregnancy be monitored for possible symptoms such as: too much or too little muscle tone (stiff or floppy), sleepiness, agitation, problems with breathing and feeding, or unusual muscle movements (tremors). It is important to note that not every newborn will have these symptoms and if they do, the symptoms usually go away in a short time.

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

One study suggested that exposure to quetiapine or similar medications might cause short-term delayed development and behavior problems. These delays were seen at two months and six months of age, but not at one year of age. This suggests such delays can be temporary. Another study found no association between quetiapine use during the pregnancy and poor outcomes in school. These findings suggest that there are no neurodevelopmental outcomes in children exposed to quetiapine during the pregnancy.

Breastfeeding while taking quetiapine? 

Quetiapine is found in low levels (less than 1% of the parent’s dose) in breast milk. The amount of medication in a breastfed infant’s blood is very low, or even undetectable. Based on limited studies, exposure to quetiapine through breastfeeding is not expected to affect development. When taking quetiapine while nursing, babies should be watched to make sure they are not more sleepy than usual. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

If a man takes quetiapine, could it affect fertility (ability to get a woman pregnant) or increase the chance of birth defects?

It is not known if there are possible risks to a pregnancy from semen exposed to quetiapine. 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 having high cholesterol during pregnancy and while breastfeeding. This information is based on published research studies. This information should not take the place of medical care and advice from your healthcare provider. 

What is cholesterol?  

Cholesterol is a waxy substance that our bodies make to help build healthy cells. There are two types of cholesterol: the high-density lipoprotein cholesterol (HDL) (often called “good” cholesterol) and the low-density lipoprotein cholesterol (LDL) called “bad” cholesterol.  

People also get some cholesterol from eating certain foods. Foods high in cholesterol includes butter, fatty meat, and full fat cheese. Lack of exercise, being overweight, and eating foods with high cholesterol can all increase levels of LDL cholesterol. Smoking cigarettes lowers the amount of HDL cholesterol in the body. Some people have a genetic condition called Familial Hypercholesterolemia (FH) that causes very high levels of LDL cholesterol. For people with FH, medication is usually needed to lower their LDL cholesterol levels.  

High cholesterol can reduce blood flow and increase the chance of acute pancreatitis (inflamed pancreas) and heart disease, which can lead to heart attacks and strokes.  

I have high cholesterol. What should I talk about with my healthcare team before I get pregnant? 

It is important to talk to your healthcare team (including your obstetrician, primary care provider, cardiologist, endocrinologist, dietician, etc.) about plans for treating your condition before and during pregnancy, during delivery, and after delivery. If possible, talk with your healthcare team before getting pregnant. If your pregnancy is unplanned, contact your healthcare providers as soon as you find out you are pregnant. Each woman with high cholesterol is unique and personalized clinical management is important for pregnancy and breastfeeding. 

Topics to talk about with your healthcare team include: 

• Ways to monitor your pregnancy and your disease symptoms. 

• Any medications or vitamins you should take during pregnancy.  

• Getting any necessary vaccines before and during pregnancy. Many vaccines can be given in pregnancy. For more information, please see the MotherToBaby fact sheet on vaccines at https://mothertobaby.org/fact-sheets/vaccines-pregnancy/. 

• Any other questions or concerns you have. 

I have high cholesterol. Can it make it harder for me to get pregnant?  

It is not known if high cholesterol can make it harder to get pregnant. One study suggests it might take longer to get pregnant if a woman has high cholesterol. However, related factors like diabetes, obesity, and polyendocrine metabolic ovarian syndrome (PMOS) could make it harder to get pregnant. For more information on obesity and diabetes, see our sheets on obesity https://mothertobaby.org/fact-sheets/obesity-pregnancy/ and diabetes https://mothertobaby.org/fact-sheets/type-1-and-type-2-diabetes/ and https://mothertobaby.org/fact-sheets/diabetes-pregnancy/.   

I just found out I am pregnant. Should I stop taking my medication for high cholesterol? 

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. 

Will pregnancy affect my cholesterol levels? 

For most women, cholesterol levels lower slightly in early pregnancy but then increase. Diet, exercise, genetics, and the use of medications can affect cholesterol levels. Talk with your healthcare providers if you are worried about your cholesterol levels. 

Does having high cholesterol increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Based on the studies reviewed, having high cholesterol alone is not expected to increase the chance of miscarriage. However, related medical factors, like diabetes and obesity, might increase the chance for miscarriage.  

Does having high cholesterol 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 high cholesterol, might increase the chance of birth defects in a pregnancy. Having high cholesterol alone is not expected to increase the chance for birth defects above the background risk. Other related medical factors, like diabetes and obesity, can increase the chance of birth defects.  

Does having high cholesterol increase the chance of other pregnancy-related problems?  

Based on the studies reviewed, it is not known if high cholesterol can increase the chance of other pregnancy-related problems. Some studies have reported an increased chance for gestational diabetes, preeclampsia (dangerously high blood pressure in pregnancy), preterm delivery (birth before 37 weeks) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Other studies have not reported an increased chance of pregnancy complications. Other related medical factors, like diabetes and obesity, can increase the chance of other pregnancy-related problems. 

Does having high cholesterol in pregnancy affect future behavior or learning for the child?   

It is not known if high cholesterol in a pregnancy can cause behavior or learning issues. Related factors like diabetes and obesity might increase the chance for behavior or learning issues.  

Breastfeeding while taking medication for high cholesterol: 

There are different medications used to treat high cholesterol. For information on a specific medication, see our information sheets https://mothertobaby.org/fact-sheets/ or contact MotherToBaby. Be sure to talk to your healthcare providers about all of your breastfeeding questions. 

If a man has high cholesterol, could it affect his fertility or increase the chance of birth defects? 

High cholesterol could affect fertility (ability to make healthy sperm). In general, exposures that men have are unlikely to increase the risks to a pregnancy. For more information, please see the MotherToBaby fact sheet on male exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.  

Please click here for references.

This sheet is about exposure to vitamin A 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 vitamin A? 

Vitamin A is an essential vitamin. Essential vitamins are nutrients that your body cannot make on its own (or in enough amounts), so you must get them from food or supplements. Essential vitamins support growth, immunity, energy production, and repair of body tissues. Vitamin A can be found in food and supplements.  

What are the different types of vitamin A? 

“Preformed” vitamin A is found in animal foods like liver, eggs, fish, and dairy. Preformed vitamin A is ready for the body to use right away.  

“Provitamin” A is found in plant foods like leafy greens, tomatoes, and orange or yellow fruits and vegetables (such as carrots, corn, and squash). The body changes provitamin A into vitamin A that it can use. 

There are some medications that are forms of vitamin A called retinoids. Medications that are made from vitamin A act differently in the body than supplements and multivitamins that contain vitamin A. For information on retinoid medications, see our fact sheets on topical tretinoin here: https://mothertobaby.org/fact-sheets/tretinoin-retin-a-pregnancy/ and isotretinoin here: https://mothertobaby.org/fact-sheets/isotretinoin-accutane-pregnancy/.  

In supplements and multivitamins, vitamin A can be found as preformed vitamin A (such as retinyl acetate, retinyl palmitate), provitamin A (beta carotene), or a combination of both. Preformed vitamin A can quickly build up in the body to toxic (harmful) amounts if too much is taken. Provitamin A from beta carotene does not result in vitamin A buildup, because the body controls the rate at which beta carotene is changed to vitamin A.  

How much vitamin A do I need?  

The Recommended Dietary Allowance (RDA) of vitamin A is the amount that most people should aim to get each day. The Tolerable Upper Intake Level (UL) is the highest level of daily intake that is not expected to increase health risks for most people. If your vitamin A intake is not meeting the Recommended Dietary Allowance (below), talk with your healthcare provider about taking a supplement. Some prenatal vitamins contain vitamin A.  

Talk with your healthcare providers about all supplements/vitamins that you take. Have the bottles or photos of the labels with you so that all ingredients and their amounts can be seen. Your provider can review the total amount of vitamin A and other nutrients in the products and compare them to the recommended amounts.  

Vitamin A intake during pregnancy: 

Age	Recommended Dietary Allowance (RDA)	Upper Limit (UL)*
Pregnant and age 14 to 18 years old	750 mcg RAE^ / 2,500 IU⌂	2,800 mcg
Pregnant and age 19 years or older	770 mcg RAE / 2,566 IU	3,000 mcg

*The Upper Limits listed in this table only apply to products from animal sources and supplements where the vitamin A comes entirely from retinol and its forms (“preformed vitamin A”). Some supplements may have only provitamin A (like beta carotene), only preformed vitamin A (retinol), or a blend of both. From the supplement label, the percentage of retinol (or retinyl ester) should be used to calculate the vitamin A intake and whether it exceeds the Upper Limit.  

⌂ IU – International Units.  

^ RAE – Retinol Activity Equivalents. RAE is the current unit of measurement for vitamin A. 

It is typically not recommended to take more than the RDA of vitamin A unless directed to do so by your healthcare provider. When looking at your daily intake, remember to count the amounts of vitamin A in foods, drinks, and supplements (including prenatal vitamins). Resources that list the amounts of vitamin A typically found in foods are available online, such as the United States Department of Agriculture (USDA) National Nutrient Database: https://ods.od.nih.gov/factsheets/list-all/. The amount of vitamin A in supplements is listed on the product label. Be sure to talk with your healthcare provider about your specific nutritional needs before, during, and after pregnancy.  

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

It is not known if taking the recommended amount or more than the recommended amount of vitamin A can make it harder to get pregnant. Not getting enough vitamin A might be linked to infertility (trouble getting pregnant).  

Does taking vitamin A 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 having vitamin A deficiency, taking the recommended amount of vitamin A, or taking more than the recommended amount of vitamin A can increase the chance of miscarriage. 

Does taking vitamin A 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 vitamin A, might increase the chance of birth defects in a pregnancy. Taking more than 20,000 IU of vitamin A per day, especially preformed vitamin A, has been linked in some studies to an increased chance of birth defects. 

The concern with too much vitamin A is that retinol-based medications can increase the chance of birth defects. However, this risk has not been clearly linked to vitamin A supplements, particularly those with beta-carotene. While studies show mixed results on whether extra vitamin A from supplements can increase the chance of birth defects, the form of vitamin A could matter. Preformed vitamin A (retinol) in high doses is more concerning than beta-carotene. The body only converts beta-carotene to retinol as needed. It is important to follow dosage guidelines and consult a healthcare provider during pregnancy.  

Taking too much preformed vitamin A (more than the recommended limit) or not getting enough vitamin A might increase the chance of birth defects. It is usually suggested to meet the Recommended Dietary Allowance and avoid doses above 10,000 IU per day unless otherwise directed by your healthcare provider.  

Some studies suggest the chance of birth defects might increase at levels of preformed vitamin A of 10,000 IU/day, while other studies have found no increased chance of birth defects unless the dose was above 25,000 IU/day. One study reported a link between an intake of 10,000 IU/day of vitamin A from supplements (not food) and an increased chance of some heart defects. One case report described a child with birth defects after exposure to daily doses of 150,000 IU of vitamin A during pregnancy to treat acne (the specific form of vitamin A used was not reported). The birth defects included microcephaly (a small head), brain changes including enlarged brain ventricles, small adrenal glands, and underdeveloped kidneys. However, 2 other studies found no increase in birth defects in general or in brain defects with preformed vitamin A intakes of greater than 10,000 IU/day. 

Some information suggests that vitamin A deficiency can increase the chance of certain birth defects, such as congenital diaphragmatic hernia (when the muscles that separate the chest from the abdomen [diaphragm] do not fully develop, leaving a hole). This allows abdominal organs, such as the stomach, liver, and intestines, to move into the chest cavity, which could affect lung development.  

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

Taking vitamin A in the recommended amounts is not expected to increase the chance of other 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). It is not known if taking more than the recommended amounts of vitamin A can increase the chance of pregnancy-related complications.  

Vitamin A deficiency during pregnancy has been linked to lower hemoglobin (protein in blood that moves oxygen through the body) levels in both the mother and the fetal cord blood. This can increase the chance of anemia (low levels of hemoglobin, leading to low levels of oxygen in the body), infections, and heavy bleeding in the mother, as well as low birth weight, increased chance of preterm delivery, and a weakened immune system for the baby.  

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

Taking vitamin A in the recommended amounts is not expected to affect future behavior or learning for the child. A study of children exposed to 23,000 IU of vitamin A before birth and as newborns found no effects on intelligence, memory, or motor skills at age 8. 

Vitamin A deficiency during pregnancy has been linked to lower hemoglobin levels in both the mother and the fetal cord blood. This can lower iron stores in the fetal body, which can affect growth and brain development. 

What screenings or tests are available to see if my pregnancy has birth defects or other issues?  

Prenatal ultrasounds can be used to screen for some birth defects, such as heart or brain defects. Ultrasound can also be used to watch the growth of the pregnancy. Talk with your healthcare provider about any prenatal screenings or testing that are available to you. There are no tests available during pregnancy that can tell how much effect there could be on future behavior or learning.  

Breastfeeding while taking vitamin A: 

Vitamin A passes into breast milk in small amounts and is a typical part of breast milk. Women who are breastfeeding should continue to get the daily recommended amount of vitamin A unless otherwise directed by their healthcare provider.  

Age	Recommended Dietary Allowance (RDA)	Upper Limit (UL) for Preformed Vitamin A
Breastfeeding and age 14 to 18 years old	1,200 mcg RAE / 4,000 IU	2,800 mcg
Breastfeeding and age 19 years or older	1,300 mcg RAE / 4,333 IU	3,000 mcg

Talk with your healthcare provider and your child’s pediatrician about your and your child’s specific nutritional needs before, during, and after breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

One study found that men with infertility had lower vitamin A levels in their semen compared to men without fertility issues. It is not known if taking the recommended amount or more than the recommended amount of vitamin A can affect men’s fertility (ability to 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.  

This sheet is about exposure to vitamin D 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 vitamin D?

Vitamin D is a nutrient used by the body to grow and to help absorb calcium, which keeps a person’s bones strong. Most people’s bodies can make vitamin D with exposure to ultraviolet (UV) rays from sunlight. Vitamin D is also found in some foods, such as fatty fish (salmon, trout, tuna, and mackerel), egg yolks, cheese, and some milks. Vitamin D is also available as a dietary supplement. Vitamin D deficiency (not having enough vitamin D) can increase the chance of certain health issues. For example, vitamin D deficiency is the most common cause of rickets, a bone disease that causes softening and weakening of the bones.

There are several forms of vitamin D. There are two major forms: vitamin D₂ (ergocalciferol) and vitamin D₃ (cholecalciferol). Vitamin D₂ is mostly human-made and is added to foods. Vitamin D₃ is made in a person’s body and is found in animal products. Both vitamin D₂ and D₃ can be found in supplements or fortified foods.

The Endocrine Society recommends that women who are pregnant get vitamin D through foods, prenatal vitamins, or other supplements. Talk with your healthcare providers about all supplements/vitamins that you take. Have the bottles or photos of the labels with you so that all ingredients and their recommended daily levels can be reviewed. Products that contain herbal supplements are typically not recommended during pregnancy. For more information on herbal products please see our fact sheet at: https://mothertobaby.org/fact-sheets/herbal-products-pregnancy/.

How much vitamin D is needed by women who are pregnant?

The Recommended Dietary Allowance (RDA) is the amount of nutrients people should aim to get each day. The Tolerable Upper Intake Level (UL) is the highest level of daily nutrient intake that is not expected to increase health risks for most people in the general population.

	Recommended daily allowance (RDA)		Upper limit (UL)
Pregnant and age 14 to 18 years old	15 mcg / 600 IU	100 mcg / 4,000 IU
Pregnant and age 19 years or older	15 mcg / 600 IU	100 mcg / 4,000 IU

It is not recommended to take more than the RDA in a day unless it has been prescribed by your healthcare provider.

When looking at daily intake, remember to count amounts from foods, drinks, and from supplements. There are resources available online that list amounts of vitamin D typically found in foods, such as the USDA National Nutrient Database for Vitamin D here: https://ods.od.nih.gov/pubs/usdandb/VitaminD-Food.pdf. Labels on supplements will list the amount of vitamin D in the product. Be sure to talk with your healthcare providers about your specific nutritional needs before, during, and after pregnancy.

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

Taking vitamin D at the RDA and staying below the UL is not expected to make it harder to get pregnant. In 1 study, taking vitamin D up to the daily UL was associated with an increased chance to get pregnant among women who have experienced infertility (inability to get pregnant after 1 year of trying).

It is not known if taking more than the UL of vitamin D can make it harder to get pregnant. Low levels of vitamin D have been associated with an increased chance of infertility.

Does taking vitamin D increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. There is mixed information about low levels of vitamin D (blood levels of vitamin D below 50 nmol/L) and a possible increased chance of miscarriage. In 1 study of over 1,600 women that looked at low levels of vitamin D during pregnancy, an increased chance of miscarriage was reported. However, another study among 5,000 women did not find an increased chance of miscarriage with low levels of vitamin D during pregnancy. Another study found that women who had multiple miscarriages had lower blood concentrations of vitamin D compared to those who had not had multiple miscarriages. Because there can be many causes of miscarriage, it is hard to know if a supplement, an underlying medical condition, or other factors are the cause of a miscarriage.

Does taking vitamin D 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. It is not known if high or low levels of vitamin D might affect the chance of birth defects.

In 27 case reports of infants exposed to high levels of vitamin D (blood levels of vitamin D above 125 nmol/L) during pregnancy, there was no reported increase in the chance of birth defects.

Data from two studies with 192 women suggest a link between neural tube defects (birth defects where the spinal cord or brain did not form correctly) and low levels of vitamin D. This is not enough data to know if low levels of vitamin D increase the chance of birth defects.

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

Limited information suggests taking vitamin D within the RDA is not expected to 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).

High levels of vitamin D (blood levels of vitamin D above 125 nmol/L) have not been linked to an increased chance of pregnancy-related problems. There are case reports of an infant having hypercalcemia (high levels of calcium) after being exposed to high levels of vitamin D during pregnancy. However, no increase in hypercalcemia or hypercalciuria (high levels of calcium in the urine) was reported in a clinical trial of vitamin D supplementation of 2000 IU vs 4000 IU during pregnancy.

Having low levels of vitamin D in pregnancy might increase the chance of low birth weight, low infant calcium levels (hypocalcemia), or preeclampsia (high blood pressure and problems with organs, such as the kidneys), which can lead to seizures (called eclampsia). Low levels of vitamin D have been associated with preterm birth with non-white but not white women who are pregnant.

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

No behavioral or learning differences were reported in 27 case reports of children exposed to high levels of vitamin D (blood levels of vitamin D above 125 nmol/L) during pregnancy,

Some studies have suggested that low levels of vitamin D in pregnancy might increase the chance for the child to have attention deficit hyperactive disorder (ADHD), lower language skills, or autism spectrum disorder. However, many factors are involved when a person develops one or more of these conditions. That makes it hard to study these outcomes and most of these studies did not look at other factors such as underlying medical conditions, family history, medications used, or other exposures. Overall, there is not enough evidence to say that low levels of vitamin D in pregnancy increase the chance of ADHD, lower language skills, or autism spectrum disorder.

Breastfeeding while taking vitamin D:

Vitamin D is a normal part of breast milk. Women who are breastfeeding should continue to get the daily recommended amount of vitamin D unless otherwise directed by their healthcare provider. The RDA for breastfeeding is the same as for pregnancy.

	Recommended daily allowance (RDA)		Upper limit (UL)
Breastfeeding and age 14 to 18 years old	15 mcg / 600 IU	100 mcg /4000 IU
Breastfeeding and age 19 years or older	15 mcg/ 600 IU	100 mcg /4000 IU

Women who are breastfeeding should talk to their healthcare provider and their child’s pediatrician about their specific nutritional needs before, during, and after breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

In one study, men with low levels of vitamin D (blood levels of vitamin D below 50 nmol/L) had lower sperm motility (movement of sperm) than men with sufficient levels of vitamin D. This could affect a man’s fertility (ability to get a woman pregnant). Studies in humans have not been done to see if vitamin D levels increase the chance of birth defects above the background risk. 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.