This sheet is about exposure to ustekinumab 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 ustekinumab? 

Ustekinumab is a medication that has been used to treat moderate to severe psoriasis, Crohn’s disease, and active psoriatic arthritis. The brand name of ustekinumab is Stelara®.  

MotherToBaby has fact sheets on psoriasis and psoriatic arthritis https://mothertobaby.org/fact-sheets/psoriasis-and-pregnancy/ and Crohn’s disease https://mothertobaby.org/fact-sheets/inflammatory-bowel-disease-pregnancy/. 

 Sometimes when people 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 ustekinumab. Can it make it harder for me to get pregnant? 

Studies have not been done to see if taking ustekinumab can make it harder to get pregnant .  

Does taking ustekinumab increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies of over 3000 pregnancies did not find an increased chance of miscarriage when ustekinumab was used during pregnancy.  

Does taking ustekinumab 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 ustekinumab, might increase the chance of birth defects in a pregnancy. Studies of over 2,500 pregnancies found no increased chance of birth defects when ustekinumab was used during pregnancy.  

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

Studies of over 2000 pregnancies found no 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) when ustekinumab was used during pregnancy.  

Can my baby receive live vaccines before one year of age if I take ustekinumab later in pregnancy? 

Ustekinumab can weaken the immune system of the person taking it, so there’s a theoretical (not proven) concern it might also weaken a baby’s immune system if they are exposed during pregnancy. Live vaccines, which contain a small amount of live virus, can cause an infection in people with weak immune systems. Inactivated vaccines, which do not contain live virus, cannot cause an infection with the disease they protect from. In the U.S., the rotavirus vaccine is the only live vaccine routinely given in a baby’s first year.  

Studies of babies exposed to ustekinumab during pregnancy who got the rotavirus vaccine in the first 4 months of life found no higher risk of infections or health problems. There are also reports of babies who were exposed to ustekinumab during pregnancy and received the measles, mumps, and rubella (MMR) vaccine or the varicella vaccine without any health issues.  

Talk with your child’s healthcare provider about your exposure to ustekinumab during pregnancy. They can talk with you about the vaccines your child should receive and the best time for your child to receive them. 

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

Four studies of 122 children exposed to ustekinumab during pregnancy showed no increased chance of behavior or learning issues at around 12 months of age. 

Breastfeeding while taking ustekinumab:

Ustekinumab has not been well studied during breastfeeding. Because ustekinumab is a very large protein, it is thought that very little medication would pass into breast milk. Ustekinumab is also a medication that is not well absorbed by the GI tract (gut), so any of the medication that gets into breast milk would be unlikely to enter the baby’s system. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

A small study of 12 men exposed to ustekinumab reported no effect of on fertility (ability to get a partner pregnant). Larger studies of over 200 men exposed to ustekinumab and similar medications showed no increased chances of birth defects or miscarriages. 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/.

MotherToBaby is currently conducting a study looking at autoimmune diseases like psoriasis and the medications used to treat autoimmune diseases in pregnancy. If you are interested in taking part in this study, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study.

Please click here for references.

This sheet is about using topical tretinoin 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 tretinoin?

Topical tretinoin is a medication that is applied to the skin to treat acne, prevent wrinkles, and help with other skin problems. Some brand names for tretinoin include Altreno®, Atralin®, Avita®, Retin-A®, Refissa®, Renova® and Tretin-X®. The amount of tretinoin in each brand can vary.

Tretinoin belongs to a group of medications called the retinoids. Retinoids are related to Vitamin A. Other medications in the retinoid family are isotretinoin (Accutane®, Claravis®), acitretin (Soriatane®) and adapalene (Differin®). MotherToBaby has a fact sheet on isotretinoin here: https://mothertobaby.org/fact-sheets/isotretinoin-accutane-pregnancy/.

Tretinoin is also available in an oral form (to take by mouth) for the treatment of leukemia. This sheet will discuss the topical (applied to skin) use of tretinoin.

My healthcare provider said that tretinoin is like isotretinoin. I’ve heard that it should not be used during pregnancy.

Tretinoin is related to a medication called isotretinoin. Isotretinoin is a medication known to cause birth defects involving the face, heart and brain. However, isotretinoin is taken by mouth and easily enters a person’s bloodstream at higher levels than with topical use of tretinoin. When tretinoin is applied to the skin, lower levels pass through the skin and get into the bloodstream than with oral (taken by mouth) isotretinoin.

In general, skin serves as a good barrier. Because of this, only a small amount of the tretinoin is likely to be absorbed with topical (skin) exposure when used as directed. More tretinoin could be absorbed into the person’s bloodstream if tretinoin is used on skin that is broken or irritated, or when it is used more than needed, or when used over a large area of the body. In general, the less tretinoin that is used on the skin, the less likely there will be risks to the fetus. However, because there might still be a small amount of tretinoin absorbed through the skin, the safest approach may be to avoid use of tretinoin during pregnancy.

I use topical tretinoin. Can it make it harder for me to get pregnant?

Studies have not been done to see if tretinoin can make it harder to become pregnant.

I am using tretinoin, but I would like to stop using it before becoming pregnant. How long does it stay in my body?

The time it takes the body to metabolize (to process) medication is not the same for everyone. In healthy non-pregnant adults, it takes up to 1 day, on average, for most of the tretinoin to be gone from the body. The makers of oral isotretinoin suggest that women stop using isotretinoin 1 month before trying to get pregnant. Based on this suggestion for isotretinoin, it may be suggested to stop using tretinoin 1 month before trying to get pregnant.

Does using topical tretinoin increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. The topical use of tretinoin is not expected to increase the chance for miscarriage.

Does taking tretinoin 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. Several studies have tried to learn if use of topical tretinoin could harm a pregnancy. These studies have not found a greater chance for birth defects with proper application of tretinoin to the skin.

However, there have been case reports of babies born with birth defects after women used tretinoin on their skin during pregnancy. Usually, a few case reports do not cause healthcare providers to worry, but the birth defects reported in these case reports are similar to the birth defects seen in babies exposed to oral isotretinoin use during pregnancy. Since tretinoin and isotretinoin are related, it is possible that these two medications can affect the baby in the same way. Because many women have used tretinoin during pregnancy and have not had babies with a birth defect, the chance for birth defects is probably low. However, it has generally been recommended not to use tretinoin in pregnancy.

Does using tretinoin in pregnancy increase the chance of other pregnancy related problems?

Studies that have looked at this question have not reported a greater chance for preterm delivery (delivery before 37 weeks of pregnancy) with proper application of tretinoin to the skin.

If I stop using tretinoin in the first trimester, is it okay to start using it again later in my pregnancy?

During the first 3 months of pregnancy, the baby’s organs are forming. In months 4 through 9, the baby’s body and brain are growing. Tretinoin use in the 2nd and 3rd trimesters is less likely to cause a birth defect. However, until more information is available, avoiding this product throughout pregnancy might be the best course of action. For general information on the timing of exposures in pregnancy, see the MotherToBaby fact sheet on critical periods of development at https://mothertobaby.org/fact-sheets/critical-periods-development/.

Does using tretinoin in pregnancy affect future behavior or learning for the child?

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

Breastfeeding while using tretinoin:

Tretinoin use during breastfeeding has not been studied. However, when used on your skin, very little tretinoin passes into your body, and so the amount in breast milk would probably be small. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

If a man used topical tretinoin, could it affect fertility or increase the chance of birth defects in a partner’s pregnancy?

Studies have not been done to see if topical tretinoin use could affect a man’s fertility (ability to get a woman pregnant) 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 natalizumab 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 natalizumab? 

Natalizumab is a monoclonal antibody given by injection (shot). Natalizumab has been used to treat severe multiple sclerosis (MS) or Crohn’s disease when other medications have not worked. Natalizumab is sold under the brand name Tysabri®. 

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. Available information suggests that stopping natalizumab before pregnancy may increase the chance of a return of symptoms (relapse), while continuing treatment during pregnancy was associated with fewer relapses and lower recurrence rates. It is important that you talk with your healthcare providers about your treatment options before pregnancy, or as soon as you learn that you are pregnant. They can go over the best way to treat your condition before, during, and after pregnancy. 

MotherToBaby has fact sheets on MS https://mothertobaby.org/fact-sheets/multiple-sclerosis/ and inflammatory bowel disease (including Crohn’s disease) https://mothertobaby.org/fact-sheets/inflammatory-bowel-disease-pregnancy/.  

I am taking natalizumab, but I would like to stop taking it before getting pregnant. How long does the drug stay in my body? 

The time it takes the body to metabolize (process) medication is not the same for everyone. In healthy non-pregnant adults, it could take up to 70 days (a little over 2 months), on average, for most of the natalizumab to be gone from the body. 

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

Studies have not been done in humans to see if natalizumab can make it harder to get pregnant.  

Does taking natalizumab increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Information on over 500 pregnancies does not suggest an increased chance of miscarriage.  

Does taking natalizumab 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 natalizumab, might increase the chance of birth defects in a pregnancy. Data on the use of natalizumab in pregnancy is limited. Most available information does not suggest an increased chance of birth defects.  

Natalizumab, like other monoclonal antibodies, crosses the placenta at the end of the first 3 months of pregnancy. This limits the overall exposure to the fetus. The transfer of natalizumab increases for the rest of the pregnancy.  

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

Some studies found that natalizumab exposure during pregnancy, especially in the third trimester, was associated with lower infant birth weight and shorter length at birth. Most studies did not find an increased chance of preterm birth (before 37 weeks), stillbirth, placental complications, or poor newborn outcomes compared with unexposed pregnancies, other MS treatments, or the general population. Higher rates of C-section were reported in women using natalizumab or similar medications during pregnancy. 

Studies have reported mild blood disorders in infants exposed to natalizumab during the third trimester, including thrombocytopenia (low number of platelets, which help the blood clot) and anemia (low amount of red blood cells). These conditions did not require treatment and went away on their own within 4 months. One case of neonatal pancytopenia, where all major blood cell types are low, was also reported after exposure to natalizumab throughout pregnancy; it resolved without treatment. Not all babies exposed to natalizumab will have these issues. It is important that your healthcare providers know you are taking natalizumab so your baby can be monitored for these conditions after delivery, if needed. 

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

Studies on natalizumab use during pregnancy and possible effects on learning and behavior are limited. Available studies found no increased chance of autism, developmental delays, learning problems, behavioral, or psychiatric issues in children exposed during pregnancy. In most pregnancies, children showed normal motor and language development up to 7 years of age. Although one child was diagnosed with autism spectrum disorder and some children had mild behavioral or sleep problems, these were not linked to natalizumab exposure during pregnancy. 

Breastfeeding while taking natalizumab: 

Limited information suggests small amounts of natalizumab pass into breast milk in some women, mainly in the first week after a dose. It has not been detected in the blood of breastfed infants. Because natalizumab is a large protein, it is unlikely to be absorbed in large amounts by the baby when swallowed. Most experts consider breastfeeding while on natalizumab acceptable. Waiting about 2 weeks after delivery before restarting treatment may further lower infant exposure. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

One small study compared 16 men who had severe MS and were taking natalizumab for treatment to 16 other men who were not taking natalizumab. Over 12 months, no difference in fertility (ability to make healthy sperm) was reported between the two groups. For some men, the underlying condition being treated can increase the chance of sexual dysfunction or lower quality of sperm, which can affect fertility. 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 losartan in pregnancy and while breastfeeding. This information is based on available published studies. It should not take the place of medical care and advice from your healthcare provider.

What is losartan?

Losartan is part of a group of medications called angiotensin II receptor antagonists (also known as angiotensin receptor blockers (ARBs)). Losartan has been used to treat high blood pressure, protect the kidneys in people with diabetes, and lower the chance of cerebrovascular accident (when the supply of blood to the brain is reduced or blocked). A brand name for losartan is Cozaar®. Losartan is also available in combination with a diuretic called hydrochlorothiazide under the brand name Hyzaar®.

It is usually recommended that women who are pregnant stop taking losartan under their healthcare provider’s guidance. 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.

I am taking Losartan, but I would like to stop taking it before getting pregnant. How long does the drug stay in my body?

The time it takes the body to metabolize (to process) medication is not the same for everyone. In healthy non-pregnant adults, it takes up to 2 days, on average, for most of the Losartan to be gone from the body.

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

It is not known if losartan can make it harder to get pregnant. One animal study did not find effects on fertility (ability to get pregnant).

Does taking losartan increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if losartan increases the chance for miscarriage.

Does taking losartan 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 Losartanm might increase the chance of birth defects in a pregnancy.

Losartan has not been well studied for use during pregnancy. It is not known if losartan can increase the chance of birth defects when used in the first trimester of pregnancy. There are case reports with typical outcomes after first trimester exposure to losartan when the medication was not used throughout pregnancy. One small study looked at 20 pregnancies exposed to the class of ARB medications. The study reported that 1 infant had craniosynostosis (when the bones in the skull join together too early) and another had inguinal hernia (when soft tissue bulges through a weak place in the belly muscles). Some of the women in this study had diabetes, which has also been linked to an increased chance of birth defects. It is not known if the medication taken, or other factors caused the reported birth defects.

Using losartan in the 2^nd and 3^rd trimesters can increase the chance of other pregnancy complications, such as low amniotic fluid (the fluid that surrounds the baby). Low amniotic fluid levels can cause birth defects. This is discussed in more detail below.

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

Losartan use in the 2^nd and/or 3^rd trimester of pregnancy can cause other pregnancy-related problems, such as low levels of amniotic fluid (called oligohydramnios). Low levels of amniotic fluid can lead to poor lung and skull development, joint contractures (joints become stiff and unable to move), and growth restriction in the fetus. Oligohydramnios can also increase the need for an early delivery through induction of labor or C-section. In some cases, oligohydramnios could cause fetal demise.

Low blood pressure, kidney disease, and kidney failure have also been reported in babies exposed to losartan during pregnancy. In some cases, the affected infant died from these complications.

Because of these possible complications, it is usually recommended that women who are pregnant stop taking losartan under their healthcare provider’s guidance. It is important to talk with your healthcare provider before you stop taking losartan. They can talk with you about the best way to treat your condition during pregnancy. Some untreated conditions can also increase risks to a pregnancy.

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

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

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. Ultrasound can also be used to track 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 here could be on future behavior or learning.

Breastfeeding while taking losartan:

Losartan has not been studied in humans for use during breastfeeding. Information from animal studies suggest that losartan passes into milk and could affect the kidneys of the nursing baby. The product label for losartan recommends women who are breastfeeding not use this medication. But the benefit of using losartan may outweigh possible risks. Your healthcare providers can talk with you about using losartan and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if losartan 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 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 naloxone 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 naloxone?

Naloxone is a medication that has been used to block the effects of opioids. Examples of some opioids are heroin, morphine, codeine, oxycodone, and hydrocodone. Naloxone has also been used to stop someone from dying from an opioid overdose. Brand names for naloxone are Narcan® (nasal spray) and Evzio® (auto-injector).

The combination of naloxone and buprenorphine is sold under the brand name Suboxone®. This combination drug is used to treat opioid use disorder (“OUD”). Much of the information on naloxone in pregnancy comes from studies on the use of naloxone and buprenorphine together used rather than the study of naloxone on its own.

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.

If you have been taking naloxone regularly or have OUD, talk with your healthcare provider before making changes to how you take your medication. Stopping an opioid medication suddenly (also called “cold turkey”) could cause you to go into withdrawal. It is not known if or how withdrawal might affect a pregnancy. It is suggested that any reduction in naloxone be done slowly, and under the direction of your healthcare provider.

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

Studies have not been done to see if taking naloxone can make it harder for to get pregnant.

Does taking naloxone increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if naloxone can increase the chance of miscarriage.

Does taking naloxone 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. Studies have not shown an increased chance of birth defects when taking naloxone. No studies have been done to see if treatment with naloxone for an opioid overdose in the first trimester can increase the chance of birth defects.

Some studies that have looked at opioids as a group suggest that opioids in general might be associated with an increased chance of birth defects. However, studies have not found a specific pattern of birth defects caused by opioids. Based on these studies, if there is an increased chance of birth defects with opioid use in pregnancy, it is likely to be small.

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

It is not known if taking naloxone can increase the chance of pregnancy-related problems. One study has shown that use of naloxone might increase the chance for 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). No studies have been done to see if treatment with naloxone for an opioid overdose can increase the chance of pregnancy-related problems.

Studies find that women who are pregnant and take opioids in higher doses or for longer than recommended by their healthcare providers (i.e. misuse or “abuse” opioids) have an increased chance for pregnancy problems. These include poor growth of the baby, stillbirth, preterm delivery, and the need for C-section.

Will my baby have withdrawal (Neonatal Abstinence Syndrome) if I continue to take naloxone?

Taking naloxone in pregnancy can increase the chance of Neonatal Abstinence Syndrome (NAS) in the infant after birth. NAS is the term used to describe withdrawal symptoms in newborns from opioid medication(s) that a woman takes during pregnancy. NAS symptoms can include irritability, crying, sneezing, stuffy nose, poor sleep, extreme drowsiness (very tired), yawning, poor feeding, sweating, tremors, seizures, vomiting, and diarrhea. Most often, symptoms of NAS appear 2 days after birth and may last more than 2 weeks.

The chance that NAS will occur depends on the length of time and/or the dose of opioid taken during pregnancy, if other medications were also taken, if baby was born preterm, and/or size of the baby at birth. The chance of NAS is lower with naloxone then with other medications like methadone which are also used to treat OUD. If opioid medications were taken in pregnancy, it is important to let your baby’s healthcare providers know so that they can check for symptoms of NAS and provide the best care for your newborn.

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

Studies have not been done to see if naloxone can increase the chance of behavior or learning issues for the child. Some studies on opioids as a general group have found more problems with learning and behavior in children exposed to opioids for a long period of time during pregnancy. However, it is hard to know if this is due to the medication exposure or other factors that might increase the chances of these problems.

Breastfeeding while taking naloxone:

Naloxone gets into breastmilk in small amounts. The amount of medication that does make it into the stomach of the nursing infant is not well absorbed by the body. If naloxone is used to treat opioid overdose, it may be suggested to stop breastfeeding until the opiate is out of the body of the woman who is breastfeeding. Contact the baby’s healthcare provider immediately if your baby has any problems such as increased sleepiness (more than usual), trouble feeding, trouble breathing, or limpness. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if naloxone 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 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.