This sheet is about exposure to hydrocodone 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 hydrocodone? 

Hydrocodone is an opioid medication that has been used to treat pain. Opioids are sometimes called narcotics. Some commonly used hydrocodone products also contain other medication, such as acetaminophen. Brand names for these combination products include Lortab®, Norco®, and Vicodin®. For more information on acetaminophen, please see our fact sheet: https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/.  

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 hydrocodone regularly or have a dependency or opioid use disorder, you should not stop taking the medication suddenly. Stopping an opioid medication suddenly 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 hydrocodone be done slowly, and under the direction of your healthcare provider.  

I am taking hydrocodone, 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 24 hours, on average, for most of the hydrocodone to be gone from the body.   

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

It is not known if using hydrocodone could make it harder to get pregnant. The results from a limited number of studies on the use of opioids during pregnancy are mixed and do not clearly show if opioids, like hydrocodone, could make it harder to get pregnant.  

Does taking hydrocodone increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. There are no published studies that have looked at the link between the use of hydrocodone and the chance of miscarriage. Some studies on the use of other opioids suggest an increased chance of miscarriage, while other studies do not.  

Does taking hydrocodone 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 hydrocodone, might increase the chance of birth defects in a pregnancy. 

Two studies suggested a possible increase in heart defects when hydrocodone was used in the first trimester. One of these studies also reported a small increase in spina bifida (an opening in the spine and spinal cord) and gastroschisis (an opening in the wall of the abdomen). However, the number of exposed pregnancies was small, and no clear pattern of birth defects was found. Two other studies did not find an increased chance of birth defects. Factors such as other exposures or the condition being treated may have contributed to the findings. Based on available studies, if there is an increased chance of birth defects with opioid use in pregnancy, it is likely to be small. 

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

Studies on some opioids have found an increased chance for pregnancy-related problems, including poor growth of the fetus, low levels of amniotic fluid (fluid that surrounds the fetus in the uterus), stillbirth, preterm delivery (birth before week 37), and C-section. This is more commonly reported in women who are using heroin or who are using opioid medication in greater amounts or for longer than recommended by their healthcare provider. Use of an opioid close to the time of delivery can result in withdrawal symptoms in the baby (see the section of this fact sheet on neonatal abstinence syndrome). 

One study found that women who used hydrocodone and other opioids in pregnancy were more likely to have babies that were born smaller than expected. However, the women in this study were also more likely to smoke cigarettes during pregnancy, which can also cause babies to be born small. 

Will my baby have withdrawal (neonatal opioid withdrawal syndrome) if I continue to take hydrocodone? 

Neonatal opioid withdrawal syndrome (NOWS) is the term used to describe withdrawal symptoms in newborns after exposure to opioids during pregnancy. NOWS 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 NOWS appear 2 days after birth and may last more than 2 weeks. The chance that NOWS will happen 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. If opioids were taken in pregnancy, it is important to let your baby’s healthcare providers know so that they can check for symptoms of NOWS and provide the best care for your newborn. 

Some opioids have been linked to NOWS, but not all have been well studied. Based on what is known about other opioids, hydrocodone is also likely to carry a risk of NOWS. It is not known whether the chance with hydrocodone is higher or lower than with other opioids that have been better studied. 

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

It is not known if hydrocodone can increase the chance of behavior or learning issues for the child. Some studies of opioids in general have found more learning and behavior problems in children exposed for a long-time during pregnancy, but it is hard to know if this is related to the medication or other factors. 

What if I have an opioid use disorder?  

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 of pregnancy problems such as poor growth of the fetus, stillbirth, preterm delivery, and need for a C-section.  

Hydrocodone and breastfeeding: 

Talk with your healthcare provider about your pain and medications that can be used while you are breastfeeding. Hydrocodone can pass into breast milk. Babies might have problems with the amounts of hydrocodone in breast milk. Talk with your healthcare provider or a MotherToBaby specialist about your medication. The chance of side effects can depend on factors like your baby’s age, your dose, and other individual circumstances. 

The use of some opioids in breastfeeding might cause babies to be very sleepy and have trouble latching on. Some opioids can cause trouble with breathing. If you are using any opioid, talk to your healthcare provider about how to use the least amount for the shortest time and how to monitor (watch) your baby for any signs of concern. Contact the baby’s healthcare provider immediately if your baby has any problems such as increased sleepiness (more than usual), trouble feeding, changes in skin color, trouble breathing, or limpness. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

It is not known if hydrocodone could affect male fertility (ability to make healthy sperm) or increase the chance of birth defects. Use or misuse of opioids in general has been shown to lower fertility in males. 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 general anesthesia 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 general anesthesia? 

General anesthesia has been used for medical procedures that require the patient be “put to sleep” so they do not feel pain. General anesthesia can use a combination of gases you breathe in (inhale) and or get though IV (a needle in the vein). General anesthesia is given by expert healthcare providers, and the patient is carefully monitored during the procedure. It is estimated that about 1 in 50 to 1 in 100 (1% to 2%) of women require surgery during pregnancy. 

Anesthesia given by inhalation might include halothane, enflurane, isoflurane, or nitrous oxide. Some commonly used IV medications include fentanyl, propofol and ketamine. MotherToBaby has fact sheets on fentanyl: https://mothertobaby.org/fact-sheets/fentanyl/ and ketamine: https://mothertobaby.org/fact-sheets/ketamine-ketalar/.  

Can exposure to general anesthesia make it harder for me to get pregnant?  

It is not known if general anesthesia could make it harder to get pregnant. 

Does general anesthesia increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Some studies suggest there might be a small increase in miscarriage in women who had surgery in the first half of pregnancy. It is unclear whether this is due to anesthesia, a response of the body to surgery, illness in the person who is pregnant, or another reason.  

Does general anesthesia 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 general anesthesia, might increase the chance of birth defects in a pregnancy.  

Some studies suggest an increased chance for neural tube defects (an opening in the fetal spine or skull) and issues, such as microcephaly (small head size). However, most studies looking at the chance of birth defects in women who had surgery and anesthesia in the first and early second trimester of pregnancy did not show an increased chance of birth defects. 

Does general anesthesia increase the chance of other pregnancy-related problems? 

Some studies have suggested an increased chance for other pregnancy-related problems after a surgical procedure with exposure to general anesthesia later in pregnancy. This can include preterm delivery (birth before week 37), lower APGAR scores (scoring system that measures a baby’s health at birth), and preeclampsia (high blood pressure and problems with organs, such as the kidneys that can lead to seizures called eclampsia). Other studies have not shown an increased chance of pregnancy complications. As preterm delivery can be influenced by many things, it is unclear is the possible increased chance is due to anesthesia, illness in the person who is pregnant, or other factors. 

It is not known if general anesthesia can increase the chance of low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).  

Does general anesthesia in pregnancy affect future behavior or learning for the child?   

There are several studies that have suggested that a single, relatively short procedure with exposure to general anesthesia is unlikely to have negative effects on behavior or learning. Women who are pregnant and need surgery, especially for life-threatening conditions, should not be discouraged from the use of general anesthesia. Talk with your healthcare providers about the benefits, risks, and appropriate timing of surgery or procedures requiring general anesthesia. 

One study found possible behavior changes in children exposed to general anesthesia during pregnancy. This study had limitations such as a small sample size, and relying on parents’ reports. This makes it hard to know if the reported changes were caused by anesthesia or other factors. Another study of 129 children found no major behavior differences overall but did see slightly lower thinking skills in children exposed to general anesthesia, especially during longer or laparoscopic surgeries. However, this study also relied on parents’ reports, which can result in over- or under-report symptoms. 

In summary, information on whether use of general anesthesia in pregnancy can affect future behavior or learning for the child is limited and mixed. Usually, the benefit of doing the surgery and treating the condition outweighs the risk of an untreated condition in pregnancy.  

I work in an office that uses general anesthesia. Could that affect my pregnancy? 

Different work settings can result in different exposures. For more information on working as a veterinarian or veterinary technician during pregnancy, please see the fact sheet at https://mothertobaby.org/fact-sheets/vet-vettech/. Another fact sheet with general tips on working safely while pregnant can be found at https://mothertobaby.org/fact-sheets/reproductive-hazards-workplace/. For more information on your specific risks, contact a MotherToBaby specialist. 

Breastfeeding and general anesthesia: 

Most anesthetic medications are processed quickly by the body quickly. While there are not many studies looking at breastfeeding after a procedure, most experts suggest that breastfeeding can be restarted as soon as the person who is breastfeeding recovers from the anesthesia and is feeling well enough to breastfeed. Be sure to talk to your healthcare provider about all your breastfeeding questions. For questions on specific medication and breastfeeding, contact MotherToBaby. 

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

Studies on general anesthesia and male fertility (ability to get a woman pregnant) are limited. A survey of 5,507 male anesthetists in England found no link with miscarriage, infertility, or birth defects in their children. 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 to view references.

This sheet is about exposure to diclofenac 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 diclofenac?

Diclofenac is a medication that has been used to treat pain and inflammation. It belongs to the class of medications called non-steroidal anti-inflammatory drugs (NSAIDs). Some brand names for diclofenac include Voltaren®, Volatarol®, Cataflam®, Solarze®. Diclofenac is sometimes sold in combination with acetaminophen as Parazone-DP®, and in combination with capsaicin as Capsinac® and Diclosaicin®.  

Diclofenac can be given orally (by mouth), as an injection (shot), topically (applied to the skin), or as eye drops. Medication applied topically or as eye drops is usually found in lower levels in the blood than when taken orally or by injection. This means that using this medication topically or as eye drops would likely result in less exposure to a pregnancy than when used orally or by injection.  

The U.S. Food and Drug Administration (FDA) recommends not using NSAIDs after week 20 of pregnancy, unless specifically recommended by your healthcare provider. 

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

Some studies suggest that using diclofenac or other NSAIDs might make it harder to get pregnant. This might be more likely when NSAIDs are used often or over a long period of time. 

Does taking diclofenac increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if diclofenac can increase the chance of miscarriage. A few studies have reported an increased chance of miscarriage with diclofenac or other NSAID use. However, the reason why someone is taking the NSAID (such as a medical condition, infection, or pain from a miscarriage that is already happening) might contribute to the reported increased chance of miscarriage. As there can be many causes of miscarriage, it is hard to know if a medication, the medical condition being treated, or other factors are the cause of a miscarriage. 

Does taking diclofenac 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 diclofenac, might increase the chance of birth defects in a pregnancy.   

In a study of over 5,000 pregnancies, there was no increased chance of birth defects when NSAIDs (including diclofenac) were used during the first trimester of pregnancy. In another study of first trimester use of NSAIDs as a group (including diclofenac), there was an increased chance for heart defects. However, heart defects were not reported with diclofenac use specifically. Other factors in the study could have contributed to the reported increase in birth defects. 

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

Diclofenac is not recommended for use after week 20 of pregnancy. Diclofenac should only be used under a healthcare provider’s supervision, particularly in the 2nd and 3rd trimesters. Your healthcare providers can closely monitor your pregnancy if you need to use diclofenac after week 20.  

There have been some reports that NSAID use in the 2nd half of pregnancy might affect the fetal kidneys and the amount of amniotic fluid (fluid that surrounds the fetus in the uterus). If there is not enough amniotic fluid (called oligohydramnios), other pregnancy complications, such as poor lung development and joint contractures (joints become stiff or unable to move), could happen. Oligohydramnios can also increase the chance that an early delivery is needed. In some cases, oligohydramnios could cause fetal demise (death).   

One study suggested that the use of NSAIDS in the 1st half of pregnancy might also affect the fetal kidneys and amount of amniotic fluid. The researchers did not report which NSAIDs were included in their study.  

Diclofenac use during the 3rd trimester (28 to 40 weeks of pregnancy) might also cause premature closure of the ductus arteriosus (an opening between the two major blood vessels leading from the heart). If the ductus arteriosus closes before it should, it can cause high blood pressure in the fetal lungs (pulmonary hypertension).  

There are some studies on the class of NSAID medications that suggest NSAIDs can increase the chance of other pregnancy-related problems, including preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth. Other studies have not reported these findings. Some conditions that NSAIDs are used to treat can also increase the chance of these issues. That makes it hard to know if the medication, the condition being treated, or other factors are increasing the chance of these outcomes.  

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

It is not known if diclofenac can increase the chance of 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 screen for some pregnancy-related problems, such as oligohydramnios and fetal kidney function. Fetal echocardiograms can be used to identify premature closure of the ductus arteriosus. Ultrasound can also be used to monitor 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 diclofenac:

Diclofenac passes into breast milk in small amounts. Information is limited; however, most experts consider diclofenac to be acceptable during breastfeeding because diclofenac levels in milk are often so low that they are not able to be measured. Side effects have been reported in a breastfed child, but it was determined the side effects were caused by a different exposure. Diclofenac eye drops or topical application is not expected to get into breast milk in high amounts. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

It is not known if diclofenac could affect men’s fertility (ability to get a woman pregnant). Studies have not been done to see if diclofenac could 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 ACE inhibitors 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 an ACE inhibitor? 

ACE inhibitor stands for: angiotensin-converting-enzyme (ACE) inhibitor. ACE inhibitor is the name used to describe a group of medications used to treat high blood pressure. ACE inhibitors have also been used for treating problems with the heart and kidneys.  

ACE inhibitors are sold under many names, such as: benazepril (Lotensin®), captopril (Capoten®), cilazapril (Inhibace®), enalapril (Vasotec ®, Epaned®), fosinopril (Monopril®), lisinopril (Listril®, Lopril®, Novatec®, Prinivil®, Zestril®), perindopril (Aceon®), quinapril (Accupril®), ramipril (Altace®), and trandolapril (Mavik®).  

It is difficult to study a class of medications. Discuss your specific medication with your healthcare provider or a MotherToBaby specialist to see if there are studies for your medication. 

ACE inhibitors should be avoided during the second and third trimesters of pregnancy. 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. 

Can high blood pressure during my pregnancy cause problems? 

Uncontrolled high blood pressure in pregnancy could affect the placenta (organ that develops in pregnancy to help get food and oxygen to the baby). This can then cause problems for the developing baby, such as: slow growth (infant smaller overall), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), or preterm delivery (birth before 37 weeks of pregnancy). Uncontrolled high blood pressure in pregnancy can also affect the woman who is pregnant, by damaging organs, such as kidneys and heart. 

I take an ACE inhibitor. Can it make it harder for me to get pregnant? 

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

Does taking ACE inhibitors increase the chance of miscarriage?   

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

Does taking ACE inhibitors in the first trimester 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 ACE inhibitors, might increase the chance of birth defects in a pregnancy. 

There is no proven risk of birth defects with first trimester use of ACE inhibitors. Most studies have not found birth defects to occur more often in women who took or were prescribed an ACE inhibitor in the first trimester of their pregnancy. It is difficult to study medications as a group because even though the ACE inhibitors work in similar ways, there are some differences among the individual medications. When drugs are studied as a group, differences for individual drugs could be missed. Also, problems reported in studies may be related to the high blood pressure or medical condition being treated and might not be due to the medication. Contact MotherToBaby to see if there is specific information for your medication. 

Does taking ACE inhibitors in the second or third trimester cause other pregnancy related problems?  

ACE inhibitors should be avoided during the second and third trimesters of pregnancy.  

When used after the first trimester, ACE inhibitors can cause low levels of amniotic fluid (fluid that surrounds the baby). Low levels of amniotic fluid can lead to health problems for the developing baby. Some of these problems include poor lung development, poor growth, poor development of the skull bones, birth defects, problems with the development of the kidneys and in the most severe cases, death of the developing baby.  

Talk to your healthcare provider right away if you are pregnant and taking any ACE inhibitor. 

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

Studies have not been done to see if ACE inhibitors, in general, 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 such as skull bone and kidney defects. Ultrasound can also be used to monitor the growth of the pregnancy and the level of amniotic fluid (fluid that surrounds the baby). There are no tests available during a pregnancy that can tell if there has been any effect on behavior or ability to learn. If you took an ACE inhibitor during pregnancy, talk to your healthcare provider about screening options, your healthcare provider can help to arrange any monitoring.  

Breastfeeding while taking ACE Inhibitors: 

It might be possible to breastfeed while taking an ACE inhibitor, depending on the specific medication. Contact MotherToBaby to learn more about your specific mediation(s). Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

There is no evidence to suggest that a man’s use of an ACE inhibitor causes infertility (ability to get a woman pregnant) or birth defects. In general, exposures that males 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 tocilizumab 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 tocilizumab? 

Tocilizumab is a prescription medication that has been used to treat rheumatoid arthritis (RA), giant cell arteritis in adults, and juvenile idiopathic arthritis (JIA) in children. It has also been used to treat symptoms of severe COVID-19 in hospitalized patients. The brand name for tocilizumab is Actemra®.  

MotherToBaby has a fact sheet on rheumatoid arthritis here: https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/.  

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 tocilizumab. Can it make it harder for me to get pregnant?  

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

Does taking tocilizumab increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if taking tocilizumab can increase the chance of miscarriage. Some studies have suggested that taking tocilizumab might increase the chance of miscarriage, while other studies have not. In the studies that reported an increased chance of miscarriage, other factors that are known to increase the chance of miscarriage such as age, use of multiple medications, and symptoms of the health condition being treated were reported as well. Because miscarriage can happen for many reasons, it is hard to know whether a medication, the condition being treated, or other factors such as age or health are the cause.  

Does taking tocilizumab 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 tocilizumab, might increase the chance of birth defects in a pregnancy. 

Tocilizumab use during pregnancy is not expected to increase the chance of birth defects. Tocilizumab is not expected to cross the placenta and reach the pregnancy in large amounts during the first trimester, which is the time when a birth defect is most likely to happen. For more information on periods of development, see the MotherToBaby fact sheet on critical periods of development here: https://mothertobaby.org/fact-sheets/critical-periods-development/.  

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

Tocilizumab might cross the placenta in higher amounts in the second and third trimesters of pregnancy. Some studies have shown an increased chance of pregnancy complications including preterm delivery (birth before week 37) and low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth) when tocilizumab is used throughout pregnancy to treat conditions such as RA. However, since poorly controlled RA can also increase the chance for preterm delivery, low birth weight, babies born smaller than expected, and other pregnancy complications, it is not known if these findings are due to tocilizumab or to the medical condition being treated.  

Published reports of tocilizumab use to treat severe COVID-19 during the second or third trimesters of pregnancy have not identified an increased chance of pregnancy problems or problems for newborns related to the medication. The pregnancy-related problems reported in these cases, such as preterm delivery, c-section, or admission to the neonatal intensive care nursery (NICU) were believed to be because of the severe COVID-19 infection or other underlying medical conditions or complications.  

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

There have been limited studies done to see if tocilizumab can increase the chance of behavior or learning issues for the child. In a study that looked at infants who were exposed to tocilizumab for a short time during the second or third trimesters of the pregnancy, there were no reported changes in their development up to 6 months or 1 year of age.  

Can my child receive live vaccines if I take tocilizumab during pregnancy? 

Since tocilizumab might suppress the immune system of adults taking it, there is a theoretical (not proven) concern that the same thing could happen to the baby if they are exposed during pregnancy. If someone has a weakened immune system, they might be more likely to develop an infection from a live vaccine.  

Live vaccines contain a small amount of live virus. In the United States, rotavirus is the only live vaccine routinely given in the first year of life. Most babies can get inactivated vaccines in the first year of life. Inactivated vaccines do not contain live virus, so they cannot cause the disease they protect against. Talk to your child’s healthcare provider about your exposure to tocilizumab during pregnancy. They can talk with you about the vaccines your child should receive and the best time for your child to receive them. 

Breastfeeding while taking tocilizumab: 

Tocilizumab passes into breast milk in small amounts, but it is expected to be destroyed in a breastfed child’s stomach before it can be absorbed into the child’s body. No adverse effects have been reported in infants exposed to tocilizumab through breast milk. Experts consider tocilizumab acceptable for use in breastfeeding. If you suspect the baby has any symptoms, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Limited studies have been done to see if tocilizumab could affect male fertility (ability to make healthy sperm). There was no increase in birth defects in a report that included 8 infants born to males who used tocilizumab. 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/.  

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