This sheet is about exposure to ziprasidone 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 ziprasidone? 

Ziprasidone is a medication that has been used to treat bipolar disorder, schizophrenia, and schizoaffective disorder. Ziprasidone belongs to a group of medications called atypical antipsychotics or second-generation antipsychotics. A brand name for ziprasidone is Geodon®.  

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

It is not known if ziprasidone can make it harder to become pregnant. A reported side effect of ziprasidone is sexual dysfunction (problems with sexual desire, sexual arousal, orgasms, or sexual pain disorders). If a woman has sexual dysfunction, it might make it harder to get pregnant. In some women, ziprasidone might increase the levels of a hormone called prolactin or cause amenorrhea (temporary absence of a menstrual cycle). High levels of prolactin can stop ovulation (part of the menstrual cycle when an ovary releases and egg). Changes in ovulation or the menstrual cycle can also make it harder to get pregnant.  

Does taking ziprasidone increase the chance of miscarriage?   

Miscarriage is common and can occur in any pregnancy for many different reasons. One prescription-based study reported a slightly higher chance of miscarriage among women who filled a prescription for ziprasidone in pregnancy. Studies based on prescription records cannot tell if someone took the medication. This makes it hard to know if the study outcomes are related to the medication or other factors. Also, untreated or uncontrolled mood disorders can increase the chance of miscarriage.    

Does taking ziprasidone 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. Data on over 2,000 pregnancies exposed to ziprasidone have not reported an increased chance of birth defects. One prescription-based study with 12 women who took ziprasidone during pregnancy reported cases of polydactyly (born with extra fingers or toes). Studies based on prescription records cannot tell if someone took the medication. This makes it hard to know if the study outcomes are related to the medication or other factors. 

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

It is not known if ziprasidone can 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). In a study of 34 pregnancies exposed to ziprasidone, no increased chance of infants being small or large for gestational age was reported. In another study of 18 exposed pregnancies, no increased chance for low birth weight, short birth length, or small head size was noted. 

I need to take ziprasidone during my pregnancy. Will it cause withdrawal symptoms in my baby after birth? 

The use of some medications during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. It is unknown if taking ziprasidone could increase the chance of withdrawal symptoms in a newborn. Similar medications have been associated with a chance for withdrawal symptoms. Babies who were exposed to ziprasidone near delivery can be monitored for symptoms such as stiff or floppy muscle tone, drowsiness, agitation, tremors, trouble breathing, and problems with feeding. If a baby develops symptoms, in most cases, the symptoms are expected to go away in a few days without long term health effects. It is important that your healthcare providers know you are taking ziprasidone so that if symptoms occur, your baby can get the care that is best for them.  

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

Studies have not been done to see if ziprasidone can increase the chance of behavior or learning issues for the child. There are a few case reports of healthy children with typical development after being exposed to ziprasidone during pregnancy. 

Breastfeeding while taking ziprasidone: 

Based on the limited data, ziprasidone gets into breast milk in small amounts. There is one case report of a woman who took ziprasidone 40 mg and citalopram 60 mg throughout the pregnancy and while breastfeeding. The breastfed baby was reported to be healthy and developing well at age 6 months old. Until more information is available, babies who are breastfed while their mother is taking ziprasidone should be watched for signs like being very sleepy, getting upset easily, not feeding well, shaking, or unusual muscle movements. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

There are no well-controlled studies in men exposed to ziprasidone to see if it could affect male fertility (ability to get partner pregnant) or increase the chance of birth defects. In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.  

Please click here for references.  

This sheet is about exposure to alprazolam in 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 is alprazolam? 

Alprazolam is a medication that has been used to treat anxiety and panic disorders, including anxiety associated with depression. It is in a class of medication called benzodiazepines. Alprazolam has been sold under the brand names Xanax®, Niravam®, or Gabazolamine-0.5®. 

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. If you take this medication regularly and then suddenly stop taking it, you could have withdrawal symptoms. Some reported withdrawal symptoms include seizures and rebound anxiety. Also, untreated anxiety and depression can increase risks to a pregnancy. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.  

MotherToBaby has sheets on anxiety https://mothertobaby.org/fact-sheets/anxiety-fact/ and depression https://mothertobaby.org/fact-sheets/depression-pregnancy/.  

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

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

Does taking alprazolam increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. It is unlikely that alprazolam would greatly increase the chance of miscarriage.   

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

Most studies on alprazolam use in the first trimester have not reported an increased chance of birth defects. Two reports that looked at prescription records reported a higher chance for heart defects if a prescription for alprazolam was filled during pregnancy. Studies based on prescription records cannot tell if a person took the medication, so it is hard to know if the outcomes are related to the medication or other factors. Overall, an increased chance of birth defects has not been proven.  

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

Some studies have suggested that alprazolam might increase the chance of preterm delivery (birth before week 37) and low birth weight (less than 5 pounds, 8 ounces [2500g] at birth). Other studies have not found this association.  

I need to take alprazolam during my pregnancy. Will it cause withdrawal symptoms in my baby after birth? 

The use of benzodiazepines, including alprazolam, during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms can include trouble regulating body temperature, trouble breathing, low energy, poor feeding, and vomiting. Most often, symptoms start soon after birth and last several days. Not all babies exposed to alprazolam will have symptoms. It is important that your healthcare providers know you are taking alprazolam so that if symptoms occur, your baby can get the care that is best for them. 

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

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

Breastfeeding while taking alprazolam:   

Alprazolam gets into breast milk. While it is possible to breastfeed while taking alprazolam, a different medication might be preferred. If you suspect the baby has any symptoms (being too sleepy, poor feeding, and poor weight gain), contact the child’s healthcare provider. After a single dose of alprazolam, there is usually no need to wait to breastfeed.  

The product label for alprazolam recommends women who are breastfeeding not use this medication. But the benefit of treating your condition and breastfeeding may outweigh possible risks of taking alprazolam. Your healthcare providers can talk with you about using alprazolam and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

There is 1 report of a man who had delayed ejaculation and impotence (trouble with getting and keeping an erection) while taking alprazolam. One small study found lower sperm motility (movement) in those taking psychotropic medications (including alprazolam) compared to men who did not take psychotropic medication. These issues might make it harder to conceive a pregnancy. In general, exposures that men or sperm donors have are less likely to increase risks to a pregnancy. For more general 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 hydroxychloroquine 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 hydroxychloroquine? 

Hydroxychloroquine is a medication that has been used to prevent and treat malaria and to treat autoimmune conditions, including rheumatoid arthritis and lupus. Plaquenil® is a brand name for hydroxychloroquine. For more information on malaria, rheumatoid arthritis, and lupus, please see the MotherToBaby fact sheets at https://mothertobaby.org/fact-sheets/malaria/, https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/, https://mothertobaby.org/fact-sheets/lupus-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.  

The Society for Maternal Fetal Medicine (SMFM) has recommended that women who are pregnant and have lupus should continue or start hydroxychloroquine. For women with lupus but no current symptoms or treatment, the SMFM has recommended talking with their healthcare providers regarding the benefits and limitations of starting or not starting this medication during pregnancy. 

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

Studies have not been done to see if taking hydroxychloroquine can make it harder to get pregnant. However, hydroxychloroquine might improve the success rates of certain fertility treatments. 

Does taking hydroxychloroquine increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Several studies have not found a higher chance of miscarriage related to hydroxychloroquine use. One study reported a higher number of miscarriages than expected, but the authors stated that the mother’s health conditions may have contributed to this finding since malaria and lupus can increase the chance of miscarriage. 

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

Most studies looking at the use of hydroxychloroquine to treat rheumatic disease in pregnancy have not found an increased chance of birth defects.  

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

Studies do not suggest that hydroxychloroquine increases the chance of pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Having malaria or lupus in pregnancy might increase the chance of preterm delivery.  

When a woman who is pregnant has lupus, it can lead to symptoms of lupus in the baby (called neonatal lupus). The most serious complication of neonatal lupus is a heart rhythm problem called congenital heart block. Hydroxychloroquine might reduce the chance of congenital heart block in pregnancies that are at an increased risk for this condition.  

Damage to the inner lining of the eye (called retinopathy) is an uncommon side effect of taking hydroxychloroquine. This has raised a theoretical (not proven) concern that taking hydroxychloroquine in pregnancy could cause vision problems in the offspring. However, most studies on young children born to women who took hydroxychloroquine in pregnancy have not found an increase in eye problems.  

Does taking hydroxychloroquine affect future behavior or learning for the child? 

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

Breastfeeding while taking hydroxychloroquine: 

Hydroxychloroquine passes into breast milk in small amounts. Studies on hydroxychloroquine in breastfeeding have reported no harmful effects on infants, including no effects on vision, hearing, or growth problems in children who were followed up to about 1 year of age. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

A review of studies on men who used medications to treat rheumatic disease at or near the time of conception did not find that hydroxychloroquine affected fertility (ability to make healthy sperm) or pregnancy outcomes. 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 and the medications used to treat autoimmune diseases. If you are interested in learning more, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study/. 

Please click here for references. 

This sheet is about exposure to vitamin B12 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 B12?

Vitamin B12 is an essential vitamin that is used by the body to keep your nerve and blood cells healthy and to help make DNA (genetic material created in your body). Essential vitamins are nutrients that the body cannot make, so people need to get them from other sources. Vitamin B12 can be found in animal products including meat, seafood, eggs, and dairy products. Cereals and nutritional yeast have vitamin B12 added to them. Vitamin B12 is also available as a dietary supplement, or as a prescription medication in the form of an injection (shot) or nasal spray. Vitamin B12 has also been called cobalamin.  

Vitamin B12 deficiency (not having enough vitamin B12 in the body) can cause fatigue (feeling very tired), muscle weakness, pale or ashy skin, a racing heart, loss of appetite, weight loss, and numbness or tingling in the hands and feet. Not all people with a vitamin B12 deficiency will have symptoms. Sometimes, other health conditions or taking medications that interact with how vitamin B12 is absorbed can increase the chance of having symptoms.  

If your healthcare provider has recommended taking vitamin B12, talk with them before making changes to how you take this supplement Your healthcare providers can talk with you about the benefits of maintaining your nutrient levels and the risks of low vitamin B12 during pregnancy. 

Talk with your healthcare providers about all of the supplements and vitamins that you take. Have the bottles or photos of the labels with you so that all reported ingredients and their amounts can be reviewed.  

How much vitamin B12 is needed in pregnancy?

The Recommended Dietary Allowance (RDA) is the average daily level of intake that is enough to meet the nutrient needs for most people. The Tolerable Upper Intake Level (UL) is the dose that people can start to have side effects. It is not recommended to take more than the RDA of vitamin B12 unless you are doing so under the care of your healthcare provider to treat a condition. There is currently no UL for vitamin B12, because vitamin B12 is not stored in the body in excess (extra) amounts. The RDA for females who are pregnant is 2.6 mcg of vitamin B12 a day.  

Most people get enough vitamin B12 from their diet. When adding up how much vitamin B12 you are getting, remember to count amounts from foods, drinks, and from any supplements you are taking. There are resources available online that list amounts of vitamin B12 typically found in foods, such as the United States Department of Agriculture (USDA) National Nutrient Database, found here: https://www.nal.usda.gov/sites/default/files/page-files/Vitamin%20B-12.pdf. Diet, medications, and certain medical conditions can cause someone to have low levels of vitamin B12. Some people might need to take a vitamin B12 supplement. Be sure to talk with your healthcare providers about your specific nutritional needs before, during, and after pregnancy. 

Can vitamin B12 make it harder for me to get pregnant? 

Taking vitamin B12 at the RDA is not expected to make it harder to get pregnant. It is not known if having a vitamin B12 deficiency can make it harder to get pregnant.  

Does vitamin B12 increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Taking vitamin B12 at the RDA is not expected to increase the chance of miscarriage. Some studies reported that having low levels of vitamin B12 (less than 200-300 pg/mL in blood) was associated with an increased chance of miscarriage. Some of these studies combined multiple factors together, including other vitamins. As there can be many causes of miscarriage, it is hard to know if vitamin levels, health conditions, or other factors are the cause of a miscarriage.  

Does vitamin B12 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 B12, might increase the chance of birth defects in a pregnancy. Taking vitamin B12 at the RDA is not expected to increase the chance of birth defects.  

It is not known if having too little vitamin B12 can increase the chance of birth defects. Some studies report that having too little vitamin B12, or having lower metabolism (the body’s processing) of vitamin B12 can increase the chance of neural tube defects (an opening in the spine or skull). Other studies have not reported the same results. Two studies have reported an increased chance of cleft lip and/or palate (an opening in the upper lip or the roof of the mouth) in babies born to women who were deficient in B12 during pregnancy.  

Does vitamin B12 increase the chance of other pregnancy-related problems?

Taking vitamin B12 at the RDA 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).  

Having a vitamin B12 deficiency (B12 levels below 148mol/L) or low vitamin B12 has been associated with preterm delivery. One study did not report an association between low or deficient vitamin B12 levels and birth weight.   

Does vitamin B12 affect future behavior or learning for the child?  

Taking vitamin B12 at the RDA is not expected to affect future behavior or learning for the child. It is not known if having a vitamin B deficiency can affect future behavior or learning for the child.  

Breastfeeding and vitamin B12:

Vitamin B12 is a typical part of breast milk. If you are breastfeeding, continue to get the daily recommended daily allowance of vitamin B12 unless otherwise directed by a healthcare provider. The RDA for females who are breastfeeding is 2.8 mcg of vitamin B12 a day.  

If a person who is breastfeeding is deficient in vitamin B12, the child may have an increased chance of having vitamin B12 deficiency if they are exclusively breastfed. Infants who are vitamin B12 deficient might experience low muscle tone, uncontrolled movements (tremors), anemia, and changes in skin and hair development.  

Getting enough vitamin B12 while breastfeeding can help a child get enough vitamin B12. See the chart above to find the RDA for vitamin B12 for women who are breastfeeding. Also, talk to your healthcare provider and your baby’s pediatrician about your specific nutritional needs before, during, and after breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

Does vitamin B12 affect fertility or increase the chance of birth defects?

Taking vitamin B12 at the RDA is not expected to affect men’s fertility (ability to get a partner pregnant) or increase the chance of birth defects. Studies have not been done in humans to see if a vitamin B12 deficiency could affect men’s fertility 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 methimazole 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 methimazole?

Methimazole is a medication that has been used to treat hyperthyroidism (when the thyroid gland makes too much thyroid hormone) and Graves’ disease (a common cause of hyperthyroidism). Methimazole lowers the amount of thyroid hormone that the thyroid gland makes. Tapazole® was a brand name for methimazole.

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. Untreated hyperthyroidism can increase the chance of illness for the pregnant woman and the chance of pregnancy complications. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.

The US Food and Drug Administration (FDA), The American College of Obstetricians and Gynecologists (ACOG), and The American Thyroid Association (ATA) have stated that propylthiouracil (PTU), another medication that has been used to treat hyperthyroidism, might be the preferred treatment for hyperthyroidism during the first trimester of pregnancy. MotherToBaby has a fact sheet on PTU here: https://mothertobaby.org/fact-sheets/propylthiouracil-ptu/.

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

Studies have not been done to see if methimazole can make it harder to get pregnant. Untreated thyroid disorders can make it harder to get pregnant.

Does taking methimazole increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. One study did not find an increased chance of miscarriage in 241 women who were pregnant and used methimazole in early pregnancy. Hyperthyroidism has been associated with an increase in the chance for miscarriage.

Does taking methimazole 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 methimazole, might increase the chance of birth defects in a pregnancy. Some studies and case reports suggest there could be an increased chance of birth defects when taking methimazole. There has been a suggested pattern of birth defects linked to methimazole exposure. The most commonly reported findings include aplasia cutis (ulcers on the scalp), choanal atresia (narrowing in the opening to the nasal passages), and esophageal atresia (tube connecting mouth to stomach is not formed properly). There are also studies and case reports that did not find an increase in the chance of birth defects when methimazole is taken in pregnancy. Some studies suggest that the underlying medical condition (hyperthyroidism), may play a role in the chance for birth defects. In summary, there is not enough evidence to suggest that taking methimazole clearly increases the chance of birth defects above the background chance.

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

One study found a higher chance of preterm delivery (birth before week 37) and low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth) when methimazole was used during pregnancy. Hyperthyroidism has also been found to increase the chance for preterm delivery, smaller size (small for gestational age), and low birth weight.

Taking medications to lower thyroid levels, like methimazole, or having Graves’ disease in pregnancy can lead to thyroid levels that are either too low or too high in the fetus. If you take methimazole or if you have Graves’ disease, let your baby’s healthcare providers know, so that they can check your baby’s thyroid level after delivery.

The FDA has reported that methimazole can cause liver damage and or serious life-threatening decreases in white blood cells in people who take this medication, including pregnant women. There is limited information on whether methimazole use during pregnancy can cause liver damage or a decrease in white blood cells in the fetus.

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

Three studies looking at 56 children (from preschool to adult ages) exposed to methimazole during pregnancy found no difference in intelligence scores compared to their unexposed brothers or sisters or other unexposed people. Untreated thyroid disorders in pregnancy can increase the chance of learning problems in children.

Breastfeeding while taking methimazole:

Methimazole gets into breast milk. In 3 case series including 56 infants, and 1 study including 51 infants, methimazole in doses up to 20mg per day did not affect the breastfed infants’ thyroid function or intellectual development. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if methimazole could affect a man’s fertility (ability to get a woman pregnant) or increase the chance of birth defects above the background risk. 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.