This sheet is about exposure to sunless tanners 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 are sunless tanners? 

Sunless tanners, also called self-tanners, are often creams or lotions that darken your skin to give it a “tan” without sun exposure. The main ingredient is dihydroxyacetone (DHA), usually made from plants like sugar beets or sugar cane. (This DHA is different from the omega-3 fatty acid with the same abbreviation.) 

Tanning pills (taken by mouth) are considered unsafe according to the U.S. Food and Drug Administration (FDA).  Some tanning pills have a color additive called canthaxanthin. Taking too much can turn your skin orange or brown and can also cause serious health problems, like liver damage, hives, and an eye condition that affects your retinas. Tanning shots (injections under the skin) are not legally available in the United States.  

Sunless tanners do not protect your skin from the sun, so it is important to use sunscreen or protective clothing when outdoors. 

Sunless tanners are cosmetics. How are cosmetics checked for safety in the United States? 

The Food and Drug Administration (FDA) does not review cosmetics for safety and effectiveness the same way it does medications. Companies that make or sell cosmetics are responsible for making sure their products are safe, but the FDA does not require specific safety testing. There is also no requirement to test cosmetic products for use during pregnancy or breastfeeding. Because of this, there is usually little medical information to help women choose between cosmetic products during pregnancy or while breastfeeding. 

However, color additives such as DHA must be approved by the FDA. The FDA approved DHA as a tanning ingredient in the United States in the 1970s. This approval does not specifically address use during pregnancy or breastfeeding. DHA is approved only for use on the outside of the body. It is not approved for use near the eyes or lips, or for inhalation, because there is not enough safety data for these types of exposure. 

Are sunless tanners absorbed into my bloodstream if I am using them on my skin? 

When medication is taken by mouth or swallowing, it is likely to get into the blood, where it can then possibly cross the placenta and reach the developing fetus. With most topical products, the skin serves as a good barrier, so it is not expected that a large amount of the product would get into the blood. This is especially true when the topical product is used on small areas of the body, infrequently, or on healthy (non-broken) skin. 

Laboratory models suggest when DHA is placed on the skin, less than 1% of DHA is absorbed into the bloodstream. That means, only very small amounts, if any, of DHA are expected to be able to reach the fetus. 

Most over-the-counter sunless tanning products contain 3–5% DHA, although products marketed for a darker tan or for professional use may contain higher concentrations. The FDA has approved DHA for external use at concentrations up to 15%. 

There are no studies measuring how much of the other ingredients in sunless tanners are absorbed through the skin. These products may also contain moisturizers, bronzers, fragrances, vitamins, and preservatives. In general, absorption of ingredients from skin products is likely to be lower when applied to healthy skin, used infrequently, or applied to small areas of the body. 

What about using booths, which spray sunless tanner on me? 

It is possible that if you are inhaling the sunless tanning spray fumes in tanning booths, or applying the product to mucous membranes, more of the DHA could get into your system and result in higher blood levels.  

The FDA has not approved the use of DHA in tanning booths. Avoid using it near body openings or mucous membranes (such as eyes, eyelids, mouth, lips, nose or ears). This may be hard to avoid when using a spray tanning booth. The FDA recommends that any person using these booths asks for protective measures to cover the eyes, mouth and nose.  

I use sunless tanners. Can they make it harder for me to get pregnant? 

Studies have not been done to see if sunless tanners can make it harder to get pregnant.   

Does using sunless tanners increase the chance of miscarriage? 

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

Does using sunless tanners 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 sunless tanners, might increase the chance of birth defects in a pregnancy. Studies have not been done to see if sunless tanners can increase the chance of birth defects.  

Does using sunless tanners in pregnancy increase the chance of other pregnancy-related problems? 

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

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

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

Breastfeeding while using sunless tanners: 

There are no studies on the use of sunless tanners during breastfeeding. Only very small amounts of DHA applied to the skin are expected to enter the bloodstream and pass into breast milk. Absorption is likely even lower when the product is used on healthy skin, applied infrequently, or used on small areas of the body.  

If using these products while breastfeeding, avoid applying them to the breast or any area that could come into direct contact with your baby’s skin before the product has completely dried. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

If a man uses sunless tanners, could it affect his fertility or increase the chance of birth defects? 

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

Please click here for references.  

This sheet is about exposure to deucravacitinib 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 deucravacitinib?

Deucravacitinib is a medication that has been approved for the treatment of moderate-to-severe plaque psoriasis. A brand name for deucravacitinib is Sotyktu®. MotherToBaby has a fact sheet on psoriasis & psoriatic arthritis at: https://mothertobaby.org/fact-sheets/psoriasis-and-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 provid ers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

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

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

Does taking deucravacitinib increase the chance of miscarriage? 

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

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

Human pregnancy studies have not been done to see if deucravacitinib can increase the chance of birth defects. Experimental animal studies done by the manufacturer did not find an increased chance of birth defects. 

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

It is not known if deucravacitinib 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). 

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

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

Can my baby receive live vaccines before one year of age if I take deucravacitinib while pregnant?

Since deucravacitinib might suppress the immune system of the person 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. Inactivated vaccines do not contain live virus, so they cannot cause the disease they protect against. Most people can get inactivated vaccines in the first year of life.  

Talk with your child’s healthcare provider about your exposure to deucravacitinib 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 deucravacitinib:

Deucravacitinib has not been studied for use while breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Studies have not been done to see if deucravacitinib could affect men’s fertility (ability to get a partner pregnant) or increase the chance of birth defects. In general, exposures that fathers or sperm donors 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/.  

MotherToBaby is currently conducting a study looking at deucravacitinib and other medications used in pregnancy. If you are interested in taking part in this study, please call 1-877-311-8972 or sign up at https://mothertobaby.org/join-study/.

Please click here for references.

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

What is nirmatrelvir/ritonavir? 

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

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

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

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

Does taking nirmatrelvir/ritonavir increase the chance of miscarriage?  

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

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

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

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

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

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

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

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

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

Breastfeeding while taking nirmatrelvir/ritonavir: 

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

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

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

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

Please click here for references. 

This sheet is about exposure to loxapine 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 loxapine?

Loxapine is a medication that has been used to treat mental health conditions including schizophrenia and bipolar disorder. Some brand names for loxapine are Loxitane® and Adasuve®.

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. Some people might have a return of their symptoms (relapse) if they stop this medication during pregnancy.  

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

Loxapine might increase the blood levels of the hormone prolactin. Levels of prolactin that are higher than normal can cause irregular periods in some women, which might make it harder to get pregnant. Talk to your healthcare provider if you are having trouble getting pregnant. 

Does taking loxapine increase the chance of miscarriage?  

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

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

Studies have not been done to see if loxapine can increase the chance of birth defects.  

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

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

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

The use of some medications similar to loxapine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. The symptoms can include too much or too little muscle tone (stiff or floppy), sleepiness, agitation (irritability), problems with breathing and feeding, or unusual muscle movements (tremors). Not all babies exposed to these medications will have these symptoms, and it is unknown if taking loxapine would cause these symptoms. It is important that your healthcare providers know you are taking loxapine so that if symptoms occur your baby can get the care that is best for them. 

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

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

Breastfeeding while taking loxapine:  

It is not known how much loxapine gets into the breast milk or how it might affect a breastfeeding infant. The product label for loxapine recommends people who are breastfeeding not use this medication, if possible. But the benefits of using loxapine might outweigh possible risks. Your healthcare providers can talk with you about using loxapine and what treatment is best for you. If you take loxapine and suspect the baby has any symptoms such as sedation (extreme sleepiness), irritability, constipation, or tremors, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Taking loxapine might increase levels of the hormone prolactin in some males, which might cause problems with fertility (ability to get a woman pregnant). 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 caffeine 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 caffeine? 

Caffeine is a stimulant found in many foods and beverages. It is also found in some prescription and over the counter medications. Caffeine is naturally found in the leaves, seeds, and fruits of more than 60 plants. Caffeine’s main effect is making people feel more awake for a short time. Caffeine is also a diuretic, meaning that it helps get rid of fluids from the body. It is important that women who use caffeine stay well-hydrated by drinking enough water. Most experts suggest that women who are pregnant limit their caffeine intake to 200 milligrams (mg) or less per day. 

How much caffeine is in common foods and drinks?  

The best way to know how much caffeine is in a product is to check the ingredient label. The amount of caffeine in some common items is listed below (amounts are approximate and might vary between products):  

• 8 ounce (oz.) cup of brewed coffee  137 mg 

• 12 oz. (tall) Starbucks® cup of coffee  235 mg 

• 8 oz. cup of instant coffee  76 mg 

• 8 oz. cup of brewed tea  48 mg 

• 8 oz. cup of hot chocolate  5 mg 

• 12 oz. Coke®  46 mg 

• Red Bull® energy drink  67 mg 

• 1 cup of coffee ice cream  4 mg 

• Milk chocolate bar  10 mg 

• Dark chocolate bar  30 mg 

• 2 tablets of Excedrin®  130 mg 

Some herbal supplements such as guarana also contain caffeine (about 47 mg per 1 gram). Beverages made from the guarana seed also contain caffeine.  

I consume (eat/drink) products with caffeine. Can it make it harder for me to get pregnant?  

Some studies have suggested that high levels of caffeine (more than 300 mg per day) might make it harder to get pregnant, but these findings are not proven. Low (less than 200mg per day) to moderate (about 200-300 mg per day) caffeine consumption has not been proven to make it harder to get pregnant.  

Does caffeine increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Researchers have not reported an association between low (under 200 mg) levels of caffeine and an increased chance of miscarriage. Some studies suggest that the chance of miscarriage might be increased when women consume moderate (200-300 mg) or high (more than 300 mg) levels of caffeine. As there can be many causes of miscarriage (such as age, health, other exposures), it is hard to know if an exposure or other factors are the cause of a miscarriage. 

Does caffeine 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 caffeine, might increase the chance of birth defects in a pregnancy. Caffeine has not been shown to increase the chance of birth defects. 

Does consuming products with caffeine in pregnancy increase the chance of other pregnancy-related problems? 

Most studies find no clear evidence that low (less than 200 mg) to moderate (200 to 300 mg) caffeine use during pregnancy 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). High doses (more than 300 mg) of caffeine are not well studied.  

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

The use of caffeine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Large amounts of caffeine could affect babies in the same way as it does adults. Some reports suggest that children exposed to more than 500 mg of caffeine per day in the third trimester of pregnancy were more likely to have faster heart rates, shaking, increased breathing rate, and spend more time awake in the days following birth. Not all babies exposed to caffeine will have these symptoms. It is important that your healthcare providers know you are taking caffeine so that if symptoms occur your baby can get the care that is best for them. 

Does consuming products with caffeine in pregnancy affect future behavior or learning for the child?  

Most studies find no effect on learning or behavior in young school-aged children who were exposed to caffeine during pregnancy.  

Breastfeeding while consuming products with caffeine: 

Caffeine gets into breast milk in small amounts. It has been suggested to limit daily consumption to 300 mg/day or less while breastfeeding. If you suspect the baby has any symptoms (agitation, irritability, trouble with sleeping, rapid heart rate or tremor), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

If a man consumes products with caffeine, could it affect his fertility or increase the chance of birth defects? 

Studies on caffeine and male fertility (ability to get a woman pregnant) have reported mixed findings. The American Society for Reproductive Medicine (ASRM) states that caffeine consumption has no effect on semen. 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.