This sheet is about exposure to codeine 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 codeine?

Codeine is an opioid medication. Opioids are sometimes called narcotics. Codeine has been used to treat pain or cough. Some commonly used codeine products also contain other medications. For more information about other medications, please see the MotherToBaby fact sheets at https://mothertobaby.org/fact-sheets/. Some brand names of products that contain codeine are Ascomp® with Codeine, Codar®, Guaiatussin® AC, and Tylenol® with Codeine. 

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.  

If you have been taking codeine regularly, have a dependency, or opioid use disorder, talk with your healthcare provider before you stop taking this medication. 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 codeine be done slowly, and under the direction of your healthcare provider.  

I am taking codeine, 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 18 hours, on average, for most of the codeine to be gone from the body. 

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

A few studies have shown that use or misuse of opioids, including codeine, might cause changes to the menstrual cycle (periods). This could make it harder to get pregnant.  

Does taking codeine during pregnancy increase the chance of miscarriage? 

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

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

Some studies looking at codeine use in pregnancy suggest a small increased chance of some birth defects, such as spina bifida (when the fetal spinal cord does not develop as usual), cleft lip and/or palate (an opening in the upper lip or the roof of the mouth), and birth defects of the intestines and/or heart. However, findings are not the same across studies, and studies have not found a specific pattern of birth defects caused by codeine. Based on these studies, if there is an increased chance of birth defects with codeine use in pregnancy, it is likely to be small.  

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

Studies on the use of opioids during pregnancy have found an increased chance of pregnancy-related problems, including poor growth of the fetus, preterm delivery (birth before week 37), C-section, and stillbirth. This is more commonly reported in people who are taking heroin or who are using prescribed opioid medication in greater amounts or for longer than recommended by their healthcare provider. One study found that use of codeine in the third trimester was associated with a higher chance of postpartum hemorrhage (heavy bleeding after delivery) and emergency C-section. It is not known how likely these outcomes might be with the prescribed use of codeine as directed in a pregnancy. 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 opioid withdrawal syndrome). 

Will my baby have withdrawal (neonatal abstinence syndrome) if I keep taking codeine?

Neonatal abstinence syndrome (NAS) is the term used to describe withdrawal symptoms in newborns from exposure to opioid medication(s) during pregnancy. NAS symptoms can include irritability, crying, sneezing, stuffy nose, poor sleep, extreme drowsiness (very tired), poor feeding, sweating, tremors, seizures, vomiting, and diarrhea. Most often, symptoms of NAS appear 2 days after birth and might 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. 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 NAS and provide the best care for your newborn. 

Studies have reported a risk for neonatal abstinence syndrome (NAS) with some opioids; however, not all medications in this class have been studied. Based on what we know about the chance of NAS with other opioids, it is likely that codeine also has a chance for NAS. One study suggests that the chance of NAS might be lower with codeine compared to some other opioids. However, because information is limited, it is not known if the chance is higher or lower with codeine than with other, better studied opioids.  

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

It is not known if codeine can increase the chance of behavior or learning issues. 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. It is hard to tell if this is due to medication exposure or other factors that might increase the chances of these problems. 

What if I have an opioid use disorder?

Talk with your healthcare provider about your use of opioids. Studies find that women who are pregnant and take opioids in higher doses or for longer than recommended by their healthcare providers have an increased chance of pregnancy problems. These include poor growth of the baby, stillbirth, preterm delivery, and the need for C-section.  

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 spina bifida, cleft lip and/or palate, and heart defects. 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. 

Codeine and breastfeeding:

Talk with your healthcare provider about your pain and medications to use while breastfeeding. Codeine passes into breast milk. Babies might have problems with the amounts of codeine in the breast milk. There are case reports of codeine use in breastfeeding that have described babies being very sleepy, having trouble latching on, having breathing problems, having a slowed heart rate, and not getting enough oxygen. Other reports describe the use of codeine while breastfeeding without any problems in nursing babies. Talk with your healthcare provider or a MotherToBaby specialist about your specific situation, as information on breastfeeding might change based on the age of your baby, the medication dosage, and/or other factors. 

The United States Food and Drug Administration (FDA) recommends that codeine not be used during breastfeeding due to the risk of serious problems in some breastfed infants such as being too sleepy, trouble breastfeeding, and serious breathing problems that might result in death. The product label for codeine also recommends people who are breastfeeding not use this medication. However, the benefit of treating your condition might outweigh the possible risks of taking codeine.  

If you are using codeine (or any opioid), talk to your healthcare provider about how to use the smallest 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, trouble breathing, or limpness. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Animal studies have suggested that misuse of codeine might lower men’s fertility (ability to get a partner 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 tramadol 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 tramadol?

Tramadol is an opioid medication that has been used to treat pain. Opioids are sometimes called narcotics. Some brand names for tramadol are Conzip®, Ryzolt®, and Ultram®. Tramadol is also available combined with other medications, such as acetaminophen. An example is Ultracet®. For more information on acetaminophen, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/acetaminophen-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. 

If you have been taking tramadol regularly or have a dependency or opioid use disorder, talk with your healthcare provider before you stop taking this medication. 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 tramadol be done slowly, and under the direction of your healthcare provider.  

I am taking tramadol, 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 4 days, on average, for most of the tramadol to be gone from the body.  

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

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

Does taking tramadol increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if taking tramadol can increase the chance of miscarriage. Two studies have looked at the rates of miscarriage among women who filled at least one prescription for tramadol during pregnancy. One of the studies found a higher rate of miscarriage in these pregnancies, and the other study did not. Studies based on prescriptions/prescription records cannot tell if a person took the medication. This makes it hard to know if the study outcomes are related to medication or other factors. As there can be many causes of miscarriage, it is hard to know if a medication, the medical condition, or other factors are the cause of a miscarriage. 

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

It is not known if tramadol can increase the chance of birth defects. At least 3 studies have not found an increase in the chance of birth defects with the use of tramadol. Another study found a small increase in the chance of birth defects, including heart defects and clubfoot. However, this study did not consider the reasons why tramadol was being used. This makes it hard to know if the medication, an underlying health condition, or other factors might have been the cause of birth defects.   

Some studies on opioids as a group suggest that opioids in general might be associated with 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 for birth defects with opioid use in pregnancy, it is likely to be small. 

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

It is not known if tramadol 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). One study did not find a higher chance of preterm delivery with tramadol use.  

Studies involving people who often use some opioids during their pregnancy have found an increased chance for pregnancy-related problems, including poor growth of the fetus, low levels of amniotic fluid (fluid that surrounds baby in uterus), stillbirth, preterm delivery, and C-section. This is more commonly reported in those who are taking a drug like heroin or who are using prescribed pain medications 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 on neonatal opioid withdrawal syndrome). 

Will my baby have neonatal opioid withdrawal syndrome if I continue to take tramadol?

Neonatal opioid withdrawal syndrome (NOWS) is the term used to describe withdrawal symptoms in newborns from exposure to opioids during pregnancy. There are reports of NOWS with use of tramadol in pregnancy. In these reports , the medication was taken daily at doses of 200mg to 400mg throughout pregnancy. NOWS symptoms began in the infants within the first week of life and included irritability, vomiting, stiff muscles, and a fast heart rate. Not all babies exposed to tramadol during pregnancy will have NOWS.  

For any opioid, 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 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. 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.  

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

It is not known if tramadol can increase the chance of behavior or learning issues. 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. It is hard to tell if this is due to medication exposure or other factors that might increase the chances of these problems. 

What if I have an opioid use disorder? 

Talk with your healthcare provider about your use of opioids. Studies find that those who are pregnant and take opioids in higher doses or for longer than recommended by their healthcare providers have an increased chance of pregnancy problems. These problems include poor growth of the fetus, stillbirth, preterm delivery, and the need for C-section.  

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

Prenatal ultrasounds can be used to screen for some birth defects, such as heart defects and clubfoot. 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. 

Tramadol and breastfeeding: 

Tramadol can pass into breast milk. Two studies looking at the use of tramadol for postpartum pain did not report side effects in the infants. Some babies might have problems with the amounts of tramadol in breast milk. Talk with your healthcare provider or a MotherToBaby specialist about your specific situation, as information on breastfeeding might change based on the age of your baby, the medication dosage, and/or other factors. Also, talk with your healthcare provider about your pain and treatment while breastfeeding. 

The United States Food and Drug Administration (FDA) recommends that tramadol not be used during breastfeeding due to the risk of serious problems in some breastfed infants such as being too sleepy, trouble breastfeeding, and serious breathing problems that might result in death.  

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, trouble breathing, or limpness. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Use or misuse of opioids in general has been shown to lower fertility (ability to get a partner pregnant) in men. Studies have not been done to see if a man’s use of tramadol could 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/.  

Please click here for references.  

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

What is sertraline?

Sertraline is a medication that has been used to treat depression, anxiety, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder (a severe form of premenstrual syndrome), and social phobia. Sertraline belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). A brand name for sertraline is Zoloft®.  

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.  

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

Stopping this medication suddenly can cause some people to have withdrawal symptoms. It is not known if or how withdrawal might affect a pregnancy. If you plan to stop this medication, your healthcare provider might suggest that you slowly lower the dose instead of stopping all at once. Some women might have a return of their symptoms (relapse) if they stop this medication during pregnancy. If you stop taking this medication, it is important to have other forms of support in place (such as counseling or therapy and/or a different medication, if needed). 

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

It is not known if sertraline can make it harder to get pregnant. One study found that women who take sertraline or some other SSRIs have a slightly lower chance of getting pregnant. However, some of the conditions that sertraline is used for, including depression, can make it harder to get pregnant. This makes it hard to know if the medication, the condition being treated, or other factors are affecting a person’s ability to get pregnant.  

Does taking sertraline increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies looking at SSRIs and miscarriage are limited, but overall have not shown that taking sertraline increases the chance of miscarriage. Some of the conditions that sertraline is used for, including depression, might increase the chance of miscarriage.  

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

There are reports of more than 25,000 pregnancies exposed to sertraline. Most studies have not found a higher chance of birth defects when sertraline is used in pregnancy. Other studies have suggested a higher chance of birth defects, including heart defects. However, when studies look only at pregnancies in women who have depression (or other mental health conditions), they find similar rates of birth defects when sertraline is used during pregnancy and when sertraline is stopped before pregnancy. This suggests that factors other than sertraline, such as the underlying mental health condition, factors related to the condition, or other factors, could be responsible for the increase in birth defects seen in some studies.  

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

Some studies suggest a higher 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) with the use of sertraline in pregnancy. However, research has also shown that conditions such as depression or anxiety could increase the chance of pregnancy complications if the conditions are not well treated. This makes it hard to know if the medication, the underlying health condition, or other factors are increasing the chance of these problems.  

Some studies have suggested that taking sertraline or other SSRIs during the second half of pregnancy might increase the chance of a serious lung condition in the newborn called persistent pulmonary hypertension (PPH). It is not clear if the increased chance seen in these studies is due to the SSRI or to other exposures that people who take SSRIs might have in common, such as higher rates of smoking. Other studies have not found an increased chance of PPH. In the general population, PPH happens in 1 or 2 out of every 1,000 births. If taking SSRIs does increase the chance of PPH, the overall chance is still low (less than 1 in 100, or less than 1%).   

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

The use of sertraline during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms can include irritability, jitteriness, tremors (shivering), increased crying, changes in sleep patterns, lower muscle tone (hypotonia), skin discoloration (cyanosis), problems with eating, trouble controlling body temperature, and problems with breathing (apnea). In most cases, these symptoms are mild and go away on their own within a couple of weeks. Some babies might need to stay in the nursery or NICU until the symptoms go away. Not all babies exposed to sertraline will have these symptoms. It is important that your healthcare providers know you are taking sertraline so that if symptoms do occur your baby can get the care that is best for them. 

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

Most large studies have not shown that using sertraline during pregnancy would increase the chance of behavior or learning issues for the child. Some studies looking at children whose mothers had depression (or other mental health conditions) and used sertraline during pregnancy have found differences in behavior and learning compared to children whose mothers did not have depression or use sertraline during pregnancy. However, when studies look only at children whose mothers had depression (or other mental health conditions) during pregnancy, most of the studies do not find differences in child development when the mothers used sertraline and when they did not. This suggests that differences seen in child development are more likely related to the underlying depression, other factors related to the mental health condition, or other factors, and not to the sertraline used during pregnancy.  

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

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

Breastfeeding while taking sertraline:

Sertraline gets into breast milk in small amounts. Most babies who are exposed to sertraline through breast milk do not have side effects. If you suspect the baby has any symptoms, such as being irritable or sleepier than usual, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.   

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

Some studies have shown that SSRIs might have sexual side effects, like low sexual desire or problems with ejaculation. These side effects might affect a man’s fertility (ability to get a woman pregnant). Having depression might also lower sex drive. A man’s use of sertraline is not expected to 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 Exposure at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/. 

Please click here for references.

National Pregnancy Registry for Psychiatric Medications: There is a pregnancy registry for women who take psychiatric medications, such as sertraline. For more information you can look at their website: https://womensmentalhealth.org/research/pregnancyregistry/ .

This sheet is about fever and hyperthermia in pregnancy and while breastfeeding. This information is based on research studies. It should not take the place of medical care and advice from your healthcare providers. 

What is fever and hyperthermia?

A person’s typical body temperature is around 98.6oF (37oC). Fever refers to a temporary rise in body temperature over 101oF (38.3oC).  Infection is one of the most common causes of fever. Autoimmune conditions, some cancers, and allergic reactions can also cause fever.  

Hyperthermia, or overheating, is a rise in body temperature that happens when the body absorbs more heat than it releases. The most common causes of hyperthermia are heat stroke and severe reactions to medications (malignant hyperthermia). Long exposure to hot temperatures on hot days can also cause hyperthermia. Hot days are often described as being 86oF (30oC) or higher. Extreme exercise or use of hot tubs or saunas might also cause hyperthermia.   

A raise in body temperature due to fever or hyperthermia can be of concern in early pregnancy, especially if it lasts for a long period of time. Talk with your healthcare providers to learn if a fever from an infection or illness needs to be treated with fever-reducing medications. Your healthcare provider can decide if the illness causing your fever needs to be treated as well. In some cases, hyperthermia may require immediate medical attention.  

I have fever or hyperthermia. Can it make it harder for me to get pregnant?

It is not known if having a fever or hyperthermia could make it harder to get pregnant. 

Does having a fever or hyperthermia increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Some studies suggest there might be an increased chance for miscarriage with increase in body temperature in pregnancy. Other studies have not suggested an increased chance of miscarriage. As there can be many causes of miscarriage, it is hard to know if a fever, hyperthermia, underlying illness causing a fever, or other factors are the cause of a miscarriage. 

Does having a fever or hyperthermia 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 fever / hyperthermia, might increase the chance of birth defects in a pregnancy. 

Several studies have reported a small chance for birth defects called neural tube defects (NTDs) in babies of people who had fevers or hyperthermia before the 6th week of pregnancy. Neural tube defects occur when the spinal cord or brain does not form properly. High body temperatures that happen after the 6th week of pregnancy are not expected to increase the chance for NTDs.   

A few studies have reported a small increased chance for other birth defects when fever or hyperthermia occurs in early pregnancy (before week 12), especially if the fever is untreated. These include heart defects, abdominal wall defects (an opening in the abdomen through which organs such as intestines or stomach can stick out), or oral clefts (an opening in the upper lip [cleft lip] and/or the roof of the mouth [cleft palate]). However, there are also studies that have not found these results. As there can be many causes of birth defects, it is hard to know if a fever, hyperthermia, the illness that is causing a fever, or other factors are the cause of birth defects. 

Does having a fever or hyperthermia increase the chance of other pregnancy-related problems? 

It is not known if having a fever or hyperthermia can cause other pregnancy complications. Some underlying illnesses or health conditions that may cause fever could 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). 

Does having a fever or hyperthermia in pregnancy affect future behavior or learning for the child? 

A few studies have reported a small increased chance for problems such as attention deficit disorder (ADHD) and autism when a person had a fever in pregnancy, especially if the fever was untreated. As there can be many things that affect future behavior and learning for a child, it is hard to know if a fever, underlying infection, underlying medical condition, or other factors were the cause of these problems.  

Does taking medication for fever during pregnancy cause birth defects or other pregnancy complications? 

The most common medications used to treat a fever are acetaminophen/paracetamol (Tylenol®) or ibuprofen (Motrin®, Advil®, and Nuprin®).  

Most healthcare providers consider acetaminophen to be the fever-reducer of choice during pregnancy. It has been suggested to use only as needed and at the lowest effective dose, unless your healthcare provider has instructed you to use differently. For more information, please see the MotherToBaby fact sheet on acetaminophen at https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/.  

Ibuprofen is in a class of medications called non-steroidal anti-inflammatory drugs (NSAIDs). It has been recommended to avoid the use of NSAIDs, like ibuprofen, after week 20 of pregnancy, unless your healthcare provider feels it is necessary. For more information, please see the MotherToBaby fact sheet on ibuprofen at https://mothertobaby.org/fact-sheets/ibuprofen-pregnancy/.  

Talk to your healthcare provider about the best way to treat your fever. You can contact MotherToBaby with your questions about specific medication.  

How do I prevent fever or hyperthermia during pregnancy?

Fever is usually a sign of another underlying illness or infection, including cold and flu. Limiting exposure to infections, washing hands often, and staying up to date on vaccinations are some of the best ways to prevent illness and possible fever. For more information, please see the MotherToBaby fact sheet on vaccines at https://mothertobaby.org/fact-sheets/vaccines-pregnancy/. Hot tub or sauna use during pregnancy should be limited. If you live in or are visiting a hot climate, be sure you take precautions and limit the amount of time you spend in the heat.  

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 neural tube defects or congenital heart defects. A blood test looking for a chemical called alpha fetoprotein (AFP) is also available to screen for certain types of neural tube defects. Talk with your healthcare provider about prenatal screenings or testing that are available to you.  

Breastfeeding while I have a fever or hyperthermia:

Having a fever or hyperthermia does not seem to affect the ability to breastfeed. If your fever is due to an illness, there are likely antibodies in the breast milk to help lower the chance that the baby will get sick. Be sure to wash your hands often and wear a mask or try not to breathe directly on the baby’s face while nursing. For more information about the use of specific medications during breastfeeding, contact a MotherToBaby expert. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Heat can affect the process of making sperm (spermatogenesis). Studies looking at high temperature to the testes have found lower sperm production, which might make it harder to get a woman pregnant. Fever in males at the time of conception or in early pregnancy, or a male’s use of fever-reducing medication, has not been associated with an increased 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 citalopram or escitalopram 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 are citalopram and escitalopram?

Citalopram is a medication that has been used to treat depression. It belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). A common brand name for citalopram is Celexa®.   

Escitalopram contains the same active medication as citalopram and acts in a similar way in the body. It has been used to treat depression and generalized anxiety disorder. Escitalopram also belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). A common brand name is Lexapro®.   

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

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. Some people might have a return of their symptoms (relapse) if they stop this medication during pregnancy. Stopping this medication suddenly can cause some people to have withdrawal symptoms. If you plan to stop this medication, your healthcare provider might suggest that you slowly lower the dose instead of stopping all at once.  

I take citalopram or escitalopram. Can it make it harder for me to get pregnant? 

It is not known if citalopram or escitalopram can make it harder to get pregnant. Studies in animals suggest that citalopram might lower fertility (ability to get pregnant).  

Does taking citalopram or escitalopram increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. A study on citalopram and escitalopram did not find an increased chance of miscarriage in people taking these medications.   

Does taking citalopram or escitalopram 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 citalopram or escitalopram, might increase the chance of birth defects in a pregnancy.  

There is published information about more than 15,000 pregnancies exposed to citalopram or escitalopram. Most studies have not found that these medications increase the chance of birth defects. While some studies have suggested a higher chance of heart defects or other birth defects with use of citalopram or escitalopram, most of these studies have flaws that make it hard to know if the birth defects were due to the medication or to other factors.  

Does taking citalopram or escitalopram in pregnancy increase the chance of other pregnancy-related problems?

Some studies suggest that taking citalopram or escitalopram throughout pregnancy might increase the chance of pregnancy-related problems such as preterm delivery (birth before week 37) and low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). However, research has also shown that depression could increase the chance of pregnancy complications. This makes it hard to know if the medication, the underlying depression, or other factors are the cause of these problems.  

​A study looked at a worldwide database of reports of problems that happened after using medications. The study suggested that citalopram might increase the chance of stillbirth (pregnancy loss after week 20). However, this suggestion was based on only a small number of cases of stillbirth after use of citalopram in pregnancy (7 in total), and the overall increased risk appeared to be low. Also, the reports of stillbirth did not include information about other possible causes, such as the health or past medical history of the person who was pregnant, use of other medications, or other factors during the pregnancy. This makes it hard to know if the medication or other factors were the cause of these stillbirths.  

Some, but not all, studies have suggested that when people take SSRIs such as citalopram or escitalopram during the second half of pregnancy, their babies might have a higher chance of a serious lung condition called persistent pulmonary hypertension (PPH). In the general population, PPH happens in 1 or 2 out of every 1,000 births. Some studies suggest that the overall chance of PPH when an SSRI is used in pregnancy is less than 1 out of every 100 births (less than 1%). 

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

The use of citalopram or escitalopram during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms can include irritability, jitteriness, tremors (shivering), constant crying, or changes in sleep patterns. Problems with eating, controlling body temperature, or breathing can also happen. In most cases, these symptoms are mild and go away within a couple weeks with no treatment. Some babies might need to stay in the nursery or NICU until the symptoms go away. Not all babies exposed to citalopram or escitalopram will have symptoms. It is important that your healthcare providers know you are taking citalopram or escitalopram so that if symptoms occur your baby can get the care that is best for them. 

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

One study followed 11 babies exposed to citalopram during pregnancy. At one year of age, there was no difference in their development compared to children who were not exposed to citalopram. Studies on the use of SSRIs in pregnancy and the chance of attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) in children have had mixed results. However, most studies do not find an increased chance of ADHD or ASD in children exposed to SSRIs during pregnancy after considering the possible role of other factors, such as family history of these conditions.  

Breastfeeding while taking citalopram or escitalopram:

Citalopram and escitalopram get into breast milk in small amounts. There have been a few case reports of sleepiness and weight loss in infants. Most studies have not reported harmful effects, or differences in intellectual development, in babies exposed to citalopram or escitalopram through breast milk. If you suspect the baby has any symptoms, such as being very sleepy (hard to wake for feeding), poor feeding, or poor weight gain, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Citalopram, escitalopram, and other SSRIs have been reported to cause some sexual side effects in men, such as lower sexual desire or problems with ejaculation. There are several case reports of effects on sperm quality after long-term use of citalopram or escitalopram. These effects could lower men’s fertility (ability to get a partner pregnant). Sperm quality improved when the medication was stopped. 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.

National Pregnancy Registry for Psychiatric Medications:

There is a pregnancy registry for women who take psychiatric medications, such as citalopram and escitalopram. For more information you can look at their website: https://womensmentalhealth.org/research/pregnancyregistry/.