This sheet is about exposure to fentanyl 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 fentanyl? 

Fentanyl is an opioid medication. Opioids are sometimes called narcotics. Fentanyl is used to treat pain and is often given during and after surgery. Brand names of fentanyl include Abstral®, Actiq®, Duragesic®, Fentora®, Ionsys®, Lazanda®, Sublimaze®, and Subsys®. 

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. 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 fentanyl 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 fentanyl be done slowly, and under the direction of your healthcare provider. 

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

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

Does taking fentanyl increase the chance for miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done to see if fentanyl increases the chance for miscarriage. As there can be many causes of miscarriage, including surgery, it is hard to know if a medication, the medical condition, or other factors (such as a surgical procedure) are the cause of a miscarriage.  

Does taking fentanyl 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 fentanyl, might increase the chance of birth defects in a pregnancy. The majority of studies have not found that fentanyl would significantly increase the chance of birth defects above the background risk.  

There is one small case series on 10 infants born to people who had fentanyl use disorder (using fentanyl without a prescription) who were born with similar birth defects, such as: small head size (microcephaly), smaller body size than expected, similar facial features (short nose, small chin, thin upper lip, drooping of upper eyelid (ptosis), cleft palate (an opening in the roof of the mouth), feet abnormalities (foot turns inward (club foot) or rounded bottom of foot (rocker bottom feet), toes fused together (syndactyly)), and short, broad thumbs. These features are similar to those seen in another medical condition called Smith-Lemli-Opitz syndrome. Smith-Lemli-Opitz syndrome is caused by a gene change that lowers cholesterol in the body. Cholesterol is very important for a fetus to grow and develop in pregnancy. This case review suggested that fentanyl misuse might affect levels of cholesterol and might explain the similar features noted. This case series has limitations, which does not allow a firm connection to be linked to fentanyl misuse and the findings in these 10 infants. For example, the authors did not report how much fentanyl was used, the timing of exposure in pregnancy, or if the fentanyl was contaminated or laced with other ingredients. In addition, fentanyl was not the only drug exposure reported for these infants. This means it is not known if fentanyl, other exposures, or a combination of factors were the reason for the physical features discussed in the case series.  

Some studies that look at exposure to any opioid (not just fentanyl) suggest that opioids in general might be associated with birth defects. Based on these studies, if there is an increased chance for birth defects with opioid use, it is likely to be small. 

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

It is not known if fentanyl can cause 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).  

Studies involving women who often use some opioids during their pregnancy have found an increased chance for pregnancy-related problems, including poor growth of the baby, 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 heroin or who are using prescribed opioid medication in greater amounts or for longer than recommended by their healthcare provider. Use of an opioid close to the time of delivery can result in withdrawal symptoms in the baby (see the section of this fact sheet on neonatal opioid withdrawal syndrome). 

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

Neonatal opioid withdrawal syndrome (NOWS) is the term used to describe withdrawal symptoms in newborns from exposure to opioid medication(s) during pregnancy. NOWS symptoms can include irritability, crying, sneezing, stuffy nose, poor sleep, extreme drowsiness (very tired), yawning, poor feeding, sweating, tremors, seizures, vomiting, and diarrhea. Most often, symptoms of NOWS appear 2 days after birth and may last more than 2 weeks. The chance that NOWS will 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. 

Temporary problems with breathing or heart rate have been reported in some newborns following the use of fentanyl for pain at delivery. Longer exposure to fentanyl during pregnancy might result in NOWS. 

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

Short-term use of fentanyl during surgery or for pain after surgery during pregnancy is not expected to cause learning or behavior problems for the child. It is not known if longer use of fentanyl in pregnancy increases the chance for 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 the medication exposure or other factors that can 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 for 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. 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. 

Fentanyl and breastfeeding:  

Speak to your healthcare provider about your pain and medications that may be used while you are breastfeeding. Fentanyl can pass into breast milk. Babies might have problems with the amounts of fentanyl in the 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.  

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.  

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

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

Studies have not been done to see if fentanyl could affect a man’s fertility (ability to get partner 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. 

This sheet is about having a COVID-19 infection in pregnancy and while breastfeeding. This information is based on available published research studies. It should not take the place of medical care and advice from your healthcare provider.

What is COVID-19?

COVID-19 (Coronavirus Disease 2019) is an illness caused by a virus called SARS-CoV-2. The virus spreads mostly by close person-to-person contact. When an infected person breathes, talks, coughs, or sneezes, the virus can spread to others who are nearby.

The most common symptoms of COVID-19 include fever, cough, and shortness of breath. Other symptoms might include chills, muscle or body aches, headache, sore throat, new loss of taste or smell, runny nose, nausea or vomiting, and diarrhea. Some people have only mild symptoms or no symptoms at all (are asymptomatic), but they could still spread the virus to other people.

Women who are pregnant or were recently pregnant have a higher chance of getting very sick if they get COVID-19. Studies have shown higher chances of hospitalization, admission to the intensive care unit (ICU), and death from COVID-19 during pregnancy.

How can I help prevent getting COVID-19?

Staying up to date with recommended COVID-19 vaccines is the best way to protect yourself and others from COVID-19. MotherToBaby has fact sheets about COVID-19 vaccines at https://mothertobaby.org/fact-sheets/covid-19-mrna/ and https://mothertobaby.org/fact-sheets/covid-19-protein-subunit-vaccine/.

Other ways to help protect yourself and others include wearing a mask in public, avoiding large indoor gatherings, avoiding contact with people who might have COVID-19, and washing your hands often. The Centers for Disease Control and Prevention (CDC) has information about prevention at https://www.cdc.gov/covid/prevention/index.html.

What should I do if I get sick with COVID-19 while I am pregnant?

If you are pregnant and have symptoms of COVID-19 or test positive for COVID-19, be sure to tell your healthcare team. Your healthcare provider might recommend an antiviral medication to help lower the chance of getting very sick. Antiviral medications work best if taken early in the course of the illness. MotherToBaby has a fact sheet about one kind of antiviral medication used for COVID-19 at https://mothertobaby.org/fact-sheets/nirmatrelvir-ritonavir-paxlovid/. You can also talk to your healthcare provider about the best way to treat symptoms such as fever (see the section of this fact sheet about birth defects and fever for more information). While you are sick, stay home and avoid close contact with others to help prevent passing the virus to other people.

I have COVID-19. Can it make it harder for me to get pregnant?

It is not known if having COVID-19 can make it harder to get pregnant.

Does having COVID-19 increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies on COVID-19 infections in pregnancy have not suggested a higher chance of miscarriage compared to the general population.

Does having COVID-19 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 COVID-19, might increase the chance of birth defects in a pregnancy. Some studies have observed higher rates of some kinds of birth defects in infants born to women with a COVID-19 infection in pregnancy. Other studies have not found a higher chance of birth defects. Overall, the research does not find a clear link between COVID-19 and any specific birth defect or pattern of birth defects.

Fever is a possible symptom of COVID-19. A high fever in the first trimester can increase the chance of certain birth defects. Acetaminophen has been recommended to reduce fever in pregnancy. If you get sick with COVID-19 or any other illness and develop a fever, talk with your healthcare provider to confirm if taking acetaminophen is okay for you. For more information about fever and pregnancy, see the MotherToBaby fact sheet about hyperthermia at https://mothertobaby.org/fact-sheets/hyperthermia-pregnancy/.

Does having COVID-19 increase the chance of other pregnancy related problems?

Studies have shown that women who are pregnant or recently pregnant and get COVID-19 have higher chances of becoming very sick, being admitted to intensive care, and needing to be put on a ventilator (machine that helps you breathe). Some studies have also reported a higher chance of death. The chance of these outcomes can be higher among women who also have other underlying health conditions, such as obesity, pre-pregnancy diabetes, and/or chronic hypertension. Just as in the general population, pregnant women who are up to date on COVID-19 vaccines are less likely to get infected, and less likely to get severely ill, be hospitalized, or die from a COVID-19 infection.

Studies have reported higher chances of pregnancy-related problems following COVID-19 infection in pregnancy, including preterm delivery (birth before 37 weeks of pregnancy), stillbirth, preeclampsia (dangerously high blood pressure), blood clots, and the need for an emergency c-section. Some studies suggest the virus can infect the placenta (a condition called placentitis) or cause changes to the placenta, which can lead to problems with how well the placenta works to support the pregnancy and fetal growth and development. Having COVID-19 might also make it harder to manage other health conditions that are common in pregnancy, such as other infections or high blood pressure. Women who are up to date with COVID-19 vaccines in pregnancy are less likely to experience pregnancy complications from a COVID-19 infection than women who are not up to date.

Can the virus that causes COVID-19 pass to the fetus during pregnancy or at the time of delivery?

The virus can pass from a woman who is pregnant to the fetus during pregnancy, but this appears to be rare. The chance of the baby getting the virus during or soon after birth might be higher if the pregnant woman has an active infection at the time of delivery. Most infants who test positive soon after delivery have only mild or no symptoms and fully recover from the virus. Severe illness might be more likely in infants who are born preterm or have other health problems.

Does having COVID-19 in pregnancy affect future learning or behavior for the child?

Studies have looked at the development of children born to women who had COVID-19 in pregnancy. A few studies have reported a higher chance of issues related to motor (movement) skills and speech and language in children up to 2 ½ years of age. Other studies have found no differences in development, learning, or behavior up to 2 years of age. Since many factors can affect children’s development (such as their home and school environment and other possible exposures in pregnancy), it is not clear if having COVID-19 in pregnancy affects long-term development in children.

Breastfeeding while having COVID-19:

The virus that causes COVID-19 has not been found to pass into breast milk. There have not been any reported cases of infants getting COVID-19 through breast milk. Women are often encouraged to continue breastfeeding or providing breast milk even when they are sick with a virus, such as the flu.

Women who are breastfeeding while sick with COVID-19 can help prevent passing the virus to their babies by washing their hands frequently and wearing a mask while nursing. They can also consider pumping milk for someone else to feed their baby while they recover. CDC has information on COVID-19 and breastfeeding at https://www.cdc.gov/breastfeeding-special-circumstances/hcp/illnesses-conditions/covid-19.html. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a man has COVID-19, could it affect fertility or increase the chance of birth defects?

A COVID-19 infection can cause a temporary decrease in the number and motility (movement) of sperm in some men. These changes in sperm could affect fertility (ability to get a woman pregnant). In most cases, the sperm are expected to return to normal after full recovery from the infection. In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet on Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

This sheet is about exposure to methadone 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 methadone? 

Methadone is an opioid medication. Opioids are sometimes called narcotics. Methadone has been used to treat opioid use disorder (to help people stop using heroin or opioid medications) and pain.  

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

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

Can I take methadone to treat opioid use disorder during pregnancy?  

Methadone has been used to treat opioid use disorders in pregnancy since the early 1970s. Studies have found that following the treatment plan for opioid use disorder can help increase the chances of a healthy pregnancy. People who stop taking the medication used to treat opioid use disorder have an increased chance of relapse (misusing opioids again). Misusing opioids (using in greater amounts than recommended by a healthcare provider or using an opioid without a prescription) increases the chance of pregnancy complications.  

Because of how the body changes during pregnancy, your healthcare provider might talk with you about changing your methadone dose during the pregnancy. 

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

Taking methadone may make it harder to get pregnant.   

Does taking methadone increase the chance of miscarriage?  

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

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

It is not known whether methadone can increase the chance of birth defects. Some studies have not found a higher risk, while others suggested a possible increase when methadone is used in the first trimester. Two studies found a slightly higher chance of a small, recessed jaw (Pierre Robin sequence). However, other exposures were also present, making it hard to know what caused this outcome 

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

Some studies have found higher chances of preterm delivery (birth before week 37) and low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth) when methadone is used during pregnancy. This higher chance is found when methadone use is compared to someone who did not take opioids at all. These outcomes might be more likely if someone takes more methadone than their healthcare provider recommends, or if someone is using methadone without a prescription. 

Taking opioids in higher amounts or for longer than recommended by a healthcare provider can increase the chance of poor growth of the fetus, stillbirth, preterm delivery, and C-section.  

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

Neonatal opioid withdrawal syndrome (NOWS) is the term used to describe withdrawal symptoms in newborns after exposure to opioids during pregnancy. NOWS symptoms can include irritability, crying, sneezing, stuffy nose, poor sleep, extreme drowsiness (very tired), yawning, poor feeding, sweating, tremors, seizures, vomiting, and diarrhea. Most often, symptoms of NOWS appear 2 days after birth and may last more than 2 weeks. The chance that NOWS will 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. For methadone, NOWS is more likely if high amounts of methadone are taken late in pregnancy. 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 methadone in pregnancy affect future behavior or learning for the child? 

Some studies, including one that followed children up to 3 years old, did not find differences in development in children who were exposed to methadone during pregnancy compared to those who were not. Other studies on methadone and opioids as a general group have found problems with learning and behavior in children exposed during pregnancy. This includes one that followed children up to 4 years old. However, many of these children also had other exposures during pregnancy. It is hard to tell if the reported outcomes are due to medication(s), environment, or other factors.   

Breastfeeding while taking methadone: 

Talk with your healthcare provider about why you are taking methadone and medications that can be used while you are breastfeeding. Methadone can pass into breastmilk. The amount of methadone that gets into breast milk varies, based on the dose and someone’s personal ability to metabolize (break down) the medication. Taking up to 100 mg of methadone per day is not expected to cause problems for most healthy, full-term breastfed babies who were already exposed to methadone during pregnancy. Some studies have found that babies who were exposed to methadone during pregnancy and are breastfed have shorter hospital stays, less need for NOWS treatment, and shorter treatment than those who are not breastfed. Talk with your healthcare provider or a MotherToBaby specialist about your medication. The chance of side effects can depend on factors like your baby’s age, your dose, and other individual circumstances. 

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

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

Taking opioids, including methadone, for a long time may affect men’s fertility. It is not known if a man’s use of methadone could increase the chance of birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.     

Please click here for references.

This sheet is about exposure to carbamazepine 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 carbamazepine?

Carbamazepine is a medication that has been used to control seizures. It has also been used to treat bipolar disorder, schizophrenia, and pain disorders. A brand name for carbamazepine is Tegretol®.

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. If you have been taking carbamazepine and you suddenly stop taking it, you could experience a return of your symptoms (relapse). Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.

Carbamazepine might make hormonal contraception (birth control) not work as well. If you are taking carbamazepine and do not want to become pregnant, talk to your healthcare provider about effective ways to prevent pregnancy.

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

It is not known if carbamazepine can make it harder to get pregnant. Women who use seizure medications for a long time might not have regular periods, which might make it harder to get pregnant.

Does taking carbamazepine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. A few studies have reported slightly more miscarriages among women taking carbamazepine during pregnancy, while other studies have not reported this finding. As there can be many causes of miscarriage, it is hard to know if a medication, the medical condition being treated, or other factors are the cause of a miscarriage.

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

Taking carbamazepine in early pregnancy can increase the chance of neural tube defects. A neural tube defect happens when the spinal cord or the skull do not form properly. The most common type of neural tube defect is spina bifida (an opening anywhere along the spine). In the general population, the chance of a neural tube defect happening in a pregnancy is less than 1 in 1000 (less than 1% chance). For someone taking carbamazepine, the chance of a neural tube defect might increase to about 1 in 100 (1% chance). In the general population, taking folic acid before and during early pregnancy has been shown to lower the chance of neural tube defects. If you take carbamazepine, your healthcare provider might recommend that you take extra folic acid before and during pregnancy.

Other studies on carbamazepine have reported a higher chance of other major birth defects, such as heart or kidney defects, hypospadias (opening of the penis is on the underside instead of at the tip), and cleft lip and/or palate (opening in the upper lip or the roof of the mouth). Some studies have also suggested an increased chance of minor birth defects, such as a small nose, greater distance between the nose and upper lip, small fingernails and toenails, and smaller head size. The chance of birth defects might be higher with higher doses of carbamazepine. Since some of the conditions that carbamazepine is used to treat (like epilepsy) can also increase the chance of birth defects, it is hard to know if the medication, the condition being treated, or other factors are the cause of a birth defect.

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

It is not known if carbamazepine 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). Some studies have suggested an increased chance of poor growth of the fetus. Some of the conditions that carbamazepine is used to treat can also increase the chance of pregnancy-related problems.

Taking carbamazepine during pregnancy can lower vitamin K levels in the fetus and cause bleeding problems in some newborns. People who are pregnant and taking carbamazepine should talk with their healthcare providers about taking vitamin K supplements near the end of pregnancy. You can also talk with your child’s healthcare provider before delivery about giving your baby a vitamin K supplement at birth.

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

It is not known if carbamazepine can increase the chance of behavior or learning issues for the child. Some studies have found a small increased chance for speech delay or lower IQ scores in children who also have minor facial defects after exposure to carbamazepine during pregnancy. Other studies have found no differences in child development or intelligence.

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

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

Breastfeeding while taking carbamazepine:

Carbamazepine gets into breast milk in small amounts. Most breastfeeding children have not had reported side effects. Breastfeeding while taking just carbamazepine (no other medications) has not been shown to affect child growth or development. If you suspect the baby has any symptoms of jaundice (yellowing skin and eyes), drowsiness, or poor weight gain, contact the child’s healthcare provider. If needed, healthcare providers can measure the levels of carbamazepine in a child’s blood. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

It is not known if carbamazepine could affect men’s fertility (ability to get a woman pregnant) or increase the chance of birth defects. Small studies have suggested that carbamazepine might affect sperm production, which might make it harder to conceive a pregnancy. 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 alcohol 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 alcohol? 

Alcohol is the ingredient in beer, malt liquor, wine, and spirits (“hard liquor”) that can cause feelings of being “buzzed” or drunk. Alcohol can be found in some canned and bottled beverages such as hard lemonade, hard iced tea and others. Alcohol is also an ingredient in some over the counter and prescription medications such as cough syrup, liquid vitamins and others. Alcohol can be listed in products as ethanol, ethyl alcohol or alcohol. 

One standard serving of beer (12 ounces), malt liquor (8 ounces), wine (5 ounces), and spirits (1.5 ounces) all contain similar amounts of alcohol. Medications and liquid vitamins might contain from 5% alcohol to 12% or more. 

The measurement of the amount of alcohol in the blood is called blood alcohol concentration (BAC). Binge drinking has been defined as a pattern of drinking alcohol that results in a BAC of 0.08% or more. This typically happens if a female has 4 or more drinks in about 2 hours. (For males, it is typically 5 or more drinks within about 2 hours). Heavy alcohol use in females has been defined as consuming 4 or more drinks on any day or 8 or more drinks per week. (For males, it has been defined as consuming 5 or more drinks on any day or 15 or more per week.) While this can vary, it is recommended to avoid all alcohol use in pregnancy. 

Help is available: Talk with your healthcare provider as soon as possible about your drinking. They can go over what resources are available to help you stop. If you do not have a healthcare provider or cannot get a hold of them and need help quitting, there is free help available. Call 800-662-HELP (4357) or visit https://alcoholtreatment.niaaa.nih.gov/. 

Can I drink beers labeled “no-alcohol” or “low-alcohol” during pregnancy?  

Beers labeled “no-alcohol” or “low-alcohol” might contain higher levels of alcohol than listed the label. For this reason, these beverages should be avoided in pregnancy. 

I drink alcohol. Can it make it harder for me to get pregnant?  

It is not known if drinking alcohol can make it harder to get pregnant. Some research raises concerns about heavy drinking and fertility (ability to get pregnant).  

Does drinking alcohol increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies on the chance of miscarriage with alcohol exposure during pregnancy have had mixed results. Some studies have found an increased chance of miscarriage and others have not. As there can be many causes of miscarriage, it is hard to know if alcohol, a medical condition being treated (such as depression), or other factors (such as age, health, other exposures, such as cigarettes) are the cause of a miscarriage.  

Does drinking alcohol 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 alcohol, might increase the chance of birth defects in a pregnancy.  

Drinking alcohol in pregnancy can cause Fetal Alcohol Spectrum Disorder (FASD). FASD includes a range of effects related to alcohol exposure in pregnancy, from physical birth defects (including defects of the heart, kidneys, and bones) to changes in brain development. These effects can range from mild to severe. Depending on the specific effects or combination of effects, healthcare providers use different terms to describe different kinds of FASD. 

The most severe form of FASD is Fetal Alcohol Syndrome (FAS). Children with FAS have a pattern of birth defects that include specific facial features, a smaller head and body size, and effects on brain development that can cause significant challenges in learning and behavior. 

The chance of FASD depends on how much alcohol is consumed during pregnancy, how often drinking occurs, and other factors such as genetics and nutrition. The risk can vary even for the same person across different pregnancies. Research has shown that daily drinking and binge drinking are associated with a higher risk of FASD, while the effects of smaller amounts of alcohol exposure are less certain. 

I just found out I am pregnant and last weekend I had a beer. Will my baby have FASD? 

Having a single serving of alcohol one time is much less concerning than heavy or binge drinking and is considered less likely to cause alcohol-related problems for the baby. However, it is recommended that you avoid further use of alcohol during your pregnancy. 

Does drinking alcohol in pregnancy increase the chance of other pregnancy-related problems? 

Drinking alcohol might increase the chance of preterm delivery (birth before week 37) and for the fetus to be smaller than expected. Studies have reported higher rates of stillbirth among people who drink alcohol during pregnancy. 

If I drink alcohol in pregnancy, will it cause withdrawal symptoms in my baby after birth? 

The use of alcohol late during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms of withdrawal can include involuntary shaking movements (tremors), increased muscle tone, restlessness, and excessive crying. It is important that your healthcare providers know about your alcohol use so that if symptoms occur your baby can get the care that is best for them. 

Does drinking alcohol during pregnancy affect future behavior or learning for the child?  

Prenatal alcohol exposure is a leading cause of problems with brain development in the United States. The effects of alcohol on brain development include problems with learning and memory, speech and language, aggression, attention, controlling emotions (tantrums, mood issues, impulsivity, communication, depression/anxiety), and problems with daily life skills such as bathing and playing with others.  

Talk to your baby’s healthcare provider about any alcohol use during pregnancy. They can check your baby after birth for possible effects and continue to watch for learning or behavior concerns as your child grows. While FASD cannot be cured, early diagnosis and support can help children do better. Your child’s healthcare provider can also help connect you with services and resources for families affected by alcohol exposure during pregnancy. 

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

There are no tests available to diagnose FASD during pregnancy. Prenatal ultrasounds can be used to screen for some birth defects, such as heart or kidney 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 drinking alcohol: 

Alcohol gets into breast milk. The amount of alcohol in breast milk is about the same as in the blood. Alcohol passes back and forth between the bloodstream and the breast milk. Only time can lower the amount of alcohol in breast milk. Pumping and discarding milk, drinking water, taking caffeine, or exercising do not help the body get rid of alcohol faster. It takes about 2 to 2.5 hours for each standard drink to clear from breast milk. Wait another 2-2.5 hours per drink for each additional drink. If needed, pumping during this time can help you stay comfortable and keep up your milk supply. Discarding this pumped milk will help to avoid exposing the baby to any alcohol in the milk. Drinking alcohol can also make it harder for the body to make milk.  

The infant brain continues to grow after birth. Effects on child development from alcohol in breast milk are not well studied. One study suggested problems with motor development following exposure to alcohol in breast milk, but other studies did not show the same results. Some reports found that babies exposed to alcohol through breast milk might eat less and/or have changes in their sleeping patterns. If you suspect the baby has any symptoms, contact the child’s healthcare provider.  

Having more than one drink per day is not recommended while breastfeeding. However, since breastfeeding has known benefits for the baby, talk with your baby’s healthcare provider about how much and how often you drink so they can help you weigh the risks and benefits of continuing to breastfeed. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Some studies have shown that drinking alcohol lowers men’s fertility (ability to get a partner pregnant). Men’s exposure to alcohol is not known 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 Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.  

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