This sheet is about exposure to oxcarbazepine in pregnancy or while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider.

What is oxcarbazepine?

Oxcarbazepine is a medication that has been approved for the treatment of partial seizures. It has also been used to treat migraine, symptoms of dementia, epilepsy, trigeminal neuralgia (nerve pain in the face) and bipolar disorder. Some brand names for oxcarbazepine are Trileptal^® and Oxtellar XR^®.

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. Having a seizure while pregnant could be harmful to the woman who is pregnant as well as the pregnancy. Women who have bipolar disorder and stop taking their medication are at increased risk for episodes of depression or mania that may be harmful to both the woman who is pregnant and the fetus.

Women should discuss their options for treatment, including medications, with their healthcare providers before getting pregnant when possible. Women who want to become pregnant should also discuss taking a folic acid supplement with their healthcare providers.

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

Studies have not been done in humans to see if oxcarbazepine can make it harder to get pregnant. Having a seizure disorder, as well as long-term use of seizure medications, might make it harder to get pregnant.

Does taking oxcarbazepine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. One study did not find a higher rate of miscarriage among 337 women with epilepsy who took oxcarbazepine compared to those with epilepsy who took other medications.

Does taking oxcarbazepine 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. Animal studies suggest that oxcarbazepine might increase the chance of birth defects. However, reports on almost 2,600 human pregnancies have not suggested a significantly increased chance of birth defects when oxcarbazepine is used. The chance for birth defects might increase when other anticonvulsant medications are used with oxcarbazepine.

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

Animal studies have suggested that oxcarbazepine might increase the chance of lower birth weight. One human report also found low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth) in 7 out of 8 newborns exposed to oxcarbazepine in pregnancy. However, this report also found that low birth weight was more common among infants born to women with epilepsy. Another study of 94 infants did not suggest that exposure to oxcarbazepine at any point in pregnancy increased the chance of low birth weight.

In rare cases, taking anticonvulsant medications during pregnancy, including oxcarbazepine, can cause bleeding problems in the newborn due to low vitamin K levels. Women taking oxcarbazepine in pregnancy should talk with their healthcare providers about taking vitamin K supplements near the end of their pregnancies. They can also talk to their child’s pediatrician before delivery about giving the newborn a vitamin K supplement at birth.

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

It is not known if oxcarbazepine can cause withdrawal symptoms in a baby after birth. There are 2 case reports of newborns exposed to oxcarbazepine in pregnancy who had possible withdrawal symptoms after delivery. The symptoms went away after 9 to 12 days and included poor feeding, tremors, irritability, sneezing, and a high-pitched cry. Two case reports are not enough to know if oxcarbazepine was the cause of these symptoms. In contrast, a study of 94 infants exposed to oxcarbazepine at any point in pregnancy did not find an increased risk for withdrawal symptoms compared to infants not exposed to oxcarbazepine.

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

It is unclear if using oxcarbazepine in pregnancy can increase the chance of behavior or learning issues in children. One study looking at women taking anticonvulsant medications during pregnancy (only 10 took oxcarbazepine) found delayed verbal skills in infants evaluated at age 7 months. Another study that evaluated children at ages 6-14 years suggested an increased chance of intellectual disability after prenatal exposure to anticonvulsant medications including oxcarbazepine. However, other studies have found no differences in neurodevelopment, learning ability, or need for speech therapy in children exposed to oxcarbazepine compared to children exposed to some other anticonvulsant medications or those not exposed to these medications at all.

Breastfeeding while taking oxcarbazepine:

Oxcarbazepine passes into breast milk. Eleven case reports found very low levels of the medication in the blood of breastfed infants. Seventeen case reports describe healthy children with no side effects after being exposed to oxcarbazepine through breast milk. If you suspect the baby has any symptoms (being very sleepy, unable to wake for feeds, 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 oxcarbazepine, could it affect fertility or increase the chance of birth defects?

It is not known if taking oxcarbazepine can affect a man’s fertility (ability to get a woman pregnant). Men who have epilepsy might have reduced sperm quality and sexual function. This makes it hard to know if effects on a man’s sexual function and fertility are related to the medication, to the underlying condition, or other factors. 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 on Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references

North American Antiepileptic Drug (AED) Pregnancy Registry: There is a pregnancy registry for women who take antiepileptic medications, such as oxcarbazepine. Please see the registry website for more information: https://www.aedpregnancyregistry.org/introduction/

This sheet is about rheumatoid arthritis 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 rheumatoid arthritis?

Rheumatoid arthritis (RA) is a type of arthritis that mainly affects joints but can also affect other parts of the body. It is an autoimmune condition, meaning the immune system does not work the way it should, causing inflammation (swelling). Symptoms can include swelling, stiffness, discomfort, pain, and sometimes limited movement. Many people with RA might also have some symptoms that do not involve joints like fatigue, loss of appetite, and low-grade fevers (temperature above normal, but below 100.4).

I have rheumatoid arthritis and am thinking of getting pregnant. Is there anything I need to know?

Talk with your healthcare providers about getting pregnant and your condition. Many women with RA take medication to control the inflammation and prevent or reduce joint damage. It is important to talk with your healthcare providers about your medications and the best treatment options before trying to get pregnant. People with RA can have a higher chance of problems during pregnancy. If RA is well controlled for 3-6 months before getting pregnant, the chance for pregnancy complications is usually lower than in people with more active RA.

I have rheumatoid arthritis. Can it make it harder for me to get pregnant?

It might take longer for some women with RA to get pregnant. It is not clear if this is related to the RA itself, the severity of the disease, the medications used for treating RA, or other factors. In some studies, people with RA took longer to get pregnant than those without RA; however, many experts believe that the ability to conceive is not different from people without RA.

Will pregnancy affect my rheumatoid arthritis symptoms?

Studies suggest that up to 50% of pregnant people with RA experience symptom-relief over the course of pregnancy. It is unknown why some people experience relief and others do not.

Does having rheumatoid arthritis increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Most studies have found that rates of miscarriage for people with RA are similar to rates for people without RA.

Does having rheumatoid arthritis 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 RA, might increase the chance of birth defects in a pregnancy.

There is no evidence that having RA will increase the chance of having a baby with a birth defect. While most medications used to treat RA do not increase the chance of birth defects, some might. This is why it is best to review your medications with your prescribing healthcare provider before you get pregnant, if possible.

I just found out that I am pregnant. Should I stop taking my medication(s)?

Talk with your healthcare providers before making any changes to how you take your medication(s). Pregnancies are more successful when RA is well controlled, and it is important for your health and the health of the pregnancy. Because some medications (such as methotrexate or leflunomide) might be avoided during pregnancy, it is important to contact your healthcare provider as soon as possible to talk about what treatment is best for you.

Does having rheumatoid arthritis increase the chance of other pregnancy-related problems?

People with poorly controlled RA have a higher chance for preterm delivery (delivery before 37 weeks of pregnancy) and for babies to have low birth weight or be smaller than usual. Earlier delivery and lower birth weight increase the chances for health problems in a newborn. RA flares and inflammation can also increase the chance for pregnancy complications like preterm delivery and preeclampsia (a dangerous rise in blood pressure and increase of protein in the urine). C-sections have also been reported more often among women with moderate to high disease activity at time of delivery.

Does having rheumatoid arthritis in pregnancy affect future behavior or learning for the child?

It is not known if having rheumatoid arthritis can affect future learning or behavior for the child. Some studies have suggested a possible association with neurodevelopmental disorders.

Breastfeeding while I have rheumatoid arthritis:

Many women with RA who want to breastfeed are generally able to do so. Many medications that are used to treat RA can be used when breastfeeding. It is important to find out about your specific medications. To find out more about specific medications, you can view MotherToBaby Fact Sheets at https://mothertobaby.org/fact-sheets-parent/ or contact a MotherToBaby specialist. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a man has rheumatoid arthritis, could it affect fertility or increase the chance of birth defects?

Limited information has not found an increased chance of birth defects or miscarriages in pregnancies where men had been taking medications for RA. Some medications used to treat RA might affect men’s fertility (ability to get a woman pregnant). Many exposures a father or sperm donor have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

MotherToBaby is currently conducting a study looking at rheumatoid arthritis and the medications used to treat RA in pregnancy. If you are interested learning more about this study, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study/.

Please click here for references.

This sheet is about having psoriasis and psoriatic arthritis in a pregnancy or 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 psoriasis and psoriatic arthritis? 

Psoriasis is a skin condition in which skin cells grow faster than usual. This can lead to dry, thick patches on the skin. Psoriasis is not contagious, so you cannot catch it from another person. While the exact causes are not known, the immune system is thought to be involved. In addition to changes to the skin, some people with psoriasis will also develop swollen and painful joints, called psoriatic arthritis (PsA). Symptoms of psoriasis and PsA can range from mild to severe. 

I have psoriasis and /or psoriatic arthritis. Can it make it harder for me to get pregnant? 

Psoriasis and PsA might affect fertility, although not all studies agree. One study did not find an increase in time to become pregnant among women with mild to moderate psoriasis. However, another study of women with moderate to severe psoriasis has suggested that ovarian reserve (the number of eggs stored in the ovaries) might be affected by psoriasis. The women with psoriasis in this study were still able to become pregnant. Effects on fertility might depend on whether symptoms are currently mild or severe, or if there are additional health conditions.  

Does having psoriasis and/or psoriatic arthritis increase the chance for miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. It is unclear if psoriasis or PsA increases the chance for miscarriage. One study that looked at 298 pregnancies in women with moderate to severe psoriasis reported that the rates of miscarriage did not differ from the miscarriage rate in the general population. Another study reported a higher rate of miscarriage after the diagnosis of PsA in 37 pregnancies compared to their pregnancies prior to the diagnosis. However, age at time of pregnancy was higher after the diagnosis of PsA, and as women age, the chance for miscarriage can also increase. This, plus the small number of pregnancies looked at, makes it hard to draw conclusions about the chance of miscarriage and PsA. 

Does having psoriasis and/or psoriatic arthritis 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 psoriasis and PsA, might increase the chance of birth defects in a pregnancy. 

An article that summarized 5 studies reported that psoriasis did not increase the chance of birth defects. Studies have not been done to see if PsA increases the chance of birth defects.  

Does having psoriasis and/or psoriatic arthritis increase the chance of other pregnancy-related problems? 

It is not known if psoriasis and/or PsA 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 reported a higher chance of pregnancy-related problems, but other studies have not.  

One study reported that women with severe psoriasis were more likely to have a baby with low birth weight, while another study among women with moderate to severe psoriasis reported that they were more likely to have a baby with a heavier birth weight. Some studies have suggested that psoriasis or PsA increases the chance of preterm delivery or pre-eclampsia. Preeclampsia is a serious pregnancy-related condition that can cause high blood pressure and problems with organs, such as the kidneys, which can lead to seizures (called eclampsia). Other studies have not reported an increased chance of these pregnancy complications.  

The chance of pregnancy complications might depend on whether the psoriasis and/or PsA symptoms are currently mild or severe. The chance for pregnancy complications can also be affected by the woman’s overall health during pregnancy. For example, a study found a higher rate of smoking, depression, diabetes, heart disease, and obesity in pregnant women with psoriasis. These factors can also increase the chance of pregnancy-related problems. This makes it hard to know if medication, the medical condition being treated, or other factors are affecting the reported results.  

Does having psoriasis and/or psoriatic arthritis in pregnancy affect future behavior or learning for the child?    

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

I am taking medication for psoriasis and/or psoriatic arthritis. Can I take my medication during pregnancy? 

For information on specific therapies, see our medication fact sheets at: https://mothertobaby.org/fact-sheets/ or contact MotherToBaby to speak with a specialist. It is important that you discuss treatment options with your healthcare providers when planning pregnancy, and as soon as you learn that you are pregnant. 

How will pregnancy affect my psoriasis and/or psoriatic arthritis symptoms? 

Healthcare providers cannot predict how a woman’s symptoms might change, if at all, during pregnancy. Women have reported symptoms that improved, stayed the same, or became worse during a pregnancy. In general, it appears that more women report that their disease symptoms improve or stay the same rather than get worse during pregnancy. However, a flare of symptoms after delivery seems to be common.  

Breastfeeding while I have psoriasis and/or psoriatic arthritis?  

There are no cautions regarding breastfeeding specific to psoriasis or PsA. For information on specific medications, see our fact sheets or contact MotherToBaby. Be sure to talk to your healthcare provider about your breastfeeding questions. 

If a man has psoriasis and /or psoriatic arthritis, can it affect fertility or increase the chance of birth defects?  

Autoimmune diseases like psoriasis might affect male fertility (ability to make healthy sperm). Certain medications used to treat psoriasis or PsA could also affect the amount of sperm produced, which could make it harder to get a partner pregnant. 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.

MotherToBaby is currently conducting a study looking at autoimmune diseases like psoriasis and psoriatic arthritis, and the medications used to treat them in pregnancy. If you are interested in learning about this study, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study/. 

This sheet is about exposure to the Tetanus, Diphtheria and Pertussis (Tdap) vaccine in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider.

What are tetanus, diphtheria, and pertussis?

Tetanus, diphtheria, and pertussis are diseases caused by bacteria.

Tetanus causes tightening of the muscles and painful muscle spasms. Even with good medical care, 10-20% of people with tetanus die from tetanus. The tetanus bacteria come from soil and animal waste. The bacteria get into the body through an open cut or sore.

Diphtheria often starts with a fever and sore throat. A thin layer (called a membrane) can form over the back of the throat and airways, making it hard to breathe. Without treatment, diphtheria is often deadly. People get the illness from other people with diphtheria through droplets when they cough or sneeze. The use of vaccines has made diphtheria uncommon in the United States, Canada, and many other countries.

Pertussis is sometimes called whooping cough. Symptoms usually start similar to those of the common cold. Severe coughing can develop over several weeks. Fast, heavy coughing can cause a high-pitched whooping sound when breathing in. People get pertussis from other people with pertussis through droplets when they cough or sneeze. In people not vaccinated, the chance of getting pertussis in a household with an infected person is 80%. Pertussis is most serious in infants. In an outbreak in 2010 in California, 10 infants died. Serious disease and the need for hospital care can happen in up to 5% of teens and adults that get pertussis.

Do these diseases cause problems in pregnancy?

Tetanus and diphtheria can be deadly to a pregnant woman and can cause the loss of the pregnancy. They could also cause preterm delivery (birth before week 37).

Pertussis infection during pregnancy has not been well studied. There were no pregnancy complications seen in 1 case series of 32 pregnant women who had pertussis late in pregnancy. Severe disease could be a risk to the health of the mother and baby. There are a few reports of problems for the baby, but it is not known if those problems were due to pertussis during the pregnancy or for other reasons. Pertussis infection can be severe for babies under age 6 months; especially in babies born premature (birth before week 37) and babies who also have other health problems.

What is the Tdap vaccine?

The Tdap vaccine protects people from getting tetanus, diphtheria, and pertussis. Childhood vaccination for these diseases does not provide lifelong protection. Some brand names of Tdap are Adacel®, Boostrix® and Daptacel®.

The Tdap vaccine is noninfectious, meaning you cannot get the diseases from the vaccine. People get the vaccine by an injection. Like any vaccine, it does not provide 100% protection against the diseases.

Why should pregnant women get the Tdap vaccine during late pregnancy?

In the past, pregnant women did not regularly get the Tdap vaccine because pertussis used to be rare in adults. However, this is no longer the case and outbreaks have been happening across the United States. It is recommended that pregnant women get the vaccine during the third trimester of pregnancy (between weeks 27-36). However, it can be given anytime during pregnancy, if needed earlier.

After getting the vaccine, the body starts to make antibodies against the bacteria that can cause these diseases. Some of these antibodies can cross the placenta (the organ that grows in the uterus during pregnancy) and reach the fetus. Receiving the vaccine in the third trimester of pregnancy can help the baby get as many antibodies as possible. After delivery, these antibodies provide some protection against pertussis until the baby can receive their own vaccines. If all household members and caregivers get the vaccine, it can lower the chance for the baby to get pertussis.

I had Tdap in my last pregnancy. Do I need it again?

It has been recommended to get the Tdap vaccine in the third trimester of every pregnancy. Discuss current recommendations with your healthcare team.

I just got the Tdap vaccine. How long should I wait until I get pregnant?

There is no recommended waiting period after getting the Tdap shot. In addition, women can get the vaccine at any time during pregnancy.

Does taking the Tdap vaccine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. The Tdap vaccine is not associated with an increased chance of miscarriage.

Does the Tdap vaccine increase the chance of birth defects?

Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Noninfectious vaccines, like Tdap, do not increase the chance for birth defects. The tetanus and diphtheria vaccine have a long history of use during pregnancy without increased risk.

Does the Tdap vaccine increase the chance of other pregnancy-related problems?

The Tdap vaccine has not been associated with a higher chance for other pregnancy-related problems, such as preterm delivery (having the baby before 37 weeks), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), preeclampsia (high blood pressure and problems with organs, such as the kidneys, which can lead to seizures), or stillbirth.

Does the Tdap vaccine in pregnancy affect future behavior or learning for the child?

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

Breastfeeding and the Tdap vaccine:

Noninfectious vaccines like Tdap are compatible with breastfeeding. If you get the vaccine while breastfeeding, it can help prevent you from getting sick and passing the illness to your baby. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a man gets a Tdap vaccine, could it affect his fertility or increase the chance of birth defects?

There is no proof that vaccines will affect sperm, and vaccines given to men do not reach the developing baby. Vaccination of others in the home will help protect the newborn from illness. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

MotherToBaby is currently conducting a study to learn more about the pertussis vaccine in pregnancy. If you are pregnant and have received the pertussis vaccine (TDAP / DTAP), and you are interested in learning more about this study, please contact MotherToBaby Pregnancy Studies at 877-311-8972 or visit https://mothertobaby.org/join-study/

Please click here for references.

Please click here for references.