This sheet is about having hepatitis C in 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 hepatitis C? 

Hepatitis C is a type of liver disease caused by infection from the hepatitis C virus. Hepatitis C virus is often called “HCV”. People can have acute (short-term) or chronic (long-term) hepatitis C.  

Acute hepatitis C happens in the 6 months after someone is exposed to HCV. Some people have no symptoms, while others might have some or all of the following symptoms: dark colored urine, red colored stool (poop), feeling tired, joint pain, nausea, stomach pain, fever, and jaundice (yellowing of the skin and eyes).  

Chronic hepatitis C is a long-term condition that happens if HCV stays in the body long-term. Chronic hepatitis C can cause liver failure and liver cancer. Not everyone who is infected with HCV will get chronic hepatitis C. 

How do you get hepatitis C?

Hepatitis C is mostly spread through blood or other bodily fluids that contain blood. Sharing items infected with HCV (such as needles, razors, nail clippers, tattoos or body piercing equipment) or coming in contact with HCV-infected body fluids through sex, blood donation, or a workplace exposure (like a hospital) can cause a person to get hepatitis C.  

How can I find out if I am infected with hepatitis C?

To find out if you have hepatitis C, your healthcare provider will take a blood sample to see if you have HCV antibodies (proteins made by your immune system after an infection). If you are found to have HCV antibodies, then you will be tested for an active HCV infection.  

The American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) have recommended that everyone who is pregnant get testing for hepatitis C. If you have been diagnosed with hepatitis C, it is important to talk with your healthcare provider as soon as possible about treatment options.  

People who have hepatitis C might not feel or look sick. It is important to get treatment for hepatitis C infections as soon as possible to prevent chronic hepatitis C and other complications.  

Can hepatitis C be passed to the fetus during pregnancy or at the time of delivery?

Hepatitis C can be passed to the fetus when someone has an active HCV infection. It can happen during pregnancy or at the time of delivery.  

When a woman passes an infection to the fetus in a pregnancy, it is called vertical transmission. Vertical transmission can happen at any time in pregnancy, but it is usually more likely to happen when the woman has the infection closer to the time of delivery.  

Some children who get HCV infections during pregnancy will get rid of the virus on their own. Others will have HCV but will not have symptoms of an infection (asymptomatic). Some children will develop symptoms of hepatitis C including hepatomegaly (liver larger than expected), fever, diarrhea, and nausea.  

I have hepatitis C. What should I talk about with my healthcare team before I get pregnant? 

It is important to talk to your healthcare team (including your obstetrician, primary care provider, and hepatologist) about plans for treating your condition before and during pregnancy, during delivery, and after delivery. If possible, talk with your healthcare team before getting pregnant. If your pregnancy is unplanned, contact your healthcare providers as soon as you find out you are pregnant.  

Things to talk about with your healthcare team include: 

• Ways to monitor your pregnancy and your hepatitis C symptoms. 
• Any medications or vitamins you should take during pregnancy.  
• Getting any necessary vaccines before and during pregnancy. Many vaccines can be given in pregnancy. For more information, please see the MotherToBaby fact sheet on vaccines at https://mothertobaby.org/fact-sheets/vaccines-pregnancy/. 
• Any other questions or concerns you have. 

I have hepatitis C. Can it make it harder for me to get pregnant? 

In a study of 27,000 women with HCV infections, there was an increased chance of infertility (trouble getting pregnant) when someone had an HCV infection.  

Does having hepatitis C increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if hepatitis C increases the chance of miscarriage. In 1 study of 36 women with HCV infections, there was no reported increased chance of miscarriage. In another study with 100 women with HCV infections, an increased chance of miscarriage was reported.  

Does having hepatitis C 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 hepatitis C, might increase the chance of birth defects in a pregnancy. It is not known if hepatitis C can increase the chance of birth defects.  

Does having hepatitis C increase the chance of other pregnancy-related problems? 

Studies have reported that having a hepatitis C infection during pregnancy can increase the chance of preterm delivery (birth before week 37), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), babies who are small for gestational age (measuring smaller than expected for their age), pre-eclampsia (high blood pressure and problems with organs, such as the kidneys), which can lead to seizures (called eclampsia), and infants spending more time in the neonatal intensive care unit (NICU).  

Does having hepatitis C in pregnancy affect future behavior or learning for the child?   

One study reported a possible link between having a hepatitis C infection and an increased chance of a child having a neurological (brain) condition, including problems with feeding, cephalohematoma (gathering of blood under the scalp), seizures, bleeding in the brain, and problems getting enough oxygen. Having these symptoms might affect behavior or learning in the future.  

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. 

Breastfeeding while I have hepatitis C:

HCV does not usually pass into breast milk. Most women can continue to breastfeed while they have hepatitis C. The CDC recommends that breastfeeding should be temporarily stopped if someone has nipples and/or areolas that are cracked and bleeding. However, it is not known if HCV can pass from the mother’s blood to the nursing infant through dry or cracked nipples. The CDC has a page on breastfeeding with hepatitis C here: https://www.cdc.gov/breastfeeding-special-circumstances/hcp/illnesses-conditions/hepatitis-b-c.html. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

If a man has hepatitis C, can it affect fertility or increase the chance of birth defects?  

Hepatitis C infection can lower the amount of sperm made, change the shape of the sperm, and lower sperm motility (how well the sperm moves). Having hepatitis C might also lower testosterone levels. These changes might affect men’s fertility (ability to get a woman pregnant). Studies have not been done to see if hepatitis C in men 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 venlafaxine 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 venlafaxine? 

Venlafaxine is a medication that has been used to treat depression, panic disorder, social phobia, and anxiety. It has also been used to treat attention deficit hyperactivity disorder (ADHD), binge eating disorder, bipolar disorder, diabetic neuropathy, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder, and tension-type headaches. Venlafaxine is sold under the brand name Effexor 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. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.  

A return of symptoms (relapse) is possible after stopping this medication. If you plan to stop this medication, your healthcare provider might suggest that you slowly lower the dose instead of stopping it all at once. Stopping this medication suddenly can cause withdrawal symptoms. It is not known what effect, if any, withdrawal can have on a pregnancy.  

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

It is not known if venlafaxine can make it harder to get pregnant. There are a few reports of women having higher levels of the hormone prolactin while taking venlafaxine. High levels of prolactin can stop ovulation (part of the menstrual cycle when an ovary releases an egg). Stopping ovulation can make it harder to get pregnant. 

Does taking venlafaxine increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. One study suggests that taking venlafaxine might increase the chance of miscarriage, while other studies have not. Research also shows that depression itself might increase the chance of miscarriage. This makes it hard to know if it is the medication, untreated or poorly treated depression, or other factors (age, health, medical conditions, other medications used) that can increase the chance of miscarriage.  

Does taking venlafaxine 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 venlafaxine, might increase the chance of birth defects in a pregnancy. While some studies suggest that taking venlafaxine during pregnancy could possibly increase the chance of birth defects, several large studies have not found a higher chance of birth defects. If there is an increased chance of birth defects above the background risk with use of venlafaxine in pregnancy, it is likely to be small.  

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

Some studies suggest a higher chance of preterm delivery (birth before week 37) when venlafaxine is used in pregnancy, while other studies do not. However, research has also shown that when depression is left untreated during pregnancy, there could be an increased chance of pregnancy complications. This makes it hard to know if it is the medication, untreated or poorly treated depression, or other factors that can increase the chance of these problems. For more information, please see our fact sheet on depression at https://mothertobaby.org/fact-sheets/depression-pregnancy/.  

One study found a higher chance of developing gestational diabetes in women taking venlafaxine during pregnancy, while a second study did not. For more information on gestational diabetes, see our fact sheet here: https://mothertobaby.org/fact-sheets/diabetes-pregnancy/.  

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

The use of venlafaxine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal and can include jitteriness, increased muscle tone, irritability, changes in sleep patterns, tremors, seizures, trouble eating, and problems with breathing. Most of the time these effects are mild and go away on their own. Some babies might need to stay in the hospital for several days to help manage the symptoms. Not all babies exposed to venlafaxine will have these symptoms. It is important that your healthcare providers know you are taking venlafaxine so that if symptoms occur, your baby can get the care that is best for them. 

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

It is not known if venlafaxine can increase the chance of behavior or learning issues for the child. One study found no difference in IQ or behavioral problems in 4-year-olds who had been exposed to venlafaxine in pregnancy compared to children whose mothers had depression but were not treated during pregnancy. A second study found a small increase in the chance of autism spectrum disorders in children exposed to venlafaxine during pregnancy. However, it is not clear whether this was related to the medication, the condition being treated, or other factors.  

Breastfeeding while taking venlafaxine: 

Venlafaxine passes into breast milk. Side effects in children who are nursing have sometimes been reported. If you suspect the baby has any symptoms (being more sleepy or irritable than usual, poor feeding, trouble with gaining weight) contact the child’s healthcare provider. If there is a concern, the child’s healthcare provider can check the amount of medication in the infant’s blood.  

Some older product labels for venlafaxine recommend women who are breastfeeding not use this medication. Newer labels suggest weighing the benefits of taking venlafaxine and the benefits of breastfeeding your child against the risks of an untreated mental health condition. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Studies have not been done in humans to see if venlafaxine could affect male fertility (ability to make healthy sperm) or increase the chance of birth defects. There are a few reports of higher levels of the hormone prolactin while taking venlafaxine. High prolactin levels in men might affect fertility. 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 measles, mumps, and rubella 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 measles, mumps, and rubella?

Measles (rubeola), mumps, and rubella (German measles, three-day measles) are viral diseases that are mostly spread from person to person through coughing and sneezing. The measles virus can stay in the air for up to two hours after an infected person has sneezed or coughed and can spread to others even when the infected person is no longer in the area. Mumps can also be spread through close contact activities (such as playing sports) and from contact with an infected person’s saliva (sharing cups, kissing, etc.). Rubella can be spread by coughing and sneezing. If a woman has rubella during pregnancy, it can be passed to the developing fetus. Serious problems can occur with these viruses, including pneumonia, meningitis, deafness, and death.

Outbreaks of measles and mumps still happen in the U.S., especially in areas where vaccination rates are not high enough to protect the population. Rubella is no longer constantly present (endemic) in the U.S. but can be brought into the country by people who get infected in other countries. Once a person has been infected with measles, mumps, or rubella, it is rare for them to get sick from the virus again.

What are the symptoms of measles, mumps, and rubella?

Measles can cause rash, high fever, cough, runny nose, and red watery eyes. A person infected with measles can spread the virus to other people from 4 days before the rash appears until 4 days after it goes away.

Mumps can cause fever, headache, muscle aches, tiredness, loss of appetite, and swelling of the salivary glands under the ears, which can cause puffy and tender cheeks and jaw. Some people who get mumps might have mild symptoms or no symptoms at all. People without symptoms can still spread the mumps virus.

Rubella can cause fever, sore throat, and a rash that usually starts on the face. Other symptoms can include headache, cough, runny nose, red eyes, and general discomfort. People with the virus can spread it to others for about 7 days before to 7 days after the rash appears. Some people who get rubella might have no symptoms but can still spread the virus to others. A pregnant woman can pass rubella to their pregnancy.

The best ways to protect yourself against measles, mumps, and rubella are to avoid others who are sick with these diseases, wash your hands well with soap and water, and to get vaccinated before getting pregnant. Other people living in the home should also be vaccinated. For more information on the MMR vaccine, please see our fact sheet here: https://mothertobaby.org/fact-sheets/measles-mumps-and-rubella-mmr-vaccine/.

I have measles, mumps, or rubella. Can it make it harder for me to get pregnant?

It is not known if measles or rubella can make it harder to get pregnant. Rarely, a mumps infection can cause inflammation in the ovaries (oophoritis). Ovaries are the organ where eggs are stored and released. Oophoritis could make it harder to get pregnant.

Does having measles, mumps, or rubella increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Infection with measles, mumps, and/or rubella during pregnancy might increase the chance of miscarriage.

Does getting measles, mumps, or rubella during pregnancy 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 getting measles, mumps, or rubella, might increase the chance of birth defects in a pregnancy. If someone gets rubella during pregnancy, the virus can pass to the fetus and cause birth defects. This is called congenital rubella syndrome (CRS). Babies affected by CRS can have hearing loss, heart defects, and cataracts (cloudy films that form over the lens of the eyes that can affect vision). Not all babies with CRS will have all these symptoms. A baby is more likely to be affected by CRS if the pregnant woman gets rubella during the first trimester of pregnancy, although infection any time in pregnancy carries a chance of CRS. Because of these concerns, women who are pregnant are usually screened early in pregnancy to be sure they have antibodies to rubella.

Having measles or mumps during pregnancy is not expected to increase the chance of birth defects.

Does having measles, mumps, or rubella during pregnancy increase the chance of other pregnancy-related problems?

If a woman has measles during pregnancy and has not had an MMR vaccine, there might be an increased chance of preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).

Available information does not suggest a significant link between preterm delivery or low birth weight and having mumps during pregnancy.

Having measles, mumps, or rubella during pregnancy might increase the chance of stillbirth (fetal death after 20 weeks). A measles or mumps infection near the time of delivery might also increase the chance of a baby being born with the infection, although this is expected to be rare.

If a rubella infection occurs between 12 and 16 weeks of pregnancy, about half of these babies are expected to be affected by CRS. Deafness is the most common complication reported with infection after the first trimester.

CRS can also cause growth issues and low birth weight. This is most likely to occur when an infection happens before 16 weeks of pregnancy.

Does having measles, mumps, or rubella during pregnancy affect future behavior or learning for the child?

It is not known if having measles or mumps can increase the chance of behavior or learning issues for the child. Having a rubella infection in pregnancy can increase the chance of developmental delay and/or intellectual disabilities in some children.

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 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 and measles, mumps, or rubella:

If you have measles, mumps, or rubella, talk to your healthcare provider about the best ways to prevent the spread of illness to your breastfed baby. If you suspect that your baby has any symptoms of measles, mumps, or rubella, contact the child’s healthcare provider right away. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a man has measles, mumps, or rubella could it affect fertility or increase the chance of birth defects?

Studies have not been done to see if measles or rubella could affect men’s fertility or increase the chance of birth defects. Having mumps might temporarily decrease the size of testicles, but this is not likely to cause infertility. Infected partners can pass these viruses to a pregnant woman through close contact. For more information on paternal exposures, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

This sheet is about having phenylketonuria (PKU) in pregnancy or 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 phenylketonuria (PKU)?

Phenylketonuria (PKU) is an inherited genetic condition. It is caused by a gene change that lowers the amount of an enzyme in the body needed to process the amnio acid phenylalanine (Phe). Phe is commonly found in food and can build up in the body of people with PKU. Build up can lead to problems with brain development and cause intellectual disability, trouble with attention, and conditions like anxiety or depression. PKU is a health condition that requires lifelong diet changes and / or treatment to avoid buildup of Phe in the body.

I have PKU and would like to get pregnant. What should I talk about with my healthcare providers?

It is very important to talk to your healthcare providers who are familiar with PKU, such as a geneticist, genetic counselor, and a metabolic dietician. The healthcare team can work with you to come up with the best way to treat your condition. Talk with your healthcare team before getting pregnant, when possible. Since half of all pregnancies are unplanned, and because many women find out they are pregnant between 5-8 weeks of pregnancy, it is important to stay on the diet and treatment even if you are not trying to get pregnant.

During pregnancy, Phe crosses the placenta (the temporary organ that develops during pregnancy and works as the blood connection between the woman who is pregnant and the fetus). Phe levels in the developing fetus can be higher than what is measured in the parent. High levels of Phe during a pregnancy can cause problems for the fetus. Getting Phe levels under control at least 3 months before getting pregnant and throughout pregnancy can reduce the chance of these problems.

The American College of Medical Genetics (ACMG) recommends that women with PKU have Phe levels ≤360 μmol/L before getting pregnant to prevent pregnancy complications and risks to the fetus. They also recommend that women with PAH deficiency who are pregnant maintain Phe levels ≤360 umol/L throughout pregnancy and in the postpartum time for the best maternal and infant outcomes. Talk with your healthcare team about your Phe levels and plans for treatment before, during, and after pregnancy.

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

It is not known if having PKU or high levels of Phe can make it harder to get pregnant.

Does having PKU increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Some studies have found that having PKU with high levels of Phe can increase the chance of miscarriage.

Does having PKU 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 published research to try to understand if a certain exposure, like PKU, might increase the chance of birth defects or other problems in a pregnancy.

Women with PKU who are pregnant and who have high levels of Phe have a higher chance of having a baby with a very small head (microcephaly) and heart defects. Women who keep their Phe levels in an appropriate range before and during the pregnancy are not expected to have a higher chance of having a baby with a birth defect. Talk with your healthcare provider about how to get to and stay at your target levels of Phe.

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

Women who keep their Phe levels in an appropriate range before and during the pregnancy are not expected to have 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).

Women who have high levels of Phe have a higher chance of having a baby that is born smaller than expected. It is also important to not let the Phe levels get too low. Some studies show that very low Phe levels (below 100 micromoles/liter) can cause growth problems as well, especially during the second and third trimesters.

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

Babies born to women with PKU and who have high Phe levels have a higher chance of having intellectual disability, behavioral problems, and seizures. Chances of long-term problems are lower if the diet is started before getting pregnant or as soon as possible once pregnancy starts. Women with PKU who start their diet after the first trimester (after 12 weeks of pregnancy) had babies who did poorer on developmental tests. It is suggested to start the special diet as soon as possible.

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

Prenatal ultrasounds can be used screen for some birth defects, such as small head size. 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.

Breastfeeding with PKU:

A woman with PKU can breastfeed. Research suggests if a baby does not have PKU, the baby’s body is expected to be able to breakdown the Phe in breast milk. It is important to remain on a special diet while breastfeeding to minimize exposure to high levels of Phe. Your healthcare provider can also measure the Phe levels in the baby to make sure they are not too high after breastfeeding.

Babies that have PKU can be breastfed. They need to be followed closely by a metabolic team (usually a dietitian and a geneticist/genetic counselor). Infant blood levels should be checked regularly to make sure that levels of Phe are not too high. Different approaches are possible. One example might be using a mix of breast milk and a special PKU formula (with low Phe levels). Be sure to talk to your healthcare providers about the best way to feed your baby, as well as all your breastfeeding questions.

If a man has PKU, can it affect his fertility or increase the chance of birth defects?

PKU might reduce a man’s fertility (ability to get a woman pregnant). Small studies suggest no increased chance of birth defects when a man has PKU. In general, exposures that men have are unlikely to increase risk 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 fluoxetine in pregnancy and while breastfeeding. This information is based on available research studies. It should not take the place of medical care and advice from your healthcare provider.

What is fluoxetine?

Fluoxetine is a medication that has been used to treat depression, obsessive-compulsive disorder (OCD), Tourette’s syndrome, bulimia nervosa, panic disorder, and premenstrual dysphoric disorder (PMDD). Fluoxetine has also been used to treat body dysmorphic disorder, hot sweats, posttraumatic stress disorder (PTSD), and Raynaud’s phenomenon. Some brand names for fluoxetine are Prozac®, Prozac Weekly®, Rapuflux®, Selfemra®, and Sarafem®. Fluoxetine belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

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. Stopping this medication suddenly can cause some people to have withdrawal symptoms. It is not known if or how withdrawal might affect 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 people 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 (e.g. counseling or therapy) and a plan to restart the medication after delivery, if needed. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.

For more information about depression or anxiety, please see our fact sheets at https://mothertobaby.org/fact-sheets/depression-pregnancy/ or at https://mothertobaby.org/fact-sheets/anxiety-fact/.

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

Fluoxetine has been studied in women having medical treatments because they were already having a hard time getting pregnant. In these studies, those who took fluoxetine got pregnant at the same rate as those who did not take fluoxetine.

Does taking fluoxetine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. A small number of studies did not find a greater chance of miscarriage when fluoxetine was used in pregnancy.

Does taking fluoxetine increase the chance of birth defects?

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 fluoxetine, might increase the chance of birth defects in a pregnancy. Fluoxetine use is not expected to increase the chance of birth defects. There are reports of over 10,000 pregnancies exposed to fluoxetine in the first trimester (when many major birth defects can happen). No pattern of birth defects has been found and most studies have not found an increased chance of birth defects related to fluoxetine use.

Some studies have suggested an increased chance of heart defects or other birth defects. However, there is no proven increased chance of birth defects directly related to fluoxetine.

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

Some studies suggest a higher chance of 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 fluoxetine in pregnancy. However, research has also shown that when conditions such as depression or anxiety are untreated or undertreated during pregnancy, there could be an increased chance of pregnancy complications. This makes it hard to know if it is the medication, the underlying condition, or other factors that might increase the chance for these problems.

Some, but not all, studies have suggested that when women who are pregnant take SSRIs during the second half of pregnancy, their babies might have an increased chance for a serious lung condition called persistent pulmonary hypertension (PPH). PPH happens in 1 or 2 out of 1,000 births. A recent report that combined results from several studies suggested the chance for PPH might be increased if an SSRI was used during pregnancy. However, it was not clear if this was due to medication exposure or to other exposures that people who take SSRIs have in common, such as higher rates of smoking. Data from studies suggest the overall chance for PPH when an SSRI is used in pregnancy is less than 1/100 (less than 1%).

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

The use of fluoxetine during pregnancy and/or in the third trimester can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms include being irritable and/or jittery, crying, tight muscles, trouble breathing, unusual sleep patterns, tremors (shivers), and/or trouble eating. In most cases symptoms are mild and go away in a few weeks with no treatment, or with only supportive care. Not all babies exposed to fluoxetine will have these symptoms. There might be a higher chance for withdrawal symptoms if other psychiatric medications are also taken with fluoxetine during pregnancy. It is important that your healthcare providers know you are taking fluoxetine so that if symptoms occur your baby can get the care that is best for them.

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

A few studies have looked at the development of children from age 16 months to 7 years and did not find differences between children who were exposed to fluoxetine during pregnancy and those who were not. Most studies found no increase in attention deficit hyperactivity disorder (ADHD) in children exposed to SSRIs like fluoxetine during pregnancy. Most studies also find that SSRIs like fluoxetine do not appear to increase the chance of autism spectrum disorders (ASD) after adjusting for factors such as maternal illness.

Breastfeeding while taking fluoxetine:

Fluoxetine gets into breastmilk and most reports find no side effects in breastfed babies. In a small number of cases, irritability, vomiting, diarrhea, and less sleep have been reported. One study noted slightly less weight gain in infants exposed to fluoxetine via breast milk; however, this would likely only be an issue if the infant’s weight gain was already a concern. One study showed that mental and physical development was normal for infants exposed to fluoxetine in breastmilk in their first year of life. If you suspect the baby has any symptoms (such as irritability, vomiting, diarrhea, trouble sleeping, or trouble gaining weight) contact the child’s healthcare provider.

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

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

Fluoxetine and other SSRIs have been reported to cause some sexual side effects, such as lower sexual desire or problems with ejaculation. This can affect a man’s fertility (ability to get a woman pregnant). Studies looking at fluoxetine in a small number of men have reported that sperm quality can be affected (but still within the normal range) with long-term fluoxetine use. The sperm quality improved when fluoxetine was stopped. 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 http://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

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