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

What is amitriptyline? 

Amitriptyline is a medication that has been used to treat depression, pain, tinnitus (noise or ringing sounds in the ear), irritable bowel syndrome, neuropathy (nerve damage) due to diabetes mellitus, and migraine headaches. Amitriptyline belongs to a class of medications known as tricyclic antidepressants. It has been sold under many different brand names, including Amaril®, Amitrid®, Elavil®, Endep®, and Vanatrip®. Amitriptyline has also been sold in combination with other medications. 

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. 

Pregnancy might affect how the body breaks down this medication. Some women might need to have their medication doses changed as pregnancy progresses.  

Some women could have a return of their symptoms (relapse) if they stop taking this medication during pregnancy. 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 some people to have withdrawal symptoms. It is not known if or how withdrawal might affect a pregnancy, 

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

Studies have not been done to see if amitriptyline could make it harder to get pregnant.  

Does taking amitriptyline increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if amitriptyline can increase the chance of miscarriage. One study suggested that amitriptyline use to treat migraines might increase the chance of miscarriage. Untreated depression might increase the chance of miscarriage. More information on depression can be found in our sheet here: https://mothertobaby.org/fact-sheets/depression-pregnancy/.  

Does taking amitriptyline 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 amitriptyline, might increase the chance of birth defects in a pregnancy. A small number of human studies have not found a higher chance for birth defects with doses of amitriptyline used for treatment of depression. 

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

It is not known if amitriptyline can increase the chance of other pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). One report found a small increase in the chance of preeclampsia (high blood pressure and problems with organs, such as the kidneys) when amitriptyline was used in the second and third trimester of pregnancy.  

Research has 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 the medication, untreated depression, or other factors are increasing the chance of these problems.  

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

The use of some tricyclic antidepressants during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms seen during the first month of life included colic, low oxygen levels, breathing problems, and irritability. If a baby develops these symptoms, they usually go away in a few days without any long-term health effects.  

There is one case report of an infant who had temporary withdrawal symptoms after exposure to amitriptyline during pregnancy. The infant and the mother were found to have high blood levels of amitriptyline. Not all babies exposed to amitriptyline will have these symptoms. It is important that your healthcare providers know you are taking amitriptyline so that if symptoms occur, your baby can get the care that is best for them. 

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

One study looking at 29 children exposed to amitriptyline during pregnancy did not find any behavioral or learning problems. 

Breastfeeding while taking amitriptyline: 

Amitriptyline gets into breast milk in small amounts. There are several reports of amitriptyline being used during breast feeding. No side effects have been reported in most nursing infants.  

There was one report of a woman who was taking 10 mg of amitriptyline per day while breastfeeding. The breastfeeding baby (15 days old) was reported to be very sleepy. When the medication was stopped, the infant’s sleepiness resolved.  

The benefits of using amitriptyline might outweigh the risks of an untreated medical condition. If you suspect the baby has any symptoms (being too sleepy), contact the child’s healthcare provider. Your healthcare providers can talk with you about using amitriptyline and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Some studies report amitriptyline lowered sex drive and caused sexual dysfunction in men, which can affect fertility (ability to make healthy sperm). These problems can also be side effects of untreated depression. Studies have not been done to see if amitriptyline could increase the chance of birth defects. 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 eating raw, undercooked, or cold meats and seafood 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 raw, undercooked, or cold meats and seafood?

Raw meat or seafood is any meat or seafood product that has not been cooked at all. Undercooked meat or seafood has been cooked in part but has not been heated to the safe minimum internal temperature. Deli meats (also known as cold cuts) and cold seafood are precooked meats or seafood that have been frozen or chilled for later use.

Raw, undercooked, or deli meats and seafood can contain bacteria and/or parasites that can cause foodborne illnesses. For this reason, it is recommended to cook meat and seafood up to at least the minimum internal temperature, and to reheat pre-cooked cold meats or seafood. See below:

More information on specific bacteria and parasites that can be found in foods is available in these MotherToBaby fact sheets:

• E. coli (https://mothertobaby.org/fact-sheets/e-coli-pregnancy/),
• Listeria (https://mothertobaby.org/fact-sheets/listeriosis-pregnancy/),
• Salmonella (https://mothertobaby.org/fact-sheets/salmonella-pregnancy/),
• Toxoplasmosis (https://mothertobaby.org/fact-sheets/toxoplasmosis-pregnancy/),
• Vibrio (https://mothertobaby.org/fact-sheets/vibrio-pregnancy/).

Methylmercury amount is another concern with seafood. Please see our fact sheet at https://mothertobaby.org/fact-sheets/methylmercury-pregnancy/ for more information.

I heard on the news that a product I might have eaten has been recalled. Is there a place I can check?

You can check for food recalls on the U.S. Food and Drug Administration (FDA) website at https://www.foodsafety.gov/. If you heard about a recall on the news, write down all the information from the news article and call the phone numbers or check the websites that they have provided.

There can be a chance of infection from food cooked at home that is not handled safely. You can learn about safe handling of meats and poultry on the consumer section of the U.S. Department of Agriculture (USDA) website: https://www.fsis.usda.gov/wps/portal/fsis/home.

How do I know if I have eaten raw, undercooked, or cold meat and seafood that is infected with bacteria or a parasite?

People can get sick from unsafe food handling practices from eating at a restaurant, on a cruise, on a trip, a home-cooked meal, or other food-related occasions. These situations are unlikely to get reported. Some people who become infected with bacteria or parasites show no symptoms. Others might have fever, diarrhea, stomach cramps, stomachache, headache, muscle pain, swelling of lymph nodes, joint pain, and/ or vomiting, depending on the infection. The symptoms can start hours to weeks after eating contaminated food.

If you are concerned that you have been infected with bacteria and/or parasites from meat or seafood,

Ask your healthcare provider if there are tests to diagnosis the infection. In some cases, there might be medications that can treat the infection and reduce the chance of harm for your baby.

Does eating raw, undercooked, and/or cold meat and seafood increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. If meat/seafood is infected with certain bacteria or parasites and a woman who is pregnant becomes ill from eating it, there might be an increased chance of pregnancy loss. High fever can also increase risks to the baby. For more information on fever during pregnancy, please see our factsheet at https://mothertobaby.org/fact-sheets/hyperthermia-pregnancy/.

Does eating raw, undercooked, or cold meat and seafood 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. When a pregnant woman is exposed to raw, undercooked, or cold meat and seafood, the chance of birth defects depends on whether the woman becomes infected and by which parasite or bacteria.

For example, E. coli, Listeria, and Salmonella have not been associated with a higher chance of birth defects. Infants born to women who had toxoplasmosis infection during the first trimester of pregnancy have about a 10-15% chance of being born with the infection themselves (called congenital toxoplasmosis). While the chance of passing the infection to the baby (transmission) increases later in pregnancy, most observed effects are seen with first trimester infection. Some infants with congenital toxoplasmosis will have problems with the brain, eyes, heart, kidneys, blood, liver, or spleen.

Would eating raw, undercooked, or cold meat and seafood increase the chance of other pregnancy related problems?

If food is contaminated with bacteria or parasites and a woman who is pregnant becomes infected from eating it, there can be other risks to the pregnancy. This can include preterm delivery (birth before week 37) or pregnancy loss.

Does eating raw, undercooked, or cold meat and seafood in pregnancy affect future behavior or learning for the child?

Toxoplasmosis infections can cause long-term problems for the baby, such as vision loss, hearing loss, or developmental delays. Many infected infants will have no problems at birth, but symptoms of congenital toxoplasmosis can happen months or even years after birth. For this reason, infants with congenital toxoplasmosis should be treated for the infection during the first year of life and then should be checked for problems over time.

Listeriosis infections are uncommon in newborns but can also increase the chance for long-term health complications in children. Newborns with Listeria infection can have symptoms of sepsis (blood infection) or meningitis after birth. Meningitis is a condition where there is swelling around the brain and spinal cord. If not treated quickly with antibiotics, the effects of meningitis can lead to long-term problems for some children.

Breastfeeding while eating raw, undercooked, or cold meat and seafood:

Breast milk can help protect a baby from infections. There have been case reports suggesting Salmonella might be passed from a woman who is breastfeeding to a nursing child. However, most people with these types of infections do not need to stop breastfeeding. Diarrhea and other symptoms of E. coli infection might lower milk supply. In the case of E. coli and Salmonella infections, be sure to practice good hand washing. If you suspect that the baby has symptoms, such as diarrhea, contact your child’s healthcare provider. Be sure to talk to your healthcare providers about all your breastfeeding questions.

If a man eats raw, undercooked, or cold meat and seafood, can it make it harder to get a woman pregnant or increase the chance of birth defects?

Although most people get Salmonella or E. coli from eating contaminated foods or animals, these infections can also be passed from person to person. Wash hands often to help reduce the chance of passing the disease among people living in the household. In general, exposures that men have are unlikely to increase risks to a pregnancy. 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 physical trauma 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 trauma?  

Trauma can include damage to the body and/or the mind. Trauma that is caused by sudden harm to the body can include being in a car crash, falling, being burned, or experiencing physical violence. This sheet will focus on physical trauma. More information on stress can be found in our fact sheet at https://mothertobaby.org/fact-sheets/stress-pregnancy/.   

It is important that you are physically and emotionally safe before, during, and after pregnancy. Trauma can cause long-term physical and mental health issues. If you have or are currently experiencing physical trauma, talk with your healthcare provider or other trusted sources, such as the National Domestic Violence hotline at 1−800−799−7233 (SAFE) or https://www.thehotline.org/.  

Pregnancy outcomes after physical trauma can vary based on many factors, including the type of injury, how serious the injury was, when it happened during pregnancy, and where on the body the trauma occurred.  

I have experienced physical trauma. Can it make it harder for me to get pregnant?  

Some types of physical trauma might make it harder to get pregnant. For example, physical trauma that damages the uterus (the organ that would hold a pregnancy) might affect fertility (the ability to get pregnant).  

One study found that women with traumatic brain injury were more likely to experience changes to their menstrual cycle (commonly called a “period”). This might affect fertility.  

Does experiencing physical trauma increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Some types of traumas, such as trauma that causes damage to the placenta (the organ that grows in the uterus during pregnancy) or uterus, might increase the chance of miscarriage.  

Does experiencing physical trauma 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 trauma, might increase the chance of birth defects in a pregnancy. 

It is not known if physical trauma increases the chance of birth defects. There are reports of babies born with and without birth defects following physical trauma. One study of 62 pregnant women who were treated for car accidents during the first 3 months of pregnancy did not find an increased chance of birth defects.  

Does experiencing physical trauma in pregnancy increase the chance of other pregnancy-related problems? 

Women who have experienced physical trauma during pregnancy might have an increased chance for other pregnancy-related problems, such as preterm delivery (birth before week 37) and infants with low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Certain physical trauma can also increase the chance of placental abruption (when the placenta pulls away from the uterus). If this happens, this might cause pregnancy loss or stillbirth. 

Does experiencing physical trauma in pregnancy affect future behavior or learning for the child? 

Whether there are effects on future behavior or learning might be related to how serious the injury was and whether there was any injury to the developing brain. One study looking at 16 women who were pregnant and exposed to mostly minor injuries from things like a car accident or fall after 20 weeks of pregnancy did not find unusual development at 1 year of age.  

What should I do if I experience physical trauma during pregnancy?  

Call 911 or go to an emergency room for treatment of serious injuries. Let your healthcare provider know about any trauma. Healthcare providers can treat injuries and check the progress of the pregnancy. Continue to follow up for monitoring with your healthcare provider. If you or someone you know is experiencing any type of violence, please call the National Domestic Violence Hotline 1−800−799−7233 (SAFE).  

Breastfeeding after physical trauma: 

Some studies have suggested that women who experience physical violence have lower rates of breastfeeding and breastfeed for a shorter amount of time. It can be helpful for a woman who is breastfeeding to have support while nursing. This can include a breastfeeding support group, a lactation specialist, and/or friends or family members who can give help and support. If you are having trouble breastfeeding and would like to continue breastfeeding, please contact your healthcare provider or your baby’s pediatrician. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

If a man experiences physical trauma, can it affect fertility or increase the chance of birth defects? 

Trauma that harms the scrotum or testicles (the body parts that help to make sperm) might affect male fertility (ability to make healthy sperm). In general, exposures that men have are unlikely to increase the 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 sumatriptan 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 sumatriptan? 

Sumatriptan is a medication that has been used to treat migraine headaches. It can be taken by mouth (orally) in pill form, by nasal spray, or by injection (shot). Some brand names for sumatriptan are Imitrex®, Alsuma®, Imigran®, Onzetra Xsail®, Tosymra®, and Zembrace SymTouch®.   

Sumatriptan is available in a combination product (Treximet®) that also contains naproxen. The U.S. Food and Drug Administration (FDA) states pregnant women should not use NSAIDs (such as naproxen) after week 20 of pregnancy unless specifically advised to do so by their healthcare provider. For more information on naproxen, see our fact sheet at https://mothertobaby.org/fact-sheets/naproxen/.  

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. 

Can having migraine headaches affect pregnancy? 

Some studies have shown that women with a history of migraine headaches have a slightly higher chance for pregnancy complications including high blood pressure and preeclampsia (high blood pressure and problems with organs, such as the kidneys), which can lead to seizures (called eclampsia), and pregnancy-related stroke. Be sure to talk with your healthcare providers about your history of migraine headaches so they can monitor symptoms during pregnancy, if needed.   

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

It is not known if sumatriptan can make it harder to get pregnant. 

Does taking sumatriptan increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not found an increased chance of miscarriage when sumatriptan was taken during pregnancy.  

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

Studies have not found an increased chance of birth defects when sumatriptan was taken during pregnancy.  

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

Some studies have suggested a small increase in chance of some pregnancy-related problems, including preeclampsia, preterm birth (birth before 37 weeks), low birth weight (weighing less than 5 pounds, 8 ounces [2500g] at birth), and heavy bleeding after delivery if sumatriptan was used late in pregnancy. However, some of these complications (including preeclampsia, preterm birth, and low birth weight) have been associated with migraines in pregnancy. This makes it hard to know if the medication, the condition being treated, or other factors are the cause of these complications.  

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

No studies have looked at sumatriptan by itself to see if it can increase the chance of behavior or learning issues in children. One study looked at behavioral effects in children exposed to any triptan medication during pregnancy (including sumatriptan). At age 3, these children did not show behavior differences, except for a small increase in behaviors that might be related to later attention problems. However, by age 5, this difference was no longer seen. This follow-up study also found no difference in communication problems, activity levels, or temperament traits (like shyness) at age 5. Based on these two studies, there’s no confirmed evidence of behavior problems. 

Breastfeeding while taking sumatriptan: 

Sumatriptan gets into breast milk in small amounts. It is also not well absorbed by the stomach, which further limits the amount that the infant is exposed to from the breastmilk. The product label for sumatriptan notes that avoiding breastfeeding for 12 hours after a dose of sumatriptan can decrease the infant’s exposure. This is a conservative approach that might be more helpful in certain situations, like with a newborn delivered prematurely. However, given the low level of medication entering the milk, sumatriptan is generally not expected to cause side effects, even when breastfeeding takes place right after taking the medication.  

One study found that some mothers reported pain in their breasts and nipples after taking sumatriptan or similar medications. Some of these mothers also reported a decreased milk supply. It is not known how often these problems might occur. It is also not proven that these symptoms are because of the medications.  

Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

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

Please click here for references. 

This sheet is about obesity 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 obesity?  

Obesity is when someone has excess body fat. One measure of obesity is body-mass index (BMI), which is an estimate of body fat based on height and weight. BMI is calculated using weight (kg) and height (m) or pounds (lbs.) and inches, with the formula being weight (kg) / height (m)². 

A person is considered to be obese when their BMI is 30 or higher and overweight when their BMI is between 25 and 29.9. The Centers for Disease Control and Prevention (CDC) has a tool to find your BMI: https://www.cdc.gov/bmi/adult-calculator/?CDC_AAref_Val=https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html.  

What about weight gain during pregnancy? 

Weight gain during pregnancy is expected. The suggested amount of weight gain during pregnancy can be different based on your weight/BMI before pregnancy and the number of fetuses that you are carrying. In general, a total weight gain of 15–25 pounds for women who are overweight and 11–20 pounds for women who are obese is recommended during pregnancy. However, it is important to work closely with your healthcare providers to determine how much weight you should gain during pregnancy.   

Should I try to lose weight while pregnant? 

Weight loss is usually not recommended during pregnancy. Talk with your healthcare provider before trying to lose weight during pregnancy. They can go over your recommended weight gain, nutrition, and exercise.

Can obesity make it harder to get pregnant?  

Studies have shown that it can take longer for women who are obese to get pregnant. Also, they may have a lower chance of getting pregnant.   

Can obesity increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Obesity has been associated with an increased chance of miscarriage. As there can be many causes of miscarriage, it is hard to know if obesity or other factors (age, health, other exposures) are the cause of a miscarriage. 

Can obesity 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 obesity, might increase the chance of birth defects in a pregnancy. Obesity during pregnancy has been associated with a higher chance for certain birth defects, including heart defects or defects of the brain, spine, or spinal cord (neural tube defects [NTDs]). While the overall increased chance for birth defects is expected to be small, risks may be higher depending on a person’s level of obesity.  

Can obesity increase the chance of other pregnancy-related problems?  

Obesity during pregnancy can increase the chance of gestational diabetes, high blood pressure, preeclampsia (high blood pressure that can affect organs such as the kidneys), preterm delivery (birth before 37 weeks of pregnancy), stillbirth, heavy bleeding after delivery (postpartum hemorrhage), and needing a C-section delivery. It can also increase the chance of having a baby with macrosomia (weighing more than 8 pounds, 13 ounces [4000 grams] at birth), which may lead to delivery complications and may increase the child’s risk for low blood sugar, obesity, and heart problems. For more information on gestational diabetes, see the MotherToBaby fact sheet https://mothertobaby.org/fact-sheets/diabetes-pregnancy/.  

Can obesity in pregnancy affect future behavior or learning for the child? 

Some studies suggest that children born to women with obesity may have a higher chance of learning difficulties, attention-deficit/hyperactivity disorder (ADHD), or autism. However, many factors can influence a child’s behavior and development, and it is unlikely that obesity alone explains these outcomes.    

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

Prenatal ultrasounds can be used to screen for some birth defects, such as heart defects and NTDs. Ultrasound can also be used to monitor the growth of the pregnancy. However, obesity can make it harder for birth defects to be detected by ultrasound. 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 obesity: 

Women with obesity can successfully breastfeed and provide all the benefits of breast milk to their baby. Some studies suggest that women with obesity may be less likely to start or continue breastfeeding, but support and resources can help. If you have questions or need assistance with breastfeeding, talk with your healthcare provider, your baby’s pediatrician, or a lactation consultant. They can help you find the support you need to meet your breastfeeding goals. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

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

Please click here for references.