This sheet is about exposure to laxatives in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What are laxatives?

Laxatives are medications used to treat constipation. Laxatives come in different forms. This sheet discusses over-the-counter (OTC) laxatives such as osmotics, fiber or bulk, stool softeners, stimulants and lubricants. For information about the prescription laxative prucalopride (Motegrity®), please see the MotherToBaby Fact Sheet: https://mothertobaby.org/fact-sheets/prucalopride-motegrity/pdf/.

Osmotics are laxatives that work by pulling water into the intestines. Examples of osmotics include salts, such as magnesium hydroxide (Milk of Magnesia®) and sodium bisphosphate (OsmoPrep®), and sugars, such as lactulose and polyethylene glycol (Miralax®). Osmotic medications are not well absorbed by the intestine, so very little is likely to get into the bloodstream of the person taking the osmotic laxative. This means exposure to the pregnancy is expected to be small.

Fiber or bulk laxatives include psyllium (Metamucil®) and methylcellulose (Citrucel®). Since these ingredients generally do not get into the bloodstream, pregnancy exposure is unlikely.

Stool softeners include docusate sodium (Colace®) and glycerin. For more information on docusate sodium, please see the MotherToBaby Fact Sheet: https://mothertobaby.org/fact-sheets/docusate-sodium-pregnancy/pdf/.

Stimulants include senna (Senokot®), bisacodyl (Correctol®), and castor oil (made from the seeds of castor beans).

Mineral oil is a lubricant. These products enter the bloodstream in small amounts, so there may be small exposure to the pregnancy.

Stimulants and lubricants may cause stomach cramps, which can be severe.

I just found out I am pregnant. Should I stop taking laxatives?

Talk with your healthcare provider before starting a medication or making any changes in your medication. It is important to consider the benefits of treating constipation during pregnancy.

Constipation may cause pain and other health problems in pregnancy such as cramps, hemorrhoids, and breakdown of the anal tissue. Treating constipation might help reduce the risk of these problems. While occasional constipation is common in pregnancy, talk with your healthcare provider if constipation becomes an ongoing problem. Your healthcare provider may want to confirm the diagnosis of constipation and see how dietary and exercise changes can help before discussing medical treatment. Dietary changes such as increasing fluids and eating high fiber foods such as whole grains and fresh fruits and vegetables might help prevent constipation. Regular exercise might also help.

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

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

Does taking laxatives increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. As there can be many causes of miscarriage, it is hard to know if a medication, the medical condition, or other factors are the cause of a miscarriage. Studies have not been done to see if laxatives increase the chance for miscarriage.

Does taking laxatives in the first trimester 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. Only a few studies have looked at laxative use during pregnancy. However, the available studies show that when used in recommended doses, over-the-counter laxatives are not expected to increase the chance of birth defects. Talk with your healthcare provider or contact a MotherToBaby specialist to discuss information on your specific laxative medication.

Could taking laxatives cause other pregnancy complications?

When laxatives are used more than recommended, they can increase the chance of complications. Laxatives can make food go through the intestines faster than usual, which can reduce the amount of nutrients that are absorbed into the body. For this reason, using laxatives too much or too often can increase the chance of nutritional problems. Using laxatives can also affect the way the body absorbs other medications you might be taking.

Using more than the recommended amounts of laxatives can also lower the levels of needed salts in the blood, such as magnesium. A reported case of low magnesium levels in a newborn was linked to the mother using too much docusate sodium during pregnancy. The baby’s main symptom was jitteriness, which went away by the second day of life.

Castor oil has been used at the end of pregnancy to try to bring on labor. Castor oil can cause severe diarrhea and cramping of the bowel and uterus, but these contractions are unlikely to bring on labor if the lower part of the uterus (cervix) is not ready for labor. If you are at the end of your pregnancy, your health care provider can discuss other ways to begin labor.

Does using laxatives in pregnancy cause long-term problems in behavior or learning for the baby?

Using laxatives as directed in pregnancy is not expected to have long-term effects on a baby’s learning or behavior.

Can I use laxatives while breastfeeding?

The medications in some laxatives might get into the mother’s bloodstream, but the amount that passes into breast milk is usually low. Mineral oil can get into the bloodstream and breast milk in greater amounts, so it should be used carefully.

There are occasional reports of loose stools in infants exposed to laxatives from breastfeeding. Contact a MotherToBaby specialist to discuss information on your specific laxative medication. Talk to your healthcare provider about all of your breastfeeding questions.

If a man takes laxatives, could it affect fertility (ability to get a woman pregnant) or increase the chance of birth defects?

There are no studies looking at possible effects on fertility or risks to a pregnancy when the father takes laxatives. 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/.

MotherToBaby is currently conducting a study looking at functional constipation and the medications used to treat it in pregnancy. If you are interested in 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 exposure to or having a West Nile Virus infection 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 West Nile virus? 

 

West Nile virus (WNV) is a virus that can infect humans, birds, mosquitoes, horses, and some other mammals. It is commonly found in Africa, West Asia, and the Middle East. WNV has been reported in the United States since 1999. 

How do you get WNV?  

 

West Nile virus is most commonly spread to people by the bite of an infected mosquito. In rare cases, WNV has been spread through blood transfusion, organ transplant, to the fetus during pregnancy, delivery, or to a nursing child through breastfeeding. The chance of passing WNV infection to the fetus through delivery or to the child breastfeeding is unknown. 

WNV is not spread through coughing, sneezing, or touching. Also, handling or eating infected animals does not spread WNV. However, if handling dead or live animals, use proper safety precautions such as wearing gloves to dispose of animal carcasses (dead bodies). Be sure to cook meat to its safe temperature before eating.  

What are the symptoms of WNV? 

 

The time from bite to the start of symptoms (incubation period) is usually 2 to 14 days. Most people (8 out of 10) infected with WNV will have no symptoms. About 20% (1 in 5) of people who are infected will develop fever with other symptoms such as headache, body aches, joint pain, vomiting, diarrhea, or rash.  

Less than 1% (about 1 in 150 people) who are infected with WNV will develop severe infection that leads to inflammation of the brain (encephalitis) or inflammation of the area around the brain and in spinal cord (meningitis). Symptoms of severe illness include headache, high fever, neck stiffness, confusion, tremors, convulsions, muscle weakness, paralysis, and coma. Symptoms of severe WNV may last several weeks and some people may experience long-term illness. 

How can I lower my chance of getting WNV?

 

The best way to prevent WNV is to protect yourself from mosquito bites. Insect repellent and other precautions are recommended by the Centers for Disease Control and Prevention (CDC) at https://www.cdc.gov/west-nile-virus/prevention/.  MotherToBaby has fact sheets on Insect Repellents at https://mothertobaby.org/fact-sheets/insect-repellents/ and DEET at https://mothertobaby.org/fact-sheets/deet-nn-ethyl-m-toluamide-pregnancy/.  

How can I find out if I am infected with WNV?

 

WNV can be detected by a blood test. If you think you have been exposed to WNV, talk with your healthcare provider.   

I have a WNV infection. Can it make it harder for me to get pregnant? 

 

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

Does having WNV increase the chance of miscarriage?

 

Miscarriage is common and can occur in any pregnancy for many different reasons. One study looking at 77 women infected with WNV during pregnancy reported no increase chance of miscarriage. 

Does having WNV in 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 West Nile Virus, might increase the chance of birth defects in a pregnancy. Having WNV is not expected to greatly increase the chance of birth defects. No consistent pattern of birth defects has been identified after exposure to WNV in pregnancy.  

There is one case report of a pregnant woman who passed the virus to her fetus during pregnancy. The baby was born with serious medical problems, including bilateral chorioretinitis (rare but serious eye inflammation) and brain abnormalities. While the fetus was infected with WNV, it has not been proven that WNV caused these birth defects.  

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

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

 

It is not known if having WNV can increase the chance of other pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). One study looked at 28 pregnancies with known WNV infection. No differences in birth weight, length, or head circumference were found in this study.  

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

 

One study that followed 11 children for 3 years did not find a link between WNV infection during pregnancy and developmental delay. Another study looked at 17 children born to women who had WNV while they were pregnant. The results showed typical development in the children at 2 years of age.  

There is one case report of a WNV infection at 27 weeks of pregnancy where the baby had brain abnormalities at birth.  However, a case report cannot prove that WNV caused the reported abnormalities. 

Breastfeeding and WNV: 

 

There is limited research on WNV and breastfeeding. There was a case report of a person who was infected with WNV through a blood transfusion after delivering a child. The virus was found in the breast milk. The breastfed child tested positive for WNV but had no symptoms and stayed healthy.  

There are no recommendations to stop breastfeeding because of WNV. There are important benefits to breastfeeding and the chance for passing WNV through breast milk is unknown. If you suspect that the baby has symptoms of WNV, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.   

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

 

Studies have not been done to see if WNV could affect men’s fertility (ability to get a partner pregnant) 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 exposure to ustekinumab 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 ustekinumab? 

Ustekinumab is a medication that has been used to treat moderate to severe psoriasis, Crohn’s disease, and active psoriatic arthritis. The brand name of ustekinumab is Stelara®.  

MotherToBaby has fact sheets on psoriasis and psoriatic arthritis https://mothertobaby.org/fact-sheets/psoriasis-and-pregnancy/ and Crohn’s disease https://mothertobaby.org/fact-sheets/inflammatory-bowel-disease-pregnancy/. 

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

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

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

Does taking ustekinumab increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies of over 3000 pregnancies did not find an increased chance of miscarriage when ustekinumab was used during pregnancy.  

Does taking ustekinumab 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 ustekinumab, might increase the chance of birth defects in a pregnancy. Studies of over 2,500 pregnancies found no increased chance of birth defects when ustekinumab was used during pregnancy.  

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

Studies of over 2000 pregnancies found no increased 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) when ustekinumab was used during pregnancy.  

Can my baby receive live vaccines before one year of age if I take ustekinumab later in pregnancy? 

Ustekinumab can weaken the immune system of the person taking it, so there’s a theoretical (not proven) concern it might also weaken a baby’s immune system if they are exposed during pregnancy. Live vaccines, which contain a small amount of live virus, can cause an infection in people with weak immune systems. Inactivated vaccines, which do not contain live virus, cannot cause an infection with the disease they protect from. In the U.S., the rotavirus vaccine is the only live vaccine routinely given in a baby’s first year.  

Studies of babies exposed to ustekinumab during pregnancy who got the rotavirus vaccine in the first 4 months of life found no higher risk of infections or health problems. There are also reports of babies who were exposed to ustekinumab during pregnancy and received the measles, mumps, and rubella (MMR) vaccine or the varicella vaccine without any health issues.  

Talk with your child’s healthcare provider about your exposure to ustekinumab during pregnancy. They can talk with you about the vaccines your child should receive and the best time for your child to receive them. 

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

Four studies of 122 children exposed to ustekinumab during pregnancy showed no increased chance of behavior or learning issues at around 12 months of age. 

Breastfeeding while taking ustekinumab:

Ustekinumab has not been well studied during breastfeeding. Because ustekinumab is a very large protein, it is thought that very little medication would pass into breast milk. Ustekinumab is also a medication that is not well absorbed by the GI tract (gut), so any of the medication that gets into breast milk would be unlikely to enter the baby’s system. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

A small study of 12 men exposed to ustekinumab reported no effect of on fertility (ability to get a partner pregnant). Larger studies of over 200 men exposed to ustekinumab and similar medications showed no increased chances of birth defects or miscarriages. 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 looking at autoimmune diseases like psoriasis and the medications used to treat autoimmune diseases in pregnancy. If you are interested in taking part in this study, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study.

Please click here for references.

This sheet is about using topical tretinoin 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 is tretinoin?

Topical tretinoin is a medication that is applied to the skin to treat acne, prevent wrinkles, and help with other skin problems. Some brand names for tretinoin include Altreno®, Atralin®, Avita®, Retin-A®, Refissa®, Renova® and Tretin-X®. The amount of tretinoin in each brand can vary.

Tretinoin belongs to a group of medications called the retinoids. Retinoids are related to Vitamin A. Other medications in the retinoid family are isotretinoin (Accutane®, Claravis®), acitretin (Soriatane®) and adapalene (Differin®). MotherToBaby has a fact sheet on isotretinoin here: https://mothertobaby.org/fact-sheets/isotretinoin-accutane-pregnancy/.

Tretinoin is also available in an oral form (to take by mouth) for the treatment of leukemia. This sheet will discuss the topical (applied to skin) use of tretinoin.

My healthcare provider said that tretinoin is like isotretinoin. I’ve heard that it should not be used during pregnancy.

Tretinoin is related to a medication called isotretinoin. Isotretinoin is a medication known to cause birth defects involving the face, heart and brain. However, isotretinoin is taken by mouth and easily enters a person’s bloodstream at higher levels than with topical use of tretinoin. When tretinoin is applied to the skin, lower levels pass through the skin and get into the bloodstream than with oral (taken by mouth) isotretinoin.

In general, skin serves as a good barrier. Because of this, only a small amount of the tretinoin is likely to be absorbed with topical (skin) exposure when used as directed. More tretinoin could be absorbed into the person’s bloodstream if tretinoin is used on skin that is broken or irritated, or when it is used more than needed, or when used over a large area of the body. In general, the less tretinoin that is used on the skin, the less likely there will be risks to the fetus. However, because there might still be a small amount of tretinoin absorbed through the skin, the safest approach may be to avoid use of tretinoin during pregnancy.

I use topical tretinoin. Can it make it harder for me to get pregnant?

Studies have not been done to see if tretinoin can make it harder to become pregnant.

I am using tretinoin, but I would like to stop using it before becoming pregnant. How long does it stay in my body?

The time it takes the body to metabolize (to process) medication is not the same for everyone. In healthy non-pregnant adults, it takes up to 1 day, on average, for most of the tretinoin to be gone from the body. The makers of oral isotretinoin suggest that women stop using isotretinoin 1 month before trying to get pregnant. Based on this suggestion for isotretinoin, it may be suggested to stop using tretinoin 1 month before trying to get pregnant.

Does using topical tretinoin increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. The topical use of tretinoin is not expected to increase the chance for miscarriage.

Does taking tretinoin 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. Several studies have tried to learn if use of topical tretinoin could harm a pregnancy. These studies have not found a greater chance for birth defects with proper application of tretinoin to the skin.

However, there have been case reports of babies born with birth defects after women used tretinoin on their skin during pregnancy. Usually, a few case reports do not cause healthcare providers to worry, but the birth defects reported in these case reports are similar to the birth defects seen in babies exposed to oral isotretinoin use during pregnancy. Since tretinoin and isotretinoin are related, it is possible that these two medications can affect the baby in the same way. Because many women have used tretinoin during pregnancy and have not had babies with a birth defect, the chance for birth defects is probably low. However, it has generally been recommended not to use tretinoin in pregnancy.

Does using tretinoin in pregnancy increase the chance of other pregnancy related problems?

Studies that have looked at this question have not reported a greater chance for preterm delivery (delivery before 37 weeks of pregnancy) with proper application of tretinoin to the skin.

If I stop using tretinoin in the first trimester, is it okay to start using it again later in my pregnancy?

During the first 3 months of pregnancy, the baby’s organs are forming. In months 4 through 9, the baby’s body and brain are growing. Tretinoin use in the 2nd and 3rd trimesters is less likely to cause a birth defect. However, until more information is available, avoiding this product throughout pregnancy might be the best course of action. For general information on the timing of exposures in pregnancy, see the MotherToBaby fact sheet on critical periods of development at https://mothertobaby.org/fact-sheets/critical-periods-development/.

Does using tretinoin in pregnancy affect future behavior or learning for the child?

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

Breastfeeding while using tretinoin:

Tretinoin use during breastfeeding has not been studied. However, when used on your skin, very little tretinoin passes into your body, and so the amount in breast milk would probably be small. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

If a man used topical tretinoin, could it affect fertility or increase the chance of birth defects in a partner’s pregnancy?

Studies have not been done to see if topical tretinoin use could affect a man’s fertility (ability to get a woman pregnant) 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.