This sheet is about exposure to buprenorphine 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 buprenorphine?

Buprenorphine is an opioid medication. Opioids are sometimes called narcotics. Buprenorphine has been used to treat substance use disorders involving other opioid drugs and narcotic painkillers. Buprenorphine has also been used to treat pain. It is available as an injection (including brand names Buprenex® and Sublocade®), an oral film that dissolves in the mouth (Belbuca®), and a patch worn on the skin (Butrans®). Buprenorphine is also available in different forms combined with the medication naloxone (Bunavail®, Suboxone®, and Zubsolv®). 

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.  

The American College of Obstetritians and Gynecology (ACOG) and the American Society of Addiction Medicine (ASAM) both recommend the use of medication-assisted treatment (which can include buprenorphine) to treat opioid use disorder in pregnancy.  

If you have been taking buprenorphine regularly, have a dependency, or opioid use disorder, you should not stop taking the medication suddenly. Stopping suddenly could cause you to go into withdrawal. It is not known if or how withdrawal might affect a pregnancy. It is suggested that any reduction in buprenorphine be done slowly, and under the direction of your healthcare provider.  

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

One study reported a lower chance of getting pregnant among women using buprenorphine. However, it is not known if the participants were trying to avoid pregnancy, and it’s also unclear whether the lower chance of getting pregnant was due to the condition being treated or something else. 

Does taking buprenorphine increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Limited studies looking at buprenorphine use in pregnancy have not found higher rates of miscarriage than what is seen in the general population.  

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

Limited studies looking at buprenorphine in pregnancy have not reported an increased chance of birth defects.  

Some studies looking at all opioids as a group suggest they might be linked to birth defects. One study found a higher chance of bone problems, but it did not look at other possible causes. Another study found more stomach and intestinal defects but did not consider the dose of the medication. Based on these studies, if buprenorphine does increase the chance of birth defects during pregnancy, the risk is probably small. 

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

Some studies have found that using certain opioids during pregnancy can increase the chance of problems like preterm delivery (before 37 weeks), poor fetal growth, and stillbirth. These risks are more common in people using drugs like heroin or taking prescription pain medicine in high doses or for too long. Use of an opioid close to the time of delivery can result in withdrawal symptoms in the baby (see the section of this fact sheet on neonatal abstinence syndrome). 

Will my baby have withdrawal (neonatal opioid withdrawal syndrome) if I keep taking buprenorphine?

Neonatal opioid withdrawal syndrome (NOWS) is the name for withdrawal symptoms in newborns exposed to opioids during pregnancy. Studies have seen NOWS in babies exposed to buprenorphine. Symptoms can include fussiness, lots of crying, sneezing, stuffy nose, trouble sleeping, being very sleepy, yawning, poor feeding, sweating, shaking, seizures, throwing up, and diarrhea. These symptoms usually start around 2 days after birth and can last more than 2 weeks. 

The chance of NOWS depends on how long and how much opioid was taken during pregnancy, whether other medicines were used, if the baby was born early, and the baby’s size at birth. If opioids were taken in pregnancy, it is important to let your baby’s healthcare providers know so that they can look for symptoms of NOWS and provide the best care for your newborn. 

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

It is not known if buprenorphine can increase the chance of behavior or learning issues for the child.  

Some studies on opioids as a general group have found more problems with learning and behavior in children exposed to opioids for a long period of time during pregnancy. It is hard to know if it is the medication exposure or other factors that might increase the chances of these problems. 

What if I have an opioid use disorder? 

Studies find that people who are pregnant and take opioids in higher doses or for longer than recommended by their healthcare providers (i.e. misuse or “abuse” opioids) have an increased chance for pregnancy problems. These include poor growth of the fetus, stillbirth, and preterm delivery.  

Buprenorphine and breastfeeding:

Buprenorphine can pass into breast milk in small amounts. The amount of buprenorphine that a baby would be exposed to through breast milk is expected to be low. Experts, including the Academy of Breastfeeding Medicine, encourage breastfeeding when taking buprenorphine. Rarely, babies might have side effects, such as drowsiness, breathing problems, and not gaining enough weight.  

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

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

Studies have not been done to see if buprenorphine could affect man’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 hydromorphone 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 hydromorphone?

Hydromorphone (Dilaudid®) is a strong opioid medication that has been used to treat moderate to severe pain. Opioids are sometimes called narcotics. Hydromorphone can be given as a shot (injection) or taken by mouth (orally).  

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

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. 

If you have been taking hydromorphone regularly or have a dependency or opioid use disorder, talk to your healthcare provider before you stop taking this medication. Stopping an opioid medication suddenly could cause you to go into withdrawal. It is not known if or how withdrawal might affect a pregnancy. It is suggested that any reduction in hydromorphone be done slowly, and under the direction of your healthcare provider.  

I am taking hydromorphone, but I would like to stop taking it before getting pregnant. How long does the drug 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 2 days, on average, for most of the hydromorphone to be gone from the body.  

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

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

Does taking hydromorphone increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done to see if hydromorphone can increase the chance of miscarriage. 

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

It is not known if hydromorphone can increase the chance of birth defects. Some studies that have looked at opioids as a group suggest that opioids in general might be associated with birth defects. However, studies have not found a specific pattern of birth defects caused by opioids. Based on these studies, if there is an increased chance for birth defects with opioid use in pregnancy, it is likely to be small. 

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

Studies have not been done to see if hydromorphone can increase the 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).  

Studies involving women who often use opioids during their pregnancy have found an increased chance of pregnancy-related problems, including poor growth of the fetus, low levels of amniotic fluid (fluid that surrounds the fetus in the uterus), stillbirth, preterm delivery, and C-section. This is more commonly reported in those who are taking heroin or who are using prescribed opioid medication in greater amounts or for longer than recommended by their healthcare provider. Use of an opioid close to the time of delivery can result in withdrawal symptoms in the baby (see the section on neonatal opioid withdrawal syndrome). 

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

Neonatal opioid withdrawal syndrome (NOWS) is the term used to describe withdrawal symptoms in newborns from exposure to opioids during pregnancy. NOWS symptoms can include irritability, crying, sneezing, stuffy nose, poor sleep, extreme drowsiness (very tired), yawning, poor feeding, sweating, tremors, seizures, vomiting, and diarrhea. Most often, symptoms of NOWS appear 2 days after birth and may last more than 2 weeks. The chance that NOWS will occur depends on the length of time and/or the dose of opioid taken during pregnancy, if other medications were also taken, if baby was born preterm, and/or size of the baby at birth. If opioids were taken in pregnancy, it is important to let your baby’s healthcare providers know so that they can check for symptoms of NOWS and provide the best care for your newborn. 

Studies have reported a chance of neonatal opioid withdrawal syndrome (NOWS) with some opioids; however, not all medications in this class have been studied. Based on what we know about the chance of NOWS with other opioids, it is likely that hydromorphone also has a chance for NOWS. Because information is limited, it is not known if the chance is higher or lower with hydromorphone than with other, better studied opioids. 

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

Studies have not been done to see if hydromorphone can affect future behavior or learning for a child exposed during pregnancy. Some studies on opioids as a general group have found more problems with learning and behavior in children exposed to opioids for a long period of time during pregnancy. It is hard to tell if this is due to medication exposure or other factors that might increase the chances of these problems. 

What if I have an opioid use disorder? 

Talk with your healthcare provider about your use of opioids. Studies find that people who are pregnant and take opioids in higher doses or for longer than recommended by their healthcare providers have an increased chance of pregnancy problems. These include poor growth of the fetus, stillbirth, preterm delivery, and the need for C-section.  

Hydromorphone and breastfeeding: 

Hydromorphone can pass into breast milk in small amounts. Babies might have problems with the amounts of hydromorphone in the breast milk. Talk with your healthcare provider or a MotherToBaby specialist about your specific situation, as information on breastfeeding might change based on the age of your baby, the medication dosage, and/or other factors. Also, talk with your healthcare provider about your pain and treatment while breastfeeding.  

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

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

Studies have not been done to see if hydromorphone could affect men’s fertility (ability to get a partner pregnant) or 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 having ankylosing spondylitis in a pregnancy or while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider. 

What is ankylosing spondylitis?  

Ankylosing spondylitis (AS) is an inflammatory disease with symptoms that can include swelling, stiffness, pain, and fatigue (feeling extremely tired). AS is a type of arthritis (swelling and tenderness of 1 or more joints). Sometimes, severe AS can lead to the formation of new bone that causes the spine to become fused or stuck in one position.  

I am taking medication for ankylosing spondylitis. Can I take my medication during pregnancy? 

Since women with AS can take medication to control inflammation and prevent or reduce joint damage, it is important to talk with your healthcare providers about your medications and the best treatment options before trying to get pregnant. For information on specific medications, see our fact sheets at https://mothertobaby.org/fact-sheets/ or speak with a MotherToBaby specialist. 

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. 

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

It is not known if having AS can make it harder to get pregnant. There is no evidence to suggest AS could cause problems getting pregnant.  

Will pregnancy affect my AS symptoms? 

It is hard to predict if or how AS symptoms might change during pregnancy. Some studies suggest that symptoms stay about the same during pregnancy and others suggest symptoms can get better. However, some women report an increase in symptoms, especially as the pregnancy gets further along. Pregnancy does not appear to reduce the chance of AS flare-ups like it might for some other autoimmune conditions. An increase in symptoms is also common in the first few months after delivery. This does not mean that the symptoms will continue long-term. 

Does having ankylosing spondylitis increase the chance of miscarriage? 

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

Does having ankylosing spondylitis increase the chance of birth defects? 

Every pregnancy starts with a 3-5% chance of having a birth defect. This is called the background risk. It is not known if AS increases the chance for birth defects above the background risk. One small study found that the thymus (part of the body’s immune system) was smaller in babies born to women with rheumatic disease, including AS. However, this study did not find differences in health outcomes among this group.  

Would having ankylosing spondylitis increase the chance of other pregnancy-related problems? 

Several studies have not found an increased chance for pregnancy complications in women with AS. However, a few studies have reported that having AS might increase the chance for preterm delivery (birth before week 37) and for small for gestational age (baby is smaller than expected). There may also be an increased need for the baby to be in the neonatal intensive care unit (NICU) after delivery. The chance for these complications may be higher in those with more AS symptoms, in those who also have other medical conditions, or in women who develop preeclampsia (high blood pressure and problems with organs, such as the kidneys) in their pregnancy.  

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

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

Breastfeeding while I have ankylosing spondylitis: 

AS does not appear to affect the ability to breastfeed. If you are having trouble with breastfeeding, contact your healthcare provider or a lactation specialist.  

Can I take my medication for ankylosing spondylitis while breastfeeding? 

Many medications for AS can be used while breastfeeding. Some medications may increase risks to a nursing child. For information on specific medications, see our fact sheets or contact MotherToBaby to speak with a specialist. Be sure to talk to your healthcare provider about all of your breastfeeding questions.  

If a man has ankylosing spondylitis, can it make it harder to get a woman pregnant or increase the chance of birth defects? 

AS might affect a man’s fertility. No increased chance of birth defects was reported in a study looking at pregnancy outcomes in partners of men who were treated for AS. In general, exposures that men 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

This sheet is about exposure to low dose aspirin 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 aspirin?

Aspirin is also known as acetylsalicylic acid and has been used to reduce inflammation, fever, and pain. Aspirin can prevent blood clots and has been used to treat or help prevent conditions like heart attack and stroke. Aspirin is part of a group of drugs called non-steroidal anti-inflammatory drugs (NSAIDs).

NSAIDs, including regular and high strength aspirin, are NOT preferred pain relievers during pregnancy. In October 2020, the U.S. Food and Drug Administration (FDA) made a recommendation to avoid the use of NSAIDs, including regular strength aspirin, after 20 weeks of pregnancy, unless your healthcare provider feels it is necessary. More information about regular strength aspirin can be found in our fact sheet: https://mothertobaby.org/fact-sheets/regular-strength-aspirin/.

What is low dose aspirin?

Low dose aspirin ranges from 60 to 150 mg daily, but the usual dose taken during pregnancy to treat or prevent certain conditions is 81 mg daily.

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.

I take low dose aspirin. Can it make it harder for me to get pregnant?

Low dose aspirin is not expected to make it harder to get pregnant. A study that included women who had one or two previous pregnancy losses found that taking low dose aspirin at least 4 days a week increased the chance of pregnancy.

Does taking low dose aspirin increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Taking low doses of aspirin as directed by a healthcare provider is not expected to increase the chance of miscarriage. Some studies have shown that taking low dose aspirin before pregnancy might help lower the chance of miscarriage in some women who have had one or more miscarriages before 20 weeks of pregnancy.

Does taking low dose aspirin 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. Studies on the use of low dose aspirin during pregnancy have not found a higher chance of birth defects.

Does taking low dose aspirin in pregnancy increase the chance of other pregnancy-related problems?

Taking low dose aspirin as directed by a healthcare provider is not expected to increase the 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).

Studies have shown that low dose aspirin might improve pregnancy outcomes in some women by increasing blood flow to and reducing inflammation or swelling in the uterus. It may also lower the chances for preterm delivery and preeclampsia (high blood pressure and problems with organs, such as the kidneys), which can lead to seizures (called eclampsia) in women who have a higher risk of these complications. However, women who are pregnant should only take low dose aspirin under the direction and care of their healthcare provider.

Does taking low dose aspirin in pregnancy affect future behavior or learning for the child?

Limited information on low dose aspirin exposure during pregnancy does not suggest an increased chance for problems with physical or mental development in infants at 18 months of age. A study that looked at children up to 5 years of age who were born before 33 weeks of pregnancy and who were exposed to low dose aspirin during pregnancy did not find an effect on learning or behavior compared to children who were not exposed to low dose aspirin during pregnancy. Another study found no differences in neurodevelopmental outcomes in children between 33 and 39 months old after prenatal exposure to low dose aspirin.

Breastfeeding while taking low dose aspirin:

Low dose aspirin gets into breast milk in small amounts. Occasional use of low dose aspirin is not expected to increase risks to a breastfeeding infant. Regular strength aspirin (over 325 mg) is not preferred during breastfeeding. More information about regular strength aspirin can be found in our fact sheet: https://mothertobaby.org/fact-sheets/regular-strength-aspirin/. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

It is not known if low dose aspirin could affect a man’s fertility (ability to get a woman pregnant) or increase the chance of birth defects above the background risk. In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

This sheet is about exposure to pegvaliase 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 pegvaliase? 

Pegvaliase is a medication that has been used to treat phenylketonuria (PKU), a health condition where a person has higher levels of an amino acid called phenylalanine (Phe). People with PKU do not have the enzyme needed for the body to break down Phe. This can cause harmful buildup, leading to serious health problems. Pegvaliase works by removing excess Phe from a person’s body. A brand name for pegvaliase is Palynziq®. 

Having PKU that is not well controlled during pregnancy can increase the chance of birth defects and other pregnancy-related problems. MotherToBaby has a fact sheet on PKU here: https://mothertobaby.org/fact-sheets/maternal-pku-pregnancy/.  

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.  

For women with PKU who are pregnant or planning pregnancy, the American College of Obstetricians and Gynecologists (ACOG) recommend keeping phenylalanine (Phe) levels below 6 mg/dL (363 μmol/L) for at least 3 months before pregnancy and between 2–6 mg/dL during pregnancy to lower the chance of birth defects and other problems. The American College of Medical Genetics and Genomics (ACMG) recommends keeping Phe levels below 360 μmol/L before and during pregnancy. It is important to work closely with your healthcare team, including your obstetrician and PKU specialist, before pregnancy if possible, or as soon as you find out you are pregnant, to make a treatment plan for before, during, and after pregnancy. 

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

It is not known if taking pegvaliase can make it harder to get pregnant. In animal studies, rats given 19 times the human dose had lower fertility (ability to get pregnant). Rats given 4 times the human dose showed no changes in fertility. 

Does taking pegvaliase increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if pegvaliase can increase the chance of miscarriage. Some studies have found that having PKU with high levels of Phe can increase the chance of miscarriage.  

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

It is not known if pegvaliase can increase the chance of birth defects. In one small study of 16 children exposed to pegvaliase during pregnancy, no birth defects were reported.  

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. 

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

It is not known if pegvaliase 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).  

In one small study of 16 children exposed to pegvaliase during pregnancy, a higher number was born preterm than expected. However, more research is needed to know whether pegvaliase itself, PKU, or other factors increase the chance of preterm delivery. It is also important to keep phenylalanine (Phe) levels in a healthy range during pregnancy, as high Phe levels are linked to babies being born smaller than expected.  

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

It is not known if pegvaliase can increase the chance for behavior or learning issues for the child.  

Having high levels of Phe in pregnancy can increase the chance of a child having intellectual disability, behavior issues, and seizures.  

Breastfeeding while taking pegvaliase: 

Pegvaliase passes into breast milk in very small amounts. In 2 infants exposed to pegvaliase through breast milk, no side effects were reported. Experts from the Genetic Metabolic Dietitians International (GMDI) and Southeast Regional Genetics Network (SERN) support the use of pegvaliase in breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

It is not known if pegvaliase could increase the chance of birth defects. One study reported lower amounts of sperm in men with PKU, which can affect men’s fertility (ability to make healthy sperm). 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.