This sheet is about exposure to ketamine 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 ketamine?

Ketamine is an anesthetic medication. Anesthetics are used with medical procedures, such as surgery, to help lower a person’s ability to feel pain and to make them less aware of what is happening. Ketamine has been used to treat pain and for other medical conditions, such as asthma and major depressive disorder. This sheet will focus on the use of ketamine for medical purposes.  

MotherToBaby has fact sheets on: 

• General anesthesia – https://mothertobaby.org/fact-sheets/general-anesthesia-pregnancy/.      

• Asthma –  https://mothertobaby.org/fact-sheets/asthma-and-pregnancy/    

• Depression – https://mothertobaby.org/fact-sheets/depression-pregnancy/.     

I use ketamine and I just found out that I am pregnant. What should I do?

Talk with your healthcare provider as soon as possible. Stopping ketamine should be done under the supervision of a healthcare provider. Stopping suddenly (called “cold turkey”) could cause withdrawal. It is not known what effect, if any, withdrawal could have on a pregnancy.  

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

It is not known if using ketamine could make it harder to get pregnant.   

Does taking ketamine increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. A few studies suggest a small increased chance of miscarriage in people who had surgery with general anesthesia in the first half of pregnancy. However, it is unclear if this small risk is due to anesthesia, the body’s response to surgery, illness in the person who was pregnant, or other factors.  

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

It is not known if ketamine can increase the chance of birth defects. Some studies suggest exposure to ketamine in pregnancy can impact brain development of the fetus.  

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

It is not known if ketamine 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). 

When used as an anesthetic at the time of delivery, there might be changes in uterine tone as well as frequency and strength of contractions. Changes in fetal heart rate or breathing trouble in the newborn have been reported. There have been reports of babies born with more muscle tone (hypertonia) after ketamine was used for minor surgery during pregnancy. There are also reports of births without these issues.  

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

Some studies suggest that exposure to ketamine can affect fetal brain development. This might increase the chance of learning or behavior issues in the child. However, people who are pregnant and need surgery, especially for life-threatening conditions, should not be discouraged from the use of general anesthesia. Talk with your healthcare providers about the risks and benefits of your treatment options. 

What about misuse of ketamine?

Ketamine has also been used without a prescription or without the supervision of a healthcare provider (misused). Slang names for ketamine use include K, K-Hole, Super K and Special K. Misuse of ketamine in pregnancy and breastfeeding have not been well-studied and should be avoided.  

Some studies suggest exposure to ketamine in pregnancy can impact brain development of the fetus, which might impact growth and development. There is a case report of a baby born with low muscle tone (called hypotonia or “floppy baby syndrome”) who was exposed to ketamine misuse throughout the pregnancy. The baby’s muscle tone improved over the first month of life. If you have been misusing ketamine, talk with your healthcare provider or contact the National Drug Helpline at http://drughelpline.org/ or 1-888-633-3239.

Breastfeeding while taking ketamine or having received ketamine during labor and delivery:  

Ketamine has not been well studied for use while breastfeeding. Small amounts of ketamine get into breastmilk. There are four case reports of infants who did not have side effects from breastfeeding after ketamine was given during labor. If you suspect the baby has any symptoms (such as being too sleepy, trouble eating, or poor weight gain), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

A study of 40 men with normal semen samples were exposed to ketamine. Results showed lower sperm motility (movement). This could affect men’s fertility (ability to get a partner pregnant).  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 belimumab 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 belimumab?

Belimumab is a prescription medication used to treat systemic lupus erythematosus (SLE). Belimumab is prescribed to people who have active SLE and are receiving other lupus medications. Belimumab is a type of protein known as a monoclonal antibody and has also been referred to as a “biologic”. Belimumab is sold under the brand name Benlysta®. MotherToBaby has a sheet on lupus available at: https://mothertobaby.org/fact-sheets/lupus-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 this medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.

I am taking belimumab, but I would like to stop taking it before becoming 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 adults, it takes up to 4 months, on average, for most of the belimumab to be gone from the body.

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

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

Does taking belimumab increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Based on animal studies done by the manufacturer, a case series, and one study in humans, belimumab is not expected to increase the chance of miscarriage. Lupus itself might increase the chance of miscarriage.

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

Animal studies done by the manufacturer (with doses higher than the recommended dose used in people) did not show an increase in birth defects after exposure to belimumab. In humans, 2 case series and 1 study, totaling 77 women, have not found an increased chance for a pattern of birth defects.

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

It is not known if belimumab can cause other pregnancy complications, 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 did not find an increased chance for pregnancy related problems. Active lupus, itself, may increase the chance of pregnancy complications such as preterm delivery and poor growth of the baby.

Does taking belimumab during pregnancy have any effect on my baby after birth?

It is not yet known if belimumab can have an effect on the baby after birth. Monoclonal antibodies, such as belimumab, cross the placenta during the third trimester of pregnancy and in theory might affect the baby’s immune system (the system in the body that helps fight off infections). One small study did not find a risk for a weakened immune system in the infant in the days after birth. Animal studies done by the manufacturer showed a weakened immune system in the offspring of animals exposed to belimumab during pregnancy, but these effects went away after 3 to 12 months.

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

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

Can my baby receive live vaccines before one year of age if I take belimumab while pregnant?

Since some biologic medications might suppress the immune system of the adult taking it, there is a theoretical concern that the same thing could happen to the baby if they are exposed during pregnancy. It is not known if exposure to belimumab during pregnancy affects a baby’s ability to fight off infection. If someone has a weakened immune system, they may be more likely to develop an infection from a live vaccine. Live vaccines contain a small amount of live virus. Inactivated vaccines do not contain live virus, so they cannot cause the disease they protect against. In the United States, rotavirus is the only live vaccine routinely given in the first year of life. Most people can get inactivated vaccines in the first year of life. Talk with your child’s healthcare provider about your exposure to belimumab during pregnancy. They can talk with you about the vaccines your child should receive and the best time for your child to receive them.

Breastfeeding while taking belimumab:

Belimumab is a large protein and little of the medication is expected to pass into breast milk. Belimumab is not well absorbed from the gut when swallowed. So any medication that would get into breast milk would be unlikely to enter the baby’s system. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

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

Studies have not been done to see if belimumab could affect a man’s fertility (ability to get a woman 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/.

MotherToBaby is currently conducting a study looking at belimumab use 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 nortriptyline 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 nortriptyline?

Nortriptyline is a medication that has been used to treat depression, attention deficit hyperactivity disorder (ADHD), eating disorders, irritable bowel syndrome, migraines, and pain. It belongs to a class of medications called tricyclic antidepressants. Some brand names for nortriptyline are Aventyl® and Pamelor®.

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. Some women may have a return of their symptoms (relapse) if they stop this medication during pregnancy. 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 some women break down this medication. If so, changes to their medication doses might be needed during pregnancy. Your healthcare provider can discuss this with you, if necessary.

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

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

Does takingnortriptyline increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if nortriptyline can increase the chance of miscarriage. However, depression itself might increase the chance of miscarriage. More information on depression can be found in our fact sheet here: https://mothertobaby.org/fact-sheets/depression-pregnancy/.

Does taking nortriptyline 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. Information on the use of nortriptyline in pregnancy is limited. A small number of studies have not found a higher chance of birth defects with doses of nortriptyline used for treatment of depression.

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

It is not known if nortriptyline 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). One study found that use of other tricyclic antidepressants (not nortriptyline) might increase the chance of preterm delivery or low birth weight. However, research has shown that untreated depression during pregnancy can increase the chance of pregnancy complications. This makes it hard to know if it is the medication, untreated depression, or other factors that might increase the chance for these problems.

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

The use of other tricyclic antidepressants (not nortriptyline) during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal and can include colic, cyanosis (skin looks blue), breathing problems, and irritability. In most cases the symptoms go away in a few days without long-term health effects. Not all babies exposed to tricyclic antidepressants will have these symptoms. It is important that your healthcare providers know you are taking nortriptyline so that if symptoms occur your baby can get the care that is best for them.

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

It is not known if taking nortriptyline in pregnancy can affect future behavior and learning for the child. Reports of 11 children who were exposed to nortriptyline in pregnancy showed no differences in IQ, language, or behavior compared to children exposed to a different antidepressant or children who were not exposed to antidepressants during pregnancy.

Breastfeeding while taking nortriptyline:

Nortriptyline passes into breastmilk in small amounts. A limited number of cases have reported no side effects or negative effects on infant growth and development. The benefit of continuing nortriptyline while breastfeeding might outweigh the risks of an untreated mental health condition. Your healthcare provider can talk with you about nortriptyline and what treatment is best for you.

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

Some studies suggest that nortriptyline might lower sex drive (desire to have sex) and increase the chance of sexual dysfunction (problems during any stage of typical sexual activity). This could affect a man’s fertility (ability to get a woman pregnant). However, depression might also affect a man’s fertility.

It is not known if nortriptyline 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 exposure to oxycodone 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 oxycodone?

Oxycodone is an opioid medication. Opioids are sometimes called narcotics. Oxycodone is used to treat moderate to severe pain. A brand name for oxycodone is OxyContin®. Oxycodone is also available in combination with acetaminophen (such as Percocet®) or aspirin (such as Percodan®). For more information about acetaminophen or aspirin, please see the MotherToBaby fact sheets at https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/  and https://mothertobaby.org/fact-sheets/regular-strength-aspirin/.

I am taking oxycodone, but I would like to stop taking it before becoming pregnant. How long does the drug stay in my body?

People eliminate medications from their bodies at different rates. In healthy, non-pregnant adults, it takes up to 2 days, on average, for most of the oxycodone to be gone from the body. It might take a longer time for long-acting (extended release (ER)) oxycodone medication to leave the body.

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

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

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

Talk with your healthcare providers before making any changes to how you take this medication. If you have been taking oxycodone regularly or have a dependency or opioid use disorder, you should not stop taking it suddenly. Stopping oxycodone suddenly could cause you to go into withdrawal. More research is needed to know how going through withdrawal might affect a pregnancy. It is suggested that any reduction in oxycodone be done slowly, and under the direction of your healthcare provider.

Does taking oxycodone 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 oxycodone increases the chance of miscarriage.

Does taking oxycodone 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. Some studies looking at opioid medications as a general group, rather than studying the medications separately, suggest that opioids might increase the chance of birth defects. However, studies have not found a specific pattern of birth defects caused by opioids.

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

Studies involving women who use some opioids frequently during their pregnancy have found an increased chance for poor growth of the baby, low levels of amniotic fluid (fluid that surrounds baby in the uterus), stillbirth, preterm delivery, and C-section. This is more commonly reported in those who are using heroin or who are taking 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 of this fact sheet on Neonatal Abstinence Syndrome).

Will my baby have withdrawal (neonatal abstinence syndrome) if I continue to take oxycodone in my pregnancy?

Studies have reported an increased chance for neonatal abstinence syndrome (NAS) with use of oxycodone during the 3^rd trimester.

Neonatal abstinence syndrome (NAS) is the term used to describe withdrawal symptoms in newborns from opioid medication that a woman takes during pregnancy. NAS 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 NAS appear 2 days after birth and may last more than 2 weeks. The chance that NAS will occur depends on the length of time and/or the dose of opioid taken during pregnancy, if other medications were also taken, if the baby was born preterm, and/or the 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 NAS and provide the best care for your newborn.

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

Studies have not been done to see if oxycodone can cause 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 over a long period of time during pregnancy. It is hard to tell if this is due to the medication exposure or other factors that may increase the chances of these problems.

Breastfeeding while taking oxycodone:

The product label recommends women who are breastfeeding not use oxycodone. But, the benefit of breastfeeding and treating your condition may outweigh possible risks. Your healthcare providers can talk with you about using oxycodone and what treatment is best for you.

Oxycodone can get into breast milk. Babies might have problems with the amounts of oxycodone in the breast milk. The use of some opioids, including oxycodone, when breastfeeding might cause babies to be very sleepy, have trouble latching on, and have poor feeding. Some opioids can cause trouble with breathing. 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, the length of use, or other factors.

If you are using any opioid while breastfeeding, 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 oxycodone, could it affect fertility or increase the chance of birth defects?

Studies have not been done to see if oxycodone could affect a man’s fertility (ability to get a woman pregnant) or increase the chance of birth defects. However, use of opioids in general has been shown to lower fertility in men. 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 topiramate 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 topiramate? 

Topiramate is a medication that has been used to prevent seizures and migraine headaches. It has also been used to treat alcoholism, eating disorders, tremors, obesity, diabetes, and psychiatric disorders such as bipolar disorder. Topiramate is sold under the brand names Topamax®, Trokendi XR®, Qudexy XR®. The combination of topiramate and phentermine (Qysymia®) has been used for weight loss.  

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. 

Having a seizure while pregnant could be harmful to a pregnancy. Women who have bipolar disorder and stop taking their medication are at increased risk for episodes of depression or mania that might be harmful to both the woman who is pregnant and the pregnancy. For more information on depression in pregnancy, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/depression-pregnancy/.

I am taking topiramate, 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 (process) medication is not the same for everyone.  In healthy non-pregnant adults, it takes up to 5.25 days, on average, for most of the topiramate to be gone from the body.   

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

It is not known if topiramate can make it harder to get pregnant. Studies have found that the long-term use of seizure medications in women with a seizure disorder might be linked to irregular periods and trouble getting pregnant.  In one report, women with epilepsy had weight loss and improved menstrual cycling and fertility with topiramate use. 

The use of topiramate at the same time as birth control medications might make the birth control less effective. Talk with your healthcare provider if you take topiramate and take or want to take birth control medications. 

Does taking topiramate increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Miscarriage has been reported with topiramate use. However, one study found no increase in the chance for pregnancy loss. As there are many causes of miscarriage, it is hard to know if a medication, the medical condition being treated, or other factors (such as age, health, other exposures) are the cause of a miscarriage. 

Does taking topiramate 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 topiramate, might increase the chance of birth defects in a pregnancy. Some studies suggest that topiramate use in the first trimester might increase the chance for certain birth defects such as cleft lip (an opening in upper lip) with or without cleft palate (an opening in the roof of the mouth), heart defects, or hypospadias (when the opening of the penis is on the underside of the penis instead of at the tip). There are also studies that did not report an increased chance of birth defects. 

If you are taking topiramate, your healthcare provider might suggest you take a higher dose of folic acid for at least 3 months before getting pregnant to help lower the chance for certain birth defects. Talk with your healthcare provider to find out how much folic acid is right for you. More information about folic acid can be found in our fact sheet here: https://mothertobaby.org/fact-sheets/folic-acid/.  

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

Some studies suggest that topiramate might 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).  

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

It is not known if topiramate can affect future behavior or learning for the child. There is information that suggested topiramate use in pregnancy might increase the chance of behavior and learning issues, including intellectual disability, autism spectrum disorders, and problems with motor coordination. There are also studies that have not associated topiramate use with neurodevelopmental disorders. 

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 cleft lip or palate and heart defects.  Ultrasound can also be used to watch the growth of the pregnancy. Talk to your healthcare provider about any prenatal screening 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 taking topiramate: 

When taken in doses of up to 200 mg of topiramate per day, the medication passes into breastmilk in small amounts. Most infants do not experience side effects when exposed to topiramate through breast milk. If you suspect the baby has any symptoms (diarrhea, drowsiness, irritability, or trouble gaining weight), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

There have been reports of loss of sexual desire (libido) and erectile dysfunction in men taking topiramate. Studies have not been done to see if topiramate 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