This sheet is about exposure to olanzapine 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 olanzapine? 

Olanzapine is a medication that has been used to treat schizophrenia, major depressive disorder, mixed or maniac episodes, and bipolar disorder. It has also been used with other medications to treat anorexia, depression, and symptoms of dementia. A brand name for olanzapine is Zyprexa®. Olanzapine can also be sold in combination with fluoxetine under the brand name Symbyax® and in combination with samidorphan under the brand name Lybalvi®.  

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. MotherToBaby has a fact sheet on depression here: https://mothertobaby.org/fact-sheets/depression-pregnancy/.  

Some women may have a return of their symptoms (relapse) if they stop this medication during pregnancy. If you plan to stop this medication, your healthcare provider may suggest that you slowly lower the dose instead of stopping all at once. Stopping this medication suddenly can cause withdrawal symptoms. It is not known if or how withdrawal symptoms might affect a pregnancy. 

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

Olanzapine can raise the levels of the hormone prolactin. High levels of prolactin can stop ovulation (part of the menstrual cycle when an ovary releases an egg). This would make it harder to get pregnant. Your healthcare provider can monitor your prolactin levels if there is concern.  

Does taking olanzapine increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if olanzapine can increase the chance of miscarriage. Conditions, such as depression, can increase the chance of miscarriage. This makes it hard to know if a medication, the medical condition being treated, or other factors are increasing the chance of miscarriage. 

Does taking olanzapine 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 olanzapine, might increase the chance of birth defects in a pregnancy. Studies of over 2,500 pregnancies exposed to olanzapine early or throughout pregnancy do not suggest an increased chance of birth defects. 

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

It is not known if olanzapine 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). A study from 2000 suggested that olanzapine therapy was associated with low birth weight and infants needing care in the neonatal intensive care unit (NICU). However, more recent studies have not reported an increased chance of these outcomes. One small study did not find an increased chance of preterm delivery.  

Some studies suggest that taking olanzapine throughout pregnancy might increase the chance of gestational diabetes. Gestational diabetes can increase the chance of other complications such as preterm delivery or the fetus being larger than expected (macrosomia). Talk with your healthcare provider about your risks. If needed, they can monitor your blood sugar levels before and during pregnancy. More information about gestational diabetes can be found in our fact sheet at https://mothertobaby.org/fact-sheets/diabetes-pregnancy/.    

Research has also shown that when conditions such as depression are untreated during pregnancy, there could be an increased chance of pregnancy complications. This makes it hard to know if a medication, the medical condition being treated, or other factors are increasing the chance of these problems.  

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

The use of olanzapine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms can include stiff or floppy muscle tone, drowsiness, agitation, trouble with breathing, trouble with feeding, or tremors. Symptoms usually go away in a few days. Not all babies exposed to olanzapine will have these symptoms. It is important that your healthcare providers know you are taking olanzapine so that if symptoms occur, your baby can get the care that is best for them. 

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

It is not known if olanzapine can increase the chance of behavior or learning issues for the child. Information is limited, and no proven link has been established between prenatal exposure to olanzapine and effects on future behavior or learning in the exposed children. 

Breastfeeding while taking olanzapine: 

Olanzapine passes into breast milk in small amounts. Side effects were not reported in most infants exposed to olanzapine through breast milk. In one study, symptoms such as irritability, tremors, being more sleepy than usual, having trouble sleeping or staying asleep were reported in a small number of infants. If you suspect the baby has any symptoms (irritability, tremors, or having any sleep problems), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Using olanzapine may raise levels of the hormone prolactin, which may affect male fertility (ability to make healthy sperm). Studies have not been done to see if olanzapine could increase the chance of birth defects. 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 naproxen 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 naproxen? 

Naproxen is a medication that has been used to treat pain and fever. It belongs to the class of medication called non-steroidal anti-inflammatory drugs (NSAIDs). Some brand names for naproxen include Aflaxen®, Aleve®, Anaprox®, Flanax®, Naprelan®, Naprosyn® and Menstridol®.  

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.  

The U.S. Food and Drug Administration (FDA) recommend not using NSAIDs after week 20 of pregnancy unless your healthcare provider specifically recommends it. If a healthcare provider decides NSAIDs are needed after week 20 of pregnancy, they should be used at the lowest dose for the shortest time.   

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

It is not known if naproxen can make it harder to get pregnant. Some studies suggest that naproxen and other NSAIDs might interfere with ovulation, including causing unruptured follicle syndrome, where the follicle does not release the egg at the time of ovulation. This might make it harder to get pregnant. These effects may be more likely with frequent or long-term use. 

Does taking naproxen increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Some studies have suggested that taking naproxen may increase the chance of miscarriage, while others have not. 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.  

Does taking naproxen 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 naproxen, might increase the chance of birth defects in a pregnancy. Most studies on NSAIDs, including naproxen, have not shown an increased chance of birth defects.  

Some studies have reported a small increased chance for certain birth defects, including heart defects and cleft lip and/or palate (opening in the roof of the mouth and/or the lip), when NSAIDs are used in early pregnancy. A review of NSAID use in pregnancy has also suggested a possible small increase in the chance of some birth defects, although findings have been mixed. It is not known if naproxen, the medical condition being treated, or other factors caused these findings. 

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

Naproxen is usually not recommended after week 20 of pregnancy. Some reports suggest that using NSAIDs in the second half of pregnancy might affect the fetal kidneys and lower the amount of amniotic fluid (the fluid around the fetus in the womb). One study also suggested that NSAID use earlier in pregnancy might have similar effects. Too little amniotic fluid (called oligohydramnios) can lead to problems like poor lung development, stiff joints, or the need for early delivery by induction or C-section. In rare cases, oligohydramnios could cause fetal death before birth.  

Using naproxen later in pregnancy might cause the ductus arteriosus (an opening between the two major blood vessels leading from the heart) to close early. If the ductus arteriosus closes before it should, it can cause high blood pressure in the fetal lungs (pulmonary hypertension).   

One study found that NSAID use, including naproxen, during pregnancy was associated with an increased chance of having a baby that was smaller than expected for gestational age (small for gestational age). Naproxen should only be used under a healthcare provider’s supervision, particularly in the 2nd and 3rd trimesters. Your healthcare providers can closely monitor your pregnancy, if needed.   

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

Studies have not been done to see if naproxen could affect a child’s learning or behavior after exposure during pregnancy. Studies on NSAIDs in general have shown mixed results, and those suggesting a possible link have important limitations (the medical condition being treated, different ways of measuring outcomes, and uncertainty about the exact timing and amount of medication used). This makes it unclear whether the medication or other factors are responsible for the outcomes reported. 

Breastfeeding while taking naproxen: 

Naproxen passes into breast milk in small amounts. Using naproxen is not expected to be harmful to most breastfeeding babies. There is one report of blood-related health problems in an infant who was exposed to naproxen and another medication through breast milk. It is not known if the reported health problems were due to the naproxen, another medication, or other factors. If you suspect the baby has any symptoms (vomiting, diarrhea, bleeding, trouble with feeding, or trouble with weight gain) contact the child’s healthcare provider.  

Because naproxen remains in breast milk longer than some other NSAIDs, shorter-acting NSAIDs may be preferred during breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

It is not known if naproxen could affect male fertility (ability to make healthy sperm) 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 exposure to vedolizumab in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare providers. 

What is vedolizumab? 

Vedolizumab is a type of medication called a monoclonal antibody. It has been used to help stop swelling and irritation of the gut caused by inflammatory bowel diseases such as ulcerative colitis (UC) and Crohn’s disease (CD). Vedolizumab is given by intravenous infusion (IV) (directly to the bloodstream through a vein in the arm). The brand name for vedolizumab is Entyvio®. For more information about UC and CD, please see the MotherToBaby sheets on Inflammatory Bowel Disease (IBD) at https://mothertobaby.org/fact-sheets/inflammatory-bowel-disease-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. 

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

Limited information does not suggest that taking vedolizumab would make it harder to get pregnant.  

Does taking vedolizumab increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not found a higher chance of miscarriage when vedolizumab is used during pregnancy. 

Does taking vedolizumab 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 vedolizumab, might increase the chance of birth defects in a pregnancy. Studies have not found a higher chance of birth defects when vedolizumab is used during pregnancy.  

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

Studies have compared pregnancy outcomes of women taking vedolizumab during pregnancy to those of women taking some other medications to treat IBD and those of women without IBD. Overall, the studies have not found higher chances of preterm delivery (birth before week 37), poor growth of the fetus, or other pregnancy-related problems among women taking vedolizumab.   

Having severe IBD or IBD disease flares during pregnancy can increase the chance of pregnancy-related problems.  

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

It is not known if vedolizumab can increase the chance of behavior or learning issues for the child. Small studies looking at children who were exposed to vedolizumab during pregnancy reported typical growth and development up to 1 year of age.  

Breastfeeding while taking vedolizumab: 

Vedolizumab has not been well-studied for use during breastfeeding. It is expected to get into breast milk in small amounts. Very little of the medication is expected to be absorbed by infants who swallow these small amounts in breast milk. No increased risk of serious infection was reported in the first year of life among 64 infants exposed to vedolizumab through breast milk. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Studies have not been done to see if vedolizumab could affect a man’s fertility (ability to make healthy sperm). No birth defects were reported in 30 pregnancies in which the men used vedolizumab. 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 medications used to treat UC and CD in pregnancy. If you are interested in taking part in one of these studies, please call: 1-877-311-8972 or visit: https://mothertobaby.org/join-study/.

Please click here for references.

This sheet is about exposure to valproic acid 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 valproic acid? 

Valproic acid is a medication that has been used to control seizures in the treatment of epilepsy and to treat bipolar disorder and migraines. Valproic acid is sometimes also called sodium valproate or valproate sodium. Some brand names for valproic acid are Depakene®, Stavzor®, and Depacon®. A similar medication, divalproex (Depakote®), breaks down into valproic acid in the body. 

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. If you have a seizure, it could reduce oxygen to the fetus, cause injury from falls or accidents, and be dangerous for both you and the pregnancy. If you have a relapse of bipolar disorder, symptoms of depression or mania can be stressful and make it harder to care for yourself, which could also affect your pregnancy. Your healthcare provider can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

The U.S. Food and Drug Administration (FDA) recommends that women who are pregnant do not take valproate sodium and related products (such as valproic acid and divalproex sodium) to prevent migraine headaches. For epilepsy or bipolar disorder, valproate products should only be prescribed during pregnancy if other medications are not effective in treating the condition or cannot be used for another reason. The product label for valproic acid recommends women who are pregnant not use this medication or use caution when using this medication during pregnancy. However, the benefit of using valproic acid might outweigh possible risks. Your healthcare provider can talk with you about using valproic acid and what treatment is best for you. 

I am taking valproic acid, 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 2-4 days, on average, for most of the valproic acid to be gone from the body.   

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

Some studies suggest that women taking valproic acid might have a higher chance of developing polycystic ovary syndrome (PCOS), a condition associated with trouble getting pregnant (infertility). Women with seizure or bipolar disorders may have irregular periods or trouble getting pregnant. This can be due to the condition itself, not necessarily the medication. 

Does taking valproic acid increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if taking valproic acid can increase the chance of miscarriage. One recent study has shown an increased chance of miscarriage with valproic acid use during pregnancy. 

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

Taking valproic acid during pregnancy can increase the chance of fetal valproate spectrum disorder, which includes major and minor birth defects. About 10% (1 in 10) of babies exposed in the first trimester have major defects, such as heart problems, cleft lip (when the lip does not form correctly and needs surgery to repair after birth), or neural tube defects (an opening in the fetal spine or skull). The chance to have a baby with a neural tube defect (NTD) when taking valproic acid is approximately 1 in 50 to 1 in 100 (1% to 2%). Minor defects, like small facial differences, can also occur. Higher doses or combining valproic acid with another seizure medication may increase these risks. 

Valproic acid can lower folic acid levels in the body. Taking 400 mcg of folic acid daily before and during early pregnancy can help prevent NTDs. Studies have not shown that higher doses of folic acid reduce NTD risk for women taking valproic acid. If you are taking valproic acid, talk with your healthcare provider about what dose of folic acid is right for you. For more information on folic acid, please see the MotherToBaby fact sheet at: https://mothertobaby.org/fact-sheets/folic-acid/.   

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

Valproic acid might increase the chance of low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).  

Pregnant women with epilepsy have a higher risk of complications such as cesarean section, preterm birth (birth before 37 weeks of pregnancy), gestational diabetes, preeclampsia (high blood pressure and problems with organs, such as the kidneys), growth problems in the baby, placental problems, and stillbirth compared to women without epilepsy. These risks are increased whether epilepsy medication is taken or not. 

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

The use of valproic acid during pregnancy can cause temporary symptoms, such as jitteriness and irritability, in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Not all babies exposed to valproic acid will have these symptoms. There have been reports of temporary low blood sugar levels (hypoglycemia) in newborns. It is important that your healthcare providers know you are taking valproic acid so that if symptoms occur your baby can get the care that is best for them. 

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

Prenatal exposure to valproic acid can increase the chance of problems with learning and development. Studies have found higher chances of intellectual disability, developmental delays, autism spectrum disorder, attention deficit/hyperactivity disorder (ADHD), attachment difficulties, and delays in language, memory, social, and adaptive skills. However, not all studies show the same results, and some long-term issues may be influenced by how severe the parent’s seizure disorder is. 

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

Prenatal ultrasounds can check for some birth defects, like NTDs, cleft lip, or heart problems. A blood test can measure alpha-fetoprotein (AFP), which is often higher if a fetus has an NTD. If AFP is high, your provider may suggest more tests. Talk with your healthcare provider about available prenatal screenings. There are no tests available during pregnancy that can tell how much effect there could be on future behavior or learning. 

Breastfeeding while taking valproic acid: 

Valproic acid passes into breast milk in small amounts. The blood levels of infants exposed to valproic acid through breast milk are usually undetectable. There is a theoretical (not proven) concern that infants exposed to valproic acid through breast milk could develop liver toxicity, so infants should be monitored for any changes or problems. If you suspect the baby has symptoms such as jaundice (yellowing of the skin or eyes), unusual bruising, bleeding, rash, or fever, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Studies looking at whether valproic acid can affect men’s fertility (ability to make healthy sperm) or increase the chance of birth defects have had mixed results. Some studies suggest there may be increased risks, while others do not. 

For more general 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 rheumatic heart disease (RHD) in a pregnancy or while breastfeeding. This information is based on available research studies. It should not take the place of medical care and advice from your healthcare provider.

What is rheumatic heart disease?

Rheumatic heart disease (RHD) is a condition where the valves of the heart are permanently damaged by inflammation and scarring caused by rheumatic fever. This can cause narrowing or leaking of the heart valve, which makes it harder for the heart to work as usual. People with RHD can have mitral stenosis (narrowing of the two left chambers of the heart), aortic stenosis (narrowing of the connection between the heart and one of the main blood vessels), mitral regurgitation (when blood flows backwards within the areas of the heart), or aortic regurgitation (when blood flows backwards back into the heart from the aorta). RHD can increase the chance of stroke, changes to the heart rhythm, and infections in the heart valve.

How do you get RHD?

RHD can happen when a person has an untreated or undertreated group A strep infection that moves into the organs. When this happens, the immune system attacks the body instead of the infection. MotherToBaby has a fact sheet on group A strep infections here: https://mothertobaby.org/fact-sheets/group-a-strep-infections/.

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

It is important to talk to your healthcare team about plans for treating your condition before and during pregnancy, as well as during and after delivery. If possible, talk with your healthcare team before getting pregnant. If your pregnancy is unplanned, contact your healthcare providers as soon as you find out you are pregnant.

Things to talk about with your healthcare team include:

• Ways to monitor your pregnancy and manage your RHD symptoms.
• Any medications, vitamins, supplements, or other exposures.
• Any other questions or concerns you have.

People with RHD often need medications to best manage their health. 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 have RHD. Can it make it harder for me to get pregnant?

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

Will pregnancy affect my RHD symptoms?

A woman’s body goes through many changes while pregnant. Some of these changes include increases in how fast the heart is beating and how much blood the heart is pumping. A woman with RHD might have changes to their symptoms because of the extra effort needed by the heart during pregnancy.

Does having RHD 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 having RHD increases the chance of miscarriage.

Does having/getting RHD 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 RHD, might increase the chance of birth defects in a pregnancy. Studies have not been done to see if RHD increases the chance for birth defects.

Would having RHD increase the chance of other pregnancy related problems?

It is not known if having RHD increases 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). However, complications of RHD, like aortic valve stenosis, mitral stenosis, mitral regurgitation, or aortic regurgitation, has been associated with preterm delivery, low birth weight, and intrauterine growth restriction (IUGR) (fetus does not grow as much as expected during pregnancy. There can also be arrythmias (changes in the heartbeat) and heart failure in the woman who is pregnant.

Rarely, it has been reported that having RHD might increase the chance of severe pregnancy-related problems, including death of the woman who is pregnant or the fetus. There are also studies that have not found an increased chance for these outcomes when a woman who is pregnant has RHD. Having RHD that is treated or controlled and being monitored by a medical team that is aware of your condition can help to decrease the chance of severe pregnancy-related problems. It is important to speak with your healthcare providers about managing your condition for your health and the health of your pregnancy.

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

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

Breastfeeding while I have RHD:

Having RHD is not expected to affect a woman’s ability to breastfeed. People who have RHD might be on different medications to control their condition. It is important to talk to your healthcare provider and your child’s pediatrician about your condition, your medications, and your plans to breastfeed. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if RHD 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 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.