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

What is perphenazine?

Perphenazine is a medication that has been used to treat schizophrenia and other mental health conditions. It has also been used to treat severe nausea and vomiting during pregnancy (hyperemesis gravidarum). A brand name for perphenazine is Trilafon®. A combination of perphenazine and amitriptyline has been sold as Triavil® and Etrafon®.

MotherToBaby has fact sheets on nausea and vomiting in pregnancy here: https://mothertobaby.org/fact-sheets/nausea-vomiting-pregnancy-nvp/ and amitriptyline here: https://mothertobaby.org/fact-sheets/amitriptyline/.

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 perphenazine. Can it make it harder for me to get pregnant?

It is not known if perphenazine can make it harder to get pregnant. In some women, perphenazine might raise the levels of a hormone called prolactin. High levels of prolactin can stop ovulation (part of the menstrual cycle when an ovary releases an egg). This might make it harder to get pregnant.

Does taking perphenazine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. One study looking at over 200 pregnancies exposed to perphenazine did not report an increased chance of miscarriage.

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

Information on the use of perphenazine in human pregnancy is limited. There are case reports of two children who were born with birth defects after being exposed to perphenazine and other drugs during the first trimester. No increased chance of birth defects was reported in 119 women who were treated with perphenazine early in pregnancy. A birth registry report on 90 pregnancies with early exposure to perphenazine also did not report an increased chance of birth defects.

Animal studies using 30 to 300 times the dose given to humans reported an increased chance of birth defects, including cleft palate (opening in the roof of the mouth), retrognathia (the lower jaw is set further back than the upper jaw), and micromelia (one or more limbs are smaller than usual). At lower doses (1.5 and 14 times higher than the dose given to humans), no increased chance of birth defects was noted in animals.

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

It is not known if perphenazine 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).

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

The use of perphenazine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Babies exposed to perphenazine during late pregnancy can be monitored for symptoms such as too much or too little muscle tone (stiff or floppy), sleepiness, agitation, problems with breathing and feeding, or unusual muscle movements (tremors). Not all babies exposed to perphenazine will have these symptoms. It is important that your healthcare providers know you are taking perphenazine so that if symptoms occur your baby can get the care that is best for them.

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

It is not known if perphenazine can increase the chance for behavior or learning issues for the child. A prescription review study looked at 134 children born to women who filled at least 1 prescription for perphenazine during pregnancy. The report found no association with poorer school performance. Prescription-based studies cannot tell us if the person who filled the prescription took the medication during their pregnancy.

Breastfeeding while taking perphenazine:

Information on the use of perphenazine while breastfeeding is limited. Based on information from 1 person, low levels of perphenazine were found in breastmilk when doses of 16 or 24 mg per day were taken. When this person was taking 16 mg of perphenazine daily and breastfed her infant from 1 month to 4.5 months of age, no effects on infant growth or development were reported. If you suspect the baby has any symptoms (such as being too sleepy), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if perphenazine could affect men’s fertility (ability to get a woman pregnant) or increase the chance of birth defects. Using perphenazine could raise a man’s levels of the hormone prolactin, which might affect fertility. There is a report of a man taking perphenazine who experienced an uncontrolled erection that lasted for hours (priapism). 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 clozapine 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 clozapine?

Clozapine is a medication that has been used to treat schizophrenia and schizoaffective disorders. Some brand names are Versacloz®, FazaClo®, and Clozaril®.

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 clozapine. Can it make it harder for me to get pregnant?

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

Does taking clozapine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Information from 3 studies that looked at approximately 225 pregnancies exposed to clozapine does not suggest an increased chance of miscarriage.

Does taking clozapine 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. It is not known if clozapine can increase the chance of birth defects. One reviewer combined studies and reported a birth defect rate of 4.5% out of 264 infants with first trimester exposure to clozapine. This is similar to the background risk of birth defects.

There are case reports of infants with birth defects after exposure to clozapine in the first trimester. No pattern of birth defects was identified to suggest the birth defects noted were related to a single medication. There are also reports of babies without birth defects after prenatal exposure to clozapine.

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

It is not known if clozapine 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). No differences in birth weight or gestational age were reported in 187 children exposed to clozapine or another medication called olanzapine during pregnancy, when compared with an unexposed group.

Some studies have suggested an increased chance for pregnant women to develop gestational diabetes when clozapine is used in pregnancy. Gestational diabetes can lead to babies that are bigger than expected (called large for gestational age). Be sure to talk with your healthcare provider about your chances of gestational diabetes. They can go over any screenings, tests, or treatments they recommend for you. For more information about gestational diabetes, see the MotherToBaby fact sheet here: https://mothertobaby.org/fact-sheets/diabetes-pregnancy/

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

The use of clozapine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Some babies have also had unexplained seizures. There is one case report of a baby who had had a low white blood cell count. White blood cell count helps to see how a person’s immune system is working. If the immune system is not working well, a person could have a harder time fighting off infection. One case report cannot prove that the low white blood cell count was due to clozapine exposure in pregnancy.

Newborns exposed to clozapine during late pregnancy can be monitored for symptoms such as too much or too little muscle tone (stiff or floppy), sleepiness, agitation, problems with breathing and feeding, or unusual muscle movements (tremors). Not all babies exposed to clozapine will have symptoms. Let your baby’s healthcare providers know you are taking clozapine so that if symptoms occur your baby can get the care that is best for them.

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

It is not known if clozapine can increase the chance of behavior or learning issues for the child. One study compared the development of infants exposed to clozapine during pregnancy to that of infants exposed to other antipsychotic medications and found some behavior delays at age 2 months and 6 months of age. However, the difference was not noticed by age 1 year.

Breastfeeding while taking clozapine:

Information about the use of clozapine during breastfeeding is very limited. Drowsiness (being sleepier than usual) was reported in 1 infant exposed to clozapine in breastmilk. Another infant developed agranulocytosis (a life-threatening blood disorder when the body doesn’t make enough white blood cells). There are reports of breastfed infants who did not have side effects. If you are breastfeeding while taking this medication, the infant should be closely watched for drowsiness and have their white blood cell count checked by a healthcare provider.

The product label for clozapine recommends that breastfeeding women not use this medication. However, the benefit of using clozapine and nursing may outweigh the possible risks to your baby. Your healthcare providers can talk with you about using clozapine and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

There is a report of a man who was taking clozapine and had trouble with ejaculation, which could make it harder to get a woman pregnant. This issue resolved when the medication was stopped. Studies have not been done in males to see if clozapine 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 to view references.

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

What is ofatumumab?

 

Ofatumumab is a monoclonal anti-CD20 antibody that works by lowering the amount of B cells in a person’s body. B cells are a type of white blood cell that makes antibodies. Ofatumumab has been used to treat adults with relapsing forms of multiple sclerosis (MS). MotherToBaby has a fact sheet on multiple sclerosis here: https://mothertobaby.org/fact-sheets/multiple-sclerosis/. Ofatumumab has also been used to treat chronic lymphocytic leukemia. Some brand names for ofatumumab are Kesimpta® and Arzerra®.   

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

 

People eliminate medication at different rates. In healthy adults, it takes up to 96 days (a little over 3 months), on average, for most of the ofatumumab to be gone from the body. 

The product label for ofatumumab recommends that females who can get pregnant should use an effective method of birth control while taking this medication and to continue to use birth control for 6 months after stopping ofatumumab. 

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

 

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

Does taking ofatumumab increase the chance for miscarriage? 

 

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done in humans to see if ofatumumab can increase the chance for miscarriage. Miscarriage has been reported in people exposed to ofatumumab during pregnancy. 

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

There is limited published information describing people who were exposed to ofatumumab during pregnancy. No birth defects were reported in over 20 pregnancies exposed to ofatumumab. Animal studies done in monkeys have not reported an increased chance of birth defects.  

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

 

Studies have not been done to see if ofatumumab increases the chance for 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). 

Animal studies have reported lower B-cell counts and reduced antibody response in offspring exposed to ofatumumab during pregnancy. Having a low number of B cells can increase the chance for infections.  

It is not known if using ofatumumab in pregnancy could increase the chance of infections in infants. In over 20 pregnancies exposed to ofatumumab, there were no reports of B-cell depletion, problems with antibodies or blood (immunoglobulin/hematological abnormalities), or serious infections in live births. 

Since some biologic medications might suppress the immune system of the person taking it, there is a theoretical concern that the same thing could happen to the baby if they are exposed during pregnancy. 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. In the United States, rotavirus is the only live vaccine routinely given in the first year of life.  

The product label for this drug recommends that infants who were exposed to ofatumumab during pregnancy should have their B-cell levels tested before receiving live vaccines. This is because having low B-cells may increase the chance of infection from live vaccines. Inactivated (not live) vaccines may be given to babies on schedule before B-cell levels are back to normal. However, ofatumumab may change how well inactivated vaccines work. Talk with your child’s healthcare provider about your exposure to ofatumumab during pregnancy. They can talk with you about the vaccines your child should receive and the best time for your child to receive them.  

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

 

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

Breastfeeding while taking ofatumumab:

 

There is limited information on the use of ofatumumab while breastfeeding. Ofatumumab is a large protein molecule, which means the amount that passes into breastmilk is expected to be low. Ofatumumab would likely break down in the infant’s intestinal tract, and the amount of medication absorbed into the infant is expected to be low. In one study where 12 mothers received ofatumumab, the amount of ofatumumab in their breast milk was small and no health effects were reported among the nursing infants. Be sure to talk to your healthcare provider about all of your breastfeeding questions.  

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

 

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

MotherToBaby is currently conducting a study looking at ofatumumab and other medications used to treat multiple sclerosis 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 ibuprofen 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 ibuprofen? 

Ibuprofen is a medication that has been used to treat pain and fever. Some brand names for ibuprofen include Motrin®, Advil®, and Nuprin®. Ibuprofen belongs to the class of medications called non-steroidal anti-inflammatory drugs (NSAIDs).  

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 ibuprofen. Can it make it harder for me to get pregnant?  

It is not known if ibuprofen can make it harder to get pregnant. A few small studies have suggested using ibuprofen might increase the chance for unruptured follicle syndrome. This is when a follicle (small, fluid-filled sac in the ovary that holds an egg) does not release the egg at the time of ovulation. Unruptured follicle syndrome might make it harder to get pregnant. 

Does taking ibuprofen increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Some studies have suggested that the use of ibuprofen might increase the chance of miscarriage, especially if taken around the time of conception or over a long period of time. As there can be many causes of miscarriage, it is hard to know if a medication, the medical condition being treated, or other factors are the cause of a miscarriage. 

Does taking ibuprofen 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 ibuprofen, might increase the chance of birth defects in a pregnancy. There are several studies that have not reported an increased chance of birth defects with ibuprofen use. 

A few studies have suggested that taking ibuprofen in the first trimester might lead to a small increased chance (less than 1%, or 1 birth in 100 births) for gastroschisis (when the intestines stick out of a hole in the stomach wall).  

A small increased chance of heart defects has been reported in a few studies looking at NSAID prescriptions in early pregnancy. However, the reason the NSAID was prescribed was not available in most of the reported data. Studies based on prescription records cannot tell if a person took the medication. This makes it hard to know if the study outcomes are related to the medication or other factors.  

There is not enough information to confirm if ibuprofen increases the chance of birth defects. 

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

There are some studies that suggest NSAIDs 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. Other studies have not reported these findings.   

Ibuprofen 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 ibuprofen 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).  

Ibuprofen 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 you need to use ibuprofen after week 20 of pregnancy.  

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

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

Breastfeeding while taking ibuprofen: 

Ibuprofen gets into breast milk in small amounts. The amount of ibuprofen in breast milk is less than the doses given to infants directly. When used as directed, side effects are not expected in children exposed to ibuprofen through breast milk. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Some studies suggest ibuprofen could affect male fertility (ability to get a woman pregnant), and others do not. Studies have not been done to see if ibuprofen 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 formoterol 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 formoterol?

Formoterol (also called eformoterol) is a medication that has been used to treat asthma and chronic obstructive pulmonary disease (COPD). It is in a class of medications called long-acting beta2-agonists (LABAs). LABAs are bronchodilators. Bronchodilators relax the muscles in the lungs, making it easier to breathe. Formoterol is taken by inhalation (breathing in). Some brand names of formoterol are Foradil® and Perforomist®.

Formoterol combined with corticosteroids are sold under the brand names Symbicort® and Dulera®.

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

Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. When asthma is not well-controlled, it can increase risks to a pregnancy. MotherToBaby has a fact sheet on asthma here: https://mothertobaby.org/fact-sheets/asthma-and-pregnancy/.

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

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

Does taking formoterol increase the chance of miscarriage?

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

Does taking formoterol 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 formoterol, might increase the chance of birth defects in a pregnancy. Animal studies and human case reports do not suggest an increased chance of birth defects with the use of formoterol during pregnancy.

A study on the use of LABAs as a group reported an increased chance of heart defects when used in the first trimester. However, it is not known if the medication, the condition being treated, or other factors caused the reported birth defects.

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

It is not known if formoterol 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). In 1 report with 33 individuals who used formoterol during pregnancy, 5 infants were reported to be delivered preterm. Another study, which compared 162 pregnancies exposed to formoterol with those exposed to another LABA, found no differences in birth weight, gestational age, or the likelihood of preterm delivery.

When asthma is not well-controlled during pregnancy, it has been associated with higher rates of pregnancy complications such as preterm delivery, and low birth weight.

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

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

Breastfeeding while taking formoterol:

There are no studies on the use of formoterol while breastfeeding. Information on a similar medication suggests that inhaled formoterol would be unlikely to pass into the breast milk in large amounts. Inhaled bronchodilators are generally considered acceptable for use during breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

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

Please click here for references.