This sheet is about exposure to the JYNNEOS™ mpox/smallpox vaccine 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 mpox (formerly known as monkeypox)?

Mpox is an illness caused by a virus. The virus belongs to a group of viruses called orthopoxviruses. The virus spreads from person to person through body fluids. The virus can also pass from a woman who is pregnant to her developing baby. For more information about mpox, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/mpox/. The Centers for Disease Control and Prevention (CDC) has information on mpox here: https://www.cdc.gov/mpox/index.html.

What is the JYNNEOS™ mpox/smallpox vaccine?

The JYNNEOS™ vaccine (also known as Imvamune® or Imvanex®) helps protect against mpox, smallpox, and other diseases caused by orthopoxviruses. JYNNEOS™ does not contain live virus that could cause mpox or smallpox. Instead, it contains a weakened form of a related virus, which cannot make copies of itself (replicate) in the body to cause illness. Getting JYNNEOS™ helps the body’s immune system learn how to protect itself (make antibodies) against orthopoxviruses in general.

JYNNEOS™ can be given before or after exposure to an orthopoxvirus to help prevent illness or reduce symptoms. Most people require 2 doses (shots) given 4 weeks apart. According to the Centers for Disease Control and Prevention (CDC), JYNNEOS™ can be given at the same time as other vaccines. When there is a chance of being exposed to the virus that causes mpox, smallpox, or another orthopoxvirus, it is important to continue taking other steps to avoid exposure even after being vaccinated.

At this time, JYNNEOS™ is only recommended for people ages 18 years old or older who have been exposed to or are at high risk of being exposed to the virus that causes mpox. In these cases, the vaccine can be given even if a woman is planning pregnancy or is already pregnant. Pregnancy alone is not a reason to avoid getting the vaccine if someone is otherwise recommended to receive it.

I received JYNNEOS™, but I would like to get pregnant.

There is no recommendation to wait before trying to get pregnant after getting JYNNEOS™. If someone gets their first dose of JYNNEOS™ and then becomes pregnant, there is no recommendation to avoid or postpone the second dose in pregnancy.

I received JYNNEOS™. Can it make it harder to get pregnant?

Studies have not been done in humans to see if JYNNEOS™ can make it harder to get pregnant. Experimental animal studies did not find that JYNNEOS™ affected female fertility (ability to get pregnant).

Does getting the JYNNEOS™ vaccine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done in humans to see if getting the JYNNEOS™ vaccine would increase the chance of miscarriage. Animal studies did not report an increased chance of miscarriage.

Does getting the JYNNEOS™ vaccine 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. Studies have not been done in humans to see if getting the JYNNEOS™ vaccine could increase the chance of birth defects. Animal studies did not show an increased chance of birth defects.

Fever is an uncommon but possible side effect of the JYNNEOS™ vaccine. A high fever in the first trimester can increase the chance of certain birth defects. Acetaminophen is usually recommended to reduce fever during pregnancy. For more information about fever and pregnancy, see the MotherToBaby fact sheet about fever/hyperthermia at https://mothertobaby.org/fact-sheets/hyperthermia-pregnancy/.

Does getting the JYNNEOS™ vaccine in pregnancy increase the chance of other pregnancy-related problems?

Studies have not been done in humans to see if getting the JYNNEOS™ vaccine in pregnancy would increase the chance of other pregnancy-related problems, such as preterm delivery (before 37 weeks of pregnancy) or low birth weight (weighing less than 5 pounds, 8 ounces (2500 grams) at birth). Animal studies did not report other pregnancy problems.

Does getting the

JYNNEOS™

vaccine in pregnancy affect future behavior or learning for the child?

Studies have not been done to see if getting the JYNNEOS™ vaccine in pregnancy could affect future behavior or learning for the child.

Does getting the JYNNEOS™ vaccine during pregnancy protect the baby from mpox after delivery?

It is not known if getting the JYNNEOS™ vaccine during pregnancy would protect the baby from mpox after delivery.

Breastfeeding and the JYNNEOS™ vaccine:

Studies have not been done to see if the JYNNEOS™ vaccine passes into breast milk. However, because the weakened virus in the vaccine is not able to replicate and spread through the body, it is not expected to enter the breast milk. Breastfeeding alone is not a reason to avoid getting the JYNNEOS™ vaccine for someone who is otherwise recommended to receive it. Talk to your healthcare provider about all of your breastfeeding questions.

If a man gets a JYNNEOS™ vaccine, could it affect fertility or increase the chance of birth defects?

Studies have not been done in men to see if getting the JYNNEOS™ vaccine could affect fertility (ability to get a woman pregnant) or increase the chance for 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 to view references.

 This sheet is about having fifth disease during pregnancy or while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare provider. 

What is fifth disease?  

Fifth disease (erythema infectiosum) is a viral illness. It is caused by a virus called human parvovirus B19. Fifth disease is more common in children than adults. The illness often starts with mild fever, headache, sore throat, and other flu-like symptoms. Children can also develop a bright red rash on the face that looks like “slapped cheeks”, along with a lacy or bumpy rash on the body, arms, and legs. In adults, joint aches are a common symptom. Rash and joint symptoms can develop several weeks after the infection. Some adults with Fifth disease might not have symptoms. About 2 in 10 adults (20%) to 3 in 10 adults (30%) who get infected with parvovirus B19 will not have symptoms.  

How do people get fifth disease? 

Fifth disease is very contagious, which means it can easily spread from person to person. It is spread by coughing, sneezing, touching secretions from the nose and mouth of an infected person, and through contact with blood. When an infected person coughs or sneezes, the virus can travel several feet. The time between infection and the development of the illness (incubation period) is usually between 4 and 14 days. People with fifth disease are most likely to spread the disease before their symptoms start. People are less likely to be contagious after the rash occurs. Many people that work with children have antibodies to parvovirus B19. These antibodies can help lower the chance for infection if exposed to parvovirus B19. Everyone can lower their chance of infection by practicing good hygiene such as washing your hands regularly and not sharing eating utensils (spoons/forks) and by not drinking out of the same cups/containers.  

How can I find out if I am infected with fifth disease? 

Blood tests can show if someone is immune to the virus, if someone is not immune and has never been infected, or if someone has had a recent infection. Once you have had fifth disease, it is rare to be re-infected. Because fifth disease is a mild illness, and most people get infected as children, many adults might not remember if they ever had it. Talk to your healthcare provider if you think you have been exposed to parvovirus B19.  

I have fifth disease. Can it make it harder for me to get pregnant?  

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

Does having/getting fifth disease increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons.  Having a parvovirus B19 infection during pregnancy might slightly increase the chance of miscarriage. 

Does having/getting fifth disease 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 fifth disease, might increase the chance of birth defects in a pregnancy. It is not known if fifth disease increases the chance of birth defects. 

Does having/getting fifth disease in pregnancy increase the chance of other pregnancy-related problems? 

It is not known if fifth disease 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). Studies show that most women who become infected with fifth disease during pregnancy deliver healthy babies. 

If a woman is infected during pregnancy there is up to a 33% (33 out of 100) chance of passing the infection to the fetus. If the infection does pass to the fetus, about 10 out of 100 (10%) could have complications. 

Fetal infection with fifth disease can lead to inflammation of the heart muscle (myocarditis). Fetal infection could also damage the bone marrow so that it is harder for the body to make red blood cells (aplastic crisis). Aplastic crisis can lead to anemia, a condition in which the body does not have enough healthy red blood cells. Fetuses with mild anemia generally recover. If the heart damage or anemia is severe, hydrops fetalis (too much fluid in fetal tissues) can occur and could lead to fetal death. Sometimes, the hydrops fetalis goes away without treatment. Rarely, a baby is born unable to make red blood cells and will need blood transfusions. Babies with hydrops might also have breathing problems at birth.  

Fetal loss has been reported in a small number of cases. Infection in the first 20 weeks of pregnancy has up to a 10 out of 100 (10%) to 15 out of 100 (15%) chance of fetal loss. This chance gets lower when infection happens after 20 weeks of pregnancy.  

There is a reported case of maternal mirror syndrome (MMS) after getting fifth disease during pregnancy. MMS can look like maternal edema (swelling) and placentomegaly (an enlarged placenta). There are additional reports of the placenta becoming infected. The placenta is the organ that develops during pregnancy and works as the blood connection between the woman who is pregnant and the fetus.  

Does having/getting fifth disease in pregnancy affect future behavior or learning for the child? 

Neurodevelopmental problems have been reported in a small number of infected pregnancies that developed complications. 

What screenings or tests are available to see if my pregnancy has any issues? 

Prenatal ultrasounds can be used to screen for some issues, such as hydrops fetalis. Ultrasound can also be used to monitor the growth of the pregnancy. An amniocentesis can be done to diagnose fifth disease in the growing fetus. Talk to your healthcare provider about any prenatal screenings 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 I have fifth disease: 

Women who have fifth disease can usually keep breastfeeding. Talk with your healthcare providers about precautions when handling the baby, such as washing hands before touching and using a face mask. Women who use a breast pump should disinfect all parts of the pump that come into contact with the milk after each use. Antibodies against parvovirus B19 have been found in breast milk. It has been suggested that these antibodies might pass some immunity to the child that is breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

If a man has fifth disease, can it affect his fertility or increase the chance of birth defects? 

Studies have not been done to see if fifth disease could affect male fertility (ability to get a woman pregnant) or increase the chance of birth defects. Since fifth disease is contagious, it is important to talk to your healthcare provider if your partner or other people living in your home have been diagnosed with this disease. 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 echinacea in pregnancy and while breastfeeding. This information is based on available published research. It should not take the place of medical care and advice from your healthcare providers.

What is echinacea?

Echinacea is an herb that comes from the roots, stem, leaves, and flower of the plant Echinacea purpurea (purple coneflower). Dried roots of Echinacea angustifolia and Echinacea pallida are also used. The type of active ingredients among different products can vary widely. The active ingredients and strength of the active ingredients depends on the type of echinacea plant used, the part of the plant used, and how it is made.

Echinacea comes in many forms, such as teas, extracts, capsules, tablets, tinctures, and preparations that go on the skin (topical). Some dietary supplements can contain echinacea.

Herbal products do not need to show that they are safe or effective before they are sold to the public. The ingredients and dose on the label may be different from what is in the product. Many herbs and herbal products have not been studied, or well-studied, for use in human pregnancy. Herbal products may contain harmful substances (called contaminants) such as metals, pesticides, chemicals, or microorganisms. These contaminants may have their own negative effects on a pregnancy.

The use of herbal products is generally not recommended during pregnancy unless under the direction and care of your healthcare provider to treat a medical condition. For more information on herbal products in general, please see our fact sheet at: https://mothertobaby.org/fact-sheets/herbal-products-pregnancy/.

Tinctures can contain the extract of a plant (such as echinacea) dissolved in alcohol. These preparations could have a significant amount of alcohol. Alcohol should be avoided during pregnancy and breastfeeding. More information about alcohol can be found in our fact sheet here https://mothertobaby.org/fact-sheets/alcohol-pregnancy/.

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

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

Does taking echinacea increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Animal studies suggest that echinacea products might increase the chance of miscarriage. However, it is not clear how the echinacea preparations and dose levels used in the animal studies compare to what would be used by humans. One small study in humans found no increased chance of miscarriage in those who took echinacea when compared to those who did not.

Does taking echinacea 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 echinacea, might increase the chance of birth defects in a pregnancy. Small studies looking at exposure to echinacea during pregnancy have not reported an increased chance of birth defects above the background risk.

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

In a study comparing over 350 pregnancies exposed to echinacea and over 68,000 unexposed pregnancies, no increased chance of preterm delivery (birth before week 37), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), or small for gestational age infants was reported.

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

Studies have not been done to see if echinacea can increase the chance of behavior or learning issues for the child.

Some echinacea preparations have been found to be contaminated by heavy metals like lead. High blood lead levels during pregnancy can harm fetal development. More information on lead can be found in our factsheet here https://mothertobaby.org/fact-sheets/lead-pregnancy/,

Breastfeeding while taking echinacea: 

Information on the use of echinacea while breastfeeding is limited. One study found some components of echinacea in breast milk after a breastfeeding mother took echinacea tablets. It is not known if or how these components would affect a nursing child. If you suspect the baby has any symptoms (stomach upset, diarrhea, constipation, skin rash, or allergic reactions), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done in humans to see if taking echinacea could affect male fertility (ability to get a wonan pregnant)  or increase the chance of birth defects. 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/.

Please click here for references.

This sheet is about exposure to bupropion 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 bupropion?

Bupropion is a medication that has been used to treat depression and seasonal affective disorder. Brand names of bupropion include Aplenzin®, Forfivo®, and Wellbutrin®. Bupropion is also sold under the brand name Zyban® as an aid to quit smoking. For more information about depression, see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/depression-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. 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.

Stopping this medication suddenly can cause some women to have withdrawal symptoms. It is not known if or how withdrawal might affect a pregnancy. It is suggested that any reduction in bupropion be done slowly, and under the direction of your healthcare provider.

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

Studies have not been done to see if taking bupropion can make it harder to get pregnant. Two cases of irregular menstrual cycles (periods) have been reported with bupropion use. However, these case reports did not mention fertility problems (trouble getting pregnant).

Does taking bupropion 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 among women who were pregnant and taking bupropion compared to the background chance of miscarriage in the general population.

 Does taking bupropion 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. Most of the available data about the use of bupropion in pregnancy does not suggest an increased chance of birth defects. Two studies have suggested a possible link between bupropion use in the first trimester and an increased chance of heart defects. However, these studies had limitations that make it hard to know if other factors might have caused the increase in heart defects. Overall, it is considered unlikely that using bupropion during pregnancy would increase the chance of birth defects above the background risk.

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

It is not known if bupropion can cause other pregnancy related problems such as preterm delivery (birth before week 37). In a small study of 30 women who were given bupropion during pregnancy for 12 weeks to help them quit smoking, no differences were seen in birth weight, length, head circumference, or Apgar score (grading system in newborns to define their wellbeing).

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

The use of some antidepressants during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. These symptoms can include irritability, jitteriness, trouble sleeping, or trouble eating. Not all babies exposed to antidepressants will have these symptoms. One study has suggested that the chance of these symptoms in newborns may be lower with bupropion than with some other antidepressants. It is important that your healthcare providers know you are taking bupropion so that if symptoms occur your baby can get the care that is best for them.

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

It is not known if bupropion increases the chance for behavior or learning issues for the child. One study suggested an association between exposure to bupropion during pregnancy and attention deficit hyperactivity disorder (ADHD). However, there are many factors that contribute to ADHD. That makes it hard to know if it is the medication or other factors that can increase the chance of ADHD.

Breastfeeding while taking bupropion:

Bupropion gets into breast milk in small amounts. Taking bupropion while breastfeeding is not expected to cause harmful effects for most breastfed infants.

There are two case reports of seizures in 6-month-old babies exposed to bupropion through breast milk. The seizures stopped when bupropion was no longer used. Infant seizures can appear different than seizures in women who are older and can include unusual eye movements (rolling, roving), blinking, eyelid fluttering, staring, sucking, smacking, chewing, tongue sticking out, unusual pedaling movements of the legs, thrashing, struggling, or long pauses in breathing. Women taking bupropion while breastfeeding can monitor their child closely for side effects. If you suspect the baby has any symptoms (including unusual movements, seizures, or being sleepier than usual), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if bupropion 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 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 albuterol 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 albuterol?

Albuterol (also called salbutamol) is a medication used for the treatment of breathing conditions like asthma. It is a bronchodilator (a beta2-agonist bronchodilator). Bronchodilators help to open the airways in the lungs so you can breathe better. Albuterol has commonly been used as an inhaled medication in fast-acting inhalers for immediate treatment of trouble breathing and wheezing. Some brand names are Proventil® and Ventolin®. Albuterol can also be found in combination with another medication, budesonide in a medication called Airsupra®.

When albuterol is inhaled, it is absorbed into the body in lower amounts compared to pill / tablet forms of the medication. It is unknown how much, if any, of the medication reaches the fetus when used as an inhaler. Research suggests that the amount is likely small. Use of a fast-acting albuterol inhaler more than two days per week can be a sign that asthma symptoms may not be well controlled. If so, talk with your healthcare provider about the best way to treat your asthma.

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 treat asthma during pregnancy. 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. Untreated asthma increases the chance for complications for both the woman who is pregnant and the fetus. For more information, please see the MotherToBaby fact sheet on Asthma at https://mothertobaby.org/fact-sheets/asthma-and-pregnancy/.

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

Studies in humans have not been done to see if taking albuterol can make it harder to get pregnant. Animal studies have shown no effect on fertility.

Does taking albuterol increase the chance for miscarriage?

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

Does taking albuterol 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 albuterol, might increase the chance of birth defects in a pregnancy. Although data is limited, studies do not suggest an increased chance for birth defects with the use of inhaled albuterol during pregnancy.

One study looked at the use of 5 different inhaled beta2-agonist bronchodilators in the first trimester of pregnancy. This study did not find an increase in the number of birth defects with use of any of these medications. Of the 259 women who were pregnant in this study, 20 of them took albuterol. Another study found a link between albuterol use and several types of birth defects. However, this study could not rule out the influence of asthma. Other studies do not support the suggestion that albuterol causes an increased chance for a pattern of birth defects.

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

Albuterol has been used in the second and third trimester of pregnancy to prevent preterm delivery (delivery before 37 weeks of pregnancy). For treatment of preterm delivery, albuterol was given in high oral doses (by mouth). Treatment with high oral doses has been associated with an increase in maternal and fetal heart rate and a drop in maternal blood pressure. These effects are temporary. Long term effects from increased fetal heart rate have not been reported. Treatment with inhaled albuterol at prescribed doses has not been shown to cause these effects.

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

Studies have not been done to see if albuterol can increase the chance of behavior or learning issues for the child.

Breastfeeding while taking albuterol:

There have not been any studies among women taking albuterol while breastfeeding. However, using an albuterol inhaler is expected to lead to low amounts in the blood system and therefore likely low amounts at most in breastmilk. Inhaled bronchodilators have generally been considered acceptable for use during breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

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

MotherToBaby is currently conducting a study looking at asthma and the medications used to treat asthma in pregnancy. If you would like to learn more, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study/.

Please click here to view references.