This sheet is about exposure to heroin 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 heroin?

Heroin is an opioid. Opioids are sometimes called narcotics. Heroin can be smoked, snorted, or injected. Some street names for heroin include smack, dope, mud, horse, skag, junk, H, black tar, and skunk, among others. In the United States, heroin is an illegal substance and is not available by prescription.

I just found out I am pregnant. Should I stop using heroin?

If you have been using heroin, please seek help right away. It is important to stop using during pregnancy, but you should not stop suddenly (also called “cold turkey”). Stopping an opioid suddenly could cause you to go into withdrawal. It is not known if or how withdrawal might affect a pregnancy. It is suggested that any reduction in heroin be done slowly, and under the direction of your healthcare provider.

I use heroin. Can it make it harder for me to get pregnant?

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

Does using heroin 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 using heroin increases the chance of miscarriage.

Does using heroin increase the chance of birth defects?

Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Studies on heroin do not suggest an increased chance of birth defects. However, heroin is often combined with other drugs, medications, and even chemicals that could increase the chance of birth defects. This makes it hard to know the actual exposures and risks for each woman who uses heroin.

Does using heroin in pregnancy increase the chance of other pregnancy-related problems?

Studies involving women who use heroin or misuse other opioids during pregnancy (take them without a prescription, or in higher amounts or for longer than prescribed by healthcare providers) have found an increased chance for pregnancy-related problems including poor fetal growth, stillbirth, preterm delivery (birth before week 37), low levels of amniotic fluid (fluid that surrounds the fetus in the uterus), and increased chance for a C-section. Using heroin 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.) Sharing needles to inject opioids increases the chance of getting infections like hepatitis C and/or HIV, which can cross the placenta and infect the fetus.

Will my baby have withdrawal (neonatal abstinence syndrome) if I keep using heroin?

Studies have reported an increased chance for neonatal abstinence syndrome (NAS) with some opioids, including heroin. Neonatal Abstinence Syndrome (NAS) is the term used to describe withdrawal symptoms in newborns from opioid medication(s) or substances that a woman takes during pregnancy. NAS symptoms can include trouble breathing, 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 might last more than 2 weeks. The chance that NAS will happen depends on how often, how long, and what doses of heroin were used during pregnancy. It also depends on if other medications or substances were also taken, if baby was born preterm, and/or size of the baby at birth.

Most babies can be treated for withdrawal while in the hospital. If you used heroin or other opioids in your 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 using heroin in pregnancy affect future behavior or learning for the child?

One small study found smaller head measurements and brain volume in infants exposed to heroin during pregnancy. Some studies on opioids as a general group including heroin have found more problems with learning and behavior in children exposed to opioids for a long period of time during pregnancy. It is hard to tell if this is due to opioid exposure or other factors that might increase the chances of these problems.

Heroin and breastfeeding:

Heroin breaks down into morphine inside the body. Morphine can get into breast milk. Heroin is often combined with other medications, drugs, or chemicals that could also enter the breast milk. Use of some opioids while breastfeeding can cause babies to be very sleepy, have trouble latching on, or can cause problems with breathing.

The United States Food and Drug Administration (FDA) recommends that heroin not be used during breastfeeding due to concerns that the medication could build up to high levels in the baby’s system and cause problems, such as trouble breathing or not waking to feed. If you have used heroin while breastfeeding, contact the baby’s healthcare provider immediately if your baby has any problems such as increased sleepiness (sleeping more than usual), trouble feeding, trouble breathing, or being limp (feeling floppy when held). Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Heroin use might affect the sperm, which can impact a man’s fertility (ability to get a woman pregnant). The use of heroin by a man is not expected to increase the chance of birth defects, but injecting heroin increases the chance of exposure to infections such as hepatitis C or HIV. These infections can be passed through the semen to a woman who is pregnant and then to the fetus. 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 exposure to lamotrigine 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 lamotrigine?

Lamotrigine is a medication that has been used to treat bipolar disorder, some types of seizures, and Lennox-Gastaut syndrome (a severe form of epilepsy). A brand name for lamotrigine is Lamictal®.

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. People who have bipolar disorder and stop taking their medication are at increased risk for episodes of depression or mania that may 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/.

If your lamotrigine dose is increased during pregnancy, talk with your healthcare provider about how and when to lower your dose after delivery.

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

One study suggested lamotrigine might make it harder to get pregnant. Having a seizure disorder, as well as long-term use of seizure medications, might be associated with irregular periods and hormonal disorders which could lead to a harder time getting pregnant (infertility).

Does taking lamotrigine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not found that lamotrigine is associated with a higher chance of miscarriage.

Does taking lamotrigine 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. One study suggested a less than 1% (less than 1 in 100) increase in oral clefts such as cleft lip and/or palate (an opening in the upper lip or the roof of the mouth) with the use of lamotrigine in the first trimester of pregnancy. However, this finding was not confirmed by other studies. Also, several studies looking at several thousand pregnancies have found no increased chance of birth defects when lamotrigine is taken during pregnancy.

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

Use of lamotrigine in pregnancy has not been associated with an increased chance for other pregnancy complications, such as preterm delivery (birth before week 37) or poor growth of the fetus (small size, low birth weight, or smaller head measurement).

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

Several studies have looked at the development of babies and children who were exposed to lamotrigine during pregnancy. Most of these studies did not find differences in behavior or learning between babies exposed to lamotrigine and those who were not.

Breastfeeding while taking lamotrigine:

Lamotrigine passes into breast milk. The amount of lamotrigine in breastmilk is usually much lower than the amount that would be given to a baby directly to control seizures. Most infants who are exposed to lamotrigine in breastmilk are not expected to have side effects. There have been case reports of breastfed infants with breathing problems and anemia (low red blood cell counts).

Babies can be watched for possible side effects, such as a rash, trouble breathing, sleepiness, or poor sucking. If the baby develops any symptoms, especially a rash, contact your healthcare provider and your child’s healthcare provider right away. They will talk with you about using lamotrigine and the best way to treat your condition while breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If your lamotrigine dose was increased during pregnancy, talk with your healthcare provider about how and when to lower your dose after delivery.

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

In a small number of studies, lamotrigine has not been shown to affect sperm counts, motility (movement of the sperm), or male sex hormones. Studies have shown that men with seizure disorders or bipolar disorder may have lower fertility (ability to get a woman pregnant). In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet on Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

This sheet is about exposure to duloxetine 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 duloxetine? 

Duloxetine is a medication that has been used to treat depression, anxiety, and chronic pain. Duloxetine belongs to a group of medications known as serotonin-norepinephrine reuptake inhibitors (SNRIs). It is sold under brand names such as Cymbalta® and Irenka®. 

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. For more information on depression and anxiety in pregnancy, please see our fact sheets at https://mothertobaby.org/fact-sheets/depression-pregnancy/ and https://mothertobaby.org/fact-sheets/anxiety-fact/. 

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

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

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

Does taking duloxetine increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Two studies reported that taking duloxetine could slightly increase the chance of miscarriage, while other studies have not reported an increased risk. Research also shows that depression on its own might increase the chance of miscarriage. This makes it hard to know if the medication, the underlying condition, or other factors are increasing the chance of miscarriage.  

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

Taking duloxetine in pregnancy is not expected to increase the chance of birth defects. 

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

It is not known if duloxetine 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 [2,500 grams] at birth). 

Some studies suggest that taking duloxetine might increase the chance of pregnancy complications such as high blood pressure disorders and heavy bleeding after birth. However, research has also shown that when depression is left untreated during pregnancy, there could be an increased chance of pregnancy complications. This makes it hard to know if the medication, underlying condition, or other factors are increasing the chance of these problems.  

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

The use of duloxetine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms include problems with breathing, sleeping or eating, jitteriness / tremors, more or less muscle tone than usual, irritability, or trouble regulating their body temperature. Most of the time the symptoms are mild and go away on their own, usually within a few weeks. In rare cases, some babies might need to stay in a special care nursery for a few days. Not all babies exposed to duloxetine will have symptoms. It is important that your healthcare providers know you are taking duloxetine so that if symptoms occur, your baby can get the care that is best for them.  

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

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

Breastfeeding while taking duloxetine: 

Duloxetine passes into breastmilk in small amounts. Side effects have not been reported in breastfed infants. If you suspect your baby has any symptoms (such as being too sleepy 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 duloxetine, could it affect fertility or increase the chance of birth defects? 

One study reported that duloxetine was not associated with effects on men’s fertility (ability to make healthy sperm). Studies have not been done in men to see if duloxetine can increase the chance of birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.  

This sheet is about exposure to toxoplasmosis in pregnancy and 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 toxoplasmosis?  

Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii. Toxoplasma gondii can be found in raw or undercooked meat, raw eggs, and unpasteurized (raw) milk. Rodents or cats that eat raw meat can get infected. Once infected, the animal can shed the parasite in the feces (poop) for up to 2 weeks. Toxoplasma gondii eggs can live in cat feces or be buried in soil for up to 18 months.  

People can get toxoplasmosis by eating infected meat that has not been cooked properly, drinking water that is contaminated, or handling soil or cat feces that contain the parasite. Some studies suggest that toxoplasmosis can be passed to a partner during unprotected sex, including oral sex. People who have recently gotten a cat or have outdoor cats, eat undercooked meat, gardens without gloves, or who have had a recent mononucleosis-type illness have an increased chance of getting toxoplasmosis.  

Most adults who are infected with toxoplasmosis have no symptoms. Some people might have swelling of the lymph nodes, fever, headache, or muscle pain. In most cases, once you have gotten toxoplasmosis, you cannot get it again. However, there have been reports of people who have been infected more than 1 time. For example, people with a weakened immune system could develop another active toxoplasmosis infection. 

How can I find out if I am infected with toxoplasmosis? 

Blood tests can be used to diagnose toxoplasmosis infections. Talk with your healthcare provider about your risk for toxoplasmosis and available screening, testing, and treatment options. 

What are some things I can do to lower the chance of a toxoplasmosis infection?  

• Cook meat until it is no longer pink, and the juices run clear. Use a food thermometer to measure the internal (inside) temperature to make sure the meat is cooked all the way through. A detailed list of temperatures and foods can be found here: https://www.foodsafety.gov/food-safety-charts/safe-minimum-internal-temperatures.  

• Freeze meat for several days at sub-zero (below 0° F/-18°C) temperatures before cooking to greatly lower the chance of infection.  

• Do not eat raw or undercooked oysters, mussels, or clams. 

• Wash cutting boards, dishes, counters, and utensils with hot soapy water after any contact with raw meat, seafood, or unwashed fruits or vegetables. 

• Wash hands carefully after handling raw meat, fruits, and vegetables. 

• Wash all fruits and vegetables. Peeling fruits and vegetables also helps to lower the chance of exposure.  

• Avoid drinking untreated water. 

• Do not drink unpasteurized milk. 

• Wear gloves when gardening and during contact with soil or sand. Wash hands with soap and water after gardening or contact with soil or sand. 

• Do not touch cat feces directly; wear gloves if you change cat litter & immediately wash hands.  

• Do not feed cats raw or undercooked meat. 

• Avoid stray cats, especially kittens.  

• Keep outdoor sandboxes covered. 

I had toxoplasmosis in the past. Can that increase the chance of birth defects or other pregnancy-related problems?  

If you had toxoplasmosis in the past, you are likely immune. In general, increased risks to a pregnancy are not expected when someone is infected with toxoplasmosis for more than 6 months before getting pregnant. 

Does having toxoplasmosis make it harder to get pregnant?  

It is not known if having toxoplasmosis can make it harder to get pregnant. However, 1 study reported that toxoplasmosis might cause diminished ovarian reserve (the ovaries have fewer eggs than expected for a woman’s age), which could make it harder to get pregnant. 

Does having toxoplasmosis increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Having toxoplasmosis can increase the chance of miscarriage.  

Does having toxoplasmosis 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 toxoplasmosis, can increase the chance of birth defects in a pregnancy.  

Toxoplasmosis infection can be passed to the fetus when there is an active infection during the pregnancy. When a pregnant woman passes an infection to the fetus, it is called vertical transmission. Vertical transmission can happen at any time in pregnancy but is more likely to happen when someone gets the infection closer to delivery.  

If vertical transmission does happen in the pregnancy, the fetus has an increased chance of certain birth defects and developmental problems known as “congenital toxoplasmosis”. Some infants with congenital toxoplasmosis can have problems with the brain, eyes, heart, kidneys, blood, liver, or spleen. Hearing loss has also been reported. When the infection starts during the first trimester, the fetus has a higher chance of these problems.  

Does having toxoplasmosis increase the chance of other pregnancy-related problems?  

Toxoplasmosis might increase the chance of pregnancy-related problems such as preterm delivery (birth before week 37), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), small for gestational age, or preeclampsia. Preeclampsia is pregnancy related condition that can cause high blood pressure and problems with organs, such as the kidneys, which can lead to seizures (called eclampsia). An increased chance of stillbirth has also been reported in women with active toxoplasmosis infection during pregnancy. When toxoplasmosis infection starts late in pregnancy, the chance that the fetus will have these problems is lower. However, the chance of passing the infection to the fetus is higher when infection happens later in pregnancy.  

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

Infants with congenital toxoplasmosis (up to 90%) can develop problems over time, such as vision loss, seizures, hearing loss, or developmental delays. These symptoms can occur months or years after birth. Infants with congenital toxoplasmosis should be treated for infection during their 1st year of life and then be checked regularly for health problems. Your healthcare team can talk with you about what screenings, tests, and treatments are right for your baby.  

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 changes in brain structure (calcifications) and bowel (echogenic bowel) or extra fluid in the body. Ultrasound can also be used to watch the growth of the pregnancy. If toxoplasmosis infection is suspected in a fetus, the fluid in the uterus around the fetus (amniotic fluid) can be tested. This requires a procedure called an amniocentesis to remove a small amount of fluid. Talk with your healthcare provider about these or any other 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 toxoplasmosis: 

Toxoplasma gondii passes into breast milk. The Centers for Disease Control and Prevention (CDC) recommends that women with an active toxoplasmosis infection continue to breastfeed unless they have broken skin or bleeding in the nipple area. If you suspect the baby has any symptoms (fever or flu-like symptoms), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Toxoplasmosis might affect male fertility (ability to make healthy sperm). Some studies suggest that toxoplasmosis can be passed to a partner during unprotected sex, including oral sex. In a woman who is pregnant, an active toxoplasmosis infection can increase risks to the pregnancy. Talk with your healthcare provider if you have had sexual contact with someone who has toxoplasmosis. For more 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 exposure to sulfasalazine 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 sulfasalazine?

Sulfasalazine is a medication that has been used to treat inflammatory bowel disease (IBD) and rheumatoid arthritis (RA). A brand name for sulfasalazine is Azulfidine®.

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 IBD or RA that is untreated or not well treated in pregnancy can lower the chance of getting pregnant and can increase the chance of pregnancy complications. MotherToBaby has a fact sheet on IBD here: https://mothertobaby.org/fact-sheets/inflammatory-bowel-disease-pregnancy/ and on RA here: https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/.

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

It is not known if sulfasalazine can make it harder to get pregnant. One study looked at women with RA who were taking sulfasalazine before getting pregnant. It did not take longer for them to get pregnant compared to women with RA who were not taking sulfasalazine.

Does taking sulfasalazine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. No increased chance of miscarriage was reported in one study of 531 women taking sulfasalazine during pregnancy.

Does taking sulfasalazine 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 sulfasalazine, might increase the chance of birth defects in a pregnancy. In studies with over 950 women taking sulfasalazine alone or with other medications during pregnancy, no increased chance of birth defects was reported.

One study reported an association between heart defects and cleft lip and/or palate (an opening in the upper lip or the roof of the mouth) when sulfasalazine or similar medications were taken during pregnancy. However, this study did not look at the underlying health condition being treated, such as RA or IBD, or other health conditions. This makes it hard to know if the sulfasalazine, the underlying condition being treated, or other factors are related to the possible increased chance.

Sulfasalazine can affect folic acid levels in the body. Folic acid is recommended for all women who could become pregnant. It is important to talk with your healthcare provider about how much folic acid is right for you. MotherToBaby has a fact sheet on folic acid here: https://mothertobaby.org/fact-sheets/folic-acid/.

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

It is not known if sulfasalazine 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).

There was a theoretical (not proven) concern that taking sulfasalazine during pregnancy might increase bilirubin (chemical made in the body after the body breaks down blood cells) levels in the newborn, which could lead to jaundice (yellowing of the skin and eyes) or kernicterus (damage to the brain because of high bilirubin levels). However, in studies with more than 1800 newborns who were exposed to sulfasalazine or similar medications during pregnancy, no increased risk of jaundice or kernicterus was reported. It is important that your healthcare providers know you are taking sulfasalazine so that if symptoms occur your baby can get the care that is best for them.

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

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

Breastfeeding while taking sulfasalazine:

Sulfasalazine gets into breast milk in small amounts. Sulfasalazine is not expected to cause side effects in most infants. Children who have a weakened immune system (the body has a harder time fighting infections) or have a condition called glucose-6-phosphate dehydrogenase (G6PD) deficiency (a rare genetic condition in which red blood cells are fragile) might be more likely to experience side effects from sulfasalazine in breast milk. Diarrhea and bloody stools have been reported uncommonly in nursing infants when sulfasalazine was present in breast milk. If you suspect the child has any symptoms (such as diarrhea or bloody stools), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Some studies have reported oligospermia (less sperm than typical) and reduced sperm mobility (ability for sperm to move) in men taking sulfasalazine. This can affect a man’s fertility (ability to get a woman pregnant). 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.