This sheet is about exposure to abatacept 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 abatacept?

Abatacept is a medication that has been used to treat rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), and psoriatic arthritis (PsA). It has also been used to treat COVID-19 in some hospitalized patients. It works by lowering the activity of T cells (part of the body’s immune system) to help reduce inflammation or swelling. It can be given through a vein in the arm (infusion) or by a shot under the skin. It is sold under the brand name Orencia®.

To learn more about rheumatoid arthritis and psoriatic arthritis, please see the MotherToBaby fact sheets at https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/ and https://mothertobaby.org/fact-sheets/psoriasis-and-pregnancy/. To learn more about COVID-19, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/covid-19/.

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

People eliminate medications at different rates. In healthy adults, it takes up to 10 weeks, on average, for most of the abatacept to be gone from the body.

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

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

Does taking abatacept increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. The manufacturer did not find a higher chance of miscarriage among 151 women who used abatacept in pregnancy.

Does taking abatacept 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. Animal studies done by the manufacturer did not show an increased chance of birth defects when abatacept was used in pregnancy. Abatacept has not been well studied in human pregnancy. However, published information collected on over 200 pregnancies did not find a pattern of birth defects associated with abatacept use in pregnancy. There is also a case report of a woman with active rheumatoid arthritis who became pregnant while using abatacept, with her last dose just after the fourth week of pregnancy. She delivered a healthy infant that was also reported to be doing well at a 3.5-year follow-up visit. Based on limited information, there is probably not an increased risk for birth defects with abatacept.

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

Studies have not been done to see if abatacept 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).

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

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

Breastfeeding while taking abatacept:

Abatacept has not been well studied for use while breastfeeding. Since it is a large molecule, it is thought to be unlikely to enter the milk in high amounts. Also, abatacept is poorly absorbed from the gut, so it is unlikely that any of the medication the baby swallowed in the breast milk would be absorbed into the baby’s system. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

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

Studies have not been done to see if abatacept could affect a man’s fertility (ability to get a woman pregnant). The manufacturer reported on 10 men who were taking abatacept when their partners became pregnant and did not find a greater chance for 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 (https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/).

MotherToBaby is currently conducting a study looking at abatacept and other medications used to treat autoimmune diseases in pregnancy. If you are interested in taking part in this study, please call 1-877-311-8972 or sign up at https://mothertobaby.org/join-a-study-form/.

Please click here for references.

This sheet is about exposure to desipramine in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What is desipramine?

Desipramine is a prescription medication that has been approved to treat depression. It has also been used to treat pain caused by the nervous system (neurogenic pain), and attention deficit hyperactivity disorder (ADHD). Desipramine belongs to a class of antidepressants known as tricyclic antidepressants. Two brand names for desipramine are Norpramin® and Pertofrane®. Desipramine is a metabolite of another antidepressant called imipramine. This means that imipramine turns into desipramine 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 this medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. Some women may have a return of their symptoms (relapse) if they stop this medication during pregnancy.

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

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

Should my levels of desipramine be monitored during pregnancy?

Pregnancy might affect how some women break down this medication. Some women may need to have their medication doses changed during pregnancy. Your healthcare provider can discuss testing your blood and monitoring your symptoms to help determine if you need to adjust your medication dose to keep this medication working for you.

Does taking desipramine 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 desipramine could increase the chance of miscarriage.

Does taking desipramine 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 desipramine, might increase the chance of birth defects in a pregnancy. Studies have not been done to see if desipramine increases the chance of birth defects

There are a small number of studies on imipramine, which is an older tricyclic similar to desipramine. Based on those studies, it is unlikely that using desipramine would significantly increase the chance of birth defects.

MotherToBaby has a fact sheet on imipramine, which can be found at: https://mothertobaby.org/fact-sheets/imipramine/.

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

Studies have not been done to see if desipramine 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).

However, when depression is left untreated during pregnancy, there could be an increase in pregnancy complications. If you are taking desipramine for depression, please see our fact sheet on depression at https://mothertobaby.org/fact-sheets/depression-pregnancy/.

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

It is possible that the use of desipramine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. However, this has not been well studied with desipramine. Babies exposed to desipramine near delivery can be monitored for symptoms such as irritability, jitteriness, tremors, fast heart rate, and/or fast breathing. If a baby develops withdrawal symptoms, in most cases the symptoms can be treated and will go away without long-term health effects.

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

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

Breastfeeding while taking desipramine:

Small amounts of desipramine can get into breast milk. Case reports on 4 infants who were exposed to desipramine through breastmilk could not detect the medication in the baby’s blood. No harmful effects have been reported for 1 nursing infant who was followed up to 3 years of age. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

If a man takes desipramine, could it affect fertility (ability to get a woman pregnant) or increase the chance of birth defects?

Some reports have suggested that desipramine and other tricyclic antidepressants might reduce a man’s sex drive or ability to have sex (causing erectile and ejaculatory dysfunction), which could make it harder to conceive a pregnancy. 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 dextromethorphan in pregnancy and while breastfeeding. This information is based on published research. It should not take the place of medical care and advice from your healthcare providers. 

What is dextromethorphan? 

Dextromethorphan is a medication that has been used in over-the-counter products to treat cough (cough suppressant). It comes in pill, liquid, and cough drop forms. It is also available in combination with other medications in over-the-counter multi-symptom cold, cough, and flu products. 

Some over-the-counter liquid products that contain dextromethorphan contain alcohol, so it is important to review all the ingredients on the label before using. Products that contain alcohol are not recommended in pregnancy.  

This sheet will focus on over-the-counter use of dextromethorphan to treat cough. However, dextromethorphan is also available by prescription in combination with other medications. When dextromethorphan is used in combination with other prescription medications, it might work differently in the body than when it is used in over-the-counter products. Speak with your healthcare provider about using these prescription medications during pregnancy or while breastfeeding.  

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

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

Does taking dextromethorphan increase the chance for miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. A study looking at the pregnancies of 128 women who took dextromethorphan to treat cough in the first trimester did not report an increase in miscarriages.

Does taking dextromethorphan 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 dextromethorphan, might increase the chance of birth defects in a pregnancy. Taking dextromethorphan as directed to treat cough in pregnancy is not expected to increase the chance of birth defects.  

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

A study looking at the pregnancies of 184 women who took dextromethorphan to treat cough at any time during pregnancy did not find an increased chance of stillbirth or low birthweight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Studies have not been done to see if taking dextromethorphan for cough increases the chance of other pregnancy-related problems, such as preterm delivery (birth before week 37).  

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

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

Breastfeeding while taking dextromethorphan: 

When used as directed to treat cough, dextromethorphan gets into breast milk in small amounts. Taking over-the-counter dextromethorphan as directed for a short time is not expected to cause problems for most breastfed infants. If you suspect the baby has any symptoms (such as a rash or unusual sleepiness), contact the child’s healthcare provider.  

Some over-the-counter liquid products with dextromethorphan contain alcohol, so it is important to review all the ingredients on the label before using. Alcohol-free cough syrups are preferred while breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Studies have not been done to see if dextromethorphan could affect male fertility (ability to make healthy sperm) or increase the chance of birth defects. In general, exposures in men are less likely to increase risks to a pregnancy. For more general 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 imipramine 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 imipramine? 

Imipramine is a medication that has been used to treat depression and bedwetting. It has also been used to treat anxiety, panic disorder, diabetic neuropathy, and urinary incontinence. Imipramine belongs to a class of medications called tricyclic antidepressants. A brand name for imipramine is Tofranil®.  

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 or anxiety during pregnancy, please see our fact sheets at: https://mothertobaby.org/fact-sheets/depression-pregnancy/ and https://mothertobaby.org/fact-sheets/anxiety-fact/.  

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

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

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

Does taking imipramine 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 imipramine can increase the chance of miscarriage. However, depression itself might increase the chance of miscarriage. 

Does taking imipramine 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 imipramine, might increase the chance of birth defects in a pregnancy. Use of imipramine in pregnancy is not expected to increase the chance of birth defects. 

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

Older studies on tricyclic antidepressant used during pregnancy, including imipramine, suggest a possible link with preterm delivery (birth before week 37) and low birth weight (weighing less than 5 pounds, 8 ounces [about 2500 grams] at birth). Newer studies have not reported these findings. Research has also shown that when depression is left untreated during pregnancy, there could be an increased chance for pregnancy complications. This makes it hard to know if it is the medication, untreated depression, or factors that are increasing the chance for these problems.  

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

The use of imipramine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms can include jitteriness, vomiting, constant crying, increased muscle tone, fussiness, changes in sleep patterns, tremors, hypotonia (low muscle tone), trouble with eating, trouble with regulating body temperature, and problems with breathing. In most cases these symptoms are mild and go away on their own within a week or two after birth. Sometimes a baby may need to stay in a special care nursery for a few days until the symptoms go away. Not all babies exposed to imipramine will have these symptoms. It is important that your healthcare providers know you are taking imipramine so that if symptoms occur your baby can get the care that is best for them. 

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

It is not known if imipramine can increase the chance for behavior or learning issues. Small studies with a total of 32 preschool-aged children exposed to imipramine during pregnancy found no effect on IQ, language development, or mood. 

Breastfeeding while taking imipramine: 

Imipramine passes into breast milk in small amounts. Side effects have not been reported in nursing infants. While follow-up information is limited, no negative effects on infant growth and development have been reported. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Some studies suggest that imipramine can lower sex drive and might cause trouble getting and keeping an erection (erectile dysfunction) and/or trouble with ejaculation. These issues can affect male fertility (ability to make healthy sperm). 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 morphine 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 morphine?  

Morphine is an opioid. Opioids are sometimes called narcotics. Morphine has been used to treat pain. Morphine can be given orally (by mouth), intravenously (IV), by epidural (an injection near the spinal cord), or as an injection (shot).  

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

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. 

If you have been taking morphine regularly or have a dependency (also called opioid use disorder), you should not stop suddenly (also called “cold turkey”). Talk with your healthcare provider before you stop taking this medication. Stopping an opioid medication 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 morphine be done slowly, and under the direction of your healthcare provider.  

I am taking morphine, 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 (to process) medication is not the same for everyone. In healthy non-pregnant adults, it takes up to 1 day, on average, for most of the morphine to be gone from the body.  

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

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

Does taking morphine 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 morphine can increase the chance of miscarriage. 

Does taking morphine 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 morphine, might increase the chance of birth defects in a pregnancy One study, looking at 70 women with exposure to morphine in the first trimester, did not find an increased chance of birth defects.  

Some studies that have looked at opioids as a group suggest that opioids in general might be associated with birth defects. However, studies have not found a specific pattern of birth defects caused by opioids.  If there is an increased chance for birth defects with opioid use in pregnancy, it is likely to be small. 

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

It is not known if morphine can increase the chance of pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).  

Studies involving women who often use some opioids during their pregnancy have found an increased chance for adverse outcomes including poor growth of the baby, stillbirth, preterm delivery, and the need for C-section. This is more commonly reported in those who are taking a drug like heroin or who are using prescribed opioids in greater amounts or for longer than recommended by their healthcare provider. Use of an opioid close to the time of delivery can result in withdrawal symptoms in the baby (see the section of this fact sheet on neonatal opioid withdrawal syndrome). 

One case of high heart rate (tachycardia) in a 36-week fetus was described after a person who was pregnant was given morphine for kidney pain (renal colic). Another case report described a woman in her third trimester who was taking morphine for chronic pain and had reduced blood flow in her placenta (placental vasoconstriction).  

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

Neonatal opioid withdrawal syndrome (NOWS) is the term used to describe withdrawal symptoms in newborns from opioid medication(s) that a person takes during pregnancy. NOWS symptoms can include irritability, crying, sneezing, stuffy nose, poor sleep, extreme drowsiness (very tired), yawning, poor feeding, sweating, tremors, seizures, vomiting, and diarrhea. Most often, symptoms of NAS appear 2 days after birth and may last more than 2 weeks.  

The chance of NOWS depends on how long and how much opioid was taken during pregnancy, whether other medications were used, if the baby was born early, and the baby’s size at birth. One study found that taking prescription opioids for more than 30 days, or at any time in the third trimester, increased the chance of NOWS. If opioids were taken in pregnancy, it is important to let your baby’s healthcare providers know so that they can check for symptoms of NOWS and provide the best care for your newborn. 

It is not known how much morphine must be used before NOWS is likely, or if the chance of NOWS is higher or lower with morphine than with other, better studied opioids.  

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

It is not known if morphine can increase the chance of behavior or learning issues for the child. Some studies on opioids as a general group have found more problems with learning and behavior in children exposed to opioids for a long period of time during pregnancy. It is hard to tell if this is due to the medication exposure or other factors that may increase the chances of these problems. 

What if I have an opioid use disorder?  

Talk with your healthcare provider about your use of opioids. Studies find that women who are pregnant and take opioids in higher doses or for longer than recommended by their healthcare providers have an increased chance for pregnancy problems. These include poor growth of the fetus, stillbirth, preterm delivery, and the need for C-section. The Substance Abuse and Mental Health Services Administration (SAMSA) can help you find treatment: https://www.samhsa.gov/. 

Breastfeeding while taking morphine:  

Morphine can get into breast milk. Babies might have problems with the amounts of morphine in the breast milk, and should be monitored for sedation (sleepiness), slowed breathing or temporarily stopping breathing (apnea), pale skin, constipation, and appropriate weight gain. Short-term use (2-3 days) with close infant monitoring is typically advised. Talk with your healthcare provider about the best way to treat your condition while breastfeeding. Be sure to talk with your healthcare provider about all your breastfeeding questions.   

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

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

Please click here for references.