This sheet is about exposure to leflunomide 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 leflunomide?

Leflunomide is a medication that has been used to treat rheumatoid arthritis. It is in the class of medications known as DMARDs (disease modifying anti-rheumatic drugs). Leflunomide can reduce arthritis symptoms and slow down joint damage. A brand name of leflunomide is Arava®.

The product label for leflunomide recommends that women who are pregnant or trying to get pregnant not use this medication. However, the benefit of using leflunomide may outweigh possible risks. Your healthcare provider can talk with you about using leflunomide and what treatment is best for you.

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

People eliminate medication at different rates. In healthy adults, it takes about 10 weeks (2 and 1/2 months), on average, for most of the leflunomide to be gone from the body. However, the manufacturer of Arava® says that for some people it could take up to 2 years for the drug to completely leave the body. Talk with your healthcare providers about checking your blood levels of leflunomide and, if needed, what treatments are available to help remove the medication from your body faster (washout treatment).

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

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

Does taking leflunomide increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Small studies and case reports of women who became pregnant while taking leflunomide have not suggested an increased chance of miscarriage.

Does taking leflunomide 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 have suggested that leflunomide can increase the chance of birth defects.

Case reports and studies on leflunomide exposure in human pregnancy have not found an increased chance of birth defects. Most women in these studies and reports stopped taking leflunomide very early in pregnancy once they found out they were pregnant and received washout treatment to remove the medication from the body more quickly. It is hard to know from these studies and reports how longer exposure to leflunomide may affect a pregnancy. Case reports and two small studies of women with longer exposures to leflunomide in pregnancy have not suggested an increased chance of birth defects.

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

Limited information about the use of leflunomide later in pregnancy does not suggest an increased 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).

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

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

Breastfeeding while taking leflunomide:

Studies have not been done on the use of leflunomide in breastfeeding. Leflunomide stays in the body for a long time, which means it could build up in the breast milk in higher amounts over time. Since leflunomide can weaken the immune system of adults who take it, there is concern that amounts of this medication in the milk might affect the immune system of a nursing child.

The product label for leflunomide recommends women who are breastfeeding not use this medication. Your healthcare providers can talk with you about using leflunomide and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if leflunomide could affect a man’s fertility (ability to get a woman pregnant). One study that included a small number of men who received prescriptions for leflunomide to treat rheumatoid arthritis did not find an increased 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.

MotherToBaby is currently conducting a study looking at leflunomide and other medications used to treat rheumatoid arthritis 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-study/.

This sheet is about exposure to lead 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 lead and where is it found? 

Lead is a heavy metal. It can be found in many places, such as soil, water, cosmetics, children’s & costume jewelry, old paint, ceramic glazes, plumbing, batteries, bullets, solders, and gasoline.  

Lead can pass from pipes into drinking water (called leaching). When lead paint is sanded or stripped, it creates dust that contains lead. Living near metal smelters, landfills, mining areas, or hazardous waste sites could increase the chance for exposure to lead.  

Traditional or folk medication (including Ayurvedic medicines) can contain high amounts of lead. Some types of candy can also contain lead. Some supplements have also been reported to contain lead. 

Some hobbies and jobs can lead to higher levels of lead exposure. Examples include making ceramics, pottery, or jewelry, auto repair, printing, construction, stained glass work, art restoration, welding, finishing furniture, indoor target practice, or making bullets or fishing lures.  

In 1978, the U.S. government banned the use of paint containing lead and the use of lead in gasoline around 1980. Even with attempts to limit sources of lead, lead can still be found in the ground and in water.  

How does lead get into my body? 

Lead gets into the body by breathing in lead dust or by swallowing lead particles. Only small amounts of lead get into the body through the skin. If you have been around lead, it is important to carefully wash your body, especially your hands, to keep lead from getting into your mouth. Since lead is found in many places in our environment, most people have small amounts of lead in their blood.  

Where is lead found in the body? 

When a person is exposed to lead over a long period of time or at a high level, the body will store lead in the bones and teeth, where it can stay for many years. During pregnancy and breastfeeding, lead can leave the bones and teeth and move back into the blood. 

How can I lower my exposure to lead? 

• Avoid exposure to any known sources of lead before and during pregnancy.  

• If you are remodeling a home built before 1978, avoid removing lead paint yourself. Lead paint should be removed by certified professionals who are following safety procedures that protect you and your family from lead exposure. 

• If you are living in a home built before 1978, wipe down windows and windowsills with a wet towel/rag and wet mop the floors to help remove lead dust. 

• Check your water. Houses that use well water should have the water tested regularly for lead and other possible contaminants. Water from public sources is regularly tested for lead. You can get information about your drinking water from your local Board of Health.  

• Eat a well-balanced diet. A diet poor in calcium, iron, zinc, vitamin C, vitamin D, and vitamin E has been associated with increased lead absorption.  

• Take off or clean your work clothes and shoes before you go inside, so you don’t bring lead into your home from dirt, job sites, or hobbies. If you can, keep your work clothes and shoes in a special spot outside the house. 

• Wash your work clothes by themselves, not with the family’s laundry. 

• After doing anything that might expose you to lead, take a shower to wash any lead dust off your skin and hair. 

Can lead in my body reach the pregnancy?  

Lead can cross the placenta and reach the developing fetus. The amount of lead in the blood of the woman who is pregnant and the fetus is almost the same. It is not known how early lead can reach the fetus in pregnancy, but reports have documented lead in a fetus as early as the end of the first trimester. 

How can I find out if I have lead in my body? 

A blood lead test can be done to see how much lead is in your blood. However, this is not a routine blood test for all women who are pregnant. Talk with your healthcare provider about checking your blood lead level if:  

• You are working with lead in your job or hobbies, 

• You eat candies or take medication imported from other countries,  

• You think there might be lead in your home (paint/pipes). 

The Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists (ACOG) recommend obstetric health care providers evaluate the risk of lead exposure for each individual patient and offer a blood test if a risk factor is present. 

I am pregnant and had a lead test. Is there a level that I should be concerned about? 

While most people will have some lead in their blood, levels greater than 5 micrograms per deciliter (mcg/dL) suggest that there is an exposure at home or in the workplace that needs to be addressed, and a search for the source of lead should be done.  

I have been exposed to lead. Can it make it harder for me to get pregnant?  

Studies have shown mixed results. Some studies suggest that lead levels that are too high or too low might make it harder to get pregnant. Other studies suggest that lead might not affect the ability to get pregnant.  

Does lead increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Multiple studies have reported a connection between high blood levels of lead during pregnancy and a higher chance of miscarriage. 

Does lead 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 lead, might increase the chance of birth defects in a pregnancy. Studies on lead exposure during pregnancy have not shown an increased chance for birth defects 

Does lead increase the chance of other pregnancy-related problems?  

High lead levels during pregnancy can increase the chance for low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), preterm delivery (birth before week 37), poor growth, and preeclampsia (high blood pressure). Problems with organs (such as the kidneys) that can lead to seizures (called eclampsia), and stillbirth have also been reported. 

Does lead affect future behavior or learning for the child?    

Lead exposure during pregnancy can negatively affect the fetal brain. This can cause future learning and behavior problems for the child. Studies have reported that children exposed to lead during pregnancy might have more difficulty with reasoning, remembering, awareness, and language, However, limitations of these studies (differences in environmental factors and different blood lead levels across groups) make it difficult to know when and how often lead exposure during pregnancy can affect future behavior or learning. 

Breastfeeding and lead exposure: 

Breastfeeding recommendations can differ based on the amount of lead in the mother’s blood. In general, women with blood lead levels under 40 mcg/dL can continue breastfeeding. However, the infant’s blood lead levels might also need to be checked. Lead levels in breast milk are usually lower than the levels in the mother’s blood. If lead is detected in a blood test, there could be an exposure at home or in the workplace that needs to be addressed. 

Women with a blood lead level higher than 40 mcg/dL should not breastfeed and are advised to pump and discard their breastmilk until their blood lead level is lower than 40 mcg/dL. 

For infant formulas, if the water you use to mix formula has lead, use bottled or distilled water or, if using tap water, allow it to run for 3 minutes before using.  

Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Lead in the body can reach the sperm. High levels of lead might cause changes in the shape, size, number, and movement of the sperm. This might impact fertility (ability to get a woman pregnant). People who work with lead can bring lead dust home on their clothes, shoes, or other items. If a woman who is pregnant handles these items, such as when doing laundry, there could be direct exposure to lead. For more information about 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 verapamil 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 verapamil?

Verapamil is a medication that has been used to treat high blood pressure (hypertension), abnormal heart rhythm (arrythmia), and chest pain (angina). It has also been used to treat headaches and migraines, coronary arteriosclerosis (thick and stiff blood vessels near the heart), and kidney disease. Verapamil is in a class of medications called calcium channel blockers. Some brand names for verapamil include Calan®, Covera®, Isoptin®, and Verelan®.

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.

Women who are pregnant and have high blood pressure have a greater chance of developing pre-eclampsia (high blood pressure and problems with organs, such as the kidneys) that can lead to seizures (called eclampsia). High blood pressure can increase the chance for medical complications for the woman who is pregnant and for the pregnancy.

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

Studies have not been done to see if verapamil can make it harder to get pregnant. In some people, verapamil might raise the levels of a hormone called prolactin. When prolactin levels are too high, it can cause the body to make milk even if the woman is not breastfeeding (galactorrhea). Those who have this side effect might have a harder time becoming pregnant.

Does taking verapamil 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 verapamil can increase the chance of miscarriage. One study looking at 78 women who took calcium channel blockers, 32 of which took verapamil, did not find a higher chance for miscarriage.

Does taking verapamil 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 verapamil, might increase the chance of birth defects in a pregnancy. There is not a lot of information about using verapamil during pregnancy. However, most studies looking at women who took verapamil, as well as other calcium channel blockers, did not find a higher chance of birth defects.

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

Some studies have reported a greater chance for preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth) with the use of calcium channel blockers, including verapamil. However, it is not known if these issues are caused by verapamil, the condition being treated, other medications, or other factors.  Uncontrolled high blood pressure during pregnancy has been associated with a greater chance of preterm delivery and low birth weight.

Two studies did not find long term effects in heart function of 40 newborns after prenatal exposure to verapamil later in pregnancy to treat high blood pressure or premature labor.

People with high blood pressure have a greater chance of developing pre-eclampsia (high blood pressure and problems with organs, such as the kidneys) that can lead to seizures (called eclampsia).

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

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

Breastfeeding while taking verapamil:

Verapamil passes into breast milk in small amounts. Three babies (ages 13 days, 8 weeks, and 3 months) who were exposed to verapamil through breast milk did not have any problems.

The product label for verapamil recommends women who are breastfeeding not use this medication if breastfeeding. This is because there is not enough information on how the verapamil in breast milk might affect a nursing infant. But the benefits of using verapamil and breastfeeding might outweigh possible risks. Your healthcare providers can talk with you about using verapamil and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Some men who took verapamil had problems like getting or keeping an erection and lower interest in sex (low sex drive) which may affect male fertility (ability to get a woman pregnant). These problems went away after they stopped taking the medication. Other men who took verapamil did not have these issues. 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 mifepristone 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 mifepristone?

Some brand names for mifepristone are Korlym® and Mifeprex®.

The product label for mifepristone recommends people who are pregnant or planning to become pregnant not use this medication. 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 using mifepristone and what treatment is best for you.

I am taking mifepristone, 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 between 5 and 20 days, on average, for most of the mifepristone to be gone from the body.

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

While the medication is in the body, mifepristone can make it harder to get pregnant.

Does taking mifepristone increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Mifepristone can cause the uterus to contract (get tight and then relax), which can increase the chance of miscarriage. The increased chance of miscarriage can depend on how much mifepristone is taken (dose), when in pregnancy it is taken (timing), the use of other medications, and other factors.

Does taking mifepristone 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. There are case reports of birth defects following the use of mifepristone during pregnancy. However, most infants born after exposure to mifepristone do not have birth defects. In early pregnancy, mifepristone is sometimes used in combination with another medication called misoprostol, which can increase the chance of birth defects. This makes it hard to know if the birth defects in these case reports are due to one of the medications, the combination of medications, or other factors.

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

Studies have not been done to see if mifepristone increases 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).

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

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

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. Ultrasound can also be used to track the growth of the pregnancy. Talk with 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 taking mifepristone:

Mifepristone gets into breast milk in small amounts. In 1 study, no medication was found in the breast milk of 2 women who took a single 200 mg mifepristone pill. Based on the amount of medication found in the breast milk of 10 women who took a single 600 mg mifepristone pill, it was estimated that a fully breastfed infant would get a small amount (less than 1%) of the dose taken. The authors of this study have suggested that breastfeeding does not need to stop after taking a single dose of mifepristone. There is no information available about breastfeeding while taking mifepristone for longer periods of time, such as treating hyperglycemia. The manufacturer has recommended pumping and discarding milk during long-term therapy with mifepristone and for 18 to 21 days after the last dose. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if mifepristone 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 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 oral levonorgestrel for emergency contraception 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 levonorgestrel? 

Levonorgestrel is a medication that has been used to prevent pregnancy (contraception). Levonorgestrel is available in different forms, either by itself or combined with other medications. This fact sheet is about the pill form of levonorgestrel used by itself as a type of emergency contraception. Emergency contraception helps prevent pregnancy after unprotected sex or a birth control accident (such as a broken condom or a missed birth control pill). 

Some brand names of emergency contraception pills that contain levonorgestrel are Plan B One-Step®, Econtra EZ®, Preventeza®, AfterPill®, My Way®, Next Choice One Dose®, and Take Action®. These products can be purchased over the counter and do not require a prescription.  

The levonorgestrel emergency contraception pill is often referred to as a “morning-after pill” because it works best when taken as soon as possible after unprotected sex (within 12 hours). However, it can be used up to 72 hours after unprotected sex. It works by delaying or preventing an egg from being released from the ovaries (ovulation). It is not guaranteed to prevent 100% pregnancies, even if taken right away. The levonorgestrel emergency contraception pill will not work if you are already pregnant.  

I have taken levonorgestrel. Can it make it harder for me to get pregnant?  

Taking levonorgestrel to prevent a pregnancy does not make it harder to get pregnant in the future. 

There have been reports of ectopic pregnancy (when a fertilized egg attaches outside of the uterus, where it cannot survive) after the use of levonorgestrel emergency contraception pills. However, large studies looking at outcomes in women who used levonorgestrel emergency contraception pills have not shown that the medication greatly increases the chance of ectopic pregnancy. Contact your healthcare provider if you notice any warning signs of an ectopic pregnancy after taking emergency contraception, such as sharp cramping or pain on one side of your body.  

Does taking levonorgestrel increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Levonorgestrel does not increase the chance of miscarriage. Emergency contraception such as levonorgestrel does not end a pregnancy that has already attached to the wall of the uterus (implanted).  

Does taking levonorgestrel 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 levonorgestrel, might increase the chance of birth defects in a pregnancy. If a woman takes levonorgestrel and still becomes pregnant, it is not expected to increase the chance of birth defects. 

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

Studies have not been done to see if levonorgestrel 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).  

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

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

Breastfeeding while taking levonorgestrel: 

Levonorgestrel gets into breast milk in small amounts. When used as emergency contraception, levonorgestrel is not expected to be harmful to a child that is breastfeeding. Waiting 3 to 4 hours to breastfeed after taking the dose (or after each dose if a two-dose method is used) will lower the amount of levonorgestrel the child might get in the breast milk. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

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

 

Please click here for references.