This sheet is about exposure to St. John’s wort 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 St. John’s wort? 

St. John’s wort (Hypericum perforatum) is a flowering plant that has been used as an herbal supplement. It is available as a tablet or capsule, liquid extract, tea, and as a cream or ointment. It is also sometimes mixed with other herbal ingredients in combination products. St. John’s wort has most commonly been used to help symptoms of mild to moderate depression. MotherToBaby has a fact sheet on depression at: https://mothertobaby.org/fact-sheets/depression-pregnancy/.  

There are many compounds in St. John’s wort. The amount and quality of these compounds can vary widely and be affected by the soil the plant was grown in, and how the plant was harvested, dried, and stored. St. John’s wort can interact with many medications (change how well they work in the body or cause side effects), including birth control pills. If you are taking any medication, talk to your healthcare providers to review the chance of interactions between your medication and St. John’s wort.  

In the United States, St. John’s wort is a dietary supplement. Unlike prescription medication, dietary supplements are not regulated by the Food and Drug Administration (FDA) in the same way and do not have set standards for preparation, safety, or effectiveness. For information on supplements in general, please see the fact sheet on herbal products at https://mothertobaby.org/fact-sheets/herbal-products-pregnancy/. 

Sometimes when women find out they are pregnant, they think about changing how they take supplements or their medication. It is important to talk with your healthcare providers before making changes in how you take your medication or supplements. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. Your healthcare team might discuss medication options that have been better studied for use in pregnancy. 

I take St. John’s wort. Can it make it harder for me to get pregnant?  

It is not known if St. John’s wort can make it harder to get pregnant. 

Does taking St. John’s wort increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if St. John’s wort can increase the chance of miscarriage. One study found the chance for a miscarriage in women taking St. John’s wort during pregnancy to be similar to the general population’s chance for miscarriage. 

Does taking St. John’s wort 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 St. John’s wort, might increase the chance of birth defects in a pregnancy. St. John’s wort has not been well-studied with use in pregnancy. Three studies that looked at pregnancies with use of St. John’s wort did not report an increase in birth defects.  

Does taking St. John’s wort in pregnancy increase the chance of other pregnancy-related problems? 

A study that included 39 women who reported using St. John’s wort early in their pregnancies did not find a higher chance for preterm delivery (delivery before 37 weeks of pregnancy) or poor growth in the babies. A second study of 54 infants prenatally exposed to St. John’s wort found a similar rate of live birth and preterm delivery when compared to babies not exposed to St. John’s wort. There is one case report of a woman who started taking St. John’s wort at week 24 of pregnancy and developed thrombocytopenia but had a normal delivery. Thrombocytopenia is a condition where the blood does not have enough platelets (cells that help your blood to clot). Some reports suggest that St. John’s wort can affect how a person’s blood clots. It is not known if the low platelet count in this case report was related to St. John’s wort or another factor. 

Does taking St. John’s wort in pregnancy affect future behavior or learning for the child?   

Studies have not been done to see if St. John’s wort can increase the chance of behavior or learning issues for the child.   

Breastfeeding while taking St. John’s wort: 

St. John’s wort gets into breastmilk. In 5 women who were breastfeeding full-term older infants (10-22 weeks of age), the amount of St. John’s wort that the infants received through breastmilk was found to be small. The parents reported no negative effects in their infants. Another study that looked at 33 women who took St. John’s wort and breastfed reported an increased amount of crying (colic) and being very sleepy (lethargy) in their infants when compared to infants of women with depression who were not taking St. John’s wort. The infants did not need medical treatment. If you suspect the baby has any symptoms from the St. John’s wort such as colic, drowsiness, or poor feeding, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all of your breastfeeding questions. 

If a male takes St. John’s wort, could it affect his fertility or increase the chance of birth defects? 

St. John’s wort has not been well studied to see how it might affect male fertility (ability to make healthy sperm) or increase the chance of birth defects above the background risk. There are case reports of sexual difficulties (reduced desire or ability to perform) in men taking St. John’s wort; similar things were reported in laboratory animal studies.  Experimental laboratory data have suggested that St. John’s wort might have spermicidal effects (kill sperm or reduce ability to swim towards the egg). In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.  

Please click here for references.  

This sheet is about exposure to salmeterol in a 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 salmeterol? 

Salmeterol (Serevent®, Serevent Diskus®) is a medication that has been used to treat asthma, chronic obstructive pulmonary disease (COPD), and also as prophylaxis for exercise induced bronchospasm. It is in a class of medications called beta2-agonists. Beta2-agonists help to open the airways in the lungs (bronchodilators). Salmeterol is a long-acting beta2-agonist taken by breathing it into the lungs (inhalation). It is used together with an inhaled corticosteroid to treat asthma. For information on inhaled corticosteroids, see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/inhaled-corticosteroids-icss-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. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

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

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

Does taking salmeterol 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 salmeterol can increase the chance of miscarriage.  

Does taking salmeterol 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 salmeterol, might increase the chance of birth defects in a pregnancy. A small number of studies do not suggest an increased chance of birth defects with the use of inhaled salmeterol during pregnancy. When salmeterol is inhaled, very little of the drug gets into the blood. Even less of the medication is expected to reach the developing fetus. 

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

Small studies have not suggested higher rates of 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 salmeterol during pregnancy. Asthma that is not well controlled can increase the chance of pregnancy complications. For information on asthma, see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/asthma-and-pregnancy/.  

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

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

Breastfeeding while taking salmeterol: 

Studies have not been done to look at the use of salmeterol during breastfeeding. When salmeterol is inhaled, very little of the drug gets into the blood and it is not expected to pass into breastmilk in large amounts. Using inhaled bronchodilators is usually compatible with breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Studies have not been done to see if salmeterol could affect male fertility (ability to get a woman pregnant) or increase the chance of birth defects. When salmeterol is inhaled, very little of the drug gets into the blood, so effects on fertility or pregnancy are not expected. 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 penicillin G 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 penicillin G?

Penicillin G is an antibiotic drug that belongs to a class of antibiotic medications called penicillins. It works by killing bacteria that cause infections and has been used to treat Staphylococcus aureus (Staph) and syphilis. Penicillin G is given intravenously, sometimes called “I.V.”. This involves injecting the medication into a vein.

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.

It is important to treat infections in pregnancy. Some infections, such as Staph or syphilis, can increase the chance of pregnancy-related problems or infections in a newborn baby if not properly treated during pregnancy. Syphilis can also be passed to a fetus during any trimester of pregnancy, which can cause health problems in the newborn. MotherToBaby has fact sheets on Staph here: https://mothertobaby.org/fact-sheets/staphylococcus-aureus-pregnancy/ and syphilis here: https://mothertobaby.org/fact-sheets/syphilis/.

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

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

Does taking penicillin G increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Taking penicillin G in pregnancy is not expected to increase the chance of miscarriage.

Does taking penicillin G 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. Multiple studies have looked at the use of penicillin G during pregnancy and have not reported an increased chance of birth defects.

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

Penicillin G is not expected to cause 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).

Some people are allergic to penicillins. In very rare cases, penicillin G can cause anaphylaxis (severe allergic reaction where the body goes into shock). Anaphylaxis can cause trouble breathing, low blood pressure, dizziness or fainting, and nausea. Severe or uncontrolled anaphylaxis can affect blood flow to the fetus, which could affect the growth and development of the fetus. If you think you are allergic to penicillin, talk with your healthcare provider about this and the best way to treat your condition.

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

Information from limited studies does not suggest that taking penicillin G during pregnancy can increase the chance of behavior or learning issues for the child.

Breastfeeding while taking penicillin G:

Limited information suggests that the amount of penicillin G that gets into breast milk is small. Taking penicillin G is not expected to cause side effects in most infants. Babies who are exposed to penicillins through breast milk might have diarrhea or develop thrush (fungal infection in the mouth). If you suspect the baby has any symptoms (such as diarrhea, white spots in the mouth, or mouth pain), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

If you are taking penicillin G for an infection that can be transmitted to others by sexual contact (such as syphilis), it is important to treat your infection for your own health and for your partner’s health. Passing infections on to a woman who is pregnant might increase risks to a pregnancy. Your healthcare provider can talk with you about what steps can be taken to help prevent sexual transmission of infections to your partner.

Studies have not been done to see if penicillin G 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 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 cariprazine 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 cariprazine?

Cariprazine is a medication that has been used to treat schizophrenia, bipolar disorder, and depression. A brand name for cariprazine is Vraylar®.

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.

MotherToBaby has a fact sheet on depression here: https://mothertobaby.org/fact-sheets/depression-pregnancy/. More information about mental health can be found here: https://mothertobaby.org/pregnancy-breastfeeding-exposures/mental-health/.

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

Studies have not been done in women to see if cariprazine can make it harder to get pregnant. In animal studies where the animals were given higher doses of cariprazine than would be given to humans, there was a decrease in fertility (ability to get pregnant).

Does taking cariprazine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done in women to see if cariprazine can increase the chance of miscarriage. In animal studies it was unclear if taking cariprazine increased the chances of miscarriage. However, because some mental health conditions can increase the chance of miscarriage, it is hard to know if a medication, the medical condition being treated, or other factors are the cause of a miscarriage.

Does taking cariprazine 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 have not been done in women to see if cariprazine can increase the chance of birth defects. Birth defects have been reported in some animal studies after the animals were given a range of cariprazine doses, some of which were higher than what would be given to humans. However, information from animal studies does not prove that a medication would affect human pregnancy in the same way.

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

Studies have not been done in women to see if cariprazine can increase 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). In animals given lower doses of cariprazine than what would be given to humans, low birth weight and decreased survival after birth were seen. However, information from animal studies does not prove that a medication would affect human pregnancy in the same way. Some mental health conditions (such as depression) can increase the chance of preterm delivery, babies who are smaller than expected, and pre-eclampsia (dangerously high blood pressure in pregnancy). This makes it hard to know if a medication, the underlying condition, or other factors are increasing the chance of complications.

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

The use of cariprazine during pregnancy can cause temporary symptoms in the newborn soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms may include too much or too little muscle tone, excessive sleepiness, involuntary muscle movements, trouble breathing, and trouble eating. Not all babies exposed to cariprazine will have these symptoms. It is important that your healthcare providers know you are taking cariprazine so that if symptoms occur your baby can get the care that is best for them.

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

Studies have not been done in women to see if cariprazine can increase the chance of behavior or learning issues for the child. In animals given a range of cariprazine doses, some of which were higher than what would be given to humans, developmental delays were reported. However, information from animal studies does not prove that a medication would affect human pregnancy in the same way. Some mental health conditions (such as depression) might affect a child’s behavior or development. This makes it hard to know if a medication, the underlying condition, or other factors are increasing the chance of learning and behavior issues.

Breastfeeding while taking cariprazine:

There is no information on the use of cariprazine while breastfeeding. It is important for your condition to be treated. Your healthcare providers can talk with you about using cariprazine and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if cariprazine could affect men’s fertility (ability to get a woman pregnant) or increase the chance of birth defects. Animal studies have not shown an effect on male fertility. 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 nitrofurantoin 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 nitrofurantoin?

Nitrofurantoin is an antibacterial medication that has been used to treat urinary tract infections (UTIs). Some brand names are Macrobid®, Macrodantin®, and Furadantin®.

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 provider can talk with you about using nitrofurantoin and what treatment is best for you.

The American College of Obstetricians and Gynecologists (ACOG) states that it is “reasonable to offer” nitrofurantoin in the first trimester when other medication is not available. ACOG also states that the use of nitrofurantoin in the second and third trimester has been considered a first-line treatment for UTIs.

The product label for nitrofurantoin recommends that women who are near the end of their pregnancy (38 to 42 weeks gestation) or are otherwise close to delivery should not use this medication.

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

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

Does taking nitrofurantoin increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Two studies including 173 pregnancies did not find an association with nitrofurantoin use and an increased chance for miscarriage. However, women with untreated urine infections might have a greater chance for miscarriage.

Does taking nitrofurantoin 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 studies with nitrofurantoin do not suggest an increased chance of birth defects. Some studies on nitrofurantoin have suggested an increased chance of birth defects with use in pregnancy. However, study design flaws make some of the results in these studies questionable. There are also many studies on nitrofurantoin use in pregnancy that did not find birth defects. Overall, an increased chance for birth defects has not been confirmed.

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

It is not known if nitrofurantoin can cause 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). However, women with untreated urine infections might have a greater chance for these and other pregnancy complications, including preeclampsia (high blood pressure and problems with organs, such as the kidneys) that can lead to seizures (called eclampsia), and cesarean section (C-section).

There have been reports of newborns with hemolytic anemia (breakdown of red blood cells) when they were exposed to nitrofurantoin late in pregnancy. For this reason, the manufacturer has recommended using different antibiotics to treat urine infections later in pregnancy.

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

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

Breastfeeding while taking nitrofurantoin:

Nitrofurantoin gets into breast milk in small amounts. In a report on 6 women taking nitrofurantoin while breastfeeding, 2 noted that their children had diarrhea. When any antibiotic is taken during breastfeeding, babies can be watched for diarrhea or rash.

The product label for nitrofurantoin recommends that women who are breastfeeding should not use this medication when infants are less than 1 month old or if the nursing infant has a diagnosis of glucose-6-phosphate dehydrogenase deficiency (G6PD) due to the risk of hemolytic anemia (breakdown of red blood cells). However, the benefits of treating your condition, as well as the benefits of breastfeeding, may outweigh possible risks. Use of nitrofurantoin while breastfeeding an older infant without G6PD is unlikely to cause side effects. Your healthcare providers can talk with you about using nitrofurantoin and what treatment is best for you while you are nursing. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

When nitrofurantoin was given to men at doses higher than typically used for 2 weeks, sperm production was low or stopped in 13 out of the 36 study participants. Low sperm production could affect fertility (ability to get a woman pregnant). However, use of typical doses of 100mg twice daily for one week did not have this same effect. This means that with typical use, nitrofurantoin is unlikely to affect a man’s fertility. 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.