This sheet is about exposure to misoprostol 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 misoprostol?

Misoprostol is sold under the brand name Cytotec®.

The product label for misoprostol recommends that women 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 misoprostol and what treatment is best for you.

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

People eliminate medication at different rates. In healthy adults, it takes up to 2 to 4 hours, on average, for most of the misoprostol to be gone from the body. However, the manufacturer has recommended to wait at least 1 month or through 1 menstrual cycle after stopping misoprostol before trying to get pregnant.

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

Studies have not suggested that misoprostol can make it harder to get pregnant.

Does taking misoprostol increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Misoprostol can cause uterine contractions and has been used to treat miscarriages (to help pass tissue from a pregnancy that is no longer viable). Therefore, an increased chance of miscarriage is expected. The increased chance of miscarriage with the use of misoprostol depends on dose, timing, use of other medications, and other factors.

Does taking misoprostol 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 infants born to women who use misoprostol during pregnancy do not have birth defects. However, misoprostol can cause poor blood flow to the fetus (called vascular disruption) and increase the chance of birth defects in early pregnancy. Birth defects related to misoprostol exposure in pregnancy are poor growth of limbs (missing parts of finger/toes, or parts of arms/legs), Moebius syndrome (weakness or paralysis of the facial and eye muscles), cleft lip and/or cleft palate (lip and or roof of mouth formed with a split), arthrogryposis (stiff joints), muscle weakness, and club foot (foot points downward and inward).

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

Misoprostol use in pregnancy might increase the chance for preterm delivery (birth before week 37), poor growth (baby smaller than expected), and uterine rupture (when the wall of the uterus tears open during late pregnancy or during labor). It can also increase the chance of the fetus having its first bowel movement (called meconium) while still in the uterus instead of after delivery. Meconium passage in the uterus might cause the fetus to get meconium in its lungs (meconium aspiration), which might need treatment after delivery.

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

It is not known if misoprostol increases the chance for behavior or learning issues. Some of the reported birth defects associated with misoprostol could affect brain development. Changes in brain development could affect future learning or behavior.

What screenings or tests are available to see if my pregnancy has birth defects or other issues?

Prenatal ultrasounds can be used screen for some birth defects, such as a poor limb growth, cleft lip, and club foot. They can also be used to monitor 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 a pregnancy that can tell how much effect there could be on future behavior or learning.

Breastfeeding while taking misoprostol:

Misoprostol gets into breast milk in very small amounts. No side effects have been reported in breastfeeding infants. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done to see if misoprostol 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/.

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This sheet is about exposure to tildrakizumab 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 tildrakizumab?

Tildrakizumab (Ilumya®) is a medication that has been used to treat moderate-to-severe plaque psoriasis. For more information about psoriasis in pregnancy, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/psoriasis-and-pregnancy/.

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.

I am taking tildrakizumab, 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 (process) medication is not the same for everyone. In healthy non-pregnant adults, it takes up to 138 days (about 5 months), on average, for most of the tildrakizumab to be gone from the body.

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

Studies have not been done in humans to see if tildrakizumab could make it harder to get pregnant. Animal studies did not report an effect on fertility (ability to get pregnant).

Does taking tildrakizumab increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. A report of 14 human pregnancies exposed to tildrakizumab in the first trimester noted miscarriages in 2 of those 14 pregnancies. This is similar to the rate of miscarriage in the general population. Animal studies did not report a higher chance of miscarriage.

Does taking tildrakizumab 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 tildrakizumab, might increase the chance of birth defects in a pregnancy. In a report on 14 human pregnancies exposed to tildrakizumab in the first trimester, no birth defects were reported in the infants. Animal studies done by the manufacturer also did not show a higher chance of birth defects with exposure to tildrakizumab.

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

Studies have not been done in humans to see if tildrakizumab 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 tildrakizumab in pregnancy affect future behavior or learning for the child?

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

Can my baby receive live vaccines before one year of age if I take tildrakizumab later in pregnancy?

Since tildrakizumab may suppress the immune system of the person taking it, there is a theoretical concern that the same thing could happen to the baby if they are exposed during pregnancy. If someone has a weakened immune system, they may be more likely to develop an infection from a live vaccine. Live vaccines contain a small amount of live virus. Inactivated vaccines do not contain live virus, so they cannot cause the disease they protect against. In the United States, rotavirus is the only live vaccine routinely given in the first year of life. Most people can get inactivated vaccines in the first year of life.

Talk with your child’s healthcare provider about your exposure to tildrakizumab during pregnancy. They can talk with you about the vaccines your child should receive and the best time for your child to receive them.

Breastfeeding while taking tildrakizumab:

Tildrakizumab has not been studied for use during breastfeeding. Tildrakizumab is a very large protein, so not much of the medication is likely to pass into breast milk. Any small amounts that might get into the breast milk are likely to be destroyed in the baby’s stomach. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Studies have not been done in humans to see if tildrakizumab could affect male fertility (ability to get a woman pregnant) or increase the chance of birth defects. Animal studies did not report 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/.

MotherToBaby is currently conducting a study looking at tildrakizumab and other medications in pregnancy. If you are interested in learning more, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study.

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This sheet is about exposure to propylthiouracil (PTU) 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 propylthiouracil?

Propylthiouracil (PTU) is a medication that has been used to treat hyperthyroidism (when the thyroid gland makes too much thyroid hormone) and Graves’ disease (a common cause of hyperthyroidism). It lowers the amount of thyroid hormone that the thyroid gland makes. One brand name for PTU is Propycil ®. 

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. Untreated hyperthyroidism can increase the chance of poor outcomes for a pregnancy, including thyroid storm (life-threatening overactive thyroid), maternal congestive heart failure, and other complications. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

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

It is not known if PTU can make it harder to get pregnant. Untreated thyroid disorders might make it harder to get pregnant. 

Does taking PTU increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Three studies did not find a higher chance of miscarriage when using PTU during pregnancy. Hyperthyroidism has been associated with an increased chance of miscarriage. 

Does taking PTU 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 published data to try to understand if an exposure, like PTU, might increase the chance of birth defects in a pregnancy. 

It is not known if taking PTU can increase the chance of birth defects. Several studies suggest there could be a small increased chance of birth defects when taking PTU, while other studies do not. There has not been a confirmed pattern of birth defects linked to PTU exposure alone.  

The U.S. Food and Drug Administration (FDA) and The American College of Obstetricians and Gynecologists (ACOG) have noted that PTU might be the preferred treatment for hyperthyroidism during the first trimester of pregnancy.  

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

It is not known if PTU can increase the chance of preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Hyperthyroidism has been found to increase the chance of pregnancy complications like preterm delivery and low birth weight.  

Antithyroid medications, like PTU, or having Graves’ disease, can lead to too low or too high thyroid levels in a baby. If you take PTU, or if you have Graves’ disease, your baby’s thyroid level should be checked after delivery. 

The FDA has reported that PTU can cause serious liver damage in people who take this medication, including pregnant women. There is limited data on whether PTU use during pregnancy can cause liver damage in the baby. Talk to your healthcare team to decide what treatment is best for your situation. 

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

Two studies looking at 44 children (from preschool to adult ages) exposed to PTU during pregnancy found no difference in intelligence scores compared to their unexposed siblings. Untreated hyperthyroidism in pregnancy can increase the chance of learning problems in children. 

Breastfeeding while taking PTU:

PTU gets into breastmilk in small amounts, and the amounts ingested by the infant are small. The American Thyroid Association has suggested that doses of PTU should be limited to 450 mg per day while breastfeeding due to the lack of research on the chance of liver damage in the breastfed infant. No side effects have been reported in babies who were exposed to PTU through breastmilk. Studies show that PTU does not significantly affect the breastfed infants’ thyroid function. If you suspect the baby has any symptoms, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Studies have not been done to see if PTU could affect men’s fertility (ability to get a woman pregnant) or 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/. 

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This sheet is about exposure to doxepin 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 doxepin?

Doxepin is a tricyclic antidepressant that has been used to treat alcoholism, anxiety, depression, and insomnia (trouble sleeping). As a cream, it has been used for short-term treatment of itchiness. Some brand names include Quitaxon^®, Prudoxin^®, Silenor^®, Sinequan^®, and Zonalon^®. It is also sold as a combination drug with another medication called levomenthol under the brand name Doxure^®.

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. If you plan to stop this medication, your healthcare provider may suggest that you slowly lower the dose instead of stopping all at once. Stopping this medication suddenly can cause some people to have withdrawal symptoms.

Pregnancy might affect how some women break down this medication. For this reason, some women might need to have their medication doses changed as a pregnancy progresses. Your healthcare provider can discuss this with you, if needed.

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

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

Does taking doxepin increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if taking doxepin increases the chance for miscarriage.

Does taking doxepin 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. Doxepin has not been well-studied with use in pregnancy. Data from animal studies does not suggest an increased chance for birth defects. In a case series looking at 8 human pregnancies, there were no birth defects reported.

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

It is not known if doxepin 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).

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

The use of tricyclic antidepressants during pregnancy can cause temporary symptoms in some newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms reported with other tricyclic antidepressant medication have included jitteriness, vomiting, crying, fussiness, changes in sleep patterns, tremors, trouble with eating and/or regulating body temperature. In most cases these symptoms were mild and went away on their own within 1 to 2 weeks after birth. Not all babies exposed to tricyclic antidepressants will have these symptoms. It is not known if taking doxepin during pregnancy would cause similar symptoms in newborns. However, it is important that your healthcare providers know you are taking doxepin so that if symptoms occur your baby can get the care that is best for them.

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

It is not known if doxepin increases the chance for behavior or learning issues as this has not been well studied for doxepin. One study looked at 80 children who were exposed to a tricyclic antidepressant medication during pregnancy (only 1 had been exposed to doxepin). This study did not find differences in learning or behavior.

Breastfeeding while taking doxepin:

Doxepin gets into breast milk in small amounts. Information about the use of doxepin while breastfeeding is limited. There are 2 case reports of respiratory depression (trouble breathing) in babies who were exposed to doxepin through breast milk. If you suspect the baby has any symptoms (trouble breathing, not gaining weight, constipation, or is very sleepy), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

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

It is not known if doxepin could affect a  man’s fertility (ability to get a woman pregnant) or increase the chance of birth defects. 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/.

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This sheet is about exposure to aripiprazole in pregnancy and while breastfeeding. This information is based on available published research studies. It should not take the place of medical care and advice from your healthcare providers. 

What is aripiprazole? 

Aripiprazole is medication that has been used to treat schizophrenia, bipolar disorder, autism spectrum disorders, and depression. Some brand names for aripiprazole are Abilify® and Aristada®. 

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, see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/depression-pregnancy/.  

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

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

Does taking aripiprazole increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if aripiprazole increases the chance of miscarriage. One study looking at the use of aripiprazole in pregnancy reported an increased chance of miscarriage, but other studies have not reported this finding. Some studies have reported a higher chance of miscarriage when depression is left untreated in pregnancy. As there can be many causes of miscarriage, it is hard to know if a medication, the medical condition being treated, or other factors (such as age, health, other exposures) are the cause of a miscarriage.  

Does taking aripiprazole 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 aripiprazole, might increase the chance of birth defects in a pregnancy. Studies have not found a higher chance of birth defects when aripiprazole is taken during pregnancy. 

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

It is not known if aripiprazole 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). Some studies have reported a slightly higher chance of preterm birth and babies born smaller than expected with the use of aripiprazole during pregnancy. However, the underlying illness being treated might also increase the chance of these pregnancy complications. Since aripiprazole was taken only for a short time in these studies, it is hard to know if the medication, the medical condition being treated, or other factors were the cause of the preterm births and smaller babies. 

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

The use of aripiprazole during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. The symptoms can include jitteriness, breathing problems, shaking, sleepiness, eating problems, rigid muscles, or low muscle tone. In some babies the symptoms go away quickly on their own, while other babies might need medical treatment to help with the symptoms. Not all babies exposed to aripiprazole will have these symptoms. It is important that your healthcare providers know you are taking aripiprazole so that if symptoms occur your baby can get the care that is best for them. 

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

It is not known if aripiprazole can increase the chance of behavior or learning issues for the child. However, the underlying illness being treated might affect a child’s behavior or development. 

Breastfeeding while taking aripiprazole: 

A few studies looking at doses of aripiprazole up to 15mg per day have shown that the medication passes into breast milk in small amounts. While there have been reports of babies becoming sleepier than usual, most breastfed babies exposed to aripiprazole in the milk have no reported symptoms. If you suspect the baby has any symptoms (such as being too sleepy or having trouble eating), contact the child’s healthcare provider.  

Aripiprazole might lower the amount of milk your body makes. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Studies have not been done to see if aripiprazole could affect a man’s fertility (ability to get a woman pregnant) 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.