This sheet is about having hepatitis A in pregnancy or 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 hepatitis A?

Hepatitis A is an infection caused by the hepatitis A virus (HAV). Hepatitis A spreads among people very easily. The virus infects the liver. It generally takes 15 to 50 days to develop the illness after coming into contact with HAV.  

Symptoms of hepatitis A can include fatigue (being very tired), nausea, vomiting, fever, abdominal pain, dark colored urine, flu-like symptoms, and jaundice (yellowing of the skin and the whites of the eyes). Symptoms tend to be mild in children, but they can be more serious in people who get the infection for the first time as adults. Unlike other forms of hepatitis, hepatitis A does not cause chronic (long-term) liver problems. 

How do you get hepatitis A?

The hepatitis A virus spreads through contact with the feces of, or through sexual contact with, an infected person. Common sources of infection include contaminated cooking/eating utensils, contaminated toys, and contaminated food and water. People working in childcare settings or living in households with affected family members have an increased chance of getting the virus. Hepatitis A is the most common cause of jaundice in woman who are pregnant. 

How can I lower the chance of getting hepatitis A?  

The hepatitis A vaccine provides the best protection against the virus. MotherToBaby has a fact sheet on the hepatitis A vaccine at: https://mothertobaby.org/fact-sheets/hepatitis-a-vaccine/.  

In addition, practicing good hygiene can lower the chance of infection. This includes washing hands with soap and water after using the bathroom, after changing a diaper, and before preparing and eating food. Boiling contaminated food or water for one minute can kill the virus.  

I have hepatitis A. Can it make it harder for me to become pregnant?  

It is not known if having hepatitis A can make it harder to get pregnant. It is possible that being ill could temporarily affect your menstrual cycle. 

Does having hepatitis A increase the chance for miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Having hepatitis A is not expected to increase the chance of miscarriage.   

Does having hepatitis A during pregnancy 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 hepatitis A, might increase the chance of birth defects in a pregnancy. Studies have not shown an increased chance for birth defects following hepatitis A exposure in pregnancy.  

Would having hepatitis A during pregnancy increase the chance of other pregnancy related problems? 

Most women who get hepatitis A during pregnancy are not expected to have serious pregnancy-related complications. Studies have shown an increased chance of preterm labor (labor that begins before 37 weeks of pregnancy) following hepatitis A infection during pregnancy; this is more common when there is fever. Separation of the placenta (the organ that grows in the uterus during pregnancy) from the uterus has also been reported. There are rare reports of the virus passing to the developing baby and causing inflammation of the baby’s liver after delivery (neonatal hepatitis).  

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

Hepatitis A in pregnancy is not expected to cause long-term problems for the child. 

Breastfeeding while I have hepatitis A:  

Most woman who are nursing can continue to breastfeed while they have a hepatitis A infection. There are antibodies present in breast milk that might help protect the baby from getting an infection. The baby might need immune globulin shots for protection against the virus. Women who get hepatitis A while breastfeeding should practice good hand washing and other hygiene practices. They should also talk with their baby’s healthcare provider about the best ways to protect the baby from the virus.  

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

Studies have not been done to see if having hepatitis A could affect male fertility (ability to make healthy sperm) or increase the chance of birth defects. Partners cannot pass hepatitis A directly to a baby during pregnancy. However, an infected partner can pass the virus to the women who is pregnant through sexual contact, or by sharing food, drink, or utensils. Both partners should practice good hand washing and other hygiene. In general, exposures that men have are unlikely to increase the risk 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 nirmatrelvir/ritonavir 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 nirmatrelvir/ritonavir? 

Nirmatrelvir and ritonavir are medications that have been used together to treat COVID-19 (the illness caused by the SARS-CoV-2 virus). The combination of nirmatrelvir and ritonavir is sold under the brand name Paxlovid®. To be most effective, nirmatrelvir/ritonavir treatment should be started as soon as possible after a diagnosis of COVID-19 and within 5 days of the start of symptoms. For more information on COVID-19, please the 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 need to take nirmatrelvir/ritonavir. Can it make it harder for me to get pregnant?  

Studies have not been done in humans to see if nirmatrelvir/ritonavir can make it harder to get pregnant. Animal studies on ritonavir have not shown effects on the ability to get pregnant (fertility). 

Does taking nirmatrelvir/ritonavir increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done in humans to see if nirmatrelvir/ritonavir can increase the chance of miscarriage.  

Does taking nirmatrelvir/ritonavir 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 nirmatrelvir/ritonavir, might increase the chance of birth defects in a pregnancy.  Studies have not been done in humans to see if the combination of nirmatrelvir/ritonavir can increase the chance of birth defects. Case reports of use in human pregnancy have not suggested an increased chance of birth defects.  

The National Institutes of Health (NIH) recommends that nirmatrelvir/ritonavir not be withheld from women who are pregnant and have COVID-19 if they otherwise qualify to receive this medication. The American College of Obstetricians and Gynecologists (ACOG) states that nirmatrelvir/ritonavir is the preferred treatment for women who are pregnant and have COVID-19 that does not require hospitalization. If you have COVID-19, your healthcare providers can talk with you about what treatment is best for you.  

Does taking nirmatrelvir/ritonavir in pregnancy increase the chance of other pregnancy-related problems? 

Small studies looking at women who took nirmatrelvir/ritonavir for COVID-19 infection during pregnancy have not reported an increased 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). Among the women who had gone on to deliver at the time of these reports, no side effects related to nirmatrelvir/ritonavir were reported in their infants at the time of delivery. Most of the women who had delivered were vaccinated against COVID-19 and received nirmatrelvir/ritonavir in the third trimester.  

Having a COVID-19 infection in pregnancy can increase the chance of pregnancy problems such as stillbirth and preterm delivery.  

Does taking nirmatrelvir/ritonavir in pregnancy affect future behavior or learning for the child?   

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

Breastfeeding while taking nirmatrelvir/ritonavir: 

Information on the use of nirmatrelvir/ritonavir during breastfeeding is limited. Nirmatrelvir/ritonavir passes into breast milk in small amounts. No adverse effects were reported in a few case reports on nursing infants. More information is available about ritonavir used by itself during breastfeeding.  

Since the amount of nirmatrelvir/ritonavir in the milk is expected to be low, it is not expected to cause side effects in nursing infants. However, if you suspect the baby has any symptoms (such as diarrhea or irritability), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Studies have not been done in humans to see if nirmatrelvir/ritonavir could affect male fertility (ability to make healthy sperm) or increase the chance of birth defects. Animal studies on ritonavir have not shown an effect on male fertility. 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 gabapentin 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 gabapentin?

Gabapentin is a medication that has been used to prevent and control partial seizures, treat some forms of nerve pain, and treat moderate-to-severe restless legs syndrome. Some brand names are Horizant®, Gralise® and Neurontin®.

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

It is not known if gabapentin can make it harder to get pregnant. Sexual dysfunction (including loss of desire to have sex and loss of ability to have an orgasm) has been reported among women who take gabapentin.

Does taking gabapentin 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 gabapentin can increase the chance of miscarriage in human pregnancy. Animal studies reported an increased chance for miscarriage.

Does taking gabapentin 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. Small, controlled studies on gabapentin have not suggested an increased chance of birth defects. There is also no known pattern of birth defects associated with the use of gabapentin in pregnancy.

One study looked at the pregnancy outcomes of women who received prescriptions for gabapentin. When looking at the outcomes of all the study participants, gabapentin exposure during early pregnancy does not appear to increase the chance of birth defects above the background risk. When the authors only looked at the data from participants who filled at least two prescriptions for gabapentin in the first trimester, an increased chance of heart defects was seen. Studies based on prescriptions cannot tell if a woman took the medication, so it is hard to know if the outcomes are related to the medication being studied or other factors.

Gabapentin might lower levels of folic acid in women who take this medication. Some professional organizations recommend that women on this type of medication take a higher dose of folic acid, while other groups do not. Talk with your healthcare provider about how much folic acid is right for you. Please see our MotherToBaby fact sheet and baby blog on folic acid/folate at https://mothertobaby.org/fact-sheets/folic-acid/ and https://mothertobaby.org/baby-blog/folic-acid-is-more-really-better/.

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

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) have been reported in some studies looking at the use of gabapentin during pregnancy. However, is hard to know if these problems are from the gabapentin, from the underlying health condition(s) being treated, or other factors.

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

Studies have not been done to see if gabapentin use alone can cause withdrawal in a newborn. One study found that when gabapentin is combined with opioids late in pregnancy, withdrawal can occur. It is not known how often withdrawal occurs in babies exposed to this combination. It is important that your healthcare providers know you are taking gabapentin so that if symptoms occur your baby can get the care that is best for them. The baby can be monitored for symptoms such as unusual eye, tongue, and/or muscle movements, restlessness of the arms and legs, and arching of the back after birth.

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

One study that looked at 378 children exposed to gabapentin during pregnancy did not find an increased chance of conditions that affect how the brain works (neurodevelopmental disorders), conditions that cause problems with social and communication skills (pervasive developmental disorders), intellectual disability, or communication-related disorders.

Breastfeeding while taking gabapentin:

Gabapentin enters breastmilk in low levels. Blood tests on breastfed infants found low levels or levels too low to be detected. There are reports of infants exposed to gabapentin through breastmilk; no side effects were noted.

If you suspect the baby has any symptoms (such as drowsiness or trouble gaining weight gain), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Sexual dysfunction, such as loss of desire to have sex and loss of ability to have an erection or ejaculate, has been reported in men using gabapentin. 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 cytomegalovirus (CMV) 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 provider. 

What is cytomegalovirus (CMV)? 

CMV is a common virus that can spread from one person to another through contact with saliva, semen, vaginal fluids, blood, urine, tears, feces, or breast milk. Most people with CMV do not have symptoms; some might have fever, tiredness, and muscle aches when they are first infected.  

Once the CMV virus gets into the body, it stays there for life. A healthy immune system usually keeps the virus in check. Sometimes the virus can be reactivated (“wakes up” and becomes active). People can also be infected with more than one strain of CMV in their lives.  

Over half (more than 50%) of people in the United States have the virus by age 40, and 1 out of 3 children have the virus by age 5. Close contact with children less than three years old, such as in daycare settings, is a common way to become infected with CMV. 

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

Blood tests can diagnose CMV infection in adults who have symptoms. Talk to your healthcare provider about your risk for CMV and what tests are right for you. 

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

Having CMV is not expected to make it harder to get pregnant. 

Does having/getting CMV increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if CMV can increase the chance of miscarriage. 

How likely is it that CMV infection in pregnancy will pass to the fetus?

When a woman is pregnant and infected with CMV for the first time, there is about 1 in 3 (30%) to a 2 in 5 (40%) chance that CMV will pass to the fetus. When an old infection is reactivated, or you get a new strain of the virus during pregnancy, there might be a lower chance of passing the infection to the fetus than with a new infection. 

Does having/getting CMV 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 a certain exposure, like CMV, might increase the chance of birth defects or other problems in a pregnancy.  

If there is a CMV infection during pregnancy, the virus can pass to the fetus. This is called congenital CMV. Congenital CMV can cause vision problems (including blindness), an enlarged liver, an enlarged spleen, small head size, and problems with the nervous system. Most babies with congenital CMV do not show signs or have health problems.  

Babies with congenital CMV can have health problems at birth or ones that develop later. Of those babies who get the virus, about 1 in 100 (1%) to 1 in 10 (10%) will have symptoms at birth. If the CMV infection happens in the first trimester, the chance that the brain, hearing, and vision will be affected is higher than if the infection happens later in pregnancy. 

Does having/getting CMV increase the chance of other pregnancy-related problems?

Pregnancies affected with CMV have a higher chance of preterm delivery (birth before week 37) or low birth weight (weighting less than 5 pounds, 8 ounces [2500 grams] at birth). CMV might also increase the chance of preeclampsia (high blood pressure and problems with organs, such as the kidneys), that can lead to seizures (called eclampsia),   

Some studies suggest that CMV might increase the chance of jaundice (yellow skin and eyes caused by the buildup of bilirubin in the blood) or delays in physical movement. CMV might be a possible cause of stillbirth. However, CMV is common, and many pregnancies with CMV result in live birth.  

Does having/getting CMV in pregnancy affect future behavior or learning for the child?

Babies that show signs of congenital CMV at birth can have long-term problems, such as intellectual disability, language delay, poor physical coordination, weakness, hearing loss, and seizures. Some babies who do not show signs of congenital CMV at birth can develop hearing loss or learning problems as they get older.  

How can I find out during my pregnancy if my baby will be affected by CMV? 

Prenatal ultrasounds can be used to screen for some issues related to congenital CMV, such as slow growth, small head size, large placenta, and changes in brain structure. However, many babies with congenital CMV will not show any signs of infection on a prenatal ultrasound. Issues such as intellectual disability and learning problems cannot be seen on ultrasound and might not be known until the child gets older.  

Amniocentesis is a procedure that removes a small amount of fluid from around the fetus (amniotic fluid). This fluid can be tested for CMV. Your healthcare providers can talk with you about the risks and benefits of having this test during pregnancy. After a baby is born, their saliva, urine, or blood can be tested for CMV. Some states include screening for CMV in their state’s newborn screening programs. 

Talk with your healthcare providers 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. 

I am pregnant and have a CMV infection. Is there a way to prevent or treat congenital CMV? 

Talk with your healthcare providers about what treatments are recommended for you and your pregnancy. At this time, there is no known treatment that can completely prevent all the symptoms or long-term effects of congenital CMV. Using antiviral medication when there is a CMV infection in pregnancy might lower the chance the virus will pass to the fetus. Newborns with CMV might be given antiviral medication to help reduce the chance of hearing loss, eye disease, and learning problems.  

Breastfeeding and CMV:

Women with CMV have been encouraged to breastfeed if their baby is full term and healthy. Full-term babies who get infected with CMV through breast milk usually do not get seriously ill. Babies born before 30 weeks of pregnancy and / or weigh less than 3.3 pounds (1500g) might have a higher chance of getting sick from CMV through breast milk. If you suspect the baby has symptoms (fever, diarrhea, or yellowish skin/eyes), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

CMV is not expected to affect male fertility (ability to get a woman pregnant). CMV can be spread to a partner who is pregnant. Men who have a partner that is pregnant can use latex condoms during intercourse to lower the chance of passing the CMV infection to the woman who is pregnant. If you or your partner have a CMV infection, talk with your healthcare providers. For more general information on exposures in Fathers or sperm donors, 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 loxapine 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 loxapine?

Loxapine is a medication that has been used to treat mental health conditions including schizophrenia and bipolar disorder. Some brand names for loxapine are Loxitane® and Adasuve®.

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. Some people might have a return of their symptoms (relapse) if they stop this medication during pregnancy.  

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

Loxapine might increase the blood levels of the hormone prolactin. Levels of prolactin that are higher than normal can cause irregular periods in some women, which might make it harder to get pregnant. Talk to your healthcare provider if you are having trouble getting pregnant. 

Does taking loxapine 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 loxapine can increase the chance of miscarriage.  

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

Studies have not been done to see if loxapine can increase the chance of birth defects.  

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

Studies have not been done to see if loxapine 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). 

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

The use of some medications similar to loxapine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. The symptoms can include too much or too little muscle tone (stiff or floppy), sleepiness, agitation (irritability), problems with breathing and feeding, or unusual muscle movements (tremors). Not all babies exposed to these medications will have these symptoms, and it is unknown if taking loxapine would cause these symptoms. It is important that your healthcare providers know you are taking loxapine so that if symptoms occur your baby can get the care that is best for them. 

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

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

Breastfeeding while taking loxapine:  

It is not known how much loxapine gets into the breast milk or how it might affect a breastfeeding infant. The product label for loxapine recommends people who are breastfeeding not use this medication, if possible. But the benefits of using loxapine might outweigh possible risks. Your healthcare providers can talk with you about using loxapine and what treatment is best for you. If you take loxapine and suspect the baby has any symptoms such as sedation (extreme sleepiness), irritability, constipation, or tremors, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Taking loxapine might increase levels of the hormone prolactin in some males, which might cause problems with fertility (ability to get a woman pregnant). 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.