This sheet is about exposure to caffeine 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 caffeine? 

Caffeine is a stimulant found in many foods and beverages. It is also found in some prescription and over the counter medications. Caffeine is naturally found in the leaves, seeds, and fruits of more than 60 plants. Caffeine’s main effect is making people feel more awake for a short time. Caffeine is also a diuretic, meaning that it helps get rid of fluids from the body. It is important that women who use caffeine stay well-hydrated by drinking enough water. Most experts suggest that women who are pregnant limit their caffeine intake to 200 milligrams (mg) or less per day. 

How much caffeine is in common foods and drinks?  

The best way to know how much caffeine is in a product is to check the ingredient label. The amount of caffeine in some common items is listed below (amounts are approximate and might vary between products):  

• 8 ounce (oz.) cup of brewed coffee  137 mg 

• 12 oz. (tall) Starbucks® cup of coffee  235 mg 

• 8 oz. cup of instant coffee  76 mg 

• 8 oz. cup of brewed tea  48 mg 

• 8 oz. cup of hot chocolate  5 mg 

• 12 oz. Coke®  46 mg 

• Red Bull® energy drink  67 mg 

• 1 cup of coffee ice cream  4 mg 

• Milk chocolate bar  10 mg 

• Dark chocolate bar  30 mg 

• 2 tablets of Excedrin®  130 mg 

Some herbal supplements such as guarana also contain caffeine (about 47 mg per 1 gram). Beverages made from the guarana seed also contain caffeine.  

I consume (eat/drink) products with caffeine. Can it make it harder for me to get pregnant?  

Some studies have suggested that high levels of caffeine (more than 300 mg per day) might make it harder to get pregnant, but these findings are not proven. Low (less than 200mg per day) to moderate (about 200-300 mg per day) caffeine consumption has not been proven to make it harder to get pregnant.  

Does caffeine increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Researchers have not reported an association between low (under 200 mg) levels of caffeine and an increased chance of miscarriage. Some studies suggest that the chance of miscarriage might be increased when women consume moderate (200-300 mg) or high (more than 300 mg) levels of caffeine. As there can be many causes of miscarriage (such as age, health, other exposures), it is hard to know if an exposure or other factors are the cause of a miscarriage. 

Does caffeine 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 caffeine, might increase the chance of birth defects in a pregnancy. Caffeine has not been shown to increase the chance of birth defects. 

Does consuming products with caffeine in pregnancy increase the chance of other pregnancy-related problems? 

Most studies find no clear evidence that low (less than 200 mg) to moderate (200 to 300 mg) caffeine use during pregnancy 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). High doses (more than 300 mg) of caffeine are not well studied.  

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

The use of caffeine during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Large amounts of caffeine could affect babies in the same way as it does adults. Some reports suggest that children exposed to more than 500 mg of caffeine per day in the third trimester of pregnancy were more likely to have faster heart rates, shaking, increased breathing rate, and spend more time awake in the days following birth. Not all babies exposed to caffeine will have these symptoms. It is important that your healthcare providers know you are taking caffeine so that if symptoms occur your baby can get the care that is best for them. 

Does consuming products with caffeine in pregnancy affect future behavior or learning for the child?  

Most studies find no effect on learning or behavior in young school-aged children who were exposed to caffeine during pregnancy.  

Breastfeeding while consuming products with caffeine: 

Caffeine gets into breast milk in small amounts. It has been suggested to limit daily consumption to 300 mg/day or less while breastfeeding. If you suspect the baby has any symptoms (agitation, irritability, trouble with sleeping, rapid heart rate or tremor), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

If a man consumes products with caffeine, could it affect his fertility or increase the chance of birth defects? 

Studies on caffeine and male fertility (ability to get a woman pregnant) have reported mixed findings. The American Society for Reproductive Medicine (ASRM) states that caffeine consumption has no effect on semen. 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 amoxicillin and clavulanic acid 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 are amoxicillin and clavulanic acid? 

Amoxicillin is a penicillin-like antibiotic. Clavulanic acid is a medication that helps amoxicillin work better.  

These two medications are combined to make an antibiotic that has been used to treat infections caused by bacteria. 

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 amoxicillin and clavulanic acid. Can it make it harder for me to get pregnant?  

It is not known if taking amoxicillin and clavulanic acid can make it harder to get pregnant. 

Does taking amoxicillin and clavulanic acid 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 taking amoxicillin and clavulanic acid together can increase the chance of miscarriage. One study on amoxicillin did not find a higher chance of miscarriage.  

Does taking amoxicillin and clavulanic acid 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 amoxicillin and clavulanic acid, might increase the chance of birth defects in a pregnancy.  

Most studies have not found an increased chance of birth defects when amoxicillin or clavulanic acid are taken during the first trimester. However, there are very few studies available about this combination of medication. There are more studies looking at the use of amoxicillin only during pregnancy. A few of these studies have shown a higher chance of cleft lip and/or cleft palate (an opening in the upper lip and/or the roof of the mouth that needs surgery to be corrected) when amoxicillin is taken during the first trimester. Other studies on amoxicillin use have not found a higher chance of cleft lip and/or palate. Overall, the chance of cleft lip and/or palate is expected to be low if amoxicillin and clavulanic acid is used in the first trimester of pregnancy.   

Does taking amoxicillin and clavulanic acid in pregnancy increase the chance of other pregnancy-related problems? 

Taking amoxicillin and clavulanic acid is not expected to increase the chance of pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). 

Studies have looked at pregnancy outcomes in women treated with antibiotics to help prevent infection following preterm premature rupture of membranes (PPROM). PPROM is when the fluid-filled sac surrounding the fetus breaks open before 37 weeks of pregnancy. Some studies have suggested that using amoxicillin with clavulanic acid following PPROM increases the chance of a serious bacterial infection known as necrotizing enterocolitis (NEC) in the newborn. NEC is a condition that can injure a baby’s intestines. Although the chance of NEC in the newborn is likely to be low with the use of amoxicillin and clavulanic acid following PPROM, some study authors have suggested that other antibiotics might be preferred in these cases.  

Does taking amoxicillin and clavulanic acid in pregnancy affect future behavior or learning for the child?   

A study that followed hundreds of children up to the age of 11 years old did not find that using amoxicillin and clavulanic acid in pregnancy causes learning or behavior problems. 

Breastfeeding while taking amoxicillin and clavulanic acid: 

Amoxicillin and clavulanic acid enter the breast milk in small amounts. These small amounts are not expected to cause side effects for most nursing infants. In a study of 67 breastfeeding infants, there were no serious side effects from this medication. Some babies had rash, diarrhea, irritability, or constipation, but these reactions did not last long. If you suspect the baby has any symptoms (such as rash or diarrhea), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

If a man takes amoxicillin and clavulanic acid, could it affect his fertility or increase the chance of birth defects? 

One study reported that taking amoxicillin and clavulanic acid could treat bacterial infections found in semen, which might improve fertility (ability to make healthy sperm) in some men. Studies have not been done to see if amoxicillin and clavulanic acid could 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.  

This sheet is about exposure to dupilumab 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 dupilumab?

Dupilumab is a monoclonal antibody. It has been used to treat moderate-to-severe atopic dermatitis (eczema), prurigo nodularis (a skin condition with hard, itchy bumps called nodules), certain types of moderate-to-severe asthma, sinusitis with nasal polyps (swelling/inflammation of the sinuses with growths inside the nose), and eosinophilic esophagitis (ongoing inflammation of the tube that connects the mouth to the stomach). It is sold under the brand name Dupixent®.

MotherToBaby has fact sheets on asthma here https://mothertobaby.org/fact-sheets/asthma-and-pregnancy/ and atopic dermatitis | eczema here: https://mothertobaby.org/fact-sheets/atopic-dermatitis/.

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

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

Does taking dupilumab 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 dupilumab can increase the chance of miscarriage. An increased chance of miscarriage has not been reported in case reports of dupilumab use in pregnancy.

Does taking dupilumab 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 dupilumab, might increase the chance of birth defects in a pregnancy. There are case reports and case series looking at the outcomes of over 50 pregnancies that were exposed to dupilumab in the first trimester. These reports did not show an increased chance of birth defects. Experimental animal studies done by the manufacturer did not report an increase in birth defects or problems with the newborns immune system with exposure to dupilumab.

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

Studies have not been done to see if dupilumab 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).

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

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

Breastfeeding while taking dupilumab:

There are no studies on the use of dupilumab in breastfeeding. Dupilumab is a very large protein, which means not much of the medication is expected to pass into breast milk. Any that does get into the breast milk is likely to be destroyed in the infant’s gastrointestinal tract (stomach and intestines), especially in infants older than 4-7 days old. There are reports on the use of dupilumab while breastfeeding, and no infant side effects noted. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Experimental animal studies did not report lower fertility when dupilumab was used. Human studies have not been done. One report described two men who used dupilumab during conception and throughout their partner’s pregnancy. No birth defects were reported. 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 dupilumab and other medications used to treat atopic dermatitis 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/.

Please click here for references.

This sheet is about exposure to nifedipine 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 nifedipine?

Nifedipine is a medication that has been used to treat high blood pressure (hypertension), irregular heartbeat (cardiac arrhythmia) and chest pain (angina). It also has been used to stop labor before 37 weeks of pregnancy (preterm labor). Nifedipine is part of a group of medications called calcium channel blockers. Some brand names for nifedipine are Procardia®, Adalat CC®, and Afeditab CR®.

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

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

Does taking nifedipine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Two studies reported a higher number of miscarriages in pregnancies exposed to calcium channel blockers, such as nifedipine, when compared to pregnancies not exposed to calcium channel blockers. As there can be many causes of miscarriage, it is hard to know if a medication, the medical condition, or other factors are the cause of a miscarriage.

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

It is not known if nifedipine can increase the chance of birth defects. Some studies have found a small increase in risk of birth defects in babies exposed to nifedipine in the 1^st trimester of pregnancy. Other studies did not find an increased risk.

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

Two studies reported that preterm delivery (birth before week 37) and lower birth weight (less than 6lbs) were more common in pregnant women treated with calcium channel blockers such as nifedipine. The authors of the studies suggest the cause of these complications is likely due to the illnesses being treated rather than the medications.

Uncontrolled high blood pressure during pregnancy can increase the chance of heart disease, kidney disease, and stroke in pregnant women. Babies can be smaller than usual (growth restriction) and have a higher chance of preterm delivery. Also, the placenta (an organ that provides oxygen and nutrients to the pregnancy) can separate from the wall of the uterus too soon (placental abruption). Some women might develop preeclampsia (a pregnancy-related condition that can cause symptoms such as high blood pressure or fluid retention) that can lead to seizures (eclampsia). These conditions are serious and can be harmful to the pregnant woman and the fetus.

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

Two studies have looked at children exposed to nifedipine during pregnancy. No concerns for behavior or learning problems were reported.

Breastfeeding while taking nifedipine:

Nifedipine gets into breastmilk in small amounts. No problems have been reported in nursing infants with exposure to nifedipine through breastmilk. However, some women metabolize the drug differently which results in a higher amount in breastmilk. If you suspect the baby has any symptoms (excessive sleepiness or poor feeding), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

One study suggested possible infertility (trouble getting a woman pregnant) in a small number of men taking nifedipine to control high blood pressure. The infertility went away when the medication was stopped. Studies have not been done to see if a man’s use of nifedipine could increase the chance of birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

This sheet is about exposure to folic acid 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 folate? 

Folate is the naturally occurring form of vitamin B9. Many foods contain folate, including dark leafy greens, asparagus, broccoli, avocados, beans, carrots, squash, nuts, and citrus fruits. Folate is important for making cells in the body and keeping cells healthy.

What is folic acid? 

Folic acid is the lab-made form of vitamin B9 (folate). Folic acid is more stable than other forms of folate and doesn’t break down as easily in light or heat (such as cooking). Folic acid is available over the counter as a dietary supplement and is often found in prenatal vitamins. In the United States, folic acid and other B vitamins are added to some cereals, wheat flours, corn meal, rice, and many types of bread and pasta to increase their nutritional value. Many other countries also add folic acid to wheat and maize flour.  

How much folic acid should I be taking?  

It has been recommended that women who are able to get pregnant take 400 micrograms (mcg) (or 0.4 milligrams [mg]) of folic acid per day, whether or not they are planning a pregnancy (since not all are planned). Taking folic acid starting at least 1 month before pregnancy can lower the chance of some kinds of birth defects in early pregnancy, including neural tube defects (certain birth defects of the brain, spine, or spinal cord, such as spina bifida).  

During pregnancy, the recommended amount of folic acid for most women is 600-800 mcg (0.6-0.8 mg) per day. Most women can get this amount by eating enough foods that have added folic acid and/or taking folic acid in a prenatal vitamin or as a separate dietary supplement.  

In addition to recommended daily amounts, many nutrients also have upper intake levels, abbreviated as “UL.” UL is the highest level of daily intake recommended for most people. The UL for folic acid/folate is 1,000 mcg (1 mg) per day. 

Some women are recommended to take more than 1,000 mcg (1 mg) of folic acid per day before and during pregnancy. These include some women with a family history of having a child with a neural tube defect. Extra folic acid might also be recommended for women who take certain medications, drink large amounts of alcohol, or have health conditions that affect how their bodies absorb nutrients. Talk with your healthcare provider about how much folic acid is right for you. 

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

Folic acid is not expected to make it harder to get pregnant. It is recommended to take a daily supplement of folic acid at least one month before getting pregnant to help lower the chance of birth defects. 

Does taking folic acid increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Folic acid is not expected to increase the chance of miscarriage. Some studies suggest that taking folic acid in recommended amounts might help lower the chance of miscarriage. 

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

Taking folic acid in recommended amounts has not been found to increase the chance of birth defects. Taking folic acid before and during pregnancy lowers the chance of neural tube defects and might lower the chance of other birth defects. 

Does taking folic acid increase the chance of other pregnancy-related problems? 

Taking folic acid in recommended amounts is not expected to 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). Some studies suggest that taking folic acid might lower the chances of preterm delivery, high blood pressure during pregnancy, stillbirth, or infant death in the newborn period.  

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

Taking folic acid in recommended amounts has not been found to increase the chance of behavior or learning issues for the child.  

Breastfeeding and folic acid: 

Folate is found naturally in the breast milk of women who are well-nourished. Babies who are exclusively breastfed get all their folate from breast milk, so it is important to get enough folate/folic acid while breastfeeding for the baby. It is recommended to get 500 mcg (0.5 mg) of folic acid per day while breastfeeding. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Taking folic acid is not expected to affect men’s fertility (ability to make healthy sperm) or increase the chance of birth defects. In one study involving men being treated for infertility, taking folic acid supplements increased sperm motility (movement). The recommended amount of folic acid for most men is 400 mcg (0.4 mg) per day. Men can talk with their healthcare providers about the right amount of folic acid for them. For more general information on paternal exposures, see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.   

Please click here for references.