This sheet is about exposure to lisinopril 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 lisinopril? 

Lisinopril is part of a class of medications called angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors help relax blood vessels and lower blood pressure. Lisinopril has been used to treat high blood pressure, protect the kidneys in people with diabetes, and lower the chance of death during a heart attack. Some brand names for lisinopril are Prinivil®, Qbrelis®, and Zestril®. Lisinopril is also available in combination with a medication called hydrochlorothiazide (Zestoretic®).  

ACE inhibitors should be avoided during the second and third trimesters of pregnancy. 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. 

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

The time it takes the body to metabolize (to process) medication is not the same for everyone.  In healthy, non-pregnant adults, it takes up to 72 hours, on average, for most of the lisinopril to be gone from the body. 

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

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

Does taking lisinopril 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 lisinopril increases the chance for miscarriage. 

Does taking lisinopril 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 lisinopril, might increase the chance of birth defects in a pregnancy. It is not known if lisinopril increases the chance for birth defects when taken during the first trimester. 

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

Talk with your healthcare provider right away if you are pregnant and taking any ACE inhibitor, including lisinopril.  

When used after the first trimester, ACE inhibitors such as lisinopril can cause low levels of amniotic fluid (fluid that surrounds the fetus during pregnancy). Low levels of amniotic fluid can lead to health problems for the developing fetus. Some of these problems include poor lung development, poor growth, poor development of the skull bones, birth defects, and problems with the development of the kidneys. In the most severe cases, fetal death could occur. ACE inhibitors can also cause low blood pressure and kidney failure in the newborn baby. There are some cases of babies who have died from these complications. 

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

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

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

Prenatal ultrasounds can be used to screen for some birth defects, such as skull bone and kidney defects. Ultrasound can also be used to track the growth of the pregnancy and the level of amniotic fluid (fluid that surrounds the fetus during pregnancy). Talk with your healthcare provider about any prenatal screenings or testing that are available to you. There are no tests available during pregnancy that can tell how much effect there could be on future behavior or learning. 

Breastfeeding while taking lisinopril: 

Lisinopril can get into breastmilk in small amounts. Lisinopril has not been well studied for use while breastfeeding. Reports on 5 infants exposed to lisinopril through breastmilk did not report any serious side effects. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Studies have not been done to see if lisinopril could affect male fertility (ability to make healthy sperm) 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 omeprazole or esomeprazole 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 are omeprazole and esomeprazole? 

These two medications contain the same active ingredient and act in the body in a similar way. Both omeprazole and esomeprazole belong to a group of medications called proton pump inhibitors (PPIs). PPIs that lower the amount of acid released by the stomach. 

Omeprazole is a medication that has been used to treat heartburn, stomach ulcers, and acid reflux (also known as GERD, or gastroesophageal reflux disease). A common brand for omeprazole is Prilosec®. Omeprazole is combined with sodium bicarbonate in the medication Zegerid®.  

Esomeprazole is a medication that has been used to treat heartburn, stomach ulcers, acid reflux (also known as GERD, or gastroesophageal reflux disease), and Zollinger-Ellison syndrome. A common brand for esomeprazole is Nexium®.  

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 omeprazole or esomeprazole. Can it make it harder for me to get pregnant? 

It is not known if taking omeprazole or esomeprazole can make it harder to get pregnant. Information from animal studies does not suggest that omeprazole or esomeprazole affects female fertility (ability to get pregnant). 

Does taking omeprazole or esomeprazole increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Information from limited studies suggest that taking omeprazole or esomeprazole during pregnancy is not expected to increase the chance of miscarriage.  

Does taking omeprazole or esomeprazole 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 omeprazole and esomeprazole, might increase the chance of birth defects in a pregnancy.  

Omeprazole (which has the same active medication as esomeprazole) is the best studied of the PPIs. Available information does not suggest an increased chance of birth defects when omeprazole or esomeprazole is used in pregnancy.   

Does taking omeprazole or esomeprazole in pregnancy increase the chance of other pregnancy-related problems? 

Information from limited studies suggests that taking omeprazole or esomeprazole is not likely 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).  

Esomeprazole is being studied as a treatment in pregnancy to prevent preeclampsia (high blood pressure and problems with organs, such as the kidneys), which can lead to seizures (called eclampsia). 

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

It is not known if omeprazole or esomeprazole use in a pregnancy can cause behavior or learning issues for the child.  

Breastfeeding while taking omeprazole or esomeprazole: 

Limited data suggest that doses of 20mg of omeprazole or 10mg or esomeprazole daily result in low levels of these medications in breastmilk. The amounts of omeprazole or esomeprazole in breastmilk are not expected to be harmful to a nursing infant. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

One study found that when PPIs were used for any period between 6 and 12 months, the sperm count was decreased. However, a more recent study looking at the effects of PPI use on male fertility (ability to make healthy sperm) did not link PPI use with negative impacts on sperm count or quality. 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 methamphetamine 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 methamphetamine?

Methamphetamine is also known as metamfetamine, methylamphetamine, and desoxyephedrine. Other names for methamphetamine include “meth,” “crystal meth,” “crank,” “speed” or “ice.” Methamphetamine has been smoked, snorted, swallowed, injected, inhaled, taken rectally, or dissolved under the tongue.

Methamphetamine has been used without a prescription and/or without medical supervision. It has also been prescribed for attention deficit hyperactivity disorder (ADHD). This sheet will focus on the use of methamphetamine without a prescription or medical supervision.

If you are using methamphetamine without a prescription or medical supervision (sometimes called recreational use), treatment is available to help you. Talk to your healthcare provider as soon as possible so that you can start treatment. If you do not have a healthcare provider, call the national number for drug treatment referral at 800-662-4357. When you call, let them know that you are pregnant so that you can get connected to the best facility to meet your needs.

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

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

Does taking methamphetamine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Using methamphetamine might increase the chance of miscarriage.

Does taking methamphetamine 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. It is not known if methamphetamine increases the chance for birth defects above the background risk. Information on whether methamphetamine increases the chance of birth defects is mixed. This makes it hard to know the actual risks for each woman who uses methamphetamine.

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

Methamphetamine use has been linked to a higher chance for preterm delivery (delivery before 37 weeks of pregnancy), poor growth (babies born too small and/or with a small head size), and low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Some studies have suggested that methamphetamine use in pregnancy can increase the chance for high blood pressure, placental abruption (the placenta pulls away from the uterus) and for fetal or infant death. Pregnancy complications are more likely to happen when methamphetamine is used throughout the whole pregnancy or when taken at high doses.

If I take methamphetamine during pregnancy. will it cause withdrawal symptoms in my baby after birth?

Using methamphetamines near the end of pregnancy can increase the chance of symptoms in newborns (sometimes referred to as withdrawal). Symptoms can include trouble eating, sleeping too little or too much, having floppy (poor) muscle control or tight muscles, being jittery, and / or having a hard time breathing. Symptoms usually go away within a few weeks but can last for a few months. The baby might need to be admitted to the special care nursery (NICU). It is important that your healthcare providers know you are taking methamphetamine so that if symptoms occur your baby can get the care that is best for them.

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

Studies have suggested that children who were exposed to methamphetamine during pregnancy could have a higher chance for changes in their brain development, as well as learning and behavior problems later in life.

What can I do to find out if the baby has issues related to methamphetamine use?

It is important to talk with your healthcare provider about any exposures you have during pregnancy. They can help you find treatment or support and can go over any screening options that are available. Prenatal ultrasounds can screen for some birth defects. Ultrasound can also be used to monitor the growth of the fetus. There are no tests available during pregnancy that can tell how much effect there could be on future behavior or learning.

Breastfeeding while taking methamphetamine:

Methamphetamine can pass into breast milk. Methamphetamine should not be used without a prescription or medical supervision while breastfeeding. If methamphetamine is used, it has been suggested to pump and discard breastmilk for 48-100 hours. Be sure to talk to your healthcare provider about all your breastfeeding questions.

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

Methamphetamine use might affect the sperm, which could affect a man’s fertility (ability to get a woman pregnant). Studies have not been done to see if a man’s use of methamphetamine could 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 to view references.

This sheet is about exposure to zolpidem 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 zolpidem? 

Zolpidem is a sedative-hypnotic medication (causes calm and sleep) that has been used to treat insomnia (not being able to fall asleep or stay asleep). It belongs to a group of medications called hypnotic benzodiazepine receptor agonists, or HBRAs (sometimes called z-hypnotics or z-drugs). HBRAs are not benzodiazepines, but they work in a similar way. Some brand names of zolpidem are Ambien®, Edluar®, and Intermezzo®. 

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. Some people who stop taking zolpidem suddenly might experience withdrawal symptoms like fatigue, nausea, vomiting, flushing, lightheadedness, crying, and nervousness. Your healthcare providers can talk with you about the benefits of treating insomnia, and the risks of untreated insomnia during pregnancy.  

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

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

Does taking zolpidem increase the chance of miscarriage? 

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

Does taking zolpidem 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 zolpidem, can increase the chance of birth defects in a pregnancy. Several studies have reported no increased chance of birth defects with the use of zolpidem during pregnancy. 

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

Several studies have found that using zolpidem during pregnancy does not greatly 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). Other studies have found that women who took zolpidem during pregnancy were slightly more likely to deliver early or have smaller babies compared with women who did not take these medications during pregnancy. These studies did not consider other factors, such as the use of other medications, smoking, alcohol or drug use, or the underlying medical condition that the medication was used to treat. This makes it hard to know if the medication, illnesses being treated, or other factors are the reason for the reported issues.    

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

It is not known if zolpidem can increase the chance of behavior or learning issues for the child. 

Breastfeeding while taking zolpidem: 

Zolpidem passes into breast milk in small amounts. One small study and a case report found that 6 women who took zolpidem during the days after delivery had small amounts of the medication in their breast milk three hours after taking it. No problems were reported in their babies. If you suspect the baby has any symptoms (being very sleepy, trouble gaining weight, low muscle tone or floppiness, or slow breathing), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Studies have not been done to see if zolpidem could affect male fertility (ability to make healthy sperm) or increase the chance of birth defects. In general, men’s exposures are unlikely to increase risks to a pregnancy. For more general 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 azathioprine / 6-mercaptopurine (6-MP) in pregnancy and while breastfeeding. This information is based on research studies. It should not take the place of medical care and advice from your healthcare providers.

What is azathioprine and 6-MP?

Azathioprine and 6-MP are medications that lower the body’s immune system. These medications are closely related to each other. In the body, azathioprine breaks down into 6-MP. The brand name of azathioprine is Imuran®. The brand name of 6-MP is Purinethol®.

Azathioprine and 6-MP have been used to treat autoimmune conditions like lupus and rheumatoid arthritis. It has also been used to treat inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. MotherToBaby has facts sheet on lupus https://mothertobaby.org/fact-sheets/lupus-pregnancy/, rheumatoid arthritis https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/, and inflammatory bowel disease https://mothertobaby.org/fact-sheets/inflammatory-bowel-disease-pregnancy/.

Azathioprine is also used to help prevent the body from rejecting an organ transplant. 6-MP is used to treat some cancers.

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 take azathioprine / 6MP. Can it make it harder for me to get pregnant?

It is not known if taking azathioprine or 6MP can make it harder to become pregnant.

Does taking azathioprine / 6MP increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Taking azathioprine or 6MP is not expected to increase the chance of miscarriage.

Does taking azathioprine / 6MP 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 azathioprine / 6-MP, might increase the chance of birth defects or other problems in a pregnancy.

Azathioprine and 6-MP have been studied in over 1,700 pregnancies. Most studies found no increased chance of birth defects. Some studies have found an overall increase in birth defects; however, these increases were usually no different from those in groups of people with similar health conditions. This makes it hard to know if the medication, the medical condition, or other factors were the cause. There was also no consistent pattern of birth defects, which means they could have been caused by chance or other reasons.

Does taking azathioprine / 6-MP in pregnancy increase the change of other pregnancy related problems?

Some studies on azathioprine and 6-MP have reported higher rates of babies being born early (birth before week 37) or with low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). The illnesses these medications are used to treat can also increase the chance of these outcomes. This means it is not clear if the outcomes are due to the medical condition being treated, the medication, or other factors.

Use of azathioprine or 6-MP near delivery has been associated with temporary problems with the immune system and low blood counts in the newborn. This seems more likely with higher doses, such as those used to treat cancer and organ transplantation. It might be more likely when the person who is pregnant has low white blood cells themselves.

Does taking azathioprine / 6-MP affect future behavior or learning for the baby?

It is not known if azathioprine / 6-MP can increase the chance of behavior or learning issues for the child.

Breastfeeding while taking azathioprine or 6-MP:

Small amounts of azathioprine and 6-MP have been found to enter breast milk in people whose bodies are able to break down these medications as expected. The highest amount of 6-MP has been found in the breast milk around 1-2 hours after the person’s last dose. About 4 hours after the last dose, the amount of medication in breast milk is very small. Most babies exposed to these medications through breastmilk have been found to have normal blood counts and do not have higher rates of infection. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a male takes azathioprine / 6-MP, could it affect fertility or increase the chance of birth defects?

No effects on male fertility (ability to get partner pregnant) have been reported with the use of azathioprine / 6-MP. Studies that have looked at pregnancy outcomes after male use of these medications before or during conception have not found an increase 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.