This sheet is about having lupus in pregnancy or 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 lupus?  

Lupus, also known as systemic lupus erythematosus (SLE), is an autoimmune disease where the body’s immune system attacks its own cells or organs. Lupus can cause problems with the skin, kidneys, joints, heart, lungs, blood vessels, and nervous system. Symptoms can be mild to severe, and they can come (referred to as high disease activity or a flare) and go (called remission).  

I have lupus. What should I talk about with my healthcare team before I get pregnant? 

It is important to talk to your healthcare team (including your obstetrician, anesthesiologist, hematologist, and lupus disease specialist) about plans for treating your condition before and during pregnancy, during delivery, and after delivery. If possible, talk with your healthcare team before getting pregnant. If your pregnancy is unplanned, contact your healthcare providers as soon as you find out you are pregnant.  

Women with lupus can have a healthy pregnancy. However, women with lupus have a higher chance of complications during pregnancy including a higher chance for nephropathy (kidney disease), thrombocytopenia (low blood cell counts), thrombosis (blood clotting), and neurological issues like headaches, seizures, and mood disorders. It is not clear if pregnancy increases the number of lupus flares or new symptoms of lupus, but disease activity might increase right after delivery (postpartum). The chance for symptom flares during pregnancy and pregnancy complications might be lower if lupus is in remission for at least six months before getting pregnant.  

I take medication for lupus. Can I take my medication during pregnancy?  

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Having lupus can cause pregnancy complications, so it is important to keep your condition controlled as much as possible. Stopping some lupus medications during pregnancy might cause lupus symptoms to get worse, which could increase the chance for complications. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

There are a variety of medications used to treat lupus. For information on specific medications contact MotherToBaby and see our medication fact sheets at https://mothertobaby.org/fact-sheets/. 

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

Some women with high disease activity have reported missing periods, which might make it harder to get pregnant. Women with lupus might have fertility problems and problems with how their ovaries work. Some medications used to treat lupus can affect how the ovaries work and might make it harder to get pregnant. Women with kidney problems due to lupus might also have a harder time getting pregnant.  

Does having lupus increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Lupus might increase the chance of miscarriage, especially in women with high disease activity, kidney disease, and the presence of certain antibodies (such as antiphospholipid). 

Does having lupus 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 lupus, might increase the chance of birth defects in a pregnancy.  

There are rare cases of babies born to women with lupus who have a condition called chondrodysplasia punctata that causes problems with bone and face development. Most babies born to women with lupus do not have this condition. Babies born to women with lupus might have a higher chance of having heart defects.  

Would having lupus increase the chance of other pregnancy related problems? 

Women with lupus have a higher chance of developing preeclampsia (high blood pressure and problems with organs, such as the kidneys), which can lead to seizures (called eclampsia). Women with lupus also might have a higher chance of preterm delivery (delivery before week 37), and poor growth of the fetus. Having flares during conception and early in pregnancy, having kidney disease, having other lupus complications, and having high blood pressure before pregnancy can also increase the chance of these complications. Women with lupus might have a higher chance of gestational diabetes. 

What is neonatal lupus erythematosus? 

If a woman who is pregnant has lupus, her child can have symptoms of lupus right after delivery. This is called neonatal lupus erythematosus (NLE). NLE is seen mostly in children who were exposed to certain antibodies (anti-Ro and/or anti-La) during pregnancy. Signs of neonatal lupus include rash, blood abnormalities that only show up on a blood test, and liver problems. Pneumonia in the infant is possible. These are usually temporary and often go away by six months of age. The most serious complication of NLE is a heart rhythm problem called congenital heart block. Congenital heart block can cause death in up to 30% of infants. Most babies born to women with lupus do not have heart block.  

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

A few small studies reported that having lupus in pregnancy might increase the chance of learning problems and developmental delays. Another study, looking at approximately 100 women with lupus, did not see an increased chance for developmental problems. As there can be many things that affect future behavior and learning for a child, it is hard to know if lupus, pregnancy complications (such as preterm delivery), medications used to treat lupus, or other factors are the cause of these problems. 

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 and to monitor the growth of the pregnancy. Your healthcare provider might do a special ultrasound of the fetal heart called a fetal echocardiogram. This type of ultrasound is usually done between 18-24 weeks of pregnancy to look at the function and structure of the fetal heart and look for signs of congenital heart block. 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 I have lupus:  

Lupus does not appear to affect a woman’s ability to breastfeed. Lupus antibodies are not passed through breastmilk. For information on specific medications while breastfeeding, look for a fact sheet at https://mothertobaby.org/fact-sheets/ or contact MotherToBaby. Be sure to talk with your healthcare provider about all your breastfeeding questions. 

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

Studies have suggested that lupus and certain medications used to treat lupus might affect male 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.  

This sheet is about exposure to chemotherapy 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 chemotherapy?

Chemotherapy (also called chemo) is a term that describes the use of medications given orally (by mouth) or intravenously (through a vein) to treat or control cancer by killing cancer cells. Chemotherapy is one of the most widely used methods to treat cancer, along with surgery, immunotherapy, hormonal therapy, targeted therapy, and radiation treatment (radiotherapy). 

Other conditions, such as lupus and rheumatoid arthritis, can be treated with chemotherapeutic drugs. MotherToBaby has fact sheets on these conditions here https://mothertobaby.org/fact-sheets/lupus-pregnancy/ and here https://mothertobaby.org/fact-sheets/multiple-sclerosis/. 

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 have had chemotherapy. Can it make it harder for me to get pregnant?

Chemotherapeutic medications affect the division of cancer cells and normal cells, including those in the organs needed for pregnancy (reproductive system). This could affect a woman’s ability to get pregnant. For some people, the ability to get pregnant (reproductive function) can return to what it used to be within months after chemotherapy has stopped. For others, it can take several years or might not happen at all. After chemotherapy, the ability to get pregnant is based on different factors, including age and the exact chemotherapeutic medication(s) used. 

Talk with your healthcare provider about your future ability to have a pregnancy (fertility preservation) before starting chemotherapy or other treatments for cancer. They might refer you to meet with a reproductive endocrinologist, someone who specializes in fertility and reproduction.  

Does having chemotherapy increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Chemotherapy has been associated with an increased chance of miscarriage in multiple studies, especially when given in the first trimester. 

Does having chemotherapy 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 chemotherapy, might increase the chance of birth defects in a pregnancy. Exposure to chemotherapy early in pregnancy has been associated with an increased chance of birth defects. There have also been case reports of babies born without birth defects after exposure to chemotherapy during the first trimester of pregnancy.  

When possible, chemotherapy is usually avoided during the first trimester of pregnancy. The chance for birth defects is less when chemotherapy is given in the second or third trimester. Most of the fetal organ systems are developed by the beginning of the second trimester. The brain and reproductive system might still be sensitive to some medications after the first trimester. 

Some chemotherapeutic medications show a stronger link to an increased chance of birth defects than others. Different factors, such as the number of medications used during pregnancy, how often they are taken, how long the medications are used, and the trimester in which they are used can also affect the outcome. Contact MotherToBaby at 1-866-626-6847 to speak with an information specialist about your specific treatments. 

I had chemotherapy as a child. Could this increase the chance of birth defects in my pregnancy?

Exposure to chemotherapy in childhood is not expected to increase the chance of birth defects in future children. 

Does having chemotherapy in pregnancy increase the chance of other pregnancy-related problems?

Exposure to chemotherapeutic medications in the second and third trimesters has been associated with a greater chance of preterm delivery (birth before week 37), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), admission to the neonatal intensive care unit (NICU), stillbirth, or a temporary reduction in some of the baby’s blood cells (low blood counts). It is unclear if the effects reported in some studies are due to a medication, other factors, or a combination of factors. 

Chemotherapy after week 35 of pregnancy is generally not recommended to allow the bone marrow of both the person who is pregnant and the fetus to recover before delivery. 

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

Studies have followed a total of 194 children who were exposed to chemotherapy during pregnancy. These children were reported to have typical development, typical performances at school, and were not more likely to have learning or behavioral problems as compared to children who were not exposed to chemotherapy during pregnancy. 

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. Ultrasound 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 pregnancy that can tell how much effect there could be on future behavior or learning. 

Breastfeeding during chemotherapy:

For most chemotherapeutic medications, there is limited information about use in breastfeeding. Generally, breastfeeding is not recommended while receiving chemotherapy. There could be serious side effects in the nursing infant. For example, some medications might  lower the baby’s ability to fight infections (suppression of the immune system). Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

A man’s ability to make sperm (sperm production) is often affected by cancer treatment. Sperm production might return to what it used to be after chemotherapy, but it is not guaranteed. Also, damage to the structure of chromosomes in sperm might happen (although most of the damage is not thought to be permanent). Some studies have found higher levels of abnormal sperm for years after the end of chemotherapy. These issues could affect men’s fertility (ability to get a partner pregnant). Men who need cancer treatments might consider sperm banking (freezing and storing) before treatment. 

 While information is limited, if sperm production restarts, it appears that a man’s treatment with chemotherapeutic medications before conception does not increase the chance of birth defects in future children. For more general information about paternal exposures, 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 codeine 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 codeine?

Codeine is an opioid medication. Opioids are sometimes called narcotics. Codeine has been used to treat pain or cough. Some commonly used codeine products also contain other medications. For more information about other medications, please see the MotherToBaby fact sheets at https://mothertobaby.org/fact-sheets/. Some brand names of products that contain codeine are Ascomp® with Codeine, Codar®, Guaiatussin® AC, and Tylenol® with Codeine. 

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.  

If you have been taking codeine regularly, have a dependency, or opioid use disorder, talk with your healthcare provider before you stop taking this medication. Stopping an opioid medication suddenly could cause you to go into withdrawal. It is not known if or how withdrawal might affect a pregnancy. It is suggested that any reduction in codeine be done slowly, and under the direction of your healthcare provider.  

I am taking codeine, 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 18 hours, on average, for most of the codeine to be gone from the body. 

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

A few studies have shown that use or misuse of opioids, including codeine, might cause changes to the menstrual cycle (periods). This could make it harder to get pregnant.  

Does taking codeine during pregnancy increase the chance of miscarriage? 

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

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

Some studies looking at codeine use in pregnancy suggest a small increased chance of some birth defects, such as spina bifida (when the fetal spinal cord does not develop as usual), cleft lip and/or palate (an opening in the upper lip or the roof of the mouth), and birth defects of the intestines and/or heart. However, findings are not the same across studies, and studies have not found a specific pattern of birth defects caused by codeine. Based on these studies, if there is an increased chance of birth defects with codeine use in pregnancy, it is likely to be small.  

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

Studies on the use of opioids during pregnancy have found an increased chance of pregnancy-related problems, including poor growth of the fetus, preterm delivery (birth before week 37), C-section, and stillbirth. This is more commonly reported in people who are taking heroin or who are using prescribed opioid medication in greater amounts or for longer than recommended by their healthcare provider. One study found that use of codeine in the third trimester was associated with a higher chance of postpartum hemorrhage (heavy bleeding after delivery) and emergency C-section. It is not known how likely these outcomes might be with the prescribed use of codeine as directed in a pregnancy. Use of an opioid close to the time of delivery can result in withdrawal symptoms in the baby (see the section of this fact sheet on neonatal opioid withdrawal syndrome). 

Will my baby have withdrawal (neonatal abstinence syndrome) if I keep taking codeine?

Neonatal abstinence syndrome (NAS) is the term used to describe withdrawal symptoms in newborns from exposure to opioid medication(s) during pregnancy. NAS symptoms can include irritability, crying, sneezing, stuffy nose, poor sleep, extreme drowsiness (very tired), poor feeding, sweating, tremors, seizures, vomiting, and diarrhea. Most often, symptoms of NAS appear 2 days after birth and might last more than 2 weeks. The chance that NAS will occur depends on the length of time and/or the dose of opioid taken during pregnancy, if other medications were also taken, if baby was born preterm, and/or size of the baby at birth. If opioids were taken in pregnancy, it is important to let your baby’s healthcare providers know so that they can check for symptoms of NAS and provide the best care for your newborn. 

Studies have reported a risk for neonatal abstinence syndrome (NAS) with some opioids; however, not all medications in this class have been studied. Based on what we know about the chance of NAS with other opioids, it is likely that codeine also has a chance for NAS. One study suggests that the chance of NAS might be lower with codeine compared to some other opioids. However, because information is limited, it is not known if the chance is higher or lower with codeine than with other, better studied opioids.  

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

It is not known if codeine can increase the chance of behavior or learning issues. Some studies on opioids as a general group have found more problems with learning and behavior in children exposed to opioids for a long period of time during pregnancy. It is hard to tell if this is due to medication exposure or other factors that might increase the chances of these problems. 

What if I have an opioid use disorder?

Talk with your healthcare provider about your use of opioids. Studies find that women who are pregnant and take opioids in higher doses or for longer than recommended by their healthcare providers have an increased chance of pregnancy problems. These include poor growth of the baby, stillbirth, preterm delivery, and the need for C-section.  

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 spina bifida, cleft lip and/or palate, and heart defects. Ultrasound 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 pregnancy that can tell how much effect there could be on future behavior or learning. 

Codeine and breastfeeding:

Talk with your healthcare provider about your pain and medications to use while breastfeeding. Codeine passes into breast milk. Babies might have problems with the amounts of codeine in the breast milk. There are case reports of codeine use in breastfeeding that have described babies being very sleepy, having trouble latching on, having breathing problems, having a slowed heart rate, and not getting enough oxygen. Other reports describe the use of codeine while breastfeeding without any problems in nursing babies. Talk with your healthcare provider or a MotherToBaby specialist about your specific situation, as information on breastfeeding might change based on the age of your baby, the medication dosage, and/or other factors. 

The United States Food and Drug Administration (FDA) recommends that codeine not be used during breastfeeding due to the risk of serious problems in some breastfed infants such as being too sleepy, trouble breastfeeding, and serious breathing problems that might result in death. The product label for codeine also recommends people who are breastfeeding not use this medication. However, the benefit of treating your condition might outweigh the possible risks of taking codeine.  

If you are using codeine (or any opioid), talk to your healthcare provider about how to use the smallest amount for the shortest time and how to monitor (watch) your baby for any signs of concern. Contact the baby’s healthcare provider immediately if your baby has any problems such as increased sleepiness (more than usual), trouble feeding, trouble breathing, or limpness. Be sure to talk to your healthcare provider about all your breastfeeding questions.  

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

Animal studies have suggested that misuse of codeine might lower men’s fertility (ability to get a partner 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.

This sheet is about exposure to tramadol 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 tramadol?

Tramadol is an opioid medication that has been used to treat pain. Opioids are sometimes called narcotics. Some brand names for tramadol are Conzip®, Ryzolt®, and Ultram®. Tramadol is also available combined with other medications, such as acetaminophen. An example is Ultracet®. For more information on acetaminophen, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/acetaminophen-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. 

If you have been taking tramadol regularly or have a dependency or opioid use disorder, talk with your healthcare provider before you stop taking this medication. Stopping an opioid medication suddenly could cause you to go into withdrawal. It is not known if or how withdrawal might affect a pregnancy. It is suggested that any reduction in tramadol be done slowly, and under the direction of your healthcare provider.  

I am taking tramadol, 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 4 days, on average, for most of the tramadol to be gone from the body.  

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

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

Does taking tramadol increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. It is not known if taking tramadol can increase the chance of miscarriage. Two studies have looked at the rates of miscarriage among women who filled at least one prescription for tramadol during pregnancy. One of the studies found a higher rate of miscarriage in these pregnancies, and the other study did not. Studies based on prescriptions/prescription records cannot tell if a person took the medication. This makes it hard to know if the study outcomes are related to medication or other factors. 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 tramadol 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 tramadol, might increase the chance of birth defects in a pregnancy.  

It is not known if tramadol can increase the chance of birth defects. At least 3 studies have not found an increase in the chance of birth defects with the use of tramadol. Another study found a small increase in the chance of birth defects, including heart defects and clubfoot. However, this study did not consider the reasons why tramadol was being used. This makes it hard to know if the medication, an underlying health condition, or other factors might have been the cause of birth defects.   

Some studies on opioids as a group suggest that opioids in general might be associated with birth defects. However, studies have not found a specific pattern of birth defects caused by opioids. Based on these studies, if there is an increased chance for birth defects with opioid use in pregnancy, it is likely to be small. 

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

It is not known if tramadol 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). One study did not find a higher chance of preterm delivery with tramadol use.  

Studies involving people who often use some opioids during their pregnancy have found an increased chance for pregnancy-related problems, including poor growth of the fetus, low levels of amniotic fluid (fluid that surrounds baby in uterus), stillbirth, preterm delivery, and C-section. This is more commonly reported in those who are taking a drug like heroin or who are using prescribed pain medications in greater amounts or for longer than recommended by their healthcare provider. Use of an opioid close to the time of delivery can result in withdrawal symptoms in the baby (see the section on neonatal opioid withdrawal syndrome). 

Will my baby have neonatal opioid withdrawal syndrome if I continue to take tramadol?

Neonatal opioid withdrawal syndrome (NOWS) is the term used to describe withdrawal symptoms in newborns from exposure to opioids during pregnancy. There are reports of NOWS with use of tramadol in pregnancy. In these reports , the medication was taken daily at doses of 200mg to 400mg throughout pregnancy. NOWS symptoms began in the infants within the first week of life and included irritability, vomiting, stiff muscles, and a fast heart rate. Not all babies exposed to tramadol during pregnancy will have NOWS.  

For any opioid, NOWS symptoms can include irritability, crying, sneezing, stuffy nose, poor sleep, extreme drowsiness (very tired), yawning, poor feeding, sweating, tremors, seizures, vomiting, and diarrhea. Most often, symptoms of NOWS appear 2 days after birth and may last more than 2 weeks. The chance that NOWS will occur depends on the length of time and/or the dose of opioid taken during pregnancy, if other medications were also taken, if baby was born preterm, and/or size of the baby at birth. If opioids were taken in pregnancy, it is important to let your baby’s healthcare providers know so that they can check for symptoms of NOWS and provide the best care for your newborn.  

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

It is not known if tramadol can increase the chance of behavior or learning issues. Some studies on opioids as a general group have found more problems with learning and behavior in children exposed to opioids for a long period of time during pregnancy. It is hard to tell if this is due to medication exposure or other factors that might increase the chances of these problems. 

What if I have an opioid use disorder? 

Talk with your healthcare provider about your use of opioids. Studies find that those who are pregnant and take opioids in higher doses or for longer than recommended by their healthcare providers have an increased chance of pregnancy problems. These problems include poor growth of the fetus, stillbirth, preterm delivery, and the need for C-section.  

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 heart defects and clubfoot. Ultrasound 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 pregnancy that can tell how much effect there could be on future behavior or learning. 

Tramadol and breastfeeding: 

Tramadol can pass into breast milk. Two studies looking at the use of tramadol for postpartum pain did not report side effects in the infants. Some babies might have problems with the amounts of tramadol in breast milk. Talk with your healthcare provider or a MotherToBaby specialist about your specific situation, as information on breastfeeding might change based on the age of your baby, the medication dosage, and/or other factors. Also, talk with your healthcare provider about your pain and treatment while breastfeeding. 

The United States Food and Drug Administration (FDA) recommends that tramadol not be used during breastfeeding due to the risk of serious problems in some breastfed infants such as being too sleepy, trouble breastfeeding, and serious breathing problems that might result in death.  

The use of some opioids in breastfeeding might cause babies to be very sleepy and have trouble latching on. Some opioids can cause trouble with breathing. If you are using any opioid, talk to your healthcare provider about how to use the least amount for the shortest time and how to monitor (watch) your baby for any signs of concern. Contact the baby’s healthcare provider immediately if your baby has any problems such as increased sleepiness (more than usual), trouble feeding, trouble breathing, or limpness. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

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

Use or misuse of opioids in general has been shown to lower fertility (ability to get a partner pregnant) in men. Studies have not been done to see if a man’s use of tramadol could increase the chance of birth defects. In general, exposures that fathers or sperm donors 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 sertraline 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 sertraline?

Sertraline is a medication that has been used to treat depression, anxiety, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder (a severe form of premenstrual syndrome), and social phobia. Sertraline belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). A brand name for sertraline is Zoloft®.  

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.  

MotherToBaby has fact sheets on anxiety https://mothertobaby.org/fact-sheets/anxiety-fact/ and depression https://mothertobaby.org/fact-sheets/depression-pregnancy/. 

Stopping this medication suddenly can cause some people to have withdrawal symptoms. It is not known if or how withdrawal might affect a pregnancy. If you plan to stop this medication, your healthcare provider might suggest that you slowly lower the dose instead of stopping all at once. Some women might have a return of their symptoms (relapse) if they stop this medication during pregnancy. If you stop taking this medication, it is important to have other forms of support in place (such as counseling or therapy and/or a different medication, if needed). 

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

It is not known if sertraline can make it harder to get pregnant. One study found that women who take sertraline or some other SSRIs have a slightly lower chance of getting pregnant. However, some of the conditions that sertraline is used for, including depression, can make it harder to get pregnant. This makes it hard to know if the medication, the condition being treated, or other factors are affecting a person’s ability to get pregnant.  

Does taking sertraline increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies looking at SSRIs and miscarriage are limited, but overall have not shown that taking sertraline increases the chance of miscarriage. Some of the conditions that sertraline is used for, including depression, might increase the chance of miscarriage.  

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

There are reports of more than 25,000 pregnancies exposed to sertraline. Most studies have not found a higher chance of birth defects when sertraline is used in pregnancy. Other studies have suggested a higher chance of birth defects, including heart defects. However, when studies look only at pregnancies in women who have depression (or other mental health conditions), they find similar rates of birth defects when sertraline is used during pregnancy and when sertraline is stopped before pregnancy. This suggests that factors other than sertraline, such as the underlying mental health condition, factors related to the condition, or other factors, could be responsible for the increase in birth defects seen in some studies.  

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

Some studies suggest a higher 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) with the use of sertraline in pregnancy. However, research has also shown that conditions such as depression or anxiety could increase the chance of pregnancy complications if the conditions are not well treated. This makes it hard to know if the medication, the underlying health condition, or other factors are increasing the chance of these problems.  

Some studies have suggested that taking sertraline or other SSRIs during the second half of pregnancy might increase the chance of a serious lung condition in the newborn called persistent pulmonary hypertension (PPH). It is not clear if the increased chance seen in these studies is due to the SSRI or to other exposures that people who take SSRIs might have in common, such as higher rates of smoking. Other studies have not found an increased chance of PPH. In the general population, PPH happens in 1 or 2 out of every 1,000 births. If taking SSRIs does increase the chance of PPH, the overall chance is still low (less than 1 in 100, or less than 1%).   

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

The use of sertraline during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal. Symptoms can include irritability, jitteriness, tremors (shivering), increased crying, changes in sleep patterns, lower muscle tone (hypotonia), skin discoloration (cyanosis), problems with eating, trouble controlling body temperature, and problems with breathing (apnea). In most cases, these symptoms are mild and go away on their own within a couple of weeks. Some babies might need to stay in the nursery or NICU until the symptoms go away. Not all babies exposed to sertraline will have these symptoms. It is important that your healthcare providers know you are taking sertraline so that if symptoms do occur your baby can get the care that is best for them. 

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

Most large studies have not shown that using sertraline during pregnancy would increase the chance of behavior or learning issues for the child. Some studies looking at children whose mothers had depression (or other mental health conditions) and used sertraline during pregnancy have found differences in behavior and learning compared to children whose mothers did not have depression or use sertraline during pregnancy. However, when studies look only at children whose mothers had depression (or other mental health conditions) during pregnancy, most of the studies do not find differences in child development when the mothers used sertraline and when they did not. This suggests that differences seen in child development are more likely related to the underlying depression, other factors related to the mental health condition, or other factors, and not to the sertraline used during pregnancy.  

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 heart defects. Ultrasound can also be used to watch 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 pregnancy that can tell how much effect there could be on future behavior or learning. 

Breastfeeding while taking sertraline:

Sertraline gets into breast milk in small amounts. Most babies who are exposed to sertraline through breast milk do not have side effects. If you suspect the baby has any symptoms, such as being irritable or sleepier than usual, contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions.   

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

Some studies have shown that SSRIs might have sexual side effects, like low sexual desire or problems with ejaculation. These side effects might affect a man’s fertility (ability to get a woman pregnant). Having depression might also lower sex drive. A man’s use of sertraline is not expected to 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 Exposure at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/. 

Please click here for references.

National Pregnancy Registry for Psychiatric Medications: There is a pregnancy registry for women who take psychiatric medications, such as sertraline. For more information you can look at their website: https://womensmentalhealth.org/research/pregnancyregistry/ .