Selected References

• Anderson PO, McGuire GG. 1989. Neonatal alprazolam withdrawal -possible effects of breastfeeding. DICP. 23:614. Letter. 
• Andrade C. 2019. Gestational Exposure to Benzodiazepines, 1: The Risk of Spontaneous Abortion Examined Through the Prism of Research Design. J Clin Psychiatry; 80(5):19f13076  
• Barry WS, St. Clair SM. 1987. Exposure to benzodiazepines in utero. Lancet; 1:1436-7. 
• Browne JL, Hauge KJ. 1986. A review of alprazolam withdrawal. Drug Intell Clin Pharm; 20(11):837-41. 
• Eros E, et al. 2002. A population-based case-control teratologic study of nitrazepam, medazepam, tofisopam, alprazolum and clonazepam treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol; 101:147-54. 
• Freeman MP, et al. 2018.  Obstetrical and neonatal outcomes after benzodiazepine exposure during pregnancy: Results from a prospective registry of women with psychiatric disorders. Gen Hosp Psychiatry; 53:73-79. 
• Furugen A, et al. 2019. Quantification of eight benzodiazepines in human breastmilk and plasma by liquid-liquid extraction and liquid-chromatography tandem mass spectrometry: Application to evaluation of alprazolam transfer into breastmilk. J Pharm Biomed Anal. 168:83-93.  
• García-Algar O, et al. 2007. Confirmation of gestational exposure to alprazolam by analysis of biological matrices in a newborn with neonatal sepsis. Clin Toxicol (Phila); 45(3):295-8. 
• Grigoriadis S, er al. 2019.  Benzodiazepine Use During Pregnancy Alone or in Combination With an Antidepressant and Congenital Malformations: Systematic Review and Meta-Analysis. J Clin Psychiatry; 80(4):18r12412. 
• Ishikawa T, et al. 2026. Benzodiazepine exposure during early pregnancy and risk of miscarriage: dose-response, half-life classification, and individual agents. Arch Womens Ment Health; 29(3):86.  
• Ito S, et al. 1993. Prospective follow-up of adverse reactions in breastfed infants exposed to maternal medication. Am J Obstet Gynecol; 168:1393-9. 
• Källén B, et al. 2013. The use of central nervous system active drugs during pregnancy. Pharmaceuticals (Basel); 6(10):1221-86. 
• Kelty E, et al. 2023. Safety of alprazolam use in pregnancy in Western Australia: A retrospective cohort study using linked health data. J of Psychoactive Drugs; 1-7.  
• Lee H, et al. 2022. Pregnancy and Neonatal Outcomes After Exposure to Alprazolam in Pregnancy. Front Pharmacol; 25: 13:854562. 
• Mazzilli R, et al. 2021. Psychotropic Drugs Levels in Seminal Fluid: A New Therapeutic Drug Monitoring Analysis?. Front Endocrinol (Lausanne); 12:620936.  
• Meng LC, et al. 2024. Benzodiazepine Use During Pregnancy and Risk of Miscarriage. JAMA Psychiatry; 81(4):366-373. 
• Munjack DJ, Crocker B. 1986. Alprazolam-induced ejaculatory inhibition. J Clin Psychopharmacol; 6:57-8. 
• Ogawa Y, et al. 2018.  Maternal exposure to benzodiazepine and risk of preterm birth and low birth weight: A case-control study using a claims database in Japan. Asia Pac Psychiatry; 10(3):e12309 
• Nishimura A, et al. 2021. Benzodiazepine Concentrations in the Breast Milk and Plasma of Nursing Mothers: Estimation of Relative Infant Dose. Breastfeed Med; 16(5):424-432. 
• Noh Y, et al. 2022. First-trimester exposure to benzodiazepines and risk of congenital malformations in offspring: A population-based cohort study in South Korea. PLoS Med. 2022; 19(3):e1003945 
• Nonacs R. 2020. “Benzodiazepines and Risk of Ectopic Pregnancy”. MGH Center for Women’s Mental Health. https://womensmentalhealth.org/posts/benzodiazepine-ectopic/. Psychiatric Disorder during Pregnancy 
• Nonacs R. 2019. “Benzodiazepines During Early Pregnancy and risk of Miscarriage”. MGH Center for Women’s Mental Health. https://womensmentalhealth.org/posts/benzodiazepine-during-early-pregnancy-and-risk-of-miscarriage-2/. Anxiety Disorder, June. Pregnancy Loss, Pregnancy Outcome. 
• Nonacs R. 2019. “Interpreting New Data on the Use of Benzodiazepines During Pregnancy. MGH Center for Women’s Mental Health. https://womensmentalhealth.org/posts/interpreting-new-data-on-the-use-of-benzodiazepines-during-pregnancy/. December. Psychiatric Disorders during Pregnancy
• Oo CY, et al. 1995. Pharmacokinetics in lactating women: prediction of alprazolam transfer into milk. Br J Clin Pharmacol; 40:231-6.  
• Petric D, et al. 2011. High doses alprazolam induced amenorrhoea and galactorrhoea. Psychiatr Danub; 23(1):123-4. 
• Sheehy O, et al. 2019. Association Between Incident Exposure to Benzodiazepines in Early Pregnancy and Risk of Spontaneous Abortion. JAMA Psychiatry; 76(9):948–957.
• Shyken JM, et. Al. 2019.  Benzodiazepines in Pregnancy. Clin Obstet Gynecol; 62(1):156-167  
• St Clair SM, Schnirmer RG. 1992. First-trimester exposure to alprazolam. Obstet Gynecol; 80:843-846. 
• Tinker SC, et al; National Birth Defects Prevention Study. 2019. Use of benzodiazepine medications during pregnancy and potential risk for birth defects, National Birth Defects Prevention Study, 1997-2011. Birth Defects Res; 111(10):613-620.  
• Wall-Wieler et al.. 2020. Benzodiazepine use before conception and risk of ectopic pregnancy. Human Reproduction; 35(7):1685–1692. 
• Wisner KL, Yonkers KA. 2019. Are Adverse Reproductive Outcomes Associated With the Illness or Its Treatment (or Both)?. JAMA Psychiatry. 2019;76(12):1317-1318 
• Yamamoto K, et al. 2019. Pharmacokinetic assessment of alprazolam-induced neonatal abstinence syndrome using physiologically based pharmacokinetic model. Drug Metab Pharmacokinet; 34(6):400-402. 

Selected References:

• Almeida AR, et al. 2023. Challenges encountered by natural repellents: Since obtaining until the final product. Pestic Biochem Physiol; 195:105538.  
• Barr DB, et al. 2010. Pesticide concentrations in maternal and umbilical cord sera and their relation to birth outcomes in a population of pregnant women and newborns in New Jersey. Sci Total Environ; 408(4):790-795. 
• Consumer Reports. 2018. Mosquito Repellents That Best Protect Against Zika. Available at: http://www.consumerreports.org/insect-repellents/mosquito-repellents-that-best-protect-against-zika/  
• Diaz JH. 2016. Chemical and plant-based insect repellents: efficacy, safety, and toxicity. Wilderness & Environmental Medicine; 27(1):153-63. 
• Dugas J, et al. 2010. Use of biocides and insect repellents and risk of hypospadias. Occup Environ Med; 67:196-200. 
• EPA. 2026. Repellents: Protection against Mosquitoes, Ticks and Other Arthropods. Available at:  https://www.epa.gov/insect-repellents. Accessed July 2026. 
• Fradin MS, et al. 2002. Comparative efficacy of insect repellents against mosquito bites. New Eng J of Med; 347(1):13-8. 
• Goodyer, L. et al. 2018. Mosquito repellents for the traveller: does picaridin provide longer protection than DEET? J Travel Med; 25:S10. 
• Lupi E, et al. 2013. The efficacy of repellents against Aedes, Anopheles, Culex and Ixodes spp.—a literature review. Travel Med Infect Dis; 11(6):374-411.  
• McGready R, et al. 2001. Safety of the insect repellent N,N-diethyl-M-toluamide (DEET) in pregnancy. Am J Trop Med Hyg; 65(4):285-9. 
• Nguyen QD, et al. 2023. Insect repellents: An updated review for the clinician. J Am Acad Dermatol; 88(1):123-130.  
• Orders, M. 2021. Insect Repellents. Med Lett Drugs Ther; 63(1628): 109-112. 
• Segal TR, et al. 2017. Urinary concentrations of 3-(diethylcarbamoyl)benzoic acid (DCBA), a major metabolite of N,N-diethyl-m-toluamide (DEET) and semen parameters among men attending a fertility center. Hum Reprod; 32(12):2532-2539. 
• The American College of Obstetricians and Gynecologists (ACOG). 2019. Management of patients in the context of Zika virus. ACOG Committee Opinion, number 784. Obstet Gynecol; 134:e64. 
• The U.S. Centers for Disease Control and Prevention (CDC). 2025. Mosquitoes, Ticks, and Other Arthropods. https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/mosquitoes-ticks-and-other-arthropods.html.   
• The U.S. Centers for Disease Control and Prevention (CDC). 2024. Prevent Mosquito Bites. https://www.cdc.gov/mosquitoes/prevention/?CDC.  
• U.S. Environmental Protection Agency (EPA). 2025. Find the Repellent that is Right for You. https://www.epa.gov/insect-repellents/find-repellent-right-you.  
• U.S. Environmental Protection Agency (EPA). 2026. Skin-Applied Repellent Ingredients. https://www.epa.gov/insect-repellents/skin-applied-repellent-ingredients.  
• U.S. Environmental Protection Agency (EPA). 2025. Using Insect Repellents Safely and Effectively. https://www.epa.gov/insect-repellents/using-insect-repellents-safely-and-effectively.  
• Wylie B, et al. 2016. Insect repellants during pregnancy in the era of the Zika Virus. Obstetrics and Gynecology; 128(5), 1111–1115. 

Selected References:

• Aljary H et al. 2020. Pregnancy outcomes in women with rheumatoid arthritis:  a retrospective population-based cohort study. The Journal of Maternal-Fetal & Neonatal Medicine; 33;4:618-624. 
• Atladóttir HO, et al. 2009. Association of family history of autoimmune diseases and autism spectrum disorders. Pediatr; 124:687-694. 
• Bandoli G et al. 2020. Mediation of adverse pregnancy outcomes in autoimmune conditions by pregnancy complications. Arthritis Care Res; 72(2):256-264. 
• Bermas BL, Sammaritano LR. 2015. Fertility and pregnancy in rheumatoid arthritis and systemic lupus erythematosus. Fertil Res Pract; 27;1:13. 
• Bourg M et al. 2020. Fertility and sexuality of women with inflammatory arthritis. European Journal of Obstetrics & Gynecology and Reproductive Biology; 251:199-205. 
• Brouwer J, et al. 2013. Levels of serum anti-Müllerian hormone, a marker for ovarian reserve, in women with rheumatoid arthritis. Arthritis Care Res (Hoboken); 65(9):1534-8. 
• Brouwer J, et al. 2015. Brief report: Miscarriages in female rheumatoid arthritis patients: Associations with serologic findings, disease activity, and antirheumatic drug treatment. Arthritis Rheumatol; 67(7):1738-1743.  
• Brouwer J, et al. 2015. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis; 74(10):1836-1841.  
• Brouwer J, et al. 2017.Subfertility in Women With Rheumatoid Arthritis and the Outcome of Fertility Assessments. Arthritis Care Res (Hoboken); 69(8):1142-1149. 
• Chang T, et al. 2024. Rheumatoid arthritis and adverse pregnancy outcomes: a bidirectional two-sample mendelian randomization study. BMC Pregnancy Childbirth; 24(1):517.  
• Comi AM, et al. 1999. Familial clustering of autoimmune disorders and evaluation of medical risk factors in autism. J Child Neurol; 14:388-394 
• de Man YA, et al. 2014. Disease activity or remission of rheumatoid arthritis before, during and following pregnancy. Curr Opin Rheumatol; 26(3):329-333. 
• de Man YA, et al. 2008. Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Rheumatol, 59(9):1241-1248. 
• De Santis M, et al. 2005. Paternal and maternal exposure to leflunomide: pregnancy and neonatal outcome. Ann Rheum Dis; 64(7):1096-1097. 
• Dissanayke TD et al. 2020. Peripartum issues in the inflammatory arthritis patient: a survey of the RAPPORT registry. Nature Scientific Report, 10:3733. 
• Ekström K, et al. 2003. Risk of malignant lymphomas in patients with rheumatoid arthritis and in their first-degree relatives. Arthritis Rheum; 48:963-970. 
• Emadi SA, et al. 2025. Impact of Rheumatoid Arthritis on Pregnancy Outcomes: Increased Risks of Abortion and Low Birth Weight in a Prospective Case-Control Study. Mediterr J Rheumatol; 36(4):557-565.  
• Fischer-Betz R, et al. 2015.  High risk of flares during pregnancy in women with rheumatoid arthritis who discontinue treatment with TNF Inhibitors at conception. Arthritis Rheumatol; 67(suppl 10).  
• Förger F, et al. 2012. Pregnancy mediated improvement of rheumatoid arthritis. Swiss Med Wkly; 142:w13644.  
• Förger F et al. 2019. Discontinuing TNF-inhibitors before gestational week 20 in well controlled rheumatoid arthritis and juvenile arthritis is not associated with a disease worsening in late pregnancy. Arthritis and Rheumatology;  71(6)901-907. 
• Giannakaki AG, et al. 2025. Current Approaches to the Management of Rheumatic Diseases in Pregnancy: Risk Stratification, Therapeutic Advances, and Maternal-Fetal Outcomes. J Pers Med; 15(9):406. 
• Götestam Skorpen C, et al. 2016. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis; 75(5):795-810. 
• Hellgren K, et al. 2022. Pregnancy outcomes in relation to disease activity and anti-rheumatic treatment strategies in women with rheumatoid arthritis: a matched cohort study from Sweden and Denmark. Rheumatology (Oxford); 61(9):3711-3722.  
• Huang W, et al. 2023. Maternal and fetal outcomes in pregnant women with rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol; 42(3):855-870. 
• Ikram N, et al. Breastfeeding in women with rheumatic diseases. Lupus Sci Med; Apr;8(1):e000491.  
• Jethwa H, et al. 2019. Does Rheumatoid Arthritis Really Improve During Pregnancy? A Systematic Review and Metaanalysis. J Rheumatol; 46(3):245-250.  
• Katz PP. 2006. Childbearing decisions and family size among women with rheumatoid arthritis. Arthritis Rheum; 55(2):217-23. 
• Keeling SO, et al. 2020. A population-level analysis of the differing effects of rheumatoid arthritis and spondyloarthritis on peripartum outcomes. J Rheumatol; 47:197-203. 
• Krause ML, Makol A. 2016. Management of rheumatoid arthritis during pregnancy: challenges and solutions. Open Access Rheumatol; 8:23-36.  
• Littlejohn, Emily A. 2020. Pregnancy and rheumatoid arthritis. Best Practice & Research Clinical Obstetrics and Gynaecology; 64: 52-58 
• Liu S,et at. 2025. Best Evidence Summary for Preconception Management in Childbearing-Age Patients with Rheumatoid Arthritis. J Multidiscip Healthc; 18:8197-8208.  
• Lv J, et al. 2023. Association between disease activity of rheumatoid arthritis and maternal and fetal outcomes in pregnant women: a systematic review and meta-analysis. BMC Pregnancy Childbirth; 23(1):724.  
• Mahadevan U, et al. 2014. 960 Exposure to anti-TNFα therapy in the third trimester of pregnancy is not associated with increased adverse outcomes: Results from the PIANO Registry. Gastroenterol; 146(5), Suppl 1:S-170. 
• Mellemkjær L, et al. 2000. Cancer among children of parents with autoimmune diseases. Br J Cancer; 82:1353-1357. 
• Mishra N, et al. 2026. The Interplay Between Rheumatoid Arthritis and Pregnancy Outcomes: A Narrative Review. Cureus; 18(3):e105178. 
• Nathan NO, et al. 2020. Rheumatoid arthritis and risk of spontaneous abortion: a Danish nationwide cohort study. Rheumatology; 59:1984-1991. 
• Østensen M, et al. 2015. State of the art: Reproduction and pregnancy in rheumatic diseases. Autoimmun Rev; 14(5):376-86.  
• Park JS et al. 2022. Risk of pregnancy complications and low birth weight offsprings in Korean women with rheumatic diseases: a nationwide population-based study. J Korean Med Sci; 37(2):e18 
• Quaak CH, et al. 2026. Time to pregnancy in women with rheumatoid arthritis who want to conceive treated according to a treat-to-target approach: a comparison of an observational cohort with a historical reference cohort. Lancet Rheumatol; 8(6):e461-e469. 
• Ranjbaran ME, Kazemi M. 2024. Reproductive health and rheumatoid arthritis. BMC Rheumatol; 8(1):53.  
• Rom AL, et al. 2014. Fetal growth and preterm birth in children exposed to maternal or paternal rheumatoid arthritis: a nationwide cohort study. Arthritis Rheumatol; 66(12):3265-73. 
• Rom AL, et al. 2016. Parental rheumatoid arthritis and long-term child morbidity: a nationwide cohort study. Ann Rheum Dis; 75:1831-1837 
• Sagberg I, et al. 2026. The biologic era and pregnancy in rheumatoid arthritis: a prospective multicenter study from the Norwegian RevNatus registry. BMC Rheumatol; doi: 10.1186/s41927-026-00663-7. Epub ahead of print. 
• Sammaritano LR, et al. 2020. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis & Rheumatology; 72(4): 529-556. 
• Sims C, Talabi MB. 2025. Family Planning and Rheumatoid Arthritis. Curr Rheumatol Rep;27(1):26.  
• Spinillo A, et al. 2016. The impact of unrecognized autoimmune rheumatic diseases on the incidence of preeclampsia and fetal growth restriction: a longitudinal cohort study. BMC Pregnancy Childbirth; 16(1):313. 
• Tsai YC, et al. 2022. Fetal-neonatal and maternal pregnancy outcomes in women with rheumatoid arthritis: a population-based cohort study. BMJ Open; 12(10):e059203. 
• Valdeyron C, et al. 2021. Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort. Rheumatology (Oxford); 60(4):1863-1870. 
• van den Brandt S, et al. 2017. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther, 19(1):64. 
• Viktil KK, et al. 2012. Outcomes after anti-rheumatic drug use before and during pregnancy: A cohort study among 50,000 pregnant women and expectant fathers. Scand J Rheumatol; 41(3):196-201. 
• Vinet, É and Bernatsky, S. 2017. Outcomes in children born to women with rheumatic diseases. Rheumatic Disease Clinics; 43(2):263-273. 
• Wallenius M, et al. 2015. Miscarriage and Stillbirth in Women with Rheumatoid Arthritis. J Rheumatol; 42(9):1570-2. 
• Williams M and Chakravarty EF, 2014. Rheumatoid arthritis and pregnancy: impediments to optimal management of both biologic use before, during and after pregnancy. Curr Opin Rheumatol; 26(3):341-346. 
• Wojcik S, et al. 2015. Risk of autism spectrum disorders in children born to mothers with rheumatoid arthritis: a systematic literature review. J Rheumatol; 42:1263-1351.  
• Zhu EH, et al. 2025. Maternal rheumatoid arthritis and the risk of offspring autism spectrum disorder: two national birth cohorts and a meta-analysis. Mol Autism; 16(1):61. 
• Ziegler CI, et al. 2025. Deciphering the influence of pregnancy on rheumatoid arthritis and psoriatic arthritis: insights from musculoskeletal ultrasound dynamics. Arch Gynecol Obstet; 312(4):1133-1143.  

Selected References:

• Banerjee M, et al. 2026. Pre-Pregnancy GLP-1 Receptor Agonist or Tirzepatide Use and Gestational Diabetes Risk: Evaluating Pharmacodynamic Carry-Over Versus Post-Discontinuation Metabolic Rebound in a Multinational Federated Cohort. Diabetes Obes Metab. May 7. doi: 10.1111/dom.70853. Online ahead of print. 
• Diab H, et al. 2025. Tirzepatide (Zepbound) in human milk during periods of maternal dosing. Paper available as preprint (not peer reviewed). Preprint submitted to J Chromatogr B 2025. doi: 10.2139/ssrn.5387250. 
• Duah J, Seifer DB. 2025. Medical therapy to treat obesity and optimize fertility in women of reproductive age: a narrative review. Reprod Biol Endocrinol. 23(1):2.  
• Drummond R, et al. 2025. Glucagon-like peptide-1 receptor agonist use in pregnancy: a review. Am J Obstet Gynecol. 232(1):17-25. 
• Howard MD, Allen SE. 2025. The use of GLP-1: receptor agonist medications for benign gynecology. Curr Opin Obstet Gynecol. 37(4):279-284. 
• Food and Drug Administration. 2022. Mounjaro prescribing information. Retrieved on May 9 2024,from https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/215866s000lbl.pdf. Accessed June 2026. 
• Food and Drug Administration. 2021. FDA nonclinical review of tirzepatide. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2022/215866Orig1s000PharmR.pdf. Accessed June 2026.  
• Howard MD, Allen SE. 2025. The use of GLP-1: receptor agonist medications for benign gynecology. Curr Opin Obstet Gynecol. 37(4):279-284. 
• Kettner J, et al. 2026. Glucagon-like Peptide-1 Receptor Agonists and Reproductive Health: Current Evidence and Clinical Implications. J Pharm Pract. 39(3):239-250.  
• Sood A, et al. 2024. Revolutionizing diabetes care: unveiling tirzepatide’s potential in glycemic control and beyond. Expert Rev Clin Pharmacol. 17(3):235-246.  
• Zepbound drug label. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b&audience=consumer#modal-label-rss.  

Selected References:

• Allergan, Inc. 2025. Vraylar Product Label. National Institute of Health DailyMed Database. Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm. 
• Balamurali S, et al. 2026. Cariprazine in Human Milk: Cautionary Implications for Use During Lactation. J Clin Psychopharmacol; doi: 10.1097/JCP.0000000000002174. Epub ahead of print. 
• Culpepper L, et al. 2022. Minimal Effects of Cariprazine on Prolactin Levels in Bipolar Disorder and Schizophrenia. Neuropsychiatr Dis Treat; 18: 995-1011.  
• Herold R, et al. 2024. Cariprazine maintenance treatment during pregnancy – a case report. Front Psychiatry; 15:1421395.  
• Huybrechts K, et al. 2023. Association of In Utero Antipsychotic Medication Exposure With Risk of Congenital Malformations in Nordic Countries and the US. JAMA Psychiatry: 80(2):156–166.  
• U.S. FDA. 2015. Vraylar (Cariprazine) pharmacology review. Available at:  https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/204370Orig1Orig2s000PharmR.pdf. Accessed May 23, 2024.