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• American College of Obstetricians and Gynecologists (ACOG). 2017. Reaffirmed October 2021. Committee Opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstet Gynecol, 130:e81-e94. 
• American Society of Addiction Medicine. 2017. Clinical Recommendations: Opioid Use and Opioid Use Disorder in Pregnancy. A Joint Opinion of the ACOG’s Committee on Obstetric Practice and ASAM. Available at https://www.asam.org/quality-care/clinical-recommendations/OUD-in-Pregnancy [retrieved February 2025]. 
• Anderson JM, et al. 2020. Prenatal exposure to methadone or buprenorphine and long-term outcomes: a meta-analysis. Early Human Development, 143:104997. 
• Asad M, et al. 2024. Reviewing the impact of maternal opioid use disorder on fetal development and long-term pediatric health outcomes. Cureus, 16(10):e72192. 
• Aslaksen AK, et al. 2024. Children had increased risks of impaired motor and visual-motor skills after prenatal exposure to opioid maintenance therapy. Acta Paediatr, 113(6):1331-1339. 
• Aslaksen AK, et al. 2024. Visual function in Norwegian children aged 5-13 years with prenatal exposure to opioid maintenance therapy: a case-control study. Acta Ophthalmol, 102(4):409-420. 
• Austin A, et al. 2021. Prenatal use of medication for opioid use disorder and other prescription opioids in cases of neonatal opioid withdrawal syndrome: North Carolina Medicaid, 2016-2018. Am J Public Health, 111(9):1682-1685. 
• Bello JK, et al. 2024. Pregnancy rates among women treated with medication for opioid use disorder. J Gen Intern Med, 39(8):1342-1348. 
• Caritis SN, Venkataramanan R. A pharmacologic evaluation of buprenorphine in pregnancy and the postpartum period. J Addict Med, 19(2):129-134.  
• Chao CR, et al. 2023. Effects of medications for opioid use disorder (MOUD) on fetal brain and cranial measurements. Neurotoxicol Teratol, 97:107177.  
• Conradt E, et al. 2019. Prenatal opioid exposure: Neurodevelopmental consequences and future research priorities. Pediatrics, 144(3):e20190128. 
• Coulson C, et al. 2021. Association of maternal buprenorphine or methadone dose with fetal growth indices and neonatal abstinence syndrome. Am J Perinatol, 38(01):028-036. 
• Dean MP, et al. 2025. Increased prevalence of skeletal anomalies on ultrasound evaluation of buprenorphine-exposed human fetuses. South Med J, 118(1):39-44. 
• Dorey A, et al. 2019. Possible buprenorphine toxicity in a breastfeeding neonate. Clin Toxicol, 57:889-890. 
• Gawronski KM, et al. 2014. Neonatal outcomes following in utero exposure to buprenorphine/naloxone or methadone. SAGE Open Medicine, 2:2050312114530282.  
• Giovannini E, et al. 2024. Fetal and infant effects of maternal opioid use during pregnancy: a literature review including clinical, toxicological, pharmacogenomic, and epigenetic aspects for forensic evaluation. Children (Basel), 11(3):278. 
• Handal M, et al. 2019. Prenatal exposure to opioid maintenance treatment and neonatal outcomes: nationwide registry studies from the Czech Republic and Norway. Pharmacol Res Perspect, 7(5):e00501. 
• Harris E. 2023. Buprenorphine treatment may be safer than methadone during pregnancy. JAMA, 331(7):555. 
• Hasan M, et al. 2024. Neurodevelopmental outcomes in children prenatally exposed to opioid maintenance treatment: a population-based study. Pharmacotherapy, 44(10):770-781. 
• Hubbell A, et al. 2024. Extended-release buprenorphine in pregnancy. Am J Addict, 33(3):354-356. 
• Ito, S. 2018. Opioids in breast milk: Pharmacokinetic principles and clinical implications. J Clin Pharmacol, 58 Suppl 10:S151-S163. 
• Jansson LM, et al. 2017. Maternal buprenorphine treatment and infant outcome. Drug Alcohol Depen, 180:56-61. 
• Jansson LM, et al. 2016. Maternal buprenorphine maintenance and lactation. J Hum Lact, 32:675-81. 
• Jones HE, et al. 2012. Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review. Addiction 107, (Suppl. 1):5–27. 
• Jones JD, et al. 2012. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend, 125(1-2):8–18. 
• Hemmati Z, et al. 2022. Ophthalmic outcomes in children exposed to opioid maintenance treatment in utero: a systematic review and meta-analysis. Neurosci Biobehav Rev, 136:104601. 
• Jansson LM, et al. 2024. Buprenorphine-naloxone maintenance and lactation. J Hum Lact, 40(1):113-119. 
• Jarlenski M, et al. 2024. Association between buprenorphine dose and outcomes among pregnant persons with opioid use disorder. Am J Obstet Gynecol, S0002-9378(24)01178-5. 
• Kacinko S, et al. 2008. Correlations of maternal buprenorphine dose, buprenorphine, and metabolite concentrations in meconium with neonatal outcomes. Clin Pharmacol Ther, 84(5):604-612. 
• Kallenbach K, et al. 2012. Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication. Addiction 107, (Suppl. 1):45-52. 
• Kanervo, MM, et al. 2023. Buprenorphine-naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder. Acta Obstet Gynecol Scand, 102:313-322. 
• Kanervo M, et al. 2024. Intrauterine exposure to maternal opioid maintenance treatment and associated risk factors may impair child growth. Acta Paediatr, 113(7):1579-1591. 
• Kanervo M, et al. 2024. Extended-release versus oral buprenorphine as opioid maintenance treatment during pregnancy-maternal and neonatal outcomes. Eur J Obstet Gynecol Reprod Biol, 297:106-110. 
• Kinsella M, et al. 2022. Buprenorphine compared with methadone in pregnancy: a systematic review and meta-analysis. Subst Use Misuse, 57(9):1400-1416.  
• Knittel AK, et al. 2023. Neonatal outcomes after medications for opioid use disorder during pregnancy in a state women’s prison facility, 2016-2019. J Addict Med, 17(5):587-591. 
• Kocherlakota P. 2014. Neonatal bstinence syndrome. Pediatrics, 134(2):e547-e561. 
• Krans EE, et al. 2021. Outcomes associated with the use of medications for opioid use disorder during pregnancy. Addiction, 116(12):3504-3514. 
• Kumar N, et al. 2021. Impact of opioid maintenance treatment during pregnancy on neonatal birth weight and head circumference. J Neonatal Perinatal Med, 14(4):475-484.  
• Kushnir A, et al. 2023. Neonatal abstinence syndrome in infants with prenatal exposure to methadone versus buprenorphine. Children (Basel), 10(6):1030. 
• Mallinson DC, et al. 2024. Maternal opioid use disorder and infant mortality in Wisconsin, United States, 2010-2018. Prev Med, 181:107914. 
• Marc B, et al. 2025. Is buprenorphine maternal dose associated with neonatal opioid withdrawal syndrome severity? Am J Addict, 34(1):15-20. 
• Nelson LF, et al. 2020. Cognitive outcomes of young children after prenatal exposure to medications for opioid use disorder: a systematic review and meta-analysis. JAMA Netw Open,3(3):e201195. 
• Reece-Stremtan S, Marinelli KA. 2015. ABM Clinical Protocol #21: Guidelines for breastfeeding and substance use or substance use disorder, Revised 2015. Breastfeed Med, 10(3):135-141. 
• Ordean A, Tubman-Broeren M. 2023. Safety and efficacy of buprenorphine-naloxone in pregnancy: a systematic review of the literature. Pathophysiology, 30(1):27-36. 
• Patel N, et al. 2024. Weaning buprenorphine in pregnant patients. J Matern Fetal Neonatal Med, 37(1):2337711. 
• Patel NB, Parilla BV. 2024. Buprenorphine induction using microdosing for the management of opioid use disorder in pregnancy. AJP Rep, 14(1):e88-e90.  
• Schuckit MA. 2016. Treatment of opioid-use disorders.  N Engl J.Med, 375:357–68. 
• Shah D, et al. 2025. Outpatient tapering of buprenorphine in opioid use disorder pregnancies may improve neonatal outcomes. J Perinatol, doi: 10.1038/s41372-025-02211-6. 
• Smith D, et al. 2024. Evaluating the effect of maternal opioid maintenance dose on the NOWS-COS outcome criteria: a pilot study. Clin Pediatr (Phila), 63(12):1670-1677. 
• Soyka M, 2013. Buprenorphine use in pregnant opioid users: a critical review. CNS Drugs, 27(8):653-662. 
• Staszewski CL, et al. 2020. Comparison of buprenorphine and methadone in the management of maternal opioid use disorder in full term pregnancies. J Perinat Med Sep, 25;48(7):677-680. 
• Straub L, et al. 2024. Comparative safety of in utero exposure to buprenorphine combined with naloxone vs buprenorphine alone. JAMA, 332(10):805-816. 
• Suarez EA, et al. 2022. Buprenorphine versus methadone for opioid use disorder in pregnancy. N Engl J Med, 387(22):2033-2044. 
• Suarez EA, et al. 2024. First trimester use of buprenorphine or methadone and the risk of congenital malformations. JAMA Intern Med, 184(3):242-251. 
• Sundelin-Wahlsten V, Sarman I. 2013. Neurobehavioural development of preschool-age children born to addicted mothers given opiate maintenance treatment with buprenorphine during pregnancy. Acta Paediat, 102(5): 544-549. 
• Wiegand SL, et al. 2015. Buprenorphine and naloxone compared with methadone treatment in pregnancy. Obstet Gynecol, 125(2):363-368. 
• Wouldes TA, Lester BM. 2023. Opioid, methamphetamine, and polysubstance use: perinatal outcomes for the mother and infant. Front Pediatr, 11:1305508. 

Selected References:

• Bohlke K, et al. 2003. Postpartum varicella vaccination: is the vaccine virus excreted in breast milk? Obstet Gynecol; 102(5 Pt 1):970-7.
• Centers for Disease Control and Prevention. 1996. Prevention of varicella. MMWR; 45(RR-11);1-36.
• Centers for Disease Control and Prevention. 2013. Updated Recommendations for Use of VariZIG — United States, 2013. MMWR. 62(28):574-576.
• Centers for Disease Control and Prevention. Guidelines for vaccinating pregnant women (2012, updated 2016). https://www.cdc.gov/vaccines-pregnancy/hcp/vaccination-guidelines/index.html
• Centers for Disease Control and Prevention. 2022. Pregnancy guidelines and recommendations by vaccine. Centers for Disease Control and Prevention.
• Chan DYL, et al. 2017. Human varicella zoster virus is not present in the semen of a man affected by chickenpox during the in vitro fertilisation of is wife. Andrologia 49(10):e12822.
• Cohen A, et al. Congenital varicella syndrome: the evidence for secondary prevention with varicella-zoster immune globulin. CMAJ:183(2):204-208.
• Committee on Infectious Diseases, American Academy of Pediatrics. 1995. Recommendations for the use of live attenuated varicella vaccine. Pediatrics; 95:791-796.
• Frederick IB, et al. 1986. Excretion of varicella-herpes zoster in breast milk. Am J Obstet Gynecol; 154:1116-1117.
• Garcia-Loygorri MC, et al. LA LECHE MATERNA COMO VEHÍCULO DE TRANSMISIÓN DE VIRUS [BREAST MILK AS A VEHICLE OF TRANSMISSION OF VIRUS]. Nutr Hosp.;32(1):4-10. Spanish.
• Gruslin A, et al; SOGC. 2008. Immunization in pregnancy: No. 220, December 2008. Int J Gynaecol Obstet; 105(2):187-191.
• Hayward K, et al. 2018. Management of herpes zoster (shingles) during pregnancy. J Obstet Gynaecol 38(7):887-894.
• Kimberlin DW, et al. 2018 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics. 883.
• Losa, L., et al. (2024). Immunogenicity of Recombinant Zoster Vaccine: A Systematic Review, Meta-Analysis, and Meta-Regression. Vaccines, 12(5), 527. https://doi.org/10.3390/vaccines12050527
• Marin M, et al. 2013. Closure of Varicella-Zoster Virus-Containing Vaccines Pregnancy Registry – United States. MMWR 63(33);732-733.
• National Center for Immunization and Respiratory Diseases. 2011. General recommendations on immunization — recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 60(2):1-64. Erratum in: MMWR Recomm Rep 2011;60:993.
• Psarris A, et.al. 2019. Immunizations during pregnancy: How, when and why.  Eur J Obstet Gynecol Reprod Biol Sep;240:29-35.
• Willis ED. et al. 2022. Merck/Centers for Disease Control and Prevention Varicella Vaccine Pregnancy Registry: 19-Year Summary of Data From Inception Through Closure, 1995-2013. J Infect Dis. 226(Suppl 4):S441-S449.
• Woodward M, et. al. 2019. Varicella virus vaccine live: A 22-year review of postmarketing safety data. Open Forum Infect Dis 6(8):ofz295.

Selected References:

• American College of Obstetricians and Gynecologists. 2018. Tubal ectopic pregnancy. ACOG Practice Bulletin No. 193. Obstet Gynecol 131:e9—e103.  
• Del Campo M, et al. 1999. Developmental delay in fetal aminopterin/methotrexate syndrome. Teratology 60:10-12.  
• Donnenfield AE, et al. 1994. Methotrexate exposure prior to and during pregnancy. Teratology 49:79-81.  
• Eck, LK, et al. 2017. Risk of adverse pregnancy outcome after paternal exposure to methotrexate within 90 days before pregnancy. Obstet Gynecol 129(4):707-714.  
• Ersoy GS, et al. 2016. Comparison of the long-term effects of single-dose methotrexate and salpingectomy on ovarian reserve in terms of anti-müllerian hormone levels. Human Fertility 19(4):262-267. 
• Feldkamp M, Carey JC. 1993. Clinical teratology counseling and consultation case report: low dose methotrexate exposure in the early weeks of pregnancy. Teratology; 47:533-439.  
• French AE, et al. 2003. Effect of methotrexate on male fertility. Can Fam Physician 49:577-578.  
• Friedman S, et al. 2017. Paternal use of azathioprine/6-mercaptopurine or methotrexate within 3 months before conception and long-term health outcomes in the offspring-A nationwide cohort study. Reprod Toxicol 73:196-200.  
• Gubatan J, et al. 2023. Paternal medications in inflammatory bowel disease and male fertility and reproductive outcomes: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 21(9):2222-2238. 
• Hoeltzenbein M, et al. 2008. Paternal exposure to drugs—is there an increased risk for congenital abnormalities? Experience of the Berlin Institute for Clinical Teratology and Drug Risk Assessment during Pregnancy. Reprod Toxicol 26: 64 [abstract].  
• Hyoun SC, et al. 2012. Teratogen update: methotrexate. Birth Defects Res A Clin Mol Teratol, 94(4):187-207. 
• Jordan RL, et al. 1976. Embryotoxicity of the folate antagonist methotrexate in rats and rabbits. Teratology 15:73-80.  
• Kozlowski RD, et al. 1990. Outcome of first-trimester to low-dose methotrexate in eight patients with rheumatic disease. Am J Med 88(6):589-592.  
• Lee CY, et al. 2010. A pilot study of paternal drug exposure: the Motherisk experience. Reprod Toxicol. 29(3):353-60.  
• Lloyd ME, et al. 1999. The effects of methotrexate on pregnancy, fertility and lactation. Q J Med 92:551-563  
• Martin M.C., et al. 2014. Methotrexate embryopathy after exposure to low weekly doses in early pregnancy. Reprod Toxicol, 43:  26-29. 
• Martínez Lopez JA, et al. 2009. Systematic review on the safety of methotrexate in rheumatoid arthritis regarding the reproductive system (fertility, pregnancy and breastfeeding). Clin Exp Rheumatol 27:678-684.  
• McLaren JF, et al. 2009. Effect of methotrexate exposure on subsequent fertility in women undergoing controlled ovarian stimulation. Fertil Steril 92(2):515-519.  
• Methorexate Drug Label, 2020: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/040054s015,s016,s017.pdf.   
• Nagafuchi H, et al. 2022. Pregnancy outcomes in patients with rheumatoid arthritis who discontinue methotrexate treatment to conceive. Clin Rheumatol; 41(3):669-675. 
• Ostensen M, et al. 2009. Management of RA medications in pregnant patients. Nat Rev Rheumatol 5(7):382-390. 
• Wentzell N, et al. 2023. Use of methotrexate in girls and women of childbearing age, occurrence of methotrexate-exposed pregnancies and their outcomes in Germany: A Claims Data Analysis. Clin Drug Investig. 43(2):109-117. 
• Zanetti A, et al. 2022. Impact of rheumatoid arthritis and methotrexate on pregnancy outcomes: retrospective cohort study of the Italian Society for Rheumatology. RMD Open; 8(2):e002412. 
• Zarén P, et al. 2023. Methotrexate use among men-association with fertility and the perinatal health of their children: a Swedish nationwide register study. Fertil Steril. 120(3 Pt 2):661-669. 

Selected References

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• Botto LD, et al. 2013. National Birth Defects Prevention Study. Congenital heart defects after maternal fever. Am J Obstet Gynecol. 210(4):359. e1-359.e11.
• Chambers CD, et al. 1998. Maternal fever and birth outcome: a prospective study. Teratology. 58:251-257.
• Chambers CD 2006. Risks of hyperthermia associated with hot tub or spa use by pregnant women. Birth Defects Reseach (part A) 76:569-573.
• Dreier JW, et al. 2014. Systematic review and meta-analyses: fever in pregnancy and health impacts in the offspring. Pediatrics.133(3):e674-688.
• Duong, et al. National Birth Defects Prevention Study. 2011. Maternal use of hot tub and major structural birth defects. Birth Defects Res A Clin Mol Teratol. 91(9):836-841.
• Edwards MJ, et al. 1995. Hyperthermia and birth defects. Reprod Toxicol 9(5):411.
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• Graham JM Jr 2020. Update on the gestational effects of maternal hyperthermia. Birth Defects Research 112.12:943-952.
• Harvey MAS, et al. 1981. Suggested limits to the use of hot tub and sauna by pregnant women. CMAJ 125:50.
• Hashmi, SS et al 2009. Maternal fever during early pregnancy and the risk of oral clefts. Birth Defects Research (part A) 88:186-194.
• Hornig M, et al. 2018. Prenatal fever and autism risk. Molecular Psychiatry. 23.3: 759-766.
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• Lyndberg MC, et al. 1994. Maternal flu, fever, and the risk of neural tube defects: A population based case-control study. Am J Epidemiol 140(3):244.
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• Andrade C. 2017. Ketamine for Depression, 2: Diagnostic and Contextual Indications. J Clin Psychiatry. 78(5):e555-e558.  
• Bai X, et al. 2013. Ketamine enhances human neural stem cell proliferation and induces neuronal apoptosis via reactive oxygen species-mediated mitochondrial pathway. Anesth Analg. 116(4):869-80.  
• Baraka A, et al. 1990. Maternal awareness and neonatal outcome after ketamine induction of anaesthesia for caesarean section. Can J Anaesth 37:641-4.  
• Brambrink AM, et al. 2012. Ketamine-induced neuroapoptosis in the fetal and neonatal rhesus macaque brain. Anesthesiology. 116(2):372-84.  
• Capitanio JP, et al. 2012. Behavioral effects of prenatal ketamine exposure in rhesus macaques are dependent on MAOA genotype. Exp Clin Psychopharmacol. 20(3):173-80.  
• Cheung HM, et al. 2017. How Ketamine Affects Livers of Pregnant Mice and Developing Mice? Int J Mol Sci. 18(5). pii: E1098. 
• Cheung, HM, & Yew, D. T. W, et al 2019. Effects of Perinatal Exposure to Ketamine on the Developing Brain. Frontiers in neuroscience, 13, 138.  
• Chomchai S, et al. 2019. Effects of unconventional recreational drug use in pregnancy. Semin Fetal Neonatal Med. pii: S1744-165X (19)30019-8.  
• Corssen G. 1974. Ketamine in obstetric anesthesia. Clin Obstet Gynecol 17:249-58.  
• Dong C, et al. 2016. Ketamine exposure during embryogenesis inhibit cellular proliferation in rat fetal cortical neurogenic regions. Acta Anaesthesiol Scand. 60(5): 579-587. 
• Galbert MW, Gardner AE. 1973. Ketamine for obstetrical anesthesia. Anesth Analg. 52:926-30.  
• Galloon S. 1976. Ketamine for obstetric delivery. Anesthesiology 44:522-4. 
• Gilder, M. E., Tun, N. W., Carter, A., Tan, F. F. S. L., Min, A. M., Eh, H., Aye, P., Carrara, V. I., Angkurawaranon, C., & McGready, R. (2021). Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting. BMC pregnancy and childbirth, 21(1), 1
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• Kocum A, et al. 2012. Spinal anesthesia under sedation using propofol and ketamine for laparoscopic cholecystectomy in a patient during 13th week of gestation. J Anesth. 26(4):634-635.  
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• Majdinasab, E., Datta, P., Krutsch, K., Baker, T., & Hale, T. W et. 2023. Pharmacokinetics of Ketamine Transfer Into Human Milk. Journal of clinical psychopharmacology, 43(5), 407–410.  
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• Moore J, et al. 1971. Preliminary report on ketamine in obstetrics. Br J Anaesth 43:779-82, 1971. 
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• Oats JN et al. 1979. Effects of ketamine on the pregnant uterus. Br J Anaesth 51:1163-6. 
• Potter J, et al. 2019. A combination of inhaled nitrous oxide and low-dose ketamine infusion for labor analgesia. J Clin Anesth. 12;57:64-65. 
• Sassano-Higgins S, et al. 2016. A Review of Ketamine Abuse and Diversion. Depress Anxiety. 33(8):718-27.  
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