ACE Inhibitors

Selected References:

  • Al-Maawali A, et al. 2012. Taking angiotensin-converting enzyme inhibitors during pregnancy: is it safe? Can Fam Physician, 58(1):49-51. 
  • Bateman BT, et al. 2017. Angiotensin-converting enzyme inhibitors and the risk of congenital malformations. Obstet Gynecol, 129:174-184. 
  • Briggs GG. 2002. Drug effects on the fetus and breast-fed infant. Clin Obstet Gynecol, 45(1):6-21. 
  • Bullo M, et al. 2012  Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists: a systematic review. Hypertension, 60(2):444-450. 
  • Cooper WO, et al. 2006. Major congenital malformations after first-trimester exposure to ACE Inhibitors. The New England Journal of Medicine,354(23):2443-2451. 
  • De-Kun Li, et al. 2011. Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study. BMJ, 343:d5931 Karthikeyan VJ, et al. 2011. Are angiotensin-converting enzyme inhibitors and angiotensin receptor blockers safe in pregnancy: a report of
  • ninety-one pregnancies. J Hypertens, 29(2):396-369. 
  • Hoelzenbein M, et al. 2018. Increased rate of birth defects after first trimester use of angiotensin converting enzyme inhibitors – treatment or hypertension related? An observational cohort study. Pregnancy Hypertens, 13:65-71.  
  • National Heart, Lung and Blood Institute. Accessed May 2015. Available at: http://www.nhlbi.nih.gov/health/resources/heart/hbp-pregnancy 
  • Papadopoulou Z, et al. 2021. In Utero Exposure to Antihypertensive Medication during the First Trimester: Is the Risk Worth Taking?. Acta Med Acad, 50(3):372-381. 
  • Pucci M, et al. 2015. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in women of childbearing age: risks versus benefits. Expert Rev Clin Pharmacol, 8(2):221-231. 
  • Quan A. 2006. Fetopathy associated with exposure to angiotensin converting enzyme inhibitors and angiotensin receptor antagonists. Early Hum Dev, 82(1):23-28. 
  • Ruys TP, et al. 2014. Cardiac medication during pregnancy, data from the ROPAC. Int J Cardiol, 177(1):124-128.  
  • Tabacova S, et al. 2003. Adverse pregnancy outcomes associated with maternal enalapril antihypertensive treatment. Pharmacoepidemiol Drug Saf, 12(8):633-646.  
  • Weber-Schoendorfer C, et al. 2020. Fetotoxic risk of AT1 blockers exceeds that of angiotensin-converting enzyme inhibitors: an observational study. J Hypertens, 38:133-41. 

 


ACE Inhibitors

Selected References:

  • Abhyankar A, et al. 2013. Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease. Aliment Pharmacol Ther, 38(5):460-466.  
  • Afzali A. 2019. Update on Pregnancy in Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (NY), 15(6):313–315. Andoh A, et al. 2021. Thiopurine pharmacogenomics and pregnancy in inflammatory bowel disease. J Gastroenterol, 56(10):881-890
  • Avni Biron I, et al. 2023. Pregnancy Outcomes in a Cohort of Patients with Inflammatory Bowel Disease: Data from a Multidisciplinary Clinic in a Tertiary Center. J Clin Med, 12(12):4120. 
  • Ban L, et al. 2014. Limited risks of major congenital anomalies in children of mothers with IBD and effects of medications. Gastroenterology, 146(1):76-84.  
  • Darmadi D, et al. 2023. Inflammatory bowel disease (ulcerative colitis type) severity shows inverse correlation with semen parameter and testosterone levels. Asian J Androl, online ahead of print.  
  • Dominitz JA. 2002. Outcomes of infants born to mothers with inflammatory bowel disease: a population based cohort study. Am J Gastroenterol, 97(3):641-648.  
  • Donovan B & Spiel M. 2023. Inflammatory Bowel Disease in the Childbearing Adult and Newborn. Neoreviews, 24(1):10-23. 
  • Druvefors E, et al. 2022. Minor impact on fertility in men with inflammatory bowel disease: A National Cohort Study from Sweden. Aliment Pharmacol Ther, 56(2):292-300. 
  • Druvefors E, et al. 2023. Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden. J Crohns Colitis, 17(10):1631-1638. 
  • Fabisiak N, et al. 2017. Fat-soluble Vitamin Deficiencies and Inflammatory Bowel Disease: Systematic Review and Meta-Analysis. J Clin Gastroenterol, 51(10):878-889.  
  • Friedman S, et al. 2025. The Consequences of Preterm Birth in the Children of Mothers with Inflammatory Bowel Disease: A Nationwide Cohort Study. Inflamm Bowel Dis. 31(9):2400-2407. 
  • Hirose M, et al. 2001. Active Crohn’s disease with maternal vitamin K deficiency and fetal subdural hematoma. Obstet Gynecol, 98(5):919-921.  
  • Innocenti T, et al. 2022. Pregnancy outcomes in inflammatory bowel disease: Data from a large cohort survey. Journal of digestive diseases, 23(8-9):473–481. 
  • Kasper OO, et al. 2002. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology, 122:15-19.  
  • Killeen S, et al. 2017. Surgical management of complicated and medically refractory inflammatory bowel disease during pregnancy. Colorectal Dis, 19(2):123-138.  
  • Lee S, et al. 2018. Pregnant Women with Inflammatory Bowel Disease Are at Increased Risk of Vitamin D Insufficiency: A Cross-Sectional Study. Journal of Crohn’s & colitis, 12(6):702–709. 
  • Leenhardt R, et al. 2019. Sexual health and fertility for individuals with inflammatory bowel disease. World J Gastroenterol, 25(36):5423-5433.  
  • Lever G, et al. 2022.  Risk of Adverse Pregnancy Outcomes for Women with IBD in an Expert IBD Antenatal Clinic. Journal of clinical medicine, 11(10):2919. 
  • Mahadevan U & Matro R. 2015. Care of the Pregnant Patient With Inflammatory Bowel Disease. Obstet Gynecol, 126(2):401-412.  
  • Malhi G, et al. 2022. Risk Factors for Postpartum Disease Activity in Women With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis, 28(7):1090-1099. 
  • Maliszewska A, et al. 2017. Inflammatory bowel disease and pregnancy. Ginekologia Polska, 88(7):398–403. 
  • Marild K, et al. 2022. Histological remission in inflammatory bowel disease and risk of adverse pregnancy outcomes. A nationwide study. E Clinical Medicine, 53:101722. 
  • Moens A, et al. 2020. Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study. Aliment Pharmacol Ther, 51(1):129-138.  
  • Moffat D, et al. 2009. A population-based study of breastfeeding in inflammatory bowel disease: initiation, duration, and effect on disease in the postpartum period. The Am J of Gastroenterol, 104(10):2517-2523. 
  • Morales M, et al. 2000. Crohn’s disease as a risk factor for the outcome of pregnancy. Hepatogastroenterology, 47:1595-1598.  
  • Norgard B, et al. 2000. Birth outcomes of women with ulcerative colitis: a nationwide Danish cohort study. Am J Gastroenterol, 95(11):3165-3170.  
  • Olendzki B, et al. 2023.  Dietary Intake of Pregnant Women with and without Inflammatory Bowel Disease in the United States. Nutrients, 15(11):2464. 
  • O’Toole A, et al. 2015. Inflammatory Bowel Disease Increases Risk of Adverse Pregnancy Outcomes: A Meta-Analysis. Dig Dis Sci, 60(9):2750-2761. 
  • Palomba S, et al. 2014. Inflammatory bowel diseases and human reproduction: a comprehensive evidence-based review. World J Gastroenterol, 20(23):7123-7136.  
  • Pervez H, et al. 2019. The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review. 11(9): e5648 
  • Restelini S, et al. 2020. Update on the Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding. Digestion, 8:1-16. 
  • Shmidt E, & Dubinsky MC. 2022. Inflammatory Bowel Disease and Pregnancy. The American journal of gastroenterology, 117(10S), 60–68.  
  • Sousa P, et al. 2024. Navigating Reproductive Care in Patients With Inflammatory Bowel Disease: A Comprehensive Review.J Crohns Colitis;18(Supplement_2):ii16-ii30. 
  • Szymańska E, et al. 2021. Reproduction and Pregnancy in Inflammatory Bowel Disease – Management and Treatment Based on Current Guidelines. J Gynecol Obstet Hum Reprod, 50(3):101777. 
  • Talavera JIR, et al. 2021. The association between ectopic pregnancy and inflammatory bowel disease, irritable bowel syndrome, and celiac disease: A systematic review. J Obstet Gynaecol Res, 47(5):1601-1609.  
  • Torres J, et al. 2023. European Crohn’s and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation. J Crohns Colitis, 17(1):1-27. 
  • Vestergaard T, et al. 2023. Predictors of disease activity during pregnancy in women with inflammatory bowel disease-a Danish cohort study. Aliment Pharmacol Ther, 57(3):335–344. 
  • Wolf JL. 2002. The impact of surgery for ulcerative colitis on fertility and sexual function in women. Gastroenterology, 122(1):226-227.  
  • Winter R, et al. 2016. Treatment of the Pregnant Patient with Inflammatory Bowel Disease. Inflamm Bowel Dis, 22(3):733-744. 


ACE Inhibitors

Selected References:

  • Al Hasan S, et al. 2026. Prescription Stimulant Continuation in Pregnancy and Birth Outcomes. J Atten Disord 30(3):315-328.  
  • Aliakbari F, et al. 2022. Relationship between long-term use of Ritalin and semen parameters in patients referred to psychiatric centres. First International Journal of Andrology, 54(11):1-6 
  • Baker AS, et al. 2018. Management of attention deficit hyperactivity disorder during pregnancy. Obstet Gynecol Clin North Am, 45(3):495-509.  
  • Bateman B, et. al. 2015. Attention deficit hyperactivity medications during pregnancy and the risk of congenital cardiac malformations: A cohort study, abstracts, 368. Pharmacoepidemiol Drug Saf, 24:1–587. 
  • Bello G, et al. 2022. Successful lactation after resuming methylphenidate in a woman with narcolepsy. J Clin Sleep Med 18:1891–1894.  
  • Besag F, 2014. ADHD treatment and pregnancy. Drug Saf, 37:397-408. 
  • Bolea-Alamanac B et. al. 2014. Methylphenidate use in pregnancy and lactation: a systematic review of evidence. Br J of Clin Pharm, 77(1):96-101. 
  • Briggs G, et. al. 2017. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Tenth edition. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. 
  • Bro SP, et. al. 2015. Adverse pregnancy outcomes after exposure to methylphenidate or atomoxetine during pregnancy. Clinical Epi, 7:139-147. 
  • Camacho X, et al. 2023. The association between psychostimulant use in pregnancy and adverse maternal and neonatal outcomes: results from a distributed analysis in two similar jurisdictions. Int J Epidemiol 52(1):190-202. 
  • Cohen JM, et al. 2017. Placental complications associated with psychostimulant use in pregnancy. Obstet Gynecol. 130(6):1192-1201. 
  • Collin-Levesque L, et al. 2018. Infant exposure to methylphenidate and duloxetine during lactation: A case report. Breastfeed Med 13:221–225. 
  • Debooy, VD. 1993. Intravenous pentazocine and methylphenidate abuse during pregnancy. Am J dis Child 147(10):1062-1065. 
  • Diav-Citrin, O et. al. 2016. Methylphenidate in Pregnancy: A multicenter, prospective, comparative, observational study. J Clin Psychiatry, 77(9):1176-1181. 
  • Dideriksen D, et. al. 2013. First trimester in utero exposure to methylphenidate. Basic and Clin Pharm and Tox, 112:73-76. 
  • Golub M, et al. 2005. NTP CERHR Expert Panel Report on the reproductive and developmental toxicity of amphetamine and methamphetamine. Birth Defects Res B Dev Reprod Toxicol, 74(6):471-584. 
  • Hackett LP, et al. 2005. Infant dose and safety of breastfeeding for dexamphetamine and methylphenidate in mothers with attention deficit hyperactivity disorder. Ther Drug Monit 27:220–221. 
  • Hackett LP, et al. 2006. Methylphenidate and breast-feeding. Ann Pharmacother 40:1890–1891. 
  • Haervig KB, et. al. 2014. Use of ADHD medication during pregnancy from 1999-2010: a Danish register-based study. Pharmacoepidemiol and Drug Saf, 23:526-533. 
  • Humphreys C, et. al. 2007. Exposure to attention deficit hyperactivity disorder medications during pregnancy. Can Fam Physician, 53:1153-1155. 
  • Huybrechts KF, et al. 2018. Association between methylphenidate and amphetamine use in pregnancy and risk of congenital malformations: a cohort study from the International Pregnancy Safety Study Consortium. JAMA Psychiatry, 75(2):167-175.  
  • Ilett KF, et. al. 2006. Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder. Br J of Clin Pharm, 63(3):371-375. 
  • Kallen B, et. al. 2013. The use of central nervous system active drugs during pregnancy. Pharmaceuticals6:1221-1286. 
  • Kim J, et al. 2025. Managing attention-deficit/hyperactivity disorder in a breastfeeding mother: A case report. Pharmacotherapy 45:529–534. 
  • Louik C, et. al. 2015. Increasing use of ADHD medications in pregnancy. Pharmacoepidemiol Drug Saf, 24(2):218-220. 
  • Madsen KB, et al. 2023. In utero exposure to ADHD medication and long-term offspring outcomes. Mol Psychiatry, 28(4):1739-1746.  
  • Madsen KB, et al. 2025. In utero exposure to methylphenidate, amphetamines and atomoxetine and offspring neurodevelopmental disorders – a population-based cohort study and meta-analysis. Mol Psychiatry 30(9): 3885-3894. 
  • Malo J et. al. 2015. ADHD drugs, pregnancy and lactation—increasing inquiries and need for more safety data. Birth Def Res Pt A, 103:458-464. 
  • Ornoy A, et al. 2020. The effects of drugs used for the treatment of attention deficit hyperactivity disorder (ADHD) on pregnancy outcome and breast feeding: a critical review. Curr Neuropharmacol, Online ahead of print.  
  • Pottegard A, et. al. 2014. First-trimester exposure to methylphenidate: a population-based cohort study. J Clin Psychiatry, 75(1):e88-93. 
  • Spigset O, et. al. 2007. Excretion of methylphenidate in breast milk. Am J Psychiatry, 164:348.  
  • Suarez, EA, et al. 2024. Prescription stimulant use during pregnancy and risk of neurodevelopmental disorders in children. JAMA Psychiatry, e235073.  
  • Szpunar MJ, et al. 2023. Risk of major malformations in infants after first-trimester exposure to stimulants. J Clin Psychopharmacol, 43:326–332. 
  • Upadhyaya HP, et al. 2003. Neuroendocrine and behavioral responses to dopaminergic agonists in adolescents with alcohol abuse. Psychopharmacology (Berl) 166:95–101. 
  • Wajnberg R, et. al. 2011. Pregnancy outcome after in-utero exposure to methylphenidate: a prospective comparative cohort study. Repro Tox, 31:255-268. 


ACE Inhibitors

Selected References:

  • Diav-Citrin et al. 2003. Pregnancy outcome after gestational exposure to loratadine or antihistamines: a prospective controlled cohort study. J Allergy Clin Immunol 111(6):1239-1243.  
  • Gilboa SM, et al. 2009. National Birth Defects Prevention Study: Use of antihistamine medications during early pregnancy and isolated major malformations. Birth Defects Res A Clin Mol Teratol 85(2):137-150. 
  • Gilboa SM, et al. 2014. Antihistamines and birth defects: a systematic review of the literature. Expert Opin Drug Saf 13(12): 1667-1698. 
  • Gonzalez-Estrada A et al. 2016. Allergy medications during pregnancy. American J Med Sci 352(3):326-331. 
  • Hilbert J, et al. 1988. Excretion of loratadine in human breast milk. J Clin Pharamacol 28:234-239. 
  • Kallen, B. 2005. Methodologic issues in the epidemiologic study of the teratogenicity of drugs. Congenit Anom (Kyoto) 45: 44-51.  
  • Kallen B, Otterblad Olausson P. 2001. Monitoring of maternal drug use and infant congenital malformations. Does loratadine cause hypospadias? Int J Risk Saf Med 14(3-4):115-119.  
  • Kallen B, Otterblad Olausson P. 2006. No increased risk of infant hypospadias after maternal use of loratadine in early pregnancy. Int M Med Sci 3(3):106-107.  
  • Keles N. 2004. Treatment of allergic rhinitis during pregnancy. Am J Rhinol 18(1):23-28.  
  • Li Q, et al. 2013. Assessment of antihistamine use in early pregnancy and birth defects. J Allergy Clin Immunol Pract. 1(6):666-74.e1. 
  • Med Lett Drugs Ther. 2019. OTC drugs for seasonal allergies; 61(1570):57-60. 
  • Merlob P, Stahl B. 2002. Prospective follow-up of adverse reactions in breast-fed infants exposed to loratadine treatment (1999-2001). BENTIS Newsletter Number 10: 43-51.  
  • Moretti M, et al. 2003. Fetal safety of loratadine use in the first trimester of pregnancy: A multicenter study. J Allergy Clin Immunol. 111(3) 479-483.  
  • Pedersen L, et al. 2006b. Maternal use of loratadine during pregnancy and risk of hypospadias in offspring. Int J Med Sci 3(1) 21-25.  
  • Schwarz EB et al. 2008. Risk of hypospadias in offspring of women using loratadine during pregnancy: a systematic review and meta-analysis. Drug Saf 31(9):775-788. 
  • Werler M, et al. 2004. Evaluation of an association between loratadine and hypospadias – United States, 1997-2001. MMWR 53(10):219-221. 


ACE Inhibitors

Selected References:

  • Bjørk M. et al. 2002. Association of Prenatal Exposure to Antiseizure Medication With Risk of Autism and Intellectual Disability. JAMA Neurol. 79(7):672–681. doi:10.1001/jamaneurol.2022.1269 
  • Blotiere PO. et al. 2020. Risk of early neurodevelopmental outcomes associated with prenatal exposure to the antiepileptic drugs most commonly used during pregnancy: a French nationwide population-based cohort study. BMJ Open 10(6). 
  • Brannon, GE. et al. 2000. Anorgasmia in a patient with bipolar disorder type 1 treated with gabapentin. J Clin Psychopharmacol. 20(3):379-81. 
  • Carrasco M, et al. 2015. Neonatal gabapentin withdrawal syndrome. Pediatr Neurol. 53:445-447  
  • Desrochers, B. et al. 2024. Risks of congenital malformations and neonatal intensive care unit admissions with gabapentin use in pregnancy: A cohort study and scoping review with meta-analysis. Paediatr Perinat Epidemiol. 38,6: 486-494. doi:10.1111/ppe.13086 
  • FDA Drug Label. Gabapentin. Food and Drug Administration. Updated date: 2025-05-23. 
  • Fujii H. et al. 2013. Pregnancy outcomes following gabapentin use: results of a prospective comparative cohort study. Neurology.80(17):1565-1570. doi:10.1212/WNL.0b013e31828f18c1 
  • Grant AC. 2002. Gabapentin-induced anorgasmia in women. Am J Psychiatry. 159(7):1247. 
  • Hernandez-Diaz S. et al., 2025. Use of Antiseizure Medications Early in Pregnancy and the Risk of Major Malformations in the Newborn. Neurology. 12;105(3): e213786. doi: 10.1212/WNL.0000000000213786.  
  • Huybrechts, KF. et al. (2017). Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. Bmj. 2017;358:j3326. doi:10.1136/bmj.j3326. 
  • Johannessen SI, Helde G, Brodtkorb E. Levetiracetam concentrations in serum and in breast milk at birth and during lactation. Epilepsia. 2005;46:775–7. 
  • Kaufman KR, Struck PJ. 2011. Gabapentin-induced sexual dysfunction. Epilepsy Behav. 21(3):324-6. 
  • Kristensen JH. et al. 2006. Gabapentin and breastfeeding: A case report. J Hum Lact. 22:426–8.  
  • Linnebank M, et al. 2011. Antiepileptic drugs interact with folate and vitamin B12 serum levels. Ann Neurol; 69(2):352-9.  
  • Loudin, S, et al. 2017. An Atypical Withdrawal Syndrome in Neonates Prenatally Exposed to Gabapentin and Opioids. Clinical and Laboratory Observations. 181:286-288.  
  • Ohman I. et al. 2005. Pharmacokinetics of gabapentin during delivery, in the neonatal period, and lactation: Does a fetal accumulation occur during pregnancy? Epilepsia. 46:1621–4.  
  • Ohman I. et al. 2009. Gabapentin kinetics during delivery, in the neonatal period, and during lactation. Epilepsia. 50 (Suppl. 10):108. Abstract. 
  • Pack AM. et al. 2024. Teratogenesis, perinatal, and neurodevelopmental outcomes after in utero exposure to antiseizure medication: practice guideline from the AAN, AES, and SMFM. Neurology. 102(11):e209279. 
  • Patorno E, et al. 2020. Gabapentin in pregnancy and the risk of adverse neonatal and maternal outcomes: A population-based cohort study nested in the US Medicaid Analytic eXtract dataset. PLoS Med. 17(9):e1003322.