Contraceptives During Pregnancy and BreastfeedingGeneric Name: Contraceptives   
Indications: Pregnancy prevention and regulation of menstrual cycles. May be prescribed for off-label uses.
FDA Drug Category: X

Summary Recommendations
: Contraceptives are available in a variety of options, including oral, implant and barrier. Barrier contraceptives are the only safe option during pregnancy as they protect against sexually transmitted disease. Oral and implant contraceptives are assigned a pregnancy category X because known birth defects and pregnancy complications are associated with use of contraceptives during pregnancy.

Contraceptives are available in pill, ring, shot, patch, hormone and implant varieties. The medication(s) in the contraceptive prevent egg release, thicken the mucus of the cervix and vagina to impede sperm movement to the egg or thin the uterine lining so the egg cannot effectively implant.
Contraceptives are delivered as a single medication or combination or two or more medications. Some of the more common contraceptive medications are:

  • Estradiol
  • Desogestrel
  • Levonorgestrel
  • Medroxyprogesterone
  • Etonogestrel
  • Norethindrone
  • Drospirenone
  • Norgestimate
  • Ethynodiol
  • Ulipristal

It is quite common for two different contraceptives from different manufacturers to have the same exact ingredients.

General Precautions
: If you are currently taking oral contraceptives and you find out you are pregnant, stop taking the birth control pills immediately and contact your gynecologist for a prenatal exam. If you have a barrier form of contraception in place, contact your gynecologist immediately to have the contraceptive removed.

Many women do not find out they are pregnant until weeks after conception occurs. If you have taken birth control during this time, there are no clinically recognized side effects to worry about. There have been reports of lower than normal birth weight and premature birth associated with use of oral contraception in early pregnancy, but these reports are not substantiated with clinical evidence – so skepticism exists. There are also reports from early research that show increased risk of enlarged clitoris, but again this has not been documented via live births. Other recent studies (including a meta-analysis of prospective studies) have suggested that an association between oral contraceptive use and congenital malformations does not exist. There is no indication for the use of oral contraceptive combinations during pregnancy. Oral contraceptive combinations are contraindicated for use during pregnancy.

Effect While Trying to Conceive
: Contraceptives do alter conception, but they are not known to affect fertility. Women taking contraception understand and choose to prevent pregnancy. After stopping contraception, pregnancy should be possible if no other underlying conditions exist. Immediate pregnancy may occur if the only form of contraception used is barrier contraception, most often the condom. Oral and implanted contraception may delay pregnancy until all of the medication leaves the body.

Effects on Pregnancy
: There are no effects of barrier contraception on pregnancy. Oral contraception may be associated with low birth weight, premature birth or enlarged clitoris, but examples of these side effects in live births do not exist. Some forms of implanted contraception are associated with increased risk of ectopic pregnancy. Ectopic pregnancy occurs when the fertilized egg implants in the fallopian tube. Ectopic pregnancies are not viable and can lead to maternal death.

Safe During Breastfeeding
: Certain contraceptives are completely safe for use during breastfeeding, including barrier (condom) and non-hormonal options like IUDs. Contraceptives that use estrogen to prevent pregnancy are not necessarily dangerous to the breastfeeding infant, but estrogen may reduce milk supply making it difficult to breastfeed. Oral contraception containing only progesterone is not associated with negative side effects during breastfeeding.