If you’ve been taking the birth control pill and discover you are pregnant, you may wonder whether this could harm a developing fetus or if there’s a chance that it may lead to a miscarriage (sometimes called spontaneous abortion) or stillbirth.
Most research suggests that you need not worry. Some types of birth control may cause complications, but, for the most part, using birth control pills or other hormone delivery devices (such as the Ortho Evra patch or NuvaRing) is relatively safe.
This article discusses birth control and miscarriage risk. It explains the potential risks of taking oral contraceptives or using other birth control during pregnancy. It also dispels common myths.
Birth Control Pill and Birth Defects
According to the Food and Drug Administration (FDA), no evidence shows taking combination birth control pills or progestin-only pills while pregnant will cause harm in any way. It does not increase the risk of birth defects or cause pregnancy complications.
It’s important to note that there has not been a lot of research on this subject. This is not because of oversight or lack of interest. Medical ethics would not allow research that may place a pregnant person or the fetus in harm’s way.
Most of the data is derived from epidemiological research comparing people who have used birth control pills during early pregnancy with those who haven’t. In this regard, there has been little difference in the number of birth defects, miscarriages, or stillbirths between either group.
The CDC notes that progestins taken in early pregnancy slightly increase the risk of hypospadias (a birth defect where the opening of the urethra is not located at the tip of the penis) in babies assigned male at birth.
However, the studies leading to this conclusion are older and were mostly of people taking progestins for infertility or to prevent pregnancy loss and not the low doses of progestins in birth control pills.
If You Think You May Be Pregnant
It’s still not recommended that you continue taking birth control if you’re pregnant, despite the fact that you’ve been using birth control medications up until pregnancy is confirmed.
There is no evidence to suggest harm to the fetus. But if you think you may be pregnant, take a pregnancy test to know for sure. If you can’t take a pregnancy test for any reason, consider using other forms of contraception (such as condoms or the sponge) until you can.
Pregnancy Risk While On Birth Control
Although abstinence is the only method of birth control that ensures 100% effectiveness for preventing pregnancy, perfect use of contraceptives is nearly 100% effective.
Perfect use means that a contraceptive is used correctly every time, while typical use accounts for common human errors, such as forgetting to take a contraceptive pill on time. Effectiveness rates vary as follows:
- Perfect use of birth control pills: more than 99%
- Typical use of birth control pills: 91%
- Perfect use of condoms: 98%
- Typical use of condoms: 82%
Long-acting reversible contraceptives (LARCs) such as an intrauterine device (IUD) and permanent contraception methods like tubal ligation (having your tubes tied) are more than 99% effective.
Birth Control and Miscarriage Myths
Most birth control methods don’t cause any harm to the fetus when they are used during early pregnancy. There are some common misunderstandings about the difference between birth control and medication abortion pills.
Birth Control Pills
Some people believe that if they continue to take the birth control pill while pregnant, they may have a miscarriage. This is not true, and there has never been any evidence to suggest that. Taking the birth control pill while pregnant doesn’t cause a miscarriage.
The hormones in the pill work by stopping ovulation and thickening cervical mucus to prevent sperm from entering the uterus. During early pregnancy, these actions don’t contribute to miscarriage or stillbirth.
Emergency Contraception
Another myth is that using emergency contraception (such as Plan B One-Step) while pregnant may cause the spontaneous termination of your pregnancy. This is again not true. These pills have no effect once a fertilized egg has been implanted.
Medication Abortion
There are specific medications that can end a pregnancy if desired. This is a form of medication abortion and is not considered birth control.
A medication abortion works through a different method than hormonal birth control. Known as Mifeprex (mifepristone) or RU-486, the abortion pill has been FDA-approved in the United States since 2000.
Legal Challenge to Mifepristone Use
The availability of mifepristone in the United States has recently been in the hands of the courts. In April 2023, a federal judge in Texas issued a ruling to suspend its FDA approval.
This decision affected the drug’s status nationwide but was quickly appealed and stayed, allowing for the continued sale of mifepristone.
The case was referred to the Supreme Court but sent back to the 5th Circuit Court of Appeals. In August 2023, the court rolled back FDA actions that had extended the time during which mifepristone could be prescribed and loosened some restrictions on prescribing and dispensing the drug. The matter will ultimately be decided by the Supreme Court.
Risks of Continuing Birth Control
Some birth control methods can cause harm when used during pregnancy. Below is a breakdown of common birth control methods and their risks if used during pregnancy.
COCs or Progestin-Only Pills
Combined estrogen-progestin oral contraceptives (COCs) and progestin-only pills are two different types of birth control pills. COCs contain synthetic forms of estrogen and progesterone, while progestin-only pills contain only synthetic progesterone.
While there’s no evidence suggesting birth defects or a miscarriage can occur if you take birth control pills while pregnant, some research suggests an increased risk of wheezing, asthma, and rhinitis in children who were exposed.
Progestin and Ectopic Pregnancy Risk
Progestin-only forms of birth control are associated with a slightly higher risk of ectopic pregnancy if they fail to prevent pregnancy. However, there isn’t a higher absolute risk of ectopic pregnancy when compared to using no contraceptive.
IUDs
If you become pregnant with an intrauterine device (IUD), there is a higher risk of complications such as miscarriage, preterm birth, and infections.
Call your healthcare provider immediately to discuss your options. If you wish to continue the pregnancy, your ob/gyn will likely recommend removing your IUD. Doing so early in a timely fashion can reduce those risks.
Implants, Shots, and Vaginal Rings
Contraceptive implants, injection shots, and vaginal rings same types of hormones found in birth control pills and carry the same risks.
There is no evidence to show using these can cause birth defects or miscarriages if used in early pregnancy.
However, some, like the Nexplanon implant, increase the risk of ectopic pregnancy.
Signs of Ectopic Pregnancy
Ectopic pregnancy is when a fertilized egg implants in a place other than the lining of the uterus (endometrium). Symptoms can include:
- Low back pain
- Sudden pain in the abdomen or pelvis
- Shoulder pain
- Abnormal vaginal bleeding
- Fainting
An ectopic pregnancy can rupture a fallopian tube and may need immediate medical attention.
Barrier Methods
There are no risks when using barrier-method birth control during pregnancy. This includes:
- Cervical caps
- Condoms
- Diaphragms
- Spermicides
- Sponges
These methods are used to physically prevent sperm from fertilizing an egg and typically do not involve hormones. Using condoms while pregnant can prevent sexually transmitted infections.
Summary
Unintended use of hormonal birth control during early pregnancy carries a very low risk of birth defects or miscarriage. However, if you find yourself pregnant, you should discontinue use and talk to your ob/gyn.
Condoms and other barrier birth control methods are safe to use in pregnancy. IUDs, however, can cause miscarriage and increases the risk of preterm birth.
Intentionally taking hormonal birth control while pregnant will not induce a miscarriage. If you are pregnant, talk to your healthcare provider about your options.