Use and Impact of Cardiac Medication During Pregnancy

Annemien E van den Bosch; Titia PE Ruys; Jolien W Roos-Hesselink


Future Cardiol. 2015;11(1):89-100. 

In This Article


The absorption, distribution, metabolism and clearance of medications during pregnancy is altered by the normal physiological changes. There is an important increase in cardiac output and glomerular filtration rate (increased by 60–80%), as well as an increased volume of distribution during pregnancy for the majority of medications. Serum albumin concentration falls during pregnancy and medications that bind to serum albumin are present in higher free concentrations.[14] Most oral medications can freely pass through the placenta, posing a potential risk to the fetus.[18] Cytochrome p450 is the most important system that is responsible for medication metabolism. The hormones estrogen and progesterone partly induce the cytochrome p450 enzymes. This can result in a higher metabolism of the liver and influence cardiac medications.[19] During pregnancy, the glomerular filtration increases by 60–80%. Therefore, drugs can be more rapidly excreted and cleared form the blood plasma.