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

Classification of Cardiovascular Drugs in Pregnancy

Teratogenesis arises during organogenesis, by which, through the first half of pregnancy, different organs develop along different timelines. The overall risk of major malformations is cited at 1–3% of all births, with only a small portion (˜10%) being attributed to medications used during pregnancy.[20] Medications are commonly used during pregnancy. In the Registry of Pregnancy and Cardiac Disease (ROPAC), 28% of women with structural heart disease used medications during pregnancy.[21] Unfortunately, only a relatively small number of the drugs are known teratogens, but for the majority of the medications, there are no data on teratogens available. The US FDA established the pregnancy risk categories (Box 1).[22] This FDA system provides guidance on the safety and use of medication during pregnancy. It should be noted that the safety of most drugs has not been established during pregnancy. The FDA system has several limitations, such as dose, duration, gestational age of exposure to the drugs or indication. Indeed, especially for newer drugs, data are not available.