Use of Medication for Cardiovascular Disease During Pregnancy

CV Medications in Pregnancy

Table for Quick Review, I posted this article earlier in the year but not the Central Illustration 

Cardiovascular disease complicating pregnancy is rising in prevalence secondary to advanced maternal age, cardiovascular risk factors, and the successful management of congenital heart disease conditions. The physiological changes of pregnancy may alter drug properties affecting both mother and fetus. Familiarity with both physiological and pharmacological attributes is key for the successful management of pregnant women with cardiac disease. This review summarizes the published data, available guidelines, and recommendations for use of cardiovascular medications during pregnancy. Care of the pregnant woman with cardiovascular disease requires a multidisciplinary team approach with members from cardiology, maternal fetal medicine, anesthesia, and nursing.

Summary:

1. Labetalol and methyldopa are the agents of choice in treating pregnant patients with hypertension.
2. Although all antihypertensive agents cross the placenta, methyldopa and labetalol appear to be the safest antihypertensive agents in pregnant women.
3. ACE inhibitors (such as lisinopril), angiotensin receptor blockers (such as losartan), spironolactone, and direct renin inhibitors (aliskiren) are teratogenic and are therefore contraindicated during pregnancy. During the first trimester, these agents can cause central nervous system and cardiovascular malformations in the fetus. Second-trimester exposure can cause developmental malformations of the kidneys and genitourinary system.
4. A 2013 guideline published by the American College of Obstetricians and Gynecologists made a strong recommendation for initiation of pharmacologic therapy for pregnant women with persistent chronic hypertension at a systolic blood pressure of 160 mm Hg or higher or a diastolic blood pressure of 105 mm Hg or higher. However, other guidelines, including one from the European Society of Cardiology, continue to recommend initiation of pharmacologic therapy at a systolic blood pressure of 150 mm Hg or higher or a diastolic blood pressure of 95 mm Hg or higher in women without symptoms or evidence of end-organ damage due to hypertension

ESC Guidelines on the management ofcardiovascular diseases during pregnancy