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Feb 04, 2019

Experts Address Safety of Heart Medications During Pregnancy

The use of heart medications takes careful consideration between women and their providers, explain experts.

Patients and providers must be thoughtful when it comes to using medications during pregnancy, based on a recent paper that addressed the risks and benefits of heart treatments among pregnant women.

Published in the Journal of the American College of Cardiology, this paper reviewed everything we know about the use of heart medication in women who are pregnant and breastfeeding. Its goal was to summarize current evidence and provide recommendations for the use of medications in pregnant women with heart disease.

Heart disease currently affects roughly 1–2% of pregnancies, increasing risk of complications for both mother and child. Among pregnant women with heart disease, about one-third take heart medications to help reduce those risks.

According to authors, heart disease treatment requires a careful balance of risk between the mother and baby. While medications may be necessary to protect the mother’s health, there are key ways to reduce potential risk to the baby.

First, experts note there are key drugs that should be avoided during pregnancy due to known risks of birth defects or other serious complications. The most common are ACE (angiotensin-converting-enzyme) and ARB (angiotensin II receptor blockers) inhibitors, which are commonly used to treat high blood pressure and can be especially harmful in the later stages of pregnancy. Certain types of blood thinners called DOACs (direct-acting oral anticoagulants) and cholesterol-lowering statins are also advised against during pregnancy. According to authors, these types of drugs should be avoided altogether and replaced with safer alternatives until the baby is born.

However, the safety of most heart medications is not crystal clear. As experts explain, only a small number of drugs have serious known side effects to a fetus, but few are deemed “safe” during pregnancy since the stakes are so high.

As a result, medication use is usually a judgement call that must be made together by patients and their providers.

According to experts, that decision usually depends on a number of key factors that are unique to each patient. For example, it’s important to consider the stage of pregnancy, since some medications are more harmful in the first trimester when major organs are being formed, while others are risker in the later stages of pregnancy. Patients and their doctors should also consider how necessary and urgent medication use is for the mother, especially given the stage in pregnancy or even while breastfeeding.

To help with the decision, experts note that maternal fetal medicine specialists should always be consulted for medication management during pregnancy and breastfeeding. Women should always be advised of the potential risks and benefits of treatment based on all available evidence. Finally, when taking medications, the lowest effective dose should always be used to help minimize risk of complications.

Ultimately, experts note that thoughtful and complete counseling will help women with heart disease make the best possible treatment decisions for themselves and their baby.

Read the full article at the Journal of the American College of Cardiology.

Questions for You to Consider

  • How do pregnancy, labor and delivery put extra stress on the heart?

  • During pregnancy, heart rate increases up to 20%, and the heart needs to work 30-50% harder to pump the amount of blood needed for the body and fetus. During labor and delivery, pain, stress and blood loss puts extra stress on the heart, which can lead to heart failure and sudden cardiac death.
  • How many women are affected by heart disease during pregnancy?
  • It is estimated that 0.2-4% of all pregnancies in western industrialized countries, such as the United States, are complicated by heart disease. Of these complications, high blood pressure and hypertensive disorders are the most common conditions that present during pregnancy, occurring in 6-8% of all pregnancies.

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