Cardiovascular Drugs in Pregnancy

Cardiovascular Drugs in Pregnancy^a

Drug	Side Effects
Amiodarone	Goiter, hypothyroidism and hyperthyroidism, IUGR
ACE inhibitors	Contraindicated; oligohydramnios, IUGR, renal failure, abnormal bone ossification; FDA class X
Aspirin	Baby aspirin not harmful
β-Blockers	Relatively safe; IUGR, neonatal bradycardia and hypoglycemia
Calcium channel blockers	Relatively safe; few data; concern regarding uterine tone at the time of delivery
Digoxin	Safe; no adverse effects
Flecainide	Relatively safe; limited data; used to treat fetal arrhythmias
Hydralazine	Safe; no major adverse effects
Furosemide	Safe; caution regarding maternal hypovolemia and reduced placental blood flow
Lidocaine	Safe; high doses may cause neonatal central nervous system depression
Methyldopa	Safe
Procainamide	Relatively safe; limited data; has been used to treat fetal arrhythmias, no major fetal side effects
Propafenone	Limited data
Quinidine	Relatively safe; rarely associated with neonatal thrombocytopenia; minimal oxytocic effect
Warfarin	Fetal embryopathy, fetal CNS abnormalities, placental and fetal hemorrhage; FDA class X

Abbreviations: ACE, angiotensin-converting enzyme; CNS, central nervous system; FDA, US Food and Drug Administration; IUGR, intrauterine growth restriction.

^aAdapted from

Elkayam�U. Pregnancy and cardiovascular disease. In: Braunwald�E, ed. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: WB Saunders; 2015:1764.

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Table 13-5