Visual summary Using cardiovascular drugs during pregnancy

Many cardiac medicines appear

KEY
safe for use during and after Drug name
pregnancy, as summarised
here. However, evidence is Associated
adverse events
lacking for some drugs, and
many of them carry risks of Contraindications
adverse events. Shared
decision making, considering
risks and benefits of medicines, Contraindicated
is vital to help women weigh up Safe
potential risks to themselves Unknown Pregnancy
and their unborn baby. Postpartum and
* Certain trimesters only breastfeeding

β blockers
Labetalol Bisoprolol Atenolol Methyldopa Digoxin
These are commonly
used by pregnant When used near term: Fetal hypoglycaemia When used in second Mild neonatal Serum levels are
women. However, Fetal hypoglycaemia Fetal bradycardia and third trimester: hypotension. Avoid unreliable
organ-specific Fetal bradycardia Fetal hypoglycaemia post partum because
malformations are of the risk of postnatal
Fetal hypotension Fetal bradycardia depression
more prevalent in the
offspring of women Low birth weight
treated with
β blockers, and fetal
growth restriction
has been reported *
Calcium Nifedipine Verapamil Platelet Acetylsalicylic acid Clopidogrel
channel aggregation
Potential synergism Low dose aspirin safe
blockers with magnesium
Limited evidence inhibitors in early pregnancy, but
Limited evidence

Not associated sulphate can induce Well tolerated usually stopped at Safe in animal studies,
with an increased hypotension in 34–36 weeks. No but caution is advised.
incidence of mother and fetal teratogenic effects Stop one week before
congenital hypoxia reported anticipated delivery
anomalies in
humans

Antiarrhythmic drugs Diuretics and aldosterone

antagonists
Adenosine Procainamide Flecainide Amiodarone Bumetanide,
Might be used in furosemide, and
Limited evidence Limited evidence Limited evidence hydrochlorothiazide
special circumstances.
No fetal adverse Unknown. Unknown. Risk of hypo-
effects reported Appears to be safe Appears to be safe thyroidism, goitre, Oligohydramnios
bradycardia, fetal and electrolyte
growth restriction, imbalance in the fetus
and preterm birth

Anticoagulants Drugs contraindicated in pregnancy

Warfarin Heparin (low ACE inhibitors† Angiotensin Spironolactone
molecular weight) receptor blockers
Risk of fetal High risk of fetal Limited evidence
abnormalities if used Seldom osteoporosis abnormalities. High risk of fetal
in the first trimester. and markedly less Captopril and Lisinopril Possible risk of
abnormalities
Can cause intracranial thrombocytopenia considered safe in anomalies of the
fetal bleeding in than unfractionated breast feeding external genitalia
second trimester. heparin.

*
† ACE inhibitors = Angiotensin converting enzyme inhibitors

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