ABC | Volume 114, Nº5, May 2020

Statement Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease – 2020 Arq Bras Cardiol. 2020; 114(5):849-942 Table 7 – Pharmacokinetics during pregnancy Decreased absorption Delayed intestinal motility Increased distribution volume Reduced peak concentration of hydrophilic and lipophilic drugs and half-life variations Increased hepatic metabolism Reduced plasma concentration of drugs that pass through the liver Increased renal clearance Reduced plasma concentration of drugs with renal excretion. Tubular absorption/excretion function is variable Adapted from Feghali et al., 2015. 54 Table 8 – Pregnancy and Lactation Labeling Rule – Food and Drug Administration Required information Related to pregnancy: Risk of medication use, compatibility with lactation, reproductive potential in men and women, information about pregnancy tests and contraceptive use Risk summary: Systemic absorption of the drug during pregnancy, labeled data from studies in humans and animals and adverse fetal outcomes, including fetal loss and malformation Contraindicated during pregnancy: Structural anomaly, embryopathy or fetal and neonatal mortality, functional impairment (multiple organ toxicity), growth alterations, retardation, or prematurity Clinical considerations: Essential guidelines for prescription considering dose adjustments during pregnancy and postpartum, associated maternal disease and/or risk of fetal embryopathy, adverse maternal and fetal reactions, and effects of medication during labor and delivery Additional data: Information from studies in humans and animals that support previously presented declarations of risk Pregnancy exposure registry: Information for healthcare professionals, with toll-free telephone number for obtaining information about the registry • Data • Human • Animal Table 9 – Effects of antihypertensive drug use during pregnancy and lactation Drugs Used during pregnancy Maternal-fetal effects Lactation ACEI and ARB No Dysgenesis and renal insufficiency Congenital cardiovascular and neurological malformation Compatible (captopril, enalapril, losartan) Amlodipine Yes Non-teratogenic Probably compatible Limited data in humans Atenolol No IUGR Compatible, but with caution (safer options) Bradycardia and fetal hypoglycemia Metoprolol succinate Yes Low birth weight and IUGR Bradycardia and fetal hypoglycemia Compatible, but with caution (effects of the beta-blocker on the newborn) Nifedipine Yes Probably low risk during all phases of gestation Compatible Methyldopa Yes Probably low risk during all phases of gestation Compatible Clonidine Yes Probably low risk during all phases of gestation Compatible Verapamil Yes Probably low risk during all phases of gestation Compatible Sodium nitroprusside Yes – risk of fetal cyanide exposure Congenital malformations have not been described Cyanide accumulation Not compatible Furosemide Yes Reduced amniotic fluid Compatible* Hydrochlorothiazide Yes No evidence of teratogenicity Risk of hypovolemia Compatible* Hydralazine Yes Neonatal thrombocytopenia and lupus-like syndrome Compatible Spironolactone No (antiandrogenic activity) No evidence of teratogenicity Antiandrogenic activity (feminization of male fetus) Not recommended ACEI: angiotensin converting enzyme inhibitors; ARB: angiotensin receptor blockers; IUGR: intrauterine growth restriction. 865