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 10 – Effects of the use of antiarrhythmic drugs during pregnancy and lactation Drugs Used during pregnancy Maternal-fetal effects Lactation Lidocaine Yes Non-teratogenic; in high doses, respiratory depression and fetal acidosis have been described Compatible Propafenone Yes No data during the first trimester; no complications during the other trimesters Probably compatible Propranolol Yes Low birth weight and IUGR Bradycardia and fetal hypoglycemia Compatible, but with caution (effects of the beta-blocker on the newborn) Sotalol No Low weight, IUGR, torsades de pointes when associated with hypomagnesemia No Amiodarone No Fetal hypo- and hyperthyroidism, low birth weight, long QT No IUGR: intrauterine growth restriction. Table 11 – Effects of heart failure treatment during pregnancy and lactation Drugs Used during pregnancy Maternal-fetal effects Lactation Isosorbide mononitrate Yes Headache, hypotension, non-teratogenic Compatible Hydralazine Yes Neonatal thrombocytopenia and lupus-like syndrome Compatible Carvedilol Yes Low birth weight and IUGR Bradycardia and fetal hypoglycemia Compatible Metoprolol succinate Yes Low birth weight and IUGR Compatible, but with caution (effects of the beta-blocker on the newborn) Bradycardia and fetal hypoglycemia Bisoprolol No Low birth weight and IUGR Compatible (effects of the beta-blocker on the newborn) Risk/benefit Bradycardia and fetal hypoglycemia Digoxin Yes Non-teratogenic Compatible Dobutamine Yes Non-teratogenic in animals Probably compatible Milrinone No Risk in animals Probably compatible Risk/benefit No evidence in humans Sacubutril/valsartan No The same as ARB; inadequate data on sacubitril No Ivabradine No Cardiac defects in animals No IUGR Bradycardia in newborns ARB: angiotensin receptor blockers; IUGR: intrauterine growth restriction. 2.5.5. Thrombolytics (Table 13) They do not cross the placental barrier but are at risk of maternal bleeding. 52 2.5.6. Anticoagulants (Table 14) When used in the first trimester, causes fetal warfarin syndrome in 5 to 10% of cases. 95 The incidence is variable because the syndrome from the clinical view can often be inconspicuous, although in the opinion of geneticists. , its frequency is much higher. The risk of spontaneous abortion (less than 20 weeks of gestation) is almost 30% and that of stillbirth (more than 20 weeks of gestation) is 10%, both caused by warfarin poisoning. 96 Maternal hemorrhage in delivery patients warfarin is serious; more severe, however, is neonatal intracranial hemorrhage and its sequelae. 96,97 For patients on oral anticoagulants who undergo premature labor, cesarean section is indicated. The hypothesis that doses of less than 5 mg warfarin may cause a lower risk of embryopathy 52 is not supported by appropriate studies to guide anticoagulation guidance in the first trimester of pregnancy. The teratogenic property of a drug is understood to be independent of its dose. Recent reports have shown the occurrence of embryopathy even at doses below 5 mg warfarin. 98.99 It is concluded that it is “good practice” that the warfarin dose is adequate in pursuit of the therapeutic goal, controlled by the index. International Standardized Study (INR) and individualized for each clinical situation. Heparin : does not cross the placental barrier. Table 15 presents the advantages of low molecular weight heparin (LMWH) over unfractionated heparin (UFH). Both are associated with a 10 to 15% risk of miscarriages due to 867