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 15 – Comparison between unfractionated heparin and low molecular weight heparin Peculiarities UFH LMWH Molecular weight 12,000 to 14,000 4,000 to 6,000 Anticoagulant action Thrombin and Xa Xa Bioavailability 30% 100% Half-life following application 45 to 60 min 12 h Absorption following SC injection Variable 100% Thrombocytopenia 27% 0% Monitoring APTT Anti-Xa factor Cost Low High Control frequency Higher Lower Control 1.5 to 2 × baseline 7 to 12 u/ml APTT: activated partial thromboplastin time; LMWH: low molecular weight heparin; SC: subcutaneous; UFH: unfractionated heparin.Adapted from Ginsberg et al., 2003. 100 Table 16 – Effects of hypolipidemic agent use during pregnancy and lactation Drugs Used during pregnancy Maternal-fetal effects Lactation Statins No Low risk of teratogenicity and toxicity No Fibrates No Teratogenicity in animals, with no evidence in humans No Ezetimibe No Low risk in animals, current evidence does not support use during gestation No Alirocumab No Low risk in animals, current evidence does not support use during gestation No Cholestyramine Yes Possible reduction in vitamin absorption Probably compatible The treatment of pulmonary arterial hypertension (PAH) will be discussed in topic 3.6.3. Drugs released for use during pregnancy include: 73,107 • Prostaglandins: epoprostenol, treprostinil, Iloprost; • Phosphodiesterase 5 inhibitors: sildenafil and tadalafil; • Calciumchannel blockers (BCC): diltiazemand nifedipine; • Nitric oxide: via inhalation. Contraindicated drugs during pregnancy are: 73,107 • Endothelin receptor antagonists: bosentan, ambrisentan, and macitentan; • Guanylate cyclase stimulators: riociguat. 2.5.8. Key Points The basic recommendations for prescribing medications during pregnancy, when possible, are: • Considerer pharmacokinetics of drugs during pregnancy, before prescription; • Prescribe when treatment is indicated, and its benefit outweighs the potential risk; • Guide to the prescription by the PLLR classification; • Avoid medication in the first trimester of pregnancy; • Use the lowest dose, as long as it is effective, for the shortest time, and, fractionate the daily dose; • Use drugs that are already widely accepted and safe in pregnancy; • Consider that drugs with molecular weight less than 1,500 Da cross the placenta and reach fetal circulation; • Guide preconception for women who make permanent use of medicines; • Consider that the priority of treatment is maternal, but obstetric and fetal risks should be considered. 2.6. Practice Recommendations during Pregnancy 2.6.1. Lifestyle Pregnancy is an ideal moment for lifestyle change. This is because pregnant women, owing to concerns about their children’s health, are motivated to improve unhealthy habits, for example, quitting smoking and alcoholism, consuming a more balanced diet, or controlling weight. Tobacco use is related to complications such as placenta praevia, premature placental detachment, low fetal weight, and prematurity, even in passive smokers. 108 Consumption of alcoholic beverages should be avoided, because it can cause fetal growth retardation, as well as abnormalities in the face and the central nervous system. 109 Pregnancy in women with heart disease should be accompanied by a multidisciplinary team. Consultations with 869