Editorial
Copyright ©2009 The WJG Press and Baishideng.
World J Gastroenterol. Feb 28, 2009; 15(8): 897-906
Published online Feb 28, 2009. doi: 10.3748/wjg.15.897
Table 2 Safety of drugs used in pregnancy-associated liver diseases
DrugFDA pregnancy categoryComments
Antiemetics
PromethazineCPossible respiratory depression if drug is administered near time of delivery
MetoclopramideBAvailable evidence suggests safe use during pregnancy
OndansetronBAdditional studies are needed to determine safety to the fetus, particularly during the first trimester
ProchlorperazineCThere are isolated reports of congenital anomalies; however, some included exposures to other drugs. Jaundice, extrapyramidal signs, hyper-/hyporeflexes have been noted in newborns
Antihypertensives
ACE inhibitorsC/DFirst trimester exposure to ACE inhibitors may cause major congenital malformations
Second and third trimester use of an ACE inhibitor is associated with oligohydramnios and anuria, hypotension, renal failure, skull hypoplasia, and death in the fetus/neonate
Beta blockersC/DFetal bradycardia, hypotension, risk of intrauterine growth retardation
Calcium channel blockersCTeratogenic and embryotoxic effects have been demonstrated in small animals. There are no adequate and well-controlled studies in pregnant women
Anticoagulation
AspirinC (1st/2nd trimesters) D (3rd trimester)Adverse effects in the fetus include intrauterine growth retardation, salicylate intoxication, bleeding abnormalities, and neonatal acidosis. Use of aspirin close to delivery may cause premature closure of the ductus arteriosus. Data have shown low-dose aspirin (60-150 mg/day) may be safe in pregnancy
EnoxaparinBNo adequate and well-controlled studies using enoxaparin. Postmarketing reports include congenital abnormalities and also fetal death
HeparinCDoes not cross the placenta
Intrahepatic cholestasis
Ursodeoxycholic acidBRelatively low risk
S-adenosyl-L-methionineNot evaluated by FDARelatively low risk
CholestyramineCCholestyramine is not absorbed systemically, but may interfere with vitamin absorption