Antiviral and antiretroviral use in pregnancy

Abstract

The history of antiviral and antiretroviral therapy is recent compared with many other medical therapies, including traditional antibiotics in pregnancy. There are few long-term data on which to base decisions of management in pregnancy. Accessing up-to-date information is critical to optimizing the safety of care for mothers and their infants. Exposure to medications in pregnancy can be toxic to a fetus in a gestational age-dependent manner. Determination of safe medications for pregnancy must take into consideration the need for certain medications and the possibility of inadvertent exposure in early pregnancy because of unplanned pregnancies. This article reviews the most commonly used antiviral and antiretroviral agents and places emphasis on the issues regarding use in pregnancy.

Birth outcomes among women exposed to neuraminidase inhibitors during pregnancy

“…Of the 86 infants exposed to neuraminidase inhibitors, there was one infant with a major malformation (VSD) and two with minor malformations (tongue tie and testicular retention). Animal studies in rodents on fetal exposure to high doses of orally administered oseltamivir have reported a dose‐dependent increase in the incidence of minor skeletal deformities . In the present study, we found no increase of minor skeletal deformities, but as we only included malformations diagnosed during the neonatal period, we cannot preclude that some of these malformations might have been present in our study population but not yet detected or recorded.…”

“…Animal studies in rodents on fetal exposure to high doses of orally administered oseltamivir have reported a dose-dependent increase in the incidence of minor skeletal deformities. [21][22][23] In the present study, we found no increase of minor skeletal deformities, but as we only included malformations diagnosed during the neonatal period, we cannot preclude that some of these malformations might have been present in our study population but not yet detected or recorded. Although we do not expect that the detection rate of congenital malformation would be influenced by knowledge of maternal treatment with antivirals, we suggest future studies to have a longer follow-up of the children to ensure inclusion of late diagnosed malformations.…”

Presentation of Seasonal Influenza A in Pregnancy

“…Amantadine and rimantadine were chosen for their availability on our hospital formulary and efficacy in adults at the time of the study. Both drugs are listed as Food and Drug Administration pregnancy category C. 18 Despite limited human safety data, the benefits of maternal treatment were felt to outweigh the potential risks. Since the collection of these data, prevalent strains of influenza A have developed resistance to these drugs as well as oseltamivir.…”

Dermatologic treatment during pregnancy: how to weigh the risk:benefit ratio for mother and fetus

“…Ribavirin (class X) is contraindicated. Many antiretroviral drugs belong to classes B and C and can be used, since maternal benefit is obvious and embryo/fetal risk is very low or absent [32].…”