Pharmacological treatment for cardiovascular disease during pregnancy and lactation

Maternal circulatory dynamics change drastically during pregnancy and delivery. Therefore, pregnancy with concomitant cardiovascular disease has risks, even for maternal death, in severe cases. This condition has tended to increase with advances in medical care and an increase in the age of pregnant women. Drug therapy during pregnancy and lactation should be administered if it is judged that this is necessary to improve the maternal pathology despite a risk of adverse effects. Fetuses and infants are exposed to maternal drugs, which is a specific concern in drug therapy for pregnant and lactating women. Care is needed because of the risk of adverse effects of teratogenicity in the organogenesis period and fetal toxicity thereafter. However, unstable maternal circulatory dynamics also inhibit fetal development and increase the risk of premature delivery, and stabilization of maternal physiologic condition by drug therapy often gives benefit to fetuses indirectly. Therefore, detailed knowledge of drug therapy during pregnancy should be acquired to manage the condition appropriately. Caution is also needed in using some obstetric drugs, such as tocolytic agents, which influence maternal circulatory dynamics. Therefore, drug therapy during pregnancy and lactation should only be used after full consideration of its benefit and possible harm to the mother and child, and after obtaining consent from the patient after giving a sufficient explanation. In this report, we review drug therapy for pregnant and lactating women with concomitant cardiovascular disease.