Antiplatelet therapy in pregnancy: A systematic review

Area of Science:

• Cardiology
• Obstetrics
• Pharmacology

Background:

• Antiplatelet agents are crucial for managing cardiovascular conditions.
• Their use during pregnancy requires careful safety evaluation due to potential maternal and neonatal risks.

Purpose of the Study:

• To systematically review contemporary data on the safety of clopidogrel and newer antiplatelet agents in pregnant women.
• To assess maternal and neonatal complications associated with antiplatelet therapy during gestation.

Main Methods:

• A systematic review following PRISMA guidelines was conducted.
• Searches of multiple databases identified 39 publications reporting on 42 live births.
• Studies included data on drug dosage, gestational timing, and pregnancy outcomes.

Main Results:

• Clopidogrel was the most frequently studied agent (37 cases).
• No significant increase in maternal or neonatal complications was observed.
• Congenital anomaly rates were comparable to background risks; two cases were unrelated to antiplatelet use.
• Two instances of post-cesarean bleeding occurred.

Conclusions:

• Clopidogrel use in pregnancy appears to carry an acceptable risk profile for both mothers and neonates.
• Evidence for other antiplatelet agents in pregnancy remains limited.
• Regional anesthesia can be considered, with a recommendation to discontinue antiplatelet therapy before delivery based on individualized risk assessment and national guidelines.