Most pregnant women will receive at least two or more prescription medications during pregnancy, yet limited data exists regarding the use of most drugs during pregnancy.

During the Monday, June 24, symposium Myth Busters on “Category X” Drugs in Pregnancy—Evidence for Stopping Commonly Used Medications during Pregnancy, Preconception, and Lactation, experts discussed the potential benefits and complications of using common medications during pregnancy. The session can be viewed on-demand by registered meeting participants on the virtual meeting platform. If you haven’t registered for the 84^th Scientific Sessions, register today to access the valuable meeting content through Aug. 26.

There are limited pharmacokinetic and pharmacodynamic data to guide or optimize drug therapy for maternal therapeutics, explained Jason G. Umans, MD, PhD, Georgetown-Howard Universities Center for Clinical and Translational Science. Good models to predict fetal safety or harm for most drugs also continue to be lacking. This has caused many people to avoid medications during pregnancy, assuming it will decrease their risk of an adverse outcome. However, fetal abnormalities can occur without drug exposure, and the teratogenic risks of high doses of maternal glucose often exceed those of any hypoglycemic drug. “The risks of untreated disease commonly exceed the risks of drugs,” Dr. Uman said. “It’s the mere fear of the pregnancy and not knowing how to manage drugs during the pregnancy that deny them optimal therapy.”

Guidelines recommend lipid screening in the first trimester of pregnancy, and that patients with triglyceride or cholesterol levels above 500 receive an urgent referral to preventive cardiology, noted Ira J. Goldberg, MD, New York University Langone School of Medicine, who discussed lipid disorders in pregnancy.

Hypertriglyceridemia causes pancreatitis, which can lead to fetal loss during pregnancy. Treatment often involves exercise and a low-fat diet, but the underlying cause should be determined to help guide therapeutic decisions, he explained. Parents with high cholesterol should undergo genetic testing, as a homozygous child is at risk of early myocardial infarction. However, the approach to treatment of lipid disorders during pregnancy is unclear.

“The risks are unknown on using the statins in pregnancy,” Dr. Goldberg said.

The data on exposure to another class of drugs that has seen a significant increase in the management of diabetes in recent years, glucagon-like peptide-1 (GLP-1) receptor agonists, in humans during pregnancy is limited but reassuring overall, said Maisa N. Feghali, MD, MSCR, University of Pittsburgh.

In the U.S. in 2021, an estimated 200 per 100,000 pregnancies were exposed to GLP-1 receptor agonists, she noted. Research suggests the highest signal for harm from these drugs may be from significant maternal weight loss associated with GLP-1 receptor agonist use. While discontinuation of drugs may be the simplest approach to avoid fetal exposure, it is critical to keep in mind the background risks associated with maternal diabetes and the risk that ensues from rebound weight gain and glycemic control, Dr. Feghali explained.

Jessica S. Tangren, MD, Massachusetts General Hospital, was scheduled to present on renin-angiotensin-aldosterone system inhibitors (RAASi) in pregnancy and lactation but could not attend.

Carol J. Levy, MD, CDCES, Icahn School of Medicine at Mount Sinai, reviewed Dr. Tangren’s presentation and highlighted the following key takeaways. Reproductive-age patients should not be deprived of appropriate care for their diabetic kidney disease. Further, first-trimester RAASi exposure has limited risk, and the best data suggests it is okay to continue therapy until conception. However, RAASi should be restarted post-partum.