Adenosine Pregnancy and Breastfeeding Warnings
Adenosine Pregnancy Warnings
A retrospective review of the use of adenosine has identified 38 arrhythmic episodes in 33 pregnant women who were treated with IV adenosine. Three patients received the drug during the first trimester, 8 during the second trimester, and 22 during the third trimester. Brief episodes of maternal bradycardia were reported in 2 patients. One patient who received adenosine at 30 weeks' gestation experienced a 4-minute period of increased uterine activity which resolved spontaneously and the patient delivered at term. Fetal heart rate was recorded in 11 patients. Of the 4 cases of maternal hypotension, fetal bradycardia, or fetal distress, none were directly attributable to adenosine, and were associated with either the use of another antiarrhythmic agent or the side effects of underlying SVT. Pregnancy outcome data were available in 30 patients. Cesarian section was performed in 10 patients (33%). Whereas none were directly attributable to adenosine, 2 of the Cesarian deliveries were for fetal distress associated with SVT. Preterm delivery (< 37 weeks) occurred in 6 patients (20%), occurred before the 34th week in only one, and was not attributed to adenosine. All 30 infants were live births, and the only reported complication was abdominal distension and a transient requirement for mechanical ventilation in a term infant whose mother experienced atrial flutter and pulmonary edema during labor that did not respond to adenosine. No congenital abnormalities were noted in any of the newborns. These results confirm previously published anecdotal reports indicating overall safety of IV adenosine for the termination of SVT during pregnancy. There are rare reports of the use of adenosine during pregnancy for either maternal or fetal (direct fetal administration) supraventricular tachycardia. One woman, with SVT associated with mitral valve prolapse, at 39 weeks' gestation, developed bradycardia (heart rate fell from 240 to 80 bpm) after receiving 6 mg IV. She subsequently delivered a healthy infant at 41 weeks' gestation. No adverse effects on the fetus were observed. Based on limited experience, direct fetal injections of adenosine might be helpful in the treatment of fetal reentry tachycardias if the sinus rhythm achieved can be quickly preserved by long-acting antiarrhythmic drugs. Fetal adenosine administration may be especially advantageous in hydropic fetuses.
Adenosine has been assigned to pregnancy category C by the FDA. Sheep studies have shown that increasing amounts of a long-acting adenosine analog progressively decreased the number of fetal sheep heart rate accelerations. Because adenosine is a naturally occurring compound, endogenous to humans, no adverse fetal effects are anticipated. Retrospective studies have confirmed previously published reports indicating overall safety of IV adenosine for the termination of supraventricular tachycardia (SVT) during pregnancy. There are no controlled data in human pregnancy. Adenosine should only be given during pregnancy when benefit outweighs risk.
Adenosine Breastfeeding Warnings
There are no data on the excretion of adenosine into human milk.
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