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Desmopressin Pregnancy and Breastfeeding Warnings

Desmopressin is also known as: DDAVP, DDAVP Nasal, DDAVP Rhinal Tube, Minirin, Stimate

Desmopressin Pregnancy Warnings

In general, desmopressin (DDAVP) appears to be an effective, nonteratogenic drug for the treatment of diabetes insipidus (DI) during pregnancy. Unlike structurally related vasopressin, DDAVP does not appear to increase the frequency or amplitude of uterine contractions. Three cases, in which DDAVP (to treat DI) was possibly associated with neonatal abnormalities, have been reported. The abnormalities included coarctation of the aorta, patent ductus arteriosus, pulmonary stenosis (case 1), trisomy 21, kyphoscoliosis, lordosis, clubfeet, endocardial cushion defect (case 2), failure to thrive, hypotonia, small stature, and retarded gross motor development (case 3). As the three infants presented with widely differing clinical appearance, it is difficult to implicate DDAVP as the causative agent in these cases. There have been many reports in which vasopressin or DDAVP was used safely to treat DI during human pregnancy. A recent Swedish study retrospectively reviewed the records of 29 infants whose mothers had received DDAVP during pregnancy for DI. Pregnancy duration and birth weight distributions were normal. Pregnancy outcome was normal except for possible intrauterine growth disturbances in three infants. One infant was born with a simian lines and a ventricular septum defect with a patent ductus arteriosus. This child died at age 14 years from a hypophyseal disease. The observation of one malformed infant among 29 born yields a risk of 3.4%, which was below the population risk of 4.5%. The statistical power of this study is low, but it is the largest published study to date. The authors concluded that maternal DI and treatment with DDAVP during pregnancy does not constitute a major risk. There appears to be a decrease in the plasma concentration of vasopressin during the first and second trimesters, and a 3-fold increase in the plasma concentration of vasopressin in the last trimester and during labor.

Desmopressin (DDAVP) has been assigned to pregnancy category B by the FDA. Animal data have failed to reveal evidence of fetotoxicity or teratogenicity. There have been many reports of the safe use of DDAVP to treat diabetes insipidus (DI) in pregnant women, but there have also been rare cases in which the drug was possibly related to neonatal defects. There are no controlled data in human pregnancy. Desmopressin is only recommended for use during pregnancy when benefit outweighs risk.

See references

Desmopressin Breastfeeding Warnings

The breast milk concentration of DDAVP in one woman who had received 10 mcg of DDAVP BID was less than 1 ng/L 3 days after the last dose. The associated maternal plasma level was approximately 1 ng/L. When given a single 10 mcg dose, the maximum maternal plasma concentration at 40 minutes was 7 ng/L. The breast milk concentration of desmopressin remained less than 1.5 ng/L for 240 minutes when her plasma was assayed. Patients receiving vasopressin or other structurally related polypeptides have breast-fed without apparent adverse effects on nursing infants. The manufacturer recommends caution when desmopressin is administered to a nursing woman.

Desmopressin is excreted into human milk in low concentrations. There have been no reports of adverse effects of desmopressin in nursing infants. The manufacturer recommends that caution be used when administering desmopressin to nursing women.

See references

References for pregnancy information

  1. Polin RA, Husain MK, James LS, Frantz AG "High vasopressin concentrations in human umbilical cord blood--lack of correlation with stress." J Perinat Med 5 (1977): 114-9
  2. Maigaard S, Forman A, Andersson KE "Differential effects of angiotensin, vasopressin and oxytocin on various smooth muscle tissues within the human uteroplacental unit." Acta Physiol Scand 128 (1986): 23-31
  3. Oravec D, Lichardus B "Management of diabetes insipidus in pregnancy." Br Med J 4 (1972): 114-5
  4. Riad AM "Studies on the enzymatic degradation of oxytocin and vasopressin by human pregnancy sera." Acta Endocrinol (Copenh) 54 (1967): 618-28
  5. Stein G, Morton J, Marsh A, Hartshorn J, Ebeling J, Desaga U "Vasopressin and mood during the puerperium." Biol Psychiatry 19 (1984): 1711-7
  6. Shah SV, Thakur V "Vasopressinase and diabetes insipidus of pregnancy." Ann Intern Med 109 (1988): 435-6
  7. Linder N, Matoth I, Ohel G, Yourish D, Tamir I "L-deamino-8-d-arginine vasopressin treatment in pregnancy and neonatal outcome. A report of three cases." Am J Perinatol 3 (1986): 165-7
  8. Ford SM "Transient vasopressin-resistant diabetes insipidus of pregnancy." Obstet Gynecol 68 (1986): 288-9
  9. "Product Information. DDAVP (desmopressin)." Rhone-Poulenc Rorer, Collegeville, PA.
  10. Hadi HA, Mashini IS, Devoe LD "Diabetes insipidus during pregnancy complicated by preeclampsia: a case report." J Reprod Med 30 (1985): 206-8
  11. Landon MJ, Copas DK, Shiells EA, Davison JM "Degradation of radiolabelled arginine vasopressin (125I-AVP) by the human placenta perfused in vitro." Br J Obstet Gynaecol 95 (1988): 488-92
  12. Hime MC, Richardson JA "Diabetes insipidus and pregnancy: case report, incidence and review of literature." Obstet Gynecol Surv 33 (1978): 375-9
  13. Davison JM, Sheills EA, Philips PR, Barron WM, Lindheimer MD "Metabolic clearance of vasopressin and an analogue resistant to vasopressinase in human pregnancy." Am J Physiol 264 (1993): f348-53
  14. Briggs GG, Freeman RK, Yaffe SJ.. "Drugs in Pregnancy and Lactation. 5th ed." Baltimore, MD: Williams & Wilkins (1998):
  15. van der Wildt B, Drayer JI, Eskes TK "Diabetes insipidus in pregnancy as a first sign of a craniopharyngioma." Eur J Obstet Gynecol Reprod Biol 10 (1980): 269-74
  16. Parboosingh J, Lederis K, Ko D, Singh N "Vasopressin concentration in cord blood: correlation with method of delivery and cord pH." Obstet Gynecol 60 (1982): 179-83
  17. Ford SM, Lumpkin HL "Transient vasopressin-resistant diabetees insipidus of pregnancy." Obstet Gynecol 68 (1986): 726-8
  18. Kallen BAJ, Carlsson SS, Bengtsson BKA "Diabetes insipidus and use of desmopressin (minirin(r)) during pregnancy." Eur J Endocrinol 132 (1995): 144-6
  19. Johannesen P, Pedersen EB, Rasmussen AB "Arginine vasopressin in amniotic fluid, arterial and venous cord plasma and maternal venous plasma." Gynecol Obstet Invest 19 (1985): 192-5
  20. Phelan JP, Guay AT, Newman C "Diabetes insipidus in pregnancy: a case review." Am J Obstet Gynecol 130 (1978): 365-6
  21. Hughes JM, Barron WM, vance ML "Recurrent diabetes insipidus associated with pregnancy: pathophysiology and therapy." Obstet Gynecol 73 (1989): 462-4
  22. Rubens R, Thiery M "Diabetes insipidus and pregnancy." Eur J Obstet Gynecol Reprod Biol 26 (1987): 265-70
  23. DeVane GW "Vasopressin levels during pregnancy and labor." J Reprod Med 30 (1985): 324-7
  24. Gaffney PR, Jenkins DM "Vasopressin: mediator of the clinical signs of fetal distress." Br J Obstet Gynaecol 90 (1983): 987
  25. Burrow GN, Wassenaar W, Robertson GL, Sehl H "DDAVP treatment of diabetes insipidus during pregnancy and the post- partum period." Acta Endocrinol (Copenh) 97 (1981): 23-5
  26. "Product Information. Stimate (desmopressin)." Forest Pharmaceuticals, St. Louis, MO.
  27. Davison JM, Barron WM, Lindheimer MD "Metabolic clearance rates of vasopressin increase markedly in late gestation: possible cause of polyuria in pregnant women." Trans Assoc Am Physicians 100 (1987): 91-8
  28. Weinbaum PJ, Cassidy SB, Campbell WA, Rickles FR, Vintzileos AM, Nochimson DJ, Tsipouras P "Pregnancy management and successful outcome of Ehlers-Danlos syndrome type IV." Am J Perinatol 4 (1987): 134-7

References for breastfeeding information

  1. Hadi HA, Mashini IS, Devoe LD "Diabetes insipidus during pregnancy complicated by preeclampsia: a case report." J Reprod Med 30 (1985): 206-8
  2. "Product Information. DDAVP (desmopressin)." Rhone-Poulenc Rorer, Collegeville, PA.
  3. "Product Information. Stimate (desmopressin)." Forest Pharmaceuticals, St. Louis, MO.
  4. Briggs GG, Freeman RK, Yaffe SJ.. "Drugs in Pregnancy and Lactation. 5th ed." Baltimore, MD: Williams & Wilkins (1998):
  5. Burrow GN, Wassenaar W, Robertson GL, Sehl H "DDAVP treatment of diabetes insipidus during pregnancy and the post- partum period." Acta Endocrinol (Copenh) 97 (1981): 23-5
  6. Hime MC, Richardson JA "Diabetes insipidus and pregnancy: case report, incidence and review of literature." Obstet Gynecol Surv 33 (1978): 375-9

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