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Desmopressin Pregnancy and Breastfeeding Warnings

Brand names: DDAVP, DDAVP Nasal, DDAVP Rhinal Tube, Minirin, Nocdurna, Noctiva, Stimate

Medically reviewed by Drugs.com. Last updated on Jul 28, 2023.

Desmopressin Pregnancy Warnings

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.

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.

See references

Desmopressin Breastfeeding Warnings

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.

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.

See references

References for pregnancy information

  1. Burrow GN, Wassenaar W, Robertson GL, Sehl H (1981) "DDAVP treatment of diabetes insipidus during pregnancy and the post- partum period." Acta Endocrinol (Copenh), 97, p. 23-5
  2. Weinbaum PJ, Cassidy SB, Campbell WA, Rickles FR, Vintzileos AM, Nochimson DJ, Tsipouras P (1987) "Pregnancy management and successful outcome of Ehlers-Danlos syndrome type IV." Am J Perinatol, 4, p. 134-7
  3. Linder N, Matoth I, Ohel G, Yourish D, Tamir I (1986) "L-deamino-8-d-arginine vasopressin treatment in pregnancy and neonatal outcome. A report of three cases." Am J Perinatol, 3, p. 165-7
  4. Shah SV, Thakur V (1988) "Vasopressinase and diabetes insipidus of pregnancy." Ann Intern Med, 109, p. 435-6
  5. Rubens R, Thiery M (1987) "Diabetes insipidus and pregnancy." Eur J Obstet Gynecol Reprod Biol, 26, p. 265-70
  6. Davison JM, Sheills EA, Philips PR, Barron WM, Lindheimer MD (1993) "Metabolic clearance of vasopressin and an analogue resistant to vasopressinase in human pregnancy." Am J Physiol, 264, f348-53
  7. Riad AM (1967) "Studies on the enzymatic degradation of oxytocin and vasopressin by human pregnancy sera." Acta Endocrinol (Copenh), 54, p. 618-28
  8. Landon MJ, Copas DK, Shiells EA, Davison JM (1988) "Degradation of radiolabelled arginine vasopressin (125I-AVP) by the human placenta perfused in vitro." Br J Obstet Gynaecol, 95, p. 488-92
  9. Parboosingh J, Lederis K, Ko D, Singh N (1982) "Vasopressin concentration in cord blood: correlation with method of delivery and cord pH." Obstet Gynecol, 60, p. 179-83
  10. Maigaard S, Forman A, Andersson KE (1986) "Differential effects of angiotensin, vasopressin and oxytocin on various smooth muscle tissues within the human uteroplacental unit." Acta Physiol Scand, 128, p. 23-31
  11. Stein G, Morton J, Marsh A, Hartshorn J, Ebeling J, Desaga U (1984) "Vasopressin and mood during the puerperium." Biol Psychiatry, 19, p. 1711-7
  12. Johannesen P, Pedersen EB, Rasmussen AB (1985) "Arginine vasopressin in amniotic fluid, arterial and venous cord plasma and maternal venous plasma." Gynecol Obstet Invest, 19, p. 192-5
  13. Polin RA, Husain MK, James LS, Frantz AG (1977) "High vasopressin concentrations in human umbilical cord blood--lack of correlation with stress." J Perinat Med, 5, p. 114-9
  14. DeVane GW (1985) "Vasopressin levels during pregnancy and labor." J Reprod Med, 30, p. 324-7
  15. Davison JM, Barron WM, Lindheimer MD (1987) "Metabolic clearance rates of vasopressin increase markedly in late gestation: possible cause of polyuria in pregnant women." Trans Assoc Am Physicians, 100, p. 91-8
  16. Kallen BAJ, Carlsson SS, Bengtsson BKA (1995) "Diabetes insipidus and use of desmopressin (minirin(r)) during pregnancy." Eur J Endocrinol, 132, p. 144-6
  17. Hime MC, Richardson JA (1978) "Diabetes insipidus and pregnancy: case report, incidence and review of literature." Obstet Gynecol Surv, 33, p. 375-9
  18. Hadi HA, Mashini IS, Devoe LD (1985) "Diabetes insipidus during pregnancy complicated by preeclampsia: a case report." J Reprod Med, 30, p. 206-8
  19. Phelan JP, Guay AT, Newman C (1978) "Diabetes insipidus in pregnancy: a case review." Am J Obstet Gynecol, 130, p. 365-6
  20. van der Wildt B, Drayer JI, Eskes TK (1980) "Diabetes insipidus in pregnancy as a first sign of a craniopharyngioma." Eur J Obstet Gynecol Reprod Biol, 10, p. 269-74
  21. Ford SM (1986) "Transient vasopressin-resistant diabetes insipidus of pregnancy." Obstet Gynecol, 68, p. 288-9
  22. Ford SM, Lumpkin HL (1986) "Transient vasopressin-resistant diabetees insipidus of pregnancy." Obstet Gynecol, 68, p. 726-8
  23. Hughes JM, Barron WM, vance ML (1989) "Recurrent diabetes insipidus associated with pregnancy: pathophysiology and therapy." Obstet Gynecol, 73, p. 462-4
  24. Oravec D, Lichardus B (1972) "Management of diabetes insipidus in pregnancy." Br Med J, 4, p. 114-5
  25. Gaffney PR, Jenkins DM (1983) "Vasopressin: mediator of the clinical signs of fetal distress." Br J Obstet Gynaecol, 90, p. 987
  26. (2001) "Product Information. DDAVP (desmopressin)." Rhone Poulenc Rorer
  27. (2001) "Product Information. Stimate (desmopressin)." Forest Pharmaceuticals
  28. Briggs GG, Freeman RK, Yaffe SJ.. (1998) "Drugs in Pregnancy and Lactation." Baltimore, MD: Williams & Wilkins

References for breastfeeding information

  1. Burrow GN, Wassenaar W, Robertson GL, Sehl H (1981) "DDAVP treatment of diabetes insipidus during pregnancy and the post- partum period." Acta Endocrinol (Copenh), 97, p. 23-5
  2. Hime MC, Richardson JA (1978) "Diabetes insipidus and pregnancy: case report, incidence and review of literature." Obstet Gynecol Surv, 33, p. 375-9
  3. Hadi HA, Mashini IS, Devoe LD (1985) "Diabetes insipidus during pregnancy complicated by preeclampsia: a case report." J Reprod Med, 30, p. 206-8
  4. (2001) "Product Information. DDAVP (desmopressin)." Rhone Poulenc Rorer
  5. (2001) "Product Information. Stimate (desmopressin)." Forest Pharmaceuticals
  6. Briggs GG, Freeman RK, Yaffe SJ.. (1998) "Drugs in Pregnancy and Lactation." Baltimore, MD: Williams & Wilkins

Further information

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