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Pregnancy and Cardiovascular Disease Drug Use in Compatibility with Comments Pregnancy Breastfeeding ACE inhibitors Captopril, enalapril No Yes Teratogenic in firsttrimester; cause fetal/neonatal kidney failure with second- or third-trimester exposure; scleroderma renal crisis is only indication Lisinopril No ? Same as above Aliskiren No ? Teratogen ic in first trimester; causes feta l/neonata I kid ney fa ilu re with second- or third-trimester exposure ARBs No ? Teratogenic in first trimester; cause fetal/neonatal kidney failure with second- or third-trimester exposure Adenosine Yes ? No change in fetal heart rate when used for supraventricular tachycardia Amiodarone No No Fetal hypothyroidism, prematurity Antiplatelet and anticoagulant agents Dipyridamole, Yes Second-line agent; no evidence of harm in animal clopidogrel clopidogrel studies; no human data Aspirin (<81 mg) Yes Yes

Drug Use in Compatibility with Comments Pregnancy Breastfeeding ACE inhibitors Captopril, enalapril No Yes Teratogenic in firsttrimester; cause fetal/neonatal kidney failure with second- or third-trimester exposure; scleroderma renal crisis is only indication Lisinopril No ? Same as above Aliskiren No ? Teratogen ic in first trimester; causes feta l/neonata I kid ney fa ilu re with second- or third-trimester exposure ARBs No ? Teratogenic in first trimester; cause fetal/neonatal kidney failure with second- or third-trimester exposure Adenosine Yes ? No change in fetal heart rate when used for supraventricular tachycardia Amiodarone No No Fetal hypothyroidism, prematurity Antiplatelet and anticoagulant agents Dipyridamole, Yes Second-line agent; no evidence of harm in animal clopidogrel clopidogrel studies; no human data Aspirin (<81 mg) Yes Yes DOACs (apixaban, ? ? Pregnancy and lactation should be avoided in DOAC-treated dabigatran, rivaroxaban, patients; available data do not suggest a high risk for DOAC edoxaban, betrixaban) embryopathy or neonatal complications p-Blockers

DOACs (apixaban, ? ? Pregnancy and lactation should be avoided in DOAC-treated dabigatran, rivaroxaban, patients; available data do not suggest a high risk for DOAC edoxaban, betrixaban) embryopathy or neonatal complications p-Blockers Atenolol Yes No Second-line agent; low birth weight, intrauterine growth restriction Esmolol Yes ? Second-line agent; more pronounced bradycardia Labetalol Yes Yes Preferred drug in class Metoprolol Yes Yes Shortened half-life Propranolol Yes Yes Second-line agent; intrauterine growth restriction Sotalol Yes ? Second-line agent; insufficient data; reserve use {or arrhythmia not responding to alternative agent Calcium channel blockers Diltiazem, verapamil Yes Yes Second-line agent; maternal hypotension with rapid intravenous nfusion; used for feta I su praventricu la r tachyca rd ia i