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Table 7 Drugs and safety data Drugs Classification (Vaughan Williams for antiarrhythmic drugs)

Former FDA category

Placenta permeable

Transfer to breast milk (foetal dose)

Pre-clinical/clinical safety data

Abciximab Monoclonal antibody with antiplatelet effects

C Unknown Unknown Inadequate human studies • use only if potential benefit outweighs potential risk Animal data: • no animal reproduction studies ACE inhibitorsa ACE inhibitor D Yes Yesb (maximum of 1.6%) Contraindicated • renal or tubular dysplasia, oligohydramnios, growth retardation, ossification dis- orders of skull, lung hypoplasia, contractures, large joints, anaemia, intrauterine foetal death Acenocoumarol Vitamin K antagonist D Yes Yes (no adverse effects reported)

Embryopathy (mainly first trimester), bleeding (see discussion in section 5)

Acetylsalicylic acid (low dose)

Antiplatelet drug B Yes Well tolerated No teratogenic effects • there is insufficient clinical experience regarding the use of doses between 100–500 mg/day Adenosinec Antiarrhythmic C No No No foetal adverse effects reported (limited human data) Alirocumab Lipid-lowering drug (monoclonal antibody)

- Yes Unknown No human data: not recommended Animal data: • no adverse effects on foetal growth or development in rats and monkeys • maternal toxicity in rats • weaker secondary response to antigen challenge in the offspring of monkeys Aliskiren Renin inhibitor D Unknown Yes (secreted in rat milk) No use in first trimester; contraindicated in second and third trimesters • see other RAAS blockers Animal data: • no evidence of embryofoetal toxicity or teratogenicity at doses <_600 mg/kg/day in rats or 100 mg/kg/day in rabbits • fertility, pre-natal development, and post-natal development were unaffected in rats at doses <_250 mg/kg/day. The doses in rats and rabbits provided systemic exposures of 1–4 and 5 MRHD Continued Downloaded from academic.oup.com/eurheartj/article/39/34/3165/5078465 by guest on 07 October 2026