Pharmacotherapeutic Strategies in High-Risk Pregnancy: Balancing Maternal and Foetal Safety

  • Geeta Saroha M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be) University, Mullana, Ambala, HR, India
  • Rina Das MM College of Pharmacy, MMDU, Mullana
  • Dinesh Kumar Mehta M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be) University, Mullana, Ambala, HR, India
DOI: https://doi.org/10.5937/scriptamed57-58977
Keywords: High-risk pregnancy, Pharmacokinetics, Therapeutics, Obstetricians, Comorbidity

Abstract


Pharmacotherapy in high-risk pregnancies necessitates customised, evidence-based strategies to provide optimal results for women and their infants. A keen awareness that physiological changes during pregnancy can affect medication pharmacokinetics necessitates careful consideration of dose and therapeutic selection to reduce teratogenic risk without compromising treatment efficacy. Likewise, non-obstetric problems such as hypertension in pregnancy, gestational diabetes, auto-immune disorders and infections necessitate immediate medical intervention according to safety classifications and evolving labelling systems. Multidisciplinary care involving obstetricians, pharmacists, subspecialists and mental health professionals is crucial for managing the intricate relationships between maternal comorbidities and foetal development. Moreover, emerging domains including pharmacogenomics, placental-drug-delivery and diversity in clinical trials are further transforming the future of perinatal pharmacotherapy. This article aimed to examine the role of pharmacotherapy in high-risk pregnancies, emphasising the contemporary paradigm of safe drug use, collaboration within a multidisciplinary framework and prospective advancements to optimise maternal and foetal health outcomes. The personalised, evidence-based pharmacotherapeutic approach that improves high-risk pregnancy outcomes is based on body modifications, safe medication use, multidisciplinary approaches and advances in pharmacogenomics and placenta-targeted therapies.

References

Queenan JT, Spong CY, Lockwood CJ. Overview of high-risk pregnancy. In: Spong CY, Lockwood CJ, Eds. Queenan’s Management of High Risk Pregnancy: An Evidence Based Approach. Amsterdam: Elsevier, 2012. Pp. 1-3. doi: 10.1002/9781119963783.ch1.

Cleveland Clinic. High risk pregnancy: age, complications & management [Internet]. [Cited: 23-Apr-2025]. Available at: https://my.clevelandclinic.org/health/diseases/22190-high-risk-pregnancy.

Encyclopaedia Britannica. High risk pregnancy | Complications, Risks & Management [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.britannica.com/science/high-risk-pregnancy.

Brigham and Women’s Hospital. High risk pregnancy overview [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.brighamandwomens.org/medical-resources/high-risk-pregnancy.

Yilmaz B, Oskay Ü. A current view of care of high risk pregnancy. Bezmialem Sci. 2021;9:112–9. doi: 10.14235/bas.galenos.2020.3815.

Kuppusamy P, Prusty RK, Kale DP. High risk pregnancy in India: prevalence and contributing risk factors – a national survey based analysis. J Glob Health. 2023;13. doi: 10.7189/JOGH.13.04116.

Johnson A, Vaithilingan S, Ragunathan L. Quantifying the occurrence of high risk pregnancy: a comprehensive survey. Cureus. 2024. doi: 10.7759/cureus.59040.

Meh C, Sharma A, Ram U, Fadel S, Correa N, Snelgrove JW, et al. Trends in maternal mortality in India over two decades in nationally representative surveys. BJOG. 2022;129:550–61. doi: 10.1111/1471-0528.16888.

Kaur M, Gupta M, Purayil VP, Rana M, Chakrapani V. Contribution of social factors to maternal deaths in urban India: use of care pathway and delay models. PLoS One. 2018;13. doi: 10.1371/journal.pone.0203209.

Chang JJ, Pien GW, Duntley SP, Macones GA. Sleep deprivation during pregnancy and maternal and fetal outcomes: is there a relationship? Sleep Med Rev. 2010;14:107–1.4. doi: 10.1016/J.SMRV.2009.05.001

Saraei M, Shafaat M, Aminian O, Eftekhari S, Hesari E, Behkar A, Najafi A. Poor maternal sleep health adversely affects neonatal and pregnancy outcomes: an important ignored health issue in prenatal care. J Obstet Gynecol Cancer Res. 2024;9:288–94. doi: 10.30699/jogcr.9.3.288.

World Health Organization. Maternal mortality ratio (per 100 000 live births) [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/maternal-mortality-ratio-(per-100-000-live-births).

UNICEF Data. Maternal mortality rates and statistics [Internet]. [Cited: 23-Apr-2025]. Available at: https://data.unicef.org/topic/maternal-health/maternal-mortality/.

Cresswell JA, Alexander M, Chong MYC, Link HM, Pejchinovska M, Gazeley U, et al. Global and regional causes of maternal deaths 2009–20: a WHO systematic analysis. Lancet Glob Health. 2025 Apr;13(4):e626-e634. doi: 10.1016/S2214-109X(24)00560-6.

Hudson RE, Metz TD, Ward RM, McKnite AM, Enioutina EY, Sherwin CM, et al. Drug exposure during pregnancy: current understanding and approaches to measure maternal fetal drug exposure. Front Pharmacol. 2023;14. doi: 10.3389/fphar.2023.1111601.

Haas DM, Renbarger JL, Denne S, Ahmed MS, Easterling T, Feibus K, et al. Pharmacotherapy and pregnancy: highlights from the first International Conference for Individualized Pharmacotherapy in Pregnancy. Clin Transl Sci. 2009;2:11–14. doi: 10.1111/j.1752-8062.2009.00079.x.

De Guadalupe Quintana Coronado M, Bravo C, Álvarez Mon M, Ortega MA, De León Luis JA. News in pharmacology for the main medical pathologies of gestation. Front Pharmacol. 2023;14. doi: 10.3389/fphar.2023.1240032.

MGH Center for Women’s Mental Health. Medications and Pregnancy: A Focus on the Pharmacokinetics[Internet]. [Cited: 23-Apr-2025]. Available at: https://womensmentalhealth.org/posts/medications-pregnancy-focus-pharmacokinetics/.

Ward RM, Varner MW. Principles of pharmacokinetics in the pregnant woman and fetus. Clin Perinatol. 2019;46:383–98. doi: 10.1016/j.clp.2019.02.014.

Frederiksen MC. Physiologic changes in pregnancy and their effect on drug disposition. Semin Perinatol. 2001;25:120–3. doi: 10.1053/SPER.2001.24565.

Pinheiro EA, Stika CS. Drugs in pregnancy: pharmacologic and physiologic changes that affect clinical care. Semin Perinatol. 2020;44. doi: 10.1016/j.semperi.2020.151221.

Eke AC, Gebreyohannes RD, Fernandes MFS, Pillai VC. Physiologic changes during pregnancy and impact on small molecule drugs, biologic (monoclonal antibody) disposition, and response. J Clin Pharmacol. 2023;63:S34–S50. doi: 10.1002/jcph.2227.

Tetro N, Moushaev S, Rubinchik Stern M, Eyal S. The placental barrier: the gate and the fate in drug distribution. Pharm Res. 2018;35. doi: 10.1007/s11095-017-2286-0.

Kuppusamy G, De A, Jaiswal A, Chatterjee A. Placenta barrier and drug delivery. Res J Pharm Technol. 2019;12:2545–52. doi: 10.5958/0974-360X.2019.00428.1.

Rubinchik Stern M, Eyal S. Drug interactions at the human placenta: what is the evidence? Front Pharmacol. 2012;3:126. doi: 10.3389/fphar.2012.00126.

Mao Q, Chen X. An update on placental drug transport and its relevance to fetal drug exposure. Med Rev. 2022;2:501–11. doi: 10.1515/mr-2022-0025.

Pemathilaka RL, Reynolds DE, Hashemi NN. Drug transport across the human placenta: review of placenta on a chip and previous approaches. Interface Focus. 2019;9. doi: 10.1098/rsfs.2019.0031.

Griffiths SK, Campbell JP. Placental structure, function and drug transfer. Continuing Educ Anaesth Crit Care Pain. 2015;15:84–9. doi: 10.1093/bjaceaccp/mku013.

Liu XI, Green DJ, van den Anker JN, Rakhmanina NY, Ahmadzia HK, Momper JD, et al. Mechanistic modeling of placental drug transfer in humans: how do differences in maternal/fetal fraction of unbound drug and placental influx/efflux transfer rates affect fetal pharmacokinetics? Front Pediatr. 2021;9. doi: 10.3389/fped.2021.723006.

Law R, Bozzo P, Koren G, Einarson A. FDA pregnancy risk categories and the CPS: do they help or are they a hindrance? Can Fam Physician. 2010 Mar;56(3):239-41. PMID: 20228306.

Leek JC, Arif H. Pregnancy Medications. StatPearls. 2023[Internet]. [Cited: 23-Apr-2025]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507858/.

Burkey BW, Holmes AP. Evaluating medication use in pregnancy and lactation: what every pharmacist should know. J Pediatr Pharmacol Ther. 2013;18:247–58. doi: 10.5863/1551-6776-18.3.247.

Addis A, Sharabi S, Bonati M. Risk classification systems for drug use during pregnancy: are they a reliable source of information? Drug Saf. 2000;23:245–53. doi: 10.2165/00002018-200023030-00006.

Viroga S. Classification system of drugs’ risk during pregnancy. J Gynecol Womens Health. 2018;8. doi: 10.19080/jgwh.2018.08.555726.

U.S. Food and Drug Administration. Pregnancy and lactation labeling resources [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.fda.gov/drugs/labeling-information-drug-products/pregnancy-and-lactation-labeling-resources.

Berglund F, Flodh H, Lundborg P, Prame B, Sannerstedt R. Drug use during pregnancy and breast feeding: a classification system for drug information. Acta Obstet Gynecol Scand. 1984;63:1–55. doi: 10.3109/00016348409156383.

U.S. Food and Drug Administration. Medicine and pregnancy [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.fda.gov/consumers/womens-health-topics/medicine-and-pregnancy.

Werler MM, Kerr SM, Ailes EC, Reefhuis J, Gilboa SM, Browne ML, et al. Patterns of prescription medication use during the first trimester of pregnancy in the United States, 1997–2018. Clin Pharmacol Ther. 2025;114:836–44. doi: 10.1002/CPT.2981.

Chitayat D, Matsui D, Amitai Y, Kennedy D, Vohra S, Rieder M, Koren G. Folic acid supplementation for pregnant women and those planning pregnancy: 2015 update. J Clin Pharmacol. 2016;56:170–5. doi: 10.1002/jcph.616.

Crider KS, Qi YP, Yeung LF, Mai CT, Head Zauche L, Wang A, et al. Folic acid and the prevention of birth defects: 30 years of opportunity and controversies. Annu Rev Nutr. 2022;42:423–52. doi: 10.1146/annurev-nutr-043020-091647.

Randhawa MA, Khan AA, Javed MS, Sajid MW. Green leafy vegetables: a health promoting source. In: Watson RR, Ed. Handbook of fertility: nutrition, diet, lifestyle and reproductive health. Cambridge: Academic Press, 2015; pp. 205–220. doi: 10.1016/B978-0-12-800872-0.00018-4.

Rísová V, Saade R, Jakuš V, Gajdošová L, Varga I, Záhumenský J. Preconceptional and periconceptional folic acid supplementation in the Visegrad Group countries for the prevention of neural tube defects. Nutrients. 2025;17. doi: 10.3390/nu17010126.

American College of Obstetricians and Gynecologists. Vaccines during pregnancy [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.acog.org/womens-health/infographics/vaccines-during-pregnancy.

Quincer EM, Cranmer LM, Kamidani S. Prenatal maternal immunization for infant protection: a review of the vaccines recommended, infant immunity and future research directions. Pathogens. 2024;13. doi: 10.3390/pathogens13030200.

Marshall H, McMillan M, Andrews RM, Macartney K, Edwards K. Vaccines in pregnancy: the dual benefit for pregnant women and infants. Hum Vaccin Immunother. 2016;12:848–56. doi: 10.1080/21645515.2015.1127485.

Mackin DW, Walker SP. The historical aspects of vaccination in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2021;76:13–22. doi: 10.1016/j.bpobgyn.2020.09.005.

Ogden SA, Ludlow JT, Waheed A, Alsayouri K, Bourjeily D. Diphtheria tetanus pertussis (DTaP) vaccine. StatPearls. 2022[Internet]. [Cited: 23-Apr-2025]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK545173/.

Fleming Dutra KE, et al. Use of the Pfizer respiratory syncytial virus vaccine during pregnancy for prevention of RSV associated lower respiratory tract disease in infants: recommendations of the Advisory Committee on Immunization Practices—United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72. doi: 10.15585/mmwr.mm7241e1.

Centers for Disease Control and Prevention. RSV vaccine guidance for pregnant women [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/pregnant-people.html.

Centers for Disease Control and Prevention. Immunizations to Protect Infants | RSV [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.cdc.gov/rsv/vaccines/protect-infants.html.

Arora M, Lakshmi R. Vaccines—safety in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2021;76:23–40. doi: 10.1016/j.bpobgyn.2021.02.002.

Radparvar AA, Vani K, Fiori K, Gupta S, Chavez P, Fisher M, et al. Hypertensive disorders of pregnancy: innovative management strategies. JACC: Adv. 2024;3. doi: 10.1016/j.jacadv.2024.100864.

Khedagi AM, Bello NA. Hypertensive disorders of pregnancy. Cardiol Clin. 2021;39:77–90. doi: 10.1016/j.ccl.2020.09.005.

Traub A, Sharma A, Gongora MC. Hypertensive disorders of pregnancy: a literature review—pathophysiology, current management, future perspectives, and healthcare disparities. US Cardiol Rev. 2024;18. doi: 10.15420/usc.2023.01.

Bruno AM, Allshouse AA, Metz TD, Theilen LH. Trends in hypertensive disorders of pregnancy in the United States from 1989 to 2020. Obstet Gynecol. 2022;140:83–6. doi: 10.1097/AOG.0000000000004824.

Rismiati H, Lee HY. Blood pressure control in hypertensive disorders of pregnancy. Cardiovasc Prev Pharmacol. 2022;4:99–105. doi: 10.36011/cpp.2022.4.e16.

Brown CM, Garovic VD. Drug treatment of hypertension in pregnancy. Drugs. 2014;74:283–96. doi: 10.1007/s40265-014-0187-7.

Medscape. Medscape registration [Internet]. [Cited: 24-Apr-2025]. Available at: https://emedicine.medscape.com/article/261435-overview?form=fpf.

Sun S, Li W, Zhang X, Aziz AUR, Zhang N. Trends in global and regional incidence and prevalence of hypertensive disorders in pregnancy (1990–2021): an age period cohort analysis. Sci Rep. 2025;15:1513. doi: 10.1038/s41598-025-85819-0.

Garovic VD, Dechend R, Easterling T, Karumanchi SA, Baird SMM, Magee LA, et al. Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American Heart Association. Hypertension. 2022;79:E21–E41. doi: 10.1161/HYP.0000000000000208.

Garovic VD, White WM, Vaughan L, Saiki M, Parashuram S, Garcia Valencia O, et al. Incidence and long term outcomes of hypertensive disorders of pregnancy. J Am Coll Cardiol. 2020;75:2323–34. doi: 10.1016/J.JACC.2020.03.028.

Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018;19. doi: 10.3390/ijms19113342.

Wang T, Yin W, Huang Y, Zhang Q. Identification of significant predictors for the need of insulin therapy and onset of postpartum impaired glucose tolerance in gestational diabetes mellitus patients. Diabetes Metab Syndr Obes. 2021;14:2609–17. doi: 10.2147/DMSO.S309618.

Metzger BE, Lowe LP, Dyer AR, Trimble ER, Sheridan B, Hod M, et al. Hyperglycemia and adverse pregnancy outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes. 2009;58:453–9. doi: 10.2337/db08-1112.

Landon MB, Gabbe SG. Gestational diabetes mellitus. Obstet Gynecol. 2011;118:1379–93. doi: 10.1097/AOG.0b013e31823974e2.

American Diabetes Association. 14. Management of diabetes in pregnancy: standards of medical care in diabetes—2021. Diabetes Care. 2021;44:S200–S210. doi: 10.2337/dc21-S014.

Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477–86. doi: 10.1056/NEJMoa042973.

Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358:2003–15. doi: 10.1056/NEJMoa0707193.

ACOG practice bulletin. Antepartum fetal surveillance. Number 9, October 1999 (replaces Technical Bulletin Number 188, January 1994). Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet. 2000 Feb;68(2):175-85. PMID: 10717828.

Shaver DC. Thromboembolic disease. The Global Library of Women’s Medicine. 2009. doi: 10.3843/GLOWM.10113.

American College of Obstetricians and Gynecologists. Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018;132:e1–e17. doi: 10.1097/AOG.0000000000002706.

Dado CD, Levinson AT, Bourjeily G. Pregnancy and pulmonary embolism. Clin Chest Med. 2018;39:525–37. doi: 10.1016/j.ccm.2018.04.007.

Samfireag M, Potre C, Potre O, Tudor R, Hoinoiu T, Anghel A. Approach to thrombophilia in pregnancy—a narrative review. Medicina (Kaunas). 2022;58. doi: 10.3390/medicina58050692.

Ionita I, Grigorita L, Miloicov CB, Petre I, Bernad E, Craina M, et al. The role of thrombophilia in pregnancy. Rev Chim. 2016;67:2643–7. doi: 10.1155/2013/516420.

Varrias D, Spanos M, Kokkinidis DG, Zoumpourlis P, Kalaitzopoulos DR. Venous thromboembolism in pregnancy: challenges and solutions. Vasc Health Risk Manag. 2023;19:469–84. doi: 10.2147/VHRM.S404537.

Singh C, Jain A, Tandon R, Malhotra P. Management of thromboembolic disorders during pregnancy in resource‑constrained settings: an Indian perspective. Indian J Med Res. 2023;157:533–42. doi: 10.4103/ijmr.ijmr_1858_21.

Kearsley R, Stocks G. Venous thromboembolism in pregnancy—diagnosis, management, and treatment. BJA Educ. 2021;21:117–23. doi: 10.1016/j.bjae.2020.10.003.

Quinn JA, Munoz FM, Gonik B, Frau L, Cutland C, Mallett‑Moore T, et al. Preterm birth: case definition & guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine. 2016;34:6047–56. doi: 10.1016/j.vaccine.2016.03.045.

Clothier B, Stringer M, Jeffcoat MK. Periodontal disease and pregnancy outcomes: exposure, risk and intervention. Best Pract Res Clin Obstet Gynaecol. 2007;21:451–66. doi: 10.1016/j.bpobgyn.2007.01.005.

Gondane P, Kumbhakarn S, Maity P, Kapat K. Recent advances and challenges in the early diagnosis and treatment of preterm labor. Bioengineering (Basel). 2024;11. doi: 10.3390/bioengineering11020161.

Schleußner E. The prevention, diagnosis and treatment of premature labor. Dtsch Arztebl Int. 2013. doi: 10.3238/arztebl.2013.0227.

Simhan HN. Practice Bulletin No. 171: management of preterm labor. Obstet Gynecol. 2016;128:e155–e164. doi: 10.1097/AOG.0000000000001711.

Higby K, Xenakis EMJ, Pauerstein CJ. Do tocolytic agents stop preterm labor? A critical and comprehensive review of efficacy and safety. Am J Obstet Gynecol. 1993;168:1247–59. doi: 10.1016/0002-9378(93)90376-T.

Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017;2017:CD004454. doi: 10.1002/14651858.CD004454.pub3.

Van Der Heijden JEM, Van Hove H, Van Elst NM, Van Den Broek P, Van Drongelen J, Scheepers HCJ, et al. Optimization of the betamethasone and dexamethasone dosing regimen during pregnancy: a combined placenta perfusion and pregnancy physiologically based pharmacokinetic modeling approach. Am J Obstet Gynecol. 2025;232:228.e1–228.e9. doi: 10.1016/J.AJOG.2024.05.012.

Baghlaf H, Snelgrove JW, Li Q, Huszti E, McDonald SD, Asztalos E, et al. One vs 2 courses of antenatal corticosteroids in pregnancies at risk of preterm birth: a secondary analysis of the MACS trial. Am J Obstet Gynecol MFM. 2023;5:101002. doi: 10.1016/J.AJOGMF.2023.101002.

Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, Rouse DJ, et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2024;2024:CD004661. doi: 10.1002/14651858.CD004661.pub4.

Rac H, Gould AP, Eiland LS, Griffin B, McLaughlin M, Stover KR, Bland CM, Bookstaver PB. Common bacterial and viral infections: review of management in the pregnant patient. Ann Pharmacother. 2019;53:639–51. doi: 10.1177/1060028018817935.

Gould AP, Winders HR, Stover KR, Bookstaver PB, Griffin B, Bland CM, Eiland LS, Murray M. Less common bacterial, fungal and viral infections: review of management in the pregnant patient. Drugs Context. 2021;10:2021-4-3. doi: 10.7573/dic.2021-4-3.

Müllegger RR, Häring NS, Glatz M. Skin infections in pregnancy. Clin Dermatol. 2016;34:368–377. doi: 10.1016/J.CLINDERMATOL.2016.02.009.

McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. 2007;2007:CD000262. doi: 10.1002/14651858.CD000262.pub3.

Lee H, Lee K, Chong Y. New treatment options for infections caused by increasingly antimicrobial‑resistant Neisseria gonorrhoeae. Expert Rev Anti Infect Ther. 2016;14:243–56. doi: 10.1586/14787210.2016.1134315.

Ben M’Barek I, Landraud L, Desfrere L, Sallah K, Couffignal C, Schneider M, Mandelbrot L. Contribution of vaginal culture to predict early onset neonatal infection in preterm prelabor rupture of membranes. Eur J Obstet Gynecol Reprod Biol. 2021;261:78–84. doi: 10.1016/J.EJOGRB.2021.04.016.

Kumar M, Saadaoui M, Al Khodor S. Infections and pregnancy: effects on maternal and child health. Front Cell Infect Microbiol. 2022;12:873253. doi: 10.3389/fcimb.2022.873253.

Richardson AN, Pollak EA, Williams D, Smith MA. Intrauterine infection. In: Comprehensive Toxicology, 2nd ed. Amsterdam: Elsevier; 2010. p.239–58. doi: 10.1016/B978-0-08-046884-6.01523-2.

Li N, Wen S, Zhu F, Liu G, Zhu D. Efficacy and safety of an Albuvirtide‑based regimen for preventing mother‑to‑child transmission of multidrug‑resistant HIV: a case report. BMC Pregnancy Childbirth. 2025;25:61. doi: 10.1186/s12884-025-07156-4.

Young G, Jewell D. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database Syst Rev. 2001;2001:CD000225. doi: 10.1002/14651858.cd000225.

US Pharmacist. Infectious diseases in pregnancy [Internet]. [Cited: 23-Apr-2025]. Available at: https://www.uspharmacist.com/article/infectious-diseases-in-pregnancy.

Paizis K. Immunomodulatory drugs in pregnancy and lactation. Aust Prescr. 2019;42:97–101. doi: 10.18773/austprescr.2019.026.

Tincani A, Nalli C, Khizroeva J, Bitsadze V, Lojacono A, Andreoli L, et al. Autoimmune diseases and pregnancy. Best Pract Res Clin Endocrinol Metab. 2019;33:101322. doi: 10.1016/J.BEEM.2019.101322.

Ferreira IJMCF, Sousa F, Vasco EM, Areia ALF, Moura JPAS, Carda J, Ribeiro L. Severe immune thrombocytopenia in pregnancy treated with Eltrombopag – a case report. J Gynecol Obstet Hum Reprod. 2018;47:405–8. doi: 10.1016/J.JOGOH.2018.06.010.

Pollinzi A, Mirdamadi K, Pour NK, Asthana‑Nijjar R, Lee D, Nevo O, Piquette‑Miller M. Decreased expression of P‑glycoprotein in the placenta of women with autoimmune disease. Drug Metab Dispos. 2025;53:100031. doi: 10.1016/J.DMD.2024.100031.

Alkhodier AA, Alsaif AS, Alqntash NH, Alanazi RB, Alotaibi G, Alrashid A. Pregnancy and inflammatory rheumatological diseases: a single‑center retrospective cohort study. Cureus. 2023. doi: 10.7759/cureus.47277.

Mollerach FB, Scolnik M, Catoggio LJ, Rosa J, Soriano ER. Causes of fetal third‑degree atrioventricular block and use of hydroxychloroquine in pregnant women with Ro/La antibodies. Clin Rheumatol. 2019;38:2211–7. doi: 10.1007/s10067-019-04556-8.

Temprano KK, Bandlamudi R, Moore TL. Antirheumatic drugs in pregnancy and lactation. Semin Arthritis Rheum. 2005;35:112–21. doi: 10.1016/J.SEMARTHRIT.2005.05.002.

de Steenwinkel FDO, Dolhain RJEM, Hazes JMW, Hokken‑Koelega ACS. Does prednisone use in pregnant women with rheumatoid arthritis induce insulin resistance in the offspring? Clin Rheumatol. 2023;42:47–54. doi: 10.1007/s10067-022-06347-0.

Colla L, Diena D, Rossetti M, Manzione AM, Marozio L, Benedetto C, Biancone L. Immunosuppression in pregnant women with renal disease: review of the latest evidence in the biologics era. J Nephrol. 2018;31:361–83. doi: 10.1007/s40620-018-0477-3.

Mizejewski GJ. Autoimmune disorders during pregnancy: effects of biomarkers on maternal serum screening and course of disease. Curr Womens Health Rev. 2016;12:95–104. doi: 10.2174/1573404812666160727122345.

Deligiannidis KM, Byatt N, Freeman MP. Pharmacotherapy for mood disorders in pregnancy: a review of pharmacokinetic changes and clinical recommendations for therapeutic drug monitoring. J Clin Psychopharmacol. 2014;34:244–55. doi: 10.1097/JCP.0000000000000087.

Viswanathan M, Middleton JC, Stuebe A, Berkman N, Goulding AN, McLaurin-Jiang S, et al. Maternal, fetal, and child outcomes of mental health treatments in women: a systematic review of perinatal pharmacologic interventions [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021 Apr. Report No.: 21-EHC001. PMID: 33950611.

Abdelhafez MMA, Ahmed KAM, Ahmed NAM, Ismail MH, Bin Mohd Daud MN, Ping NPT, et al. Psychiatric illness and pregnancy: a literature review. Heliyon. 2023;9:e20958. doi: 10.1016/J.HELIYON.2023.E20958.

Gruszczyńska‑Sińczak I, Wachowska K, Bliźniewska‑Kowalska K, Gałecki P. Psychiatric treatment in pregnancy: a narrative review. J Clin Med. 2023;12. doi: 10.3390/jcm12144746.

Beigi RH, Noguchi L, Brown G, Piper J, Watts DH. Performing drug safety research during pregnancy and lactation: biomedical HIV prevention research as a template. J Womens Health (Larchmt). 2016;25:761–6. doi: 10.1089/jwh.2013.4398.

Alwan S, Chambers C. Identifying human teratogens: an update. J Pediatr Genet. 2015;4:39–41. doi: 10.1055/s-0035-1556745.

Aral H, Vecchio‑Sadus A. Lithium: environmental pollution and health effects. In: Encyclopedia of Environmental Health. 2011:116–25. doi: 10.1016/B978-0-444-63951-6.00531-3.

Helbock MJ. How does the FDA classify teratogenic drugs? Melinda J. Helbock, APC San Diego [Internet]. [Cited: 24-Apr-2025]. Available at: https://www.helbocklaw.com/fda-classify-teratogenic-drugs/.

Barr KL. Vertical transmission of positive‑sense single‑stranded RNA viruses in plants as a model for arboviral induced teratogenesis. Curr Opin Virol. 2017;27:42–7. doi: 10.1016/j.coviro.2017.11.010.

Dang A. Real‑world evidence: a primer. Pharmaceut Med. 2023;37:25–36. doi: 10.1007/s40290-022-00456-6.

Mofid S, Bolislis WR, Kühler TC. Real‑world data in the postapproval setting as applied by the EMA and the US FDA. Clin Ther. 2022;44:306–22. doi: 10.1016/J.CLINTHERA.2021.12.010.

Lu MC, Lu JS. Prenatal care. In: Haith MM, Benson JB, Eds. Encyclopedia of Infant and Early Childhood Development. 3‑Volume Set. Cambridge: Academic Press, 2008;2. Pp. 591–604.

Hossin MZ, Kazamia K, Faxén J, Rudolph A, Johansson K, Sandström A, Razaz N. Pre‑existing maternal cardiovascular disease and the risk of offspring cardiovascular disease from infancy to early adulthood. Eur Heart J. 2024. doi: 10.1093/eurheartj/ehae547.

Barrett PM, McCarthy FP, Kublickiene K, Cormican S, Judge C, Evans M, et al. Adverse pregnancy outcomes and long‑term maternal kidney disease: a systematic review and meta‑analysis. JAMA Netw Open. 2020;3:e1920964. doi: 10.1001/jamanetworkopen.2019.20964.

Merz WM, Fischer‑Betz R, Hellwig K, Lamprecht G, Gembruch U. Pregnancy and autoimmune disease: diseases of the nervous system, connective tissue, and the bowel. Dtsch Arztebl Int. 2022;119:145–56. doi: 10.3238/arztebl.m2021.0353.

Sūdžiūtė K, Murauskienė G, Jarienė K, Jaras A, Minkauskienė M, Adomaitienė V, et al. Pre‑existing mental health disorders affect pregnancy and neonatal outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2020;20. doi: 10.1186/s12884-020-03094-5.

Chandraharan E, Arulkumaran S. Obstetric and intrapartum emergencies: a practical guide to management. Cambridge: Cambridge University Press; 2013.

World Health Organization. Standards for improving quality of maternal and newborn care in health facilities. Geneva: WHO; 2016. 73 p. ISBN:9789241511216.

Albar OH, Maghfuri LMH, Alhadri HYS, Albahli FHF, Bin Omairah MHM, Albahli HMH, et al. Innovations in maternal‑fetal medicine and neonatology: a multidisciplinary approach to enhancing care for high‑risk pregnancies and premature infants. J Ecohumanism. 2024;3:12904–14. doi: 10.62754/joe.v3i8.6155.

World Health Organization. WHO recommendations on antenatal care. Geneva: WHO; 2016. Pp. 172.

Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY, editors. Williams Obstetrics, 25th ed. Sao Paulo: McGraw Hill Brasil; 2021.

Briggs GG, Freeman RK, Towers CV, Forinash AB. Briggs: drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Philadelphia: Lippincott Williams & Wilkins; 2021.

Carter D, Better M, Abbasi S, Zulfiqar F, Shapiro R, Ensign LM. Nanomedicine for maternal and fetal health. Small. 2023. doi: 10.1002/smll.202303682.

Blehar MC, Spong C, Grady C, Goldkind SF, Sahin L, Clayton JA. Enrolling pregnant women: issues in clinical research. Womens Health Issues. 2013 Jan;23(1):e39-45. doi: 10.1016/j.whi.2012.10.003.

Published
2026/02/28
Issue
Vol. 57 No. 1 (2026): Jan-Feb
Section
Review article
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