Table 7.

Latest evidence on the safety of intravitreal anti-VEGF use during pregnancy

Study	Study design	Anti-VEGF agent(s)	Patient details and results	Inference
Polizzi et al. 2015 [67]	Case series (n = 3)	Bevacizumab	All injections in second or third trimester No drug-related adverse events Healthy full-term infants One patient had miscarriage risk factors	Anti-VEGF may be used in later trimesters when benefit outweighs fetal risk Exercise caution, especially in the first trimester
Fossum et al. 2018 [68]	Case series (n = 3)	Ranibizumab	Injections at 8, 10, and 21 weeks post-LMP All delivered healthy babies No developmental malformations	Ranibizumab did not show adverse effects, even in early pregnancy exposure
Ong et al. 2022 [69]	Retrospective study (n = 42 pregnancies)	Ranibizumab, aflibercept	40% (16/41) unaware of pregnancy during injection 81% live births (34/42) 12% miscarriages (5/42), 7% stillbirths (3/42), mostly in high-risk pregnancies	Anti-VEGF may not significantly affect obstetric outcomes Recommend routine pregnancy screening before injections in women of child-bearing age

n number of subjects or patients in the study, VEGF vascular endothelial growth factor, LMP last menstrual period