Table 4.

Other drugs for pregnant CKD women

Drug	Characteristics	FDA
Usually considered as safe, when needed
Acetyl salicylate	Low doses during pregnancy needed for the treatment of diverse medical conditions have not been shown to cause foetal harm; may be protective against pre-eclampsia, favoring placentation (see text); discontinuation before delivery is recommended [161–163, 223, 224]	NC
LMWH	Low molecular-weight heparin (LMWH) does not cross the placenta and is safe for the foetus, although bleeding at the utero-placental junction cannot be rued out. Individualized doses of LMWH are well tolerated and safe for prophylaxis and treatment of thromboembolic complications during pregnancy, and post-partum [355]. Twice-daily heparin should be discontinued prior to induction of labour or planned cesarean delivery and can be resumed after delivery [355, 356]	C
ESAs	In vitro studies suggest that recombinant erythropoietin does not cross the human placenta; higher doses may be needed in dialysis patients [357, 358]	C
Allopurinol	Adverse events were observed in animal studies. Allopurinol crosses the placenta [359]. An increased risk of malformations events has not been observed in humans (limited data) [360]	C
Vitamin D	The role for vitamin D supplementation in pregnancy is controversial, but there is no evidence of a reduction in adverse pregnancy outcomes (e.g., preeclampsia, stillbirth, neonatal death) [361] or improvement in bone mineral content in children in studies in which supplementation was given independently from blood levels [362]. Cholecalciferol (vitamin D3) crosses the placenta but the transfer to the foetus from the mother is low. Maternal supplementation has not been shown to affect pregnancy outcomes [363]. Ergocalciferol Adverse events were observed in animal studies. The ergocalciferol (vitamin D2) metabolite, 25(OH) D, crosses the placenta; maternal serum concentrations correlate with foetal concentrations at birth. Calcitriol Teratogenic effects have been observed in animal studies. Adverse effects on foetal development were not observed in women (N = 9) with pseudovitamin D-dependent rickets. Paricalcitol Adverse events were observed in some animal reproduction studies Vitamin D deficiency in a pregnant woman may lead to deficiency in the neonate [364, 365]. Serum 25(OH) D concentrations should be measured in pregnant women at increased risk of deficiency [366]. Current guidelines recommend an intake of 1000–2000 units/day until more safety data is available [366, 367]. Vitamin D and calcium levels should be monitored and kept in the lower normal range	C

FDA Classification [340]: A, controlled human studies show no risk; B, no evidence of risk in studies; C, risk cannot be ruled out; D, positive evidence of risk; X, contraindicated in pregnancy; NC, not classified