Table 1.

Management strategies for hypercalcemia, including safety in pregnancy

Management strategy	Medications	Pregnancy category
Forced diuresis	Frusemide	C Theoretical risk hypovolemia, uteroplacental insufficiency
Reduced GI absorption	Prednisolone Cellulose phosphate	A (consider alternative in T1) Not available in Australia. Not in database
Reduction of bone turnover	Bisphosphonate, i.e., Pamidronate	B3 Bilateral talipes equinovarus, LBW, shortened GA, spontaneous abortion, transient hypocalcemia in newborn with exposure during pregnancy. Concern regarding interference with fetal bone modeling and development, availability of calcium, and maternal hypocalcemia if used in T3
CYP450 inhibition	Fluconazole Ketoconazole	D Higher continuous daily doses associated with congenital malformations and increased risk of miscarriage B3 limited data
Calcitonin		B2 limited data Does not cross placenta in animal studies

GA, gestational age; LBW, low birth weight; T, trimester.