Table 7.

Fetal risk of medical therapy.

Medication Class		FDA Pregnancy Category	Recommendation during Pregnancy	Recommendation during Lactation
Calcium Channel blocker	Nifedipine		Crosses placenta	Present in breast milk. Limited use. Acceptable when relative infant dose is below 10% [14]
	Diltiazem		Avoid	Avoid
PDE5i	Sildenafil	B	Benefit: avoid HF, stroke, preterm delivery, and maternal/fetal death. Risk: May cause fetal growth restriction.	Present in breast milk.
	Tadalafil	B	data
ERA	Bosentan		Contraindicated	Unknown
	Ambrisentan	X
	Macitentan
Prostacyclin or Prostacyclin analogue	Iloprost	C	Benefit vs. Risk	Unknown, not recommended
	Epoprostenol	Not assigned	Benefit vs. Risk	Unknown, use with caution
	Treprostinil	C (oral), B (inhaled), Not assigned (parental)	Benefit vs. risk	Unknown, use with caution
	Selexipag	Not assigned	Limited data	Not recommended
Guanylate cyclase stimulator	Riociguat	X	Contraindicated	Contraindicated
Digoxin		C		Use with caution
Diuretics		C	Continue	Continue
MRA	Spironolactone Eplerenone	C C	Contraindicated	Avoid
Oxygen			SpO2 above 95%

ERA = endothelin receptor antagonist; MRA = mineraloid receptor agonist; PDE5i = Phosphodiesterase 5 inhibitor.