Intravitreal anti-vascular endothelial growth factor medications during pregnancy: current perspective
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REVIEW
Intravitreal anti-vascular endothelial growth factor medications during pregnancy: current perspective Morteza Naderan . Masomeh Sabzevary . Keivan Rezaii . Ali Banafshehafshan . Seddigheh Hantoushzadeh
Received: 15 May 2020 / Accepted: 1 October 2020 Ó Springer Nature B.V. 2020
Abstract Purpose Anti-vascular endothelial growth factor (VEGF) medications are widely used for treatment of a number of vitreoretinal disorders. However, the evidence for their effect on fetal and maternal health during pregnancy is very limited. The goal of this article is to accumulate evidence for the indications of anti-VEGF medications during pregnancy and their effects on maternal and fetal health.
M. Naderan (&) K. Rezaii A. Banafshehafshan Department of Ophthalmology, Farabi Eye Hospital Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar street, Tehran, Iran e-mail: [email protected] K. Rezaii e-mail: [email protected] A. Banafshehafshan e-mail: [email protected] M. Sabzevary Maternal, Fetal, and Neonatal Research Center, Yas Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran e-mail: [email protected]
Methods Review of literature regarding anti-VEGF administration during pregnancy and using PubMed database without language or date limit. Results The main indications for treatment with intravitreal anti-VEGF medications include choroidal neovascularization (CNV) followed by retinal vascular occlusion (RVO) and complications of diabetes such as neovascular glaucoma, diabetic retinopathy (DR) and diabetic macular edema (DME). Among anti-VEGF medications, only ranibizumab and bevacizumab have been used during pregnancy with latter by far more than the former. Conclusion Women of childbearing age should be consulted regarding the potential adverse effects of anti-VEGF medications on fetal health and the risk of early pregnancy loss. They should be strongly encouraged to use appropriate contraceptive methods during treatment. A timely obstetrics consultation may help in this situation. Attempt for pregnancy should be withheld for at least 3 months following last injection of ranibizumab and aflibercept, and for at least 6 months following last injection of bevacizumab. Keywords Anti-VEGF Anti-vascular endothelial growth factor Anti-VEGF in pregnancy Ranibizumab in pregnancy Bevacizumab in pregnancy
S. Hantoushzadeh Maternal, Fetal, and Neonatal Research Center, Valiasr Hospital, Imam Khomeini Hospital Complexs, Tehran University of Medical Sciences, Tehran, Iran e-mail: [email protected]
123
Int Ophthalmol
Introduction
Results
The use of anti-vascular endothelial growth factor medications (anti-VEGFs) has gained popularity in several ocular conditions, specifically vitreoretinal and choroidal disorders [1–15]. In fact, anti-VEGFs are so effective and widely available that their administration, either as off-label or approved indication has become first line
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