Pituitary Hormone
PREGNANCY RECOMMENDATION: Compatible
BREASTFEEDING RECOMMENDATION: Compatible
PREGNANCY SUMMARY
No reports linking the use of vasopressin with congenital defects have been located. Vasopressin and the structurally related synthetic polypeptides desmopressin and lypressin have been used during pregnancy to treat diabetes insipidus, a rare disorder (1–11). Desmopressin has also been used at delivery in three women for the management of von Willebrand’s disease (12). No adverse effects on the newborns were reported.
FETAL RISK SUMMARY
A threefold increase of circulating levels of endogenous vasopressin has been reported for women in the last trimester and in labor as compared with nonpregnant women (13). Although infrequent, the induction of uterine activity in the 3rd trimester has been reported after IM and intranasal vasopressin use (14). The IV use of desmopressin, which is normally given intranasally, has also been reported to cause uterine contractions (4).
Two investigators speculated that raised levels of vasopressin resulted from hypoxemia and acidosis and could produce signs of fetal distress (bradycardia and meconium staining) (15).
A 1995 reference described the use of desmopressin during pregnancy in 42 women with diabetes insipidus, 29 of whom received the drug throughout the whole pregnancy (16). One patient, treated with vasopressin during the first 6 months and then changed to desmopressin, delivered an infant who had a ventricular septal defect, a patent ductus arteriosus, and simian lines. The child died at age 14 years because of hypophyseal disease. Three of the infants exposed throughout gestation to desmopressin had birth weights close to or outside of the 99% confidence interval (two low and one high). The authors concluded that the use of desmopressin throughout pregnancy did not constitute a major fetal risk (16).
Diabetes insipidus developed in a 14-year-old girl at 33 weeks’ gestation with resulting oligohydramnios and an amniotic fluid index of 0 (17). She was treated with intranasal desmopressin (10 mcg twice daily) with rapid resolution of the oligohydramnios and eventual, spontaneous delivery of a healthy 2700-g male infant at 38 weeks.
BREASTFEEDING SUMMARY
Patients receiving vasopressin, desmopressin, or lypressin for diabetes insipidus have been reported to breastfeed without apparent problems in the infant (1,2). Experimental work in lactating women suggests that suckling almost doubles the maternal blood concentration of vasopressin (13).
References
1.Hime MC, Richardson JA. Diabetes insipidus and pregnancy. Obstet Gynecol Surv 1978;33:375–9.
2.Hadi HA, Mashini IS, Devoe LD. Diabetes insipidus during pregnancy complicated by preeclampsia. A case report. J Reprod Med 1985;30:206–8.
3.Phelan JP, Guay AT, Newman C. Diabetes insipidus in pregnancy: a case review. Am J Obstet Gynecol 1978;130:365–6.
4.van der Wildt B, Drayer JIM, Eske TKAB. Diabetes insipidus in pregnancy as a first sign of a craniopharyngioma. Eur J Obstet Gynecol Reprod Biol 1980;10:269–74.
5.Ford SM Jr. Transient vasopressin-resistant diabetes insipidus of pregnancy. Obstet Gynecol 1986;68:288–9.
6.Ford SM Jr, Lumpkin HL III. Transient vasopressin-resistant diabetes insipidus of pregnancy. Obstet Gynecol 1986;68:726–8.
7.Rubens R, Thiery M. Case report: diabetes insipidus and pregnancy. Eur J Obstet Gynecol Reprod Biol 1987;26:265–70.
8.Hughes JM, Barron WM, Vance ML. Recurrent diabetes insipidus associated with pregnancy: pathophysiology and therapy. Obstet Gynecol 1989;73:462–4.
9.Goolsby L, Harlass F. Central diabetes insipidus: a complication of ventriculoperitoneal shunt malfunction during pregnancy. Am J Obstet Gynecol 1996;174:1655–7.
10.Stubbe E. Pregnancies in diabetes insipidus. Geburtsh und Frauenheilk 1994;54:111–3.
11.Ray JG. DDAVP use during pregnancy: an analysis of its safety for mother and child. Obstet Gynecol Surv 1998;53:450–5.
12.Swanbeck J, Baxi L, Hurlet AM. DDAVP in the management of Von Willebrand’s disease in pregnancy (abstract). Am J Obstet Gynecol 1992;166:427.
13.Robinson KW, Hawker RW, Robertson PA. Antidiuretic hormone (ADH) in the human female. J Clin Endocrinol Metab 1957;17:320–2.
14.Oravec D, Lichardus B. Management of diabetes insipidus in pregnancy. Br Med J 1972;4:114–5.
15.Gaffney PR, Jenkins DM. Vasopressin: mediator of the clinical signs of fetal distress. Br J Obstet Gynaecol 1983;90:987.
16.Kallen BA, Carlsson SS, Bengtsson BKA. Diabetes insipidus and use of desmopressin (Minirin) during pregnancy. Eur J Endocrinol 1995;132:144–6.
17.Hanson RS, Powrie RO, Larson L. Diabetes insipidus in pregnancy: a treatable cause of oligohydramnios. Obstet Gynecol 1997;89:816–7.