Several drugs cardiologists start routinely are avoided in pregnancy: ACE inhibitors, angiotensin receptor blockers, sacubitril–valsartan, mineralocorticoid receptor antagonists and SGLT2 inhibitors among them. Because many pregnancies are unplanned, the time to raise this is when the prescription is written, not when the patient reports a positive test.
Record the conversation, agree what to do if pregnancy occurs, and involve obstetric cardiology early for women with significant heart disease who are planning a family.
- Ask every woman of reproductive age about contraception before starting a drug avoided in pregnancy
- Agree a plan for what she should do if she becomes pregnant, and record it
- Refer women with significant heart disease who plan pregnancy to obstetric cardiology before conception
Why it matters
Most first-trimester exposures happen before anyone knows the patient is pregnant.
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