Abstract：
Although desmopressin (DDAVP) is an accessible and inexpensive hemostatic drug, its use in pregnancy is still debated due to safety uncertainties.
We aimed to review the safety and effectiveness of DDAVP in women with an inherited bleeding disorder during pregnancy and delivery.
Databases were searched for articles up to July 25, 2022, reporting maternal and/or neonatal outcomes. PRISMA methodology for systematic reviews and meta-analyses was followed (PROSPERO CRD42022316490).
Fifty-three studies were included, comprising 273 pregnancies. Regarding maternal outcomes, DDAVP was administered in 73 women during pregnancy and in 232 during delivery. Safety outcome was reported in 245 pregnancies, with severe adverse events reported in 2 (1%, hyponatremia with neurologic symptoms). Overall, DDAVP was used as monotherapy in 234 pregnancies, with effectiveness reported in 153 pregnancies (82% effective; 18% ineffective). Regarding neonatal outcomes, out of 60 pregnancies with reported neonatal outcomes after DDAVP use during pregnancy, 2 children (3%) had a severe adverse event (preterm delivery n = 1; fetal growth restriction n = 1). Of the 232 deliveries, 169 neonates were exposed to DDAVP during delivery, and in 114 neonates, safety outcome was reported. Two children (2%) experienced a moderate adverse event (low Apgar score n = 1; transient hyperbilirubinemia not associated with DDAVP n = 1).
DDAVP use during pregnancy and delivery seems safe for the mother, with special attention to the occurrence of hyponatremia and for the child, especially during delivery. However, due to poor study designs and limited documentation of outcomes, a well-designed prospective study is warranted.
We aimed to review the safety and effectiveness of DDAVP in women with an inherited bleeding disorder during pregnancy and delivery.
Databases were searched for articles up to July 25, 2022, reporting maternal and/or neonatal outcomes. PRISMA methodology for systematic reviews and meta-analyses was followed (PROSPERO CRD42022316490).
Fifty-three studies were included, comprising 273 pregnancies. Regarding maternal outcomes, DDAVP was administered in 73 women during pregnancy and in 232 during delivery. Safety outcome was reported in 245 pregnancies, with severe adverse events reported in 2 (1%, hyponatremia with neurologic symptoms). Overall, DDAVP was used as monotherapy in 234 pregnancies, with effectiveness reported in 153 pregnancies (82% effective; 18% ineffective). Regarding neonatal outcomes, out of 60 pregnancies with reported neonatal outcomes after DDAVP use during pregnancy, 2 children (3%) had a severe adverse event (preterm delivery n = 1; fetal growth restriction n = 1). Of the 232 deliveries, 169 neonates were exposed to DDAVP during delivery, and in 114 neonates, safety outcome was reported. Two children (2%) experienced a moderate adverse event (low Apgar score n = 1; transient hyperbilirubinemia not associated with DDAVP n = 1).
DDAVP use during pregnancy and delivery seems safe for the mother, with special attention to the occurrence of hyponatremia and for the child, especially during delivery. However, due to poor study designs and limited documentation of outcomes, a well-designed prospective study is warranted.
摘要：
背景：尽管去氨加压素（DDAVP）是一种容易获得且廉价的止血药物，由于安全性的不确定性，其在怀孕期间的使用仍存在争议。
目的：我们旨在回顾DDAVP在妊娠和分娩期间患有遗传性出血性疾病的妇女中的安全性和有效性。
方法：数据库搜索了截至2022年7月25日的文章，报告了产妇和/或新生儿的结局。遵循PRISMA方法(PROSPEROCRD42022316490)。
结果：纳入了53项研究，包括273次怀孕。关于产妇结局，在怀孕期间的73例妊娠和分娩期间的232例妊娠中施用了DDAVP。在245例怀孕中报告了安全性结果，2例报告严重不良事件（1％；低钠血症伴神经系统症状）。总的来说,DDAVP在234例妊娠中用作单一疗法，在153例妊娠中报告了有效性（82％有效；18％无效）。关于新生儿结局，在怀孕期间使用DDAVP后报告新生儿结局的60例孕妇中，2例儿童(3%)发生严重不良事件(早产n=1;胎儿生长受限n=1).在232个交付中，169例新生儿在分娩期间暴露于DDAVP，114例新生儿暴露于DDAVP，报告了安全性结果.两名儿童（2％）经历了中度不良事件（低Apgar评分n=1；与DDAVP无关的短暂性高胆红素血症n=1）。
结论：在怀孕和分娩期间使用DDAVP对于母亲和孩子来说似乎是安全的，特别注意低钠血症的发生，特别是在交付过程中。然而,由于糟糕的研究设计和有限的结果记录，有必要进行精心设计的前瞻性研究.
目的：我们旨在回顾DDAVP在妊娠和分娩期间患有遗传性出血性疾病的妇女中的安全性和有效性。
方法：数据库搜索了截至2022年7月25日的文章，报告了产妇和/或新生儿的结局。遵循PRISMA方法(PROSPEROCRD42022316490)。
结果：纳入了53项研究，包括273次怀孕。关于产妇结局，在怀孕期间的73例妊娠和分娩期间的232例妊娠中施用了DDAVP。在245例怀孕中报告了安全性结果，2例报告严重不良事件（1％；低钠血症伴神经系统症状）。总的来说,DDAVP在234例妊娠中用作单一疗法，在153例妊娠中报告了有效性（82％有效；18％无效）。关于新生儿结局，在怀孕期间使用DDAVP后报告新生儿结局的60例孕妇中，2例儿童(3%)发生严重不良事件(早产n=1;胎儿生长受限n=1).在232个交付中，169例新生儿在分娩期间暴露于DDAVP，114例新生儿暴露于DDAVP，报告了安全性结果.两名儿童（2％）经历了中度不良事件（低Apgar评分n=1；与DDAVP无关的短暂性高胆红素血症n=1）。
结论：在怀孕和分娩期间使用DDAVP对于母亲和孩子来说似乎是安全的，特别注意低钠血症的发生，特别是在交付过程中。然而,由于糟糕的研究设计和有限的结果记录，有必要进行精心设计的前瞻性研究.
