USE OF ADENOSINE IN PREGNANCY

Adenosine is an endogenous purine nucleoside present in all cells of the body. Exogenous adenosine is used in the acute management of paroxysmal supraventricular tachycardias (SVT), including those associated with accessory-conduction pathways (e.g. Wolff-Parkinson-White syndrome), to aid diagnosis of broad or narrow complex supraventricular tachycardias, and as a coronary vasodilator used in conjunction with radionuclide myocardial perfusion imaging.  Adenosine has also been administered directly to fetuses to treat fetal arrhythmias.

There is limited experience regarding exogenous adenosine use in human pregnancy, with most reported exposures occurring in the second and third trimesters. Adverse fetal outcomes have been occasionally reported following use of adenosine in the management of maternal and fetal arrhythmias. However, these were most likely related to the maternal or fetal condition for which treatment with adenosine was indicated, rather than being a direct consequence of adenosine exposure.

Left untreated, maternal SVT may have detrimental effects on both the mother and the fetus. If clinically indicated, adenosine should not be withheld on account of pregnancy.

Exposure to adenosine at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.