In general, desmopressin (DDAVP) appears to be an effective, nonteratogenic drug for the treatment of diabetes insipidus (DI) during pregnancy. Unlike structurally related vasopressin, DDAVP does not appear to increase the frequency or amplitude of uterine contractions.

Three cases, in which DDAVP (to treat DI) was possibly associated with neonatal abnormalities, have been reported. The abnormalities included coarctation of the aorta, patent ductus arteriosus, pulmonary stenosis (case 1), trisomy 21, kyphoscoliosis, lordosis, clubfeet, endocardial cushion defect (case 2), failure to thrive, hypotonia, small stature, and retarded gross motor development (case 3). As the three infants presented with widely differing clinical appearance, it is difficult to implicate DDAVP as the causative agent in these cases.

There have been many reports in which vasopressin or DDAVP was used safely to treat DI during human pregnancy. A recent Swedish study retrospectively reviewed the records of 29 infants whose mothers had received DDAVP during pregnancy for DI. Pregnancy duration and birth weight distributions were normal. Pregnancy outcome was normal except for possible intrauterine growth disturbances in three infants. One infant was born with a simian lines and a ventricular septum defect with a patent ductus arteriosus. This child died at age 14 years from a hypophyseal disease. The observation of one malformed infant among 29 born yields a risk of 3.4%, which was below the population risk of 4.5%. The statistical power of this study is low, but it is the largest published study to date. The authors concluded that maternal DI and treatment with DDAVP during pregnancy does not constitute a major risk.

There appears to be a decrease in the plasma concentration of vasopressin during the first and second trimesters, and a 3-fold increase in the plasma concentration of vasopressin in the last trimester and during labor.

Desmopressin (DDAVP) has been assigned to pregnancy category B by the FDA. Animal data have failed to reveal evidence of fetotoxicity or teratogenicity. There have been many reports of the safe use of DDAVP to treat diabetes insipidus (DI) in pregnant women, but there have also been rare cases in which the drug was possibly related to neonatal defects. There are no controlled data in human pregnancy. Desmopressin is only recommended for use during pregnancy when benefit outweighs risk.

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The breast milk concentration of DDAVP in one woman who had received 10 mcg of DDAVP BID was less than 1 ng/L 3 days after the last dose. The associated maternal plasma level was approximately 1 ng/L. When given a single 10 mcg dose, the maximum maternal plasma concentration at 40 minutes was 7 ng/L. The breast milk concentration of desmopressin remained less than 1.5 ng/L for 240 minutes when her plasma was assayed.

Patients receiving vasopressin or other structurally related polypeptides have breast-fed without apparent adverse effects on nursing infants. The manufacturer recommends caution when desmopressin is administered to a nursing woman.

Desmopressin is excreted into human milk in low concentrations. There have been no reports of adverse effects of desmopressin in nursing infants. The manufacturer recommends that caution be used when administering desmopressin to nursing women.

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