Abstract
Background: The use of vascular endothelial growth factor (VEGF) inhibitors may cause fetal harm and systemic side effects in the mother, so these drugs are contraindicated in pregnancy. We report a case of inadvertent administration of two intravitreal bevacizumab injections in a woman with diabetes mellitus type 1, 5 days before ovulation (±3 days) and during the 5th gestational week, respectively. The patient had a past history of both miscarriage and requirement for cesarean section for preeclampsia.
Methods: Observational case report.
Results: The patient did not have any drug-related adverse event and delivered a healthy full-term infant, reaching all developmental milestones appropriately during infancy.
Conclusions: Intravitreal drug injections did not result in any detectable adverse event in the mother and infant although she had a significant past obstetric history. However, there have been no studies evaluating the effects of bevacizumab in pregnant women and suggesting that intravitreal drug injection in this patient is safe. Until more is known about this, it seems reasonable to avoid treatment with this drug a few weeks before and during pregnancy.
Conflict of interest statement
Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
References
1. Tarantola RM, Folk JC, Boldt HC, Mahajan VB. Intravitreal bevacizumab during pregnancy. Retina 2010;30:1405–11.10.1097/IAE.0b013e3181f57d58Search in Google Scholar
2. Final labeling text, highlights of prescribing information. U.S.BL 125085/168 Amendment: Bevacizumab – Genentech, Inc. Updated July 2009. South San Francisco, CA: Genentech, Inc. Available at: www.gene.com/gene/products/information/pdf/avastinprescribing.pdf. Accessed on September 10, 2010.Search in Google Scholar
3. Almawi WY, Saldanha FL, Mahmood NA, Al-Zaman I, Sater MS, Mustafa FE. Relationship between VEGFA polymorphisms and serum VEGF protein levels and recurrent spontaneous miscarriage. Hum Reprod 2013;28:2628–35.10.1093/humrep/det308Search in Google Scholar
4. Ferrara N. Role of vascular endothelial growth factor in regulation of physiological angiogenesis. Am J Physiol Cell Physiol 2001;280:C1358–66.10.1152/ajpcell.2001.280.6.C1358Search in Google Scholar
5. Gooldman C, Jeyendran RS, Coulam CB. Vascular endothelial growth factor gene polymorphism and implantation failure. Reprod Biomed Online 2008;16:720–3.10.1016/S1472-6483(10)60487-7Search in Google Scholar
6. Vuorela P, Carpen O, Tulppala M, Halmesmaki E. VEGF, its receptors and the tie receptors in recurrent miscarriage. Mol Hum Reprod 2000;6:276–82.10.1093/molehr/6.3.276Search in Google Scholar PubMed
7. Petrou P, Georgalas I, Giavaras G, Anastasiou E, Ntana Z, Petrou C. Early loss of pregnancy after intravitreal bevacizumab injection. Acta Ophthalmol 2010;88:e136.10.1111/j.1755-3768.2009.01572.xSearch in Google Scholar PubMed
8. Gómez. Neovascular membrane and pregnancy. Treatment with bevacizumab. Arch Soc Esp Oftalmol. 2013;88:453–4.Search in Google Scholar
9. Granger JP. Vascular endothelial growth factor inhibitors and hypertension: a central role for the kidney and endothelial factors? Hypertension 2009;54:465–7.10.1161/HYPERTENSIONAHA.109.132274Search in Google Scholar PubMed PubMed Central
10. Wu Z, Huang J, Sadda S. Inadvertent use of bevacizumab to treat choroidal neovascularisation during pregnancy: a case report. Ann Acad Med Singapore 2010;39:143.10.47102/annals-acadmedsg.V39N2p143Search in Google Scholar
11. Cross SN, Ratner E, Rutherford TJ, Schwartz PE, Norwitz ER. Bevacizumab-mediated interference with VEGF signaling is sufficient to induce a preeclampsia-like syndrome in nonpregnant women. Rev Obstet Gynecol 2012;5:2–8.Search in Google Scholar
12. Sullivan L, Kelly SP, Glenn A, Williams CP, McKibbin M. Intravitreal bevacizumab injection in unrecognised early pregnancy. Eye (Lond) 2014;28:492–4.10.1038/eye.2013.311Search in Google Scholar PubMed PubMed Central
13. Introini U, Casalino G, Cardani A, Scotti F, Finardi A, Candiani M, et al. Intravitreal bevacizumab for a subfoveal myopic choroidal neovascularization in the first trimester of pregnancy. J Ocul Pharmacol Ther 2012;28:553–5.10.1089/jop.2012.0067Search in Google Scholar PubMed
14. Matsuyama K, Ogata N, Matsuoka M, Wada M, Takahashi K, Nishimura T. Plasma levels of vascular endothelial growth factor and pigment epithelium-derived factor before and after intravitreal injection of bevacizumab. Br J Ophthalmol 2010;94:1215–8.10.1136/bjo.2008.156810Search in Google Scholar PubMed
15. Zehetner C, Kirchmair R, Huber S, Kralinger MT, Kieselbach GF. Plasma levels of vascular endothelial growth factor before and after intravitreal injection of bevacizumab, ranibizumab and pegaptanib in patients with age-related macular degeneration, and in patients with diabetic macular oedema. Br J Ophthalmol 2013;97:454–9.10.1136/bjophthalmol-2012-302451Search in Google Scholar PubMed
16. Direkvand-Moghadam A, Khosravi A, Sayehmiri K. Predictive factors for preeclampsia in pregnant women: a Receiver Operation Character approach. Arch Med Sci 2013;9:684–9.10.5114/aoms.2013.36900Search in Google Scholar PubMed PubMed Central
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