Acetazolamide may be safe in pregnant women with intracranial hypertension

This prospective study found that acetazolamide did not increase the risk of spontaneous abortion in pregnant women with intracranial hypertension (IH) and did not lead to major complications in their offspring.

The authors reviewed medicals records and questionnaires to evaluate the IH diagnosis and obstetric history and outcomes of 101 women with IH and the pediatric outcomes of their children. Acetazolamide was used during 63 pregnancies and before 13 weeks of gestation in 50 of these cases. The authors chose 13 weeks as their cutoff since it represents the teratogenic period.

They write that there is a lack of convincing evidence that acetazolamide use during human pregnancy is associated with an adverse or teratogenic effect, even when prescribed prior to the thirteenth week of gestation. They note that in all reported cases, there is no common morphological abnormality as one would expect with a teratogenic agent, and specifically, there are no cases of postaxial limb malformations in human offspring as found in animal models.

They conclude that while liberal use of acetazolamide should be avoided during pregnancy, the drug should remain a treatment option in pregnant women when clinically indicated.