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Anti-VEGF treatment in women of reproductive age should consider risks related to unplanned pregnancy

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HAMBURG — Anti-VEGF treatment in women of reproductive age carries the risk of unplanned pregnancy.  Educating the patients on potential treatment-related risks is mandatory in these cases, a speaker said at the Euretina meeting.

“While AMD is found in older population, younger women may develop CNV from various etiologies and macular edema from diabetic retinopathy and retinal vein occlusion,” Monika Gajdosova, MD, said.    

None of the molecules currently available is devoid of risks during embryonic and fetal development, she said.  Serous concentrations are different, and ranibizumab is eliminated from the systemic circulation faster than bevacizumab and aflibercept. On the other hand, the smaller molecule of ranibizumab could have better placental penetration.    

VEGF inhibition during the first trimester of pregnancy carries the risk of affecting  placental circulation and vasculogenesis in the developing embryo, while during the last trimester it increases the risk of pre-eclampsia . The effect increases with multiple injections. 

“A few studies have shown uneventful course of pregnancy with healthy delivery of full term infants. Other studies, however, have reported miscarriage 7-10 days after intravitreal injection of bevacizumab,” Gajdosova said.

Gajdosova reported the case a 27-year-old woman with active choroidal neovascularization of inflammatory origin who was treated with intravitreal bevacizumab.  The treatment resulted in improved visual acuity and reduced central retinal thickness.

 “At the time of 3^rd injection, the patient referred 8 weeks of pregnancy.  We discussed the risks, but the woman decided to keep the baby. We monitored fetal development monthly and luckily VA and OCT findings remained stable, so that no further injection was needed.  Eventually, she delivered a healthy full-term infant,” Gajdosova said.

Disclosure: Gajdosova has no relevant financial disclosure.