title: The use of bisphosphonates in women prior to or during pregnancy and lactation.
abstract: OBJECTIVE
  The unique pharmacokinetics of bisphosphonates (BPs) in conjunction with their use by an increasing number of women at reproductive age has raised serious concerns about their safety during pregnancy and lactation. Bisphosphonates cross the placenta. Animal studies have shown adverse effects on both the fetus and the mother, mostly at doses much higher than those commonly used in humans. Protracted parturition, maternal mortality, embryolethality, severe general underdevelopment and marked skeletal retardation of the fetuses (increased amount of diaphyseal bone trabeculae, decreased diaphyseal length), small fetal weight and abnormal tooth growth have been observed.
  
  
  METHODS
  We conducted a thorough research of the literature in order to identify human studies concerning this issue.
  
  
  RESULTS
  We identified a total of 78 cases involving fetuses whose mothers had been exposed to BPs before conception or during pregnancy, along with 7 cases of BPs exposure prior to or during lactation. The vast majority of mothers and infants did not demonstrate serious adverse effects. However, there were cases of shortened gestational age, low neonatal birth weight and transient hypocalcaemia of the newborns, while the very few reported cases of spontaneous abortions and congenital anomalies probably resulted from maternal underlying diseases and concomitant medication.
  
  
  CONCLUSIONS
  The administration of bisphosphonates in pregnancy should be assessed in view of their potential hazardous effects on both mother and fetus. In cases of absolute or relative indications of BPs prior to pregnancy, close observation of the mother and the infant, especially during the first two weeks of life, is imperative for the successful outcome of pregnancy.
authors.affiliation: Laboratory for the Research of Musculoskeletal System Th. Garofalidis, KAT Hospital, Athens, Greece. stournis@med.uoa.gr
authors.forename: Ioannis P
authors.initials: IP
authors.lastname: Stathopoulos
authors.forename: Chrysoula G
authors.initials: CG
authors.lastname: Liakou
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Katsalira
authors.forename: George
authors.initials: G
authors.lastname: Trovas
authors.forename: George G
authors.initials: GG
authors.lastname: Lyritis
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Papaioannou
authors.forename: Symeon
authors.initials: S
authors.lastname: Tournis
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation / Q000187:drug effects* / Q000502:physiology; D008431:Maternal-Fetal Exchange / Q000187:drug effects / Q000502:physiology; D010024:Osteoporosis / Q000188:drug therapy; D011247:Pregnancy / Q000187:drug effects*; D011248:Pregnancy Complications / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates