Antiarrhythmic Agents During Pregnancy

Abstract

To the Editor.— In a recent QUESTIONS AND ANSWERS section (1981;245:2105), the issue of antiarrhythmic agents in pregnancy was discussed. Four traditional antiarrhythmic agents were recommended for use during pregnancy (quinidine, procainamide hydrochloride, propranolol hydrochloride, and phenytoin sodium). It was stated that since they have been available for so long, any substantial teratogenicity in patients using them on a long-term basis probably would have been observed before now. Phenytoin is a well-known teratogen, with the hydantoin syndrome being described in human newborns. A statement issued jointly by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology suggests that phenytoins be withdrawn if at all possible before pregnancy. Although women who receive them and who have a proved seizure disorder are advised to continue taking them, it would seem reasonable, for cardiac arrhythmias, to substitute another antiarrhythmic agent if possible. There are concerns about the production of