Which antiarrhythmic is contraindicated in pregnancy due to neonatal bradycardia and prolonged QT?

Which antiarrhythmic is contraindicated in pregnancy due to neonatal bradycardia and prolonged QT?

• A. Adenosine
• B. Procainamide
• C. Amiodarone
• D. Quinidine

Answer: (C)

Amiodarone is avoided in pregnancy because it crosses the placenta and can cause significant effects in the fetus, notably neonatal bradycardia and prolongation of the QT interval. This combination raises the risk of dangerous arrhythmias after birth, making amiodarone contraindicated when safer options are available. Additional concerns with amiodarone, like iodine-related thyroid effects and potential pulmonary toxicity, add to why it’s avoided in pregnancy. By contrast, adenosine is used for acute conversion of SVT and has a very short half-life with minimal fetal impact, while procainamide and quinidine have their own maternal–fetal risks (such as lupus-like syndrome with procainamide and QT prolongation with quinidine) but do not carry the same strong association with neonatal bradycardia and prolonged QT as amiodarone.

Amiodarone is avoided in pregnancy because it crosses the placenta and can cause significant effects in the fetus, notably neonatal bradycardia and prolongation of the QT interval. This combination raises the risk of dangerous arrhythmias after birth, making amiodarone contraindicated when safer options are available. Additional concerns with amiodarone, like iodine-related thyroid effects and potential pulmonary toxicity, add to why it’s avoided in pregnancy. By contrast, adenosine is used for acute conversion of SVT and has a very short half-life with minimal fetal impact, while procainamide and quinidine have their own maternal–fetal risks (such as lupus-like syndrome with procainamide and QT prolongation with quinidine) but do not carry the same strong association with neonatal bradycardia and prolonged QT as amiodarone.