The use of the selective phosphodiesterase–5 inhibitor sildenafil during pregnancy, taking into account its possible effect on the fetus
Authors:   Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation, Ovsyannikov F.A. ,   St. Petersburg, Russian Federation, Patiy E.V. ,   Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation; St. Petersburg, Russian Federation, Kosovtsova N.V. ,   Federal State Budgetary Institution “Urals Scientific Research Institute for Maternal and Child Care”; Ekaterinburg, Russian Federation, Zagorodnikova K.A. ,   Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation; St. Petersburg, Russian Federation, Tamakhina O.N. ,   Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation; St. Petersburg, Russian Federation, Zazerskaya I.E. ,   Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation; St. Petersburg, Russian Federation
Published: February 2024

Objective of the Review: To evaluate the possibilities and effectiveness of the use of sildenafil in obstetric practice, its effect on both the fetus and the mother's body. Key points. Sildenafil is a potent vasodilator drug used to treat pulmonary hypertension in adults and children. In addition to the vasodilating effect, sildenafil has a proliferative effect on the vascular network, reduces the muscle mass of the vascular wall. The vasodilating effect of sildenafil also appears on the uterus and myometrial vessels, which leads to increased uterine circulation and thickening of the endometrium. Its use during pregnancy is mainly limited to a few specific indications. In particular, high pulmonary hypertension – is sufficient reason to prescribe this drug off–label even at the stage of pregnancy planning. To date, antenatal therapy with sildenafil for conditions such as preeclampsia, preterm labor, oligohydramnios, congenital diaphragmatic hernia, intranatal fetal distress, and intrauterine growth restriction are being actively studied in many countries. More than 130 in vivo and ex vivo animal studies, pharmacological and toxicokinetic studies have demonstrated the safety of sildenafil. It has been proven that there is no teratogenic effect, as well as an increase in the frequency of congenital anomalies in the fetus. Conclusion. The use of sildenafil during pregnancy is of interest to researchers around the world. Based on preliminary data, it can be assumed that serious side effects in pregnant women, negative effects on the fetus, an increase in the frequency of stillbirths, neonatal deaths and congenital anomalies associated with taking sildenafil were not observed. However, additional fundamental studies are needed, including using experimental animal models, in order to finally evaluate the ability of sildenafil to overcome the transplacental barrier, as well as the possibility and effectiveness of its use in various groups of patients. Keywords: sildenafil, transplacental transfer, safety during pregnancy, pharmacology, hemodynamics.