Desmopressin, DDAVP (1-deamino-8-D-arginine vasopressin) is a synthetic analogue of the antidiuretic pituitary hormone, arginine vasopressin. It is established as one of the key therapies for prevention and treatment of bleeding in patients with bleeding disorders such as mild haemophilia A and VWD . The main pharmacological action of DDAVP is a type 2 vasopressin receptor agonist. In vivo, it causes increased factor VIII (FVIII) levels and stimulates the release of von Willebrand factor (VWF) from endothelial cells. It has little activity at type 1 vasopressin receptors found in the uterus and blood vessels . Its use in pregnancy has been and remains controversial. Many Haematologists and Obstetricians remain reluctant to use it in pregnant women due to potential risks of maternal and foetal hyponatraemia as well as the theoretical risk of uterine contraction and preterm labour via its effect on smooth muscle V1 receptors and the risk of intrauterine growth retardation because of its vasopressor effect. DDAVP has been used during pregnancy successfully to prevent and treat bleeding complications in women with bleeding disorders such as type 1 VWD, carriers of haemophilia A and platelet function defects in a growing number of small case series and case reports [3–5].
Desmopressin was first used during pregnancy for the treatment of diabetes insipidus for its antidiuretic effect. A review of literature by Ray (1998) reported 53 cases in 20 publications and showed safe treatment of diabetes insipidus in pregnancy with no maternal or neonatal adverse outcomes . However, the average daily dose of DDAVP used in these cases was 29 μg intranasally (range 7.5–100 μg), which is significantly smaller than the doses of DDAVP needed for haemostatic purposes.
This systematic review aims to report the available clinical evidence associated with the use of DDAVP for prophylaxis and treatment of haemorrhage during pregnancy, delivery and postpartum to help provide a more informed view about the safety of DDAVP in this setting.