Are alpha-2 agonists contraindicated in pregnancy?

• A. True
• B. False
• C. Not studied
• D. Only nursing mothers

Answer: (B)

The main idea is how safe these drugs are during pregnancy and how we decide if a medication should be avoided. Alpha-2 adrenergic agonists used for glaucoma, like brimonidine and apraclonidine, are not categorically prohibited in pregnancy. There isn’t solid, consistent evidence showing they cause fetal harm at the low systemic exposure that comes from topical eye drops, so they can be considered when the benefit to the mother outweighs any potential risk to the fetus. In practice, this means they may be used with caution, ideally in consultation with the obstetric team, and with awareness of the small possibility of systemic effects if exposure is higher (for example, near delivery). They’re not universally contraindicated in pregnancy, though many clinicians may avoid them late in pregnancy due to rare reports of neonatal hypotension or bradycardia with systemic absorption. The other options imply absolute prohibition, lack of data, or restriction only to nursing mothers, which don’t fit the clinical nuance that these drugs aren’t outright contraindicated.