Off-label use of drugs in pregnancy: A critical review of guidelines, current practices, and a clinical perspective

Objective The objective of this narrative review was twofold: to delineate the usage patterns of the main off-label drugs during pregnancy (i.e., misoprostol, nifedipine, and corticosteroids) and to offer a medical examiner's perspective on the use of these medications. Methods An extensive review of the literature was performed to assess the off-label use of corticosteroids, nifedipine, and misoprostol in pregnancy. Results Overall, 503 records about the use of off-label medicines during pregnancy were identified. After the exclusion of papers published in languages other than English and experimental studies in animals, 340 studies were considered eligible. Studies with medicines other than corticosteroids, misoprostol, and nifedipine were removed, leaving a total of 240 articles. From the remaining records, 24 reports were not retrieved. The research strategy allowed the final identification of 76 references. Conclusion Off-label drug use in obstetrics has transitioned from being an exception to a routine, scientifically validated practice. While its application is justified by clinical outcomes and international protocols, healthcare providers must navigate a strict framework of ethical and legal responsibility.