Bisphosphonate use and pregnancy complications: insights from the FDA adverse event reporting system (FAERS) database

Abstract

The sustained incorporation of bisphosphonates (BPs) into bone matrix, together with their documented transplacental transfer, raises concerns regarding their use in women of childbearing potential. We conducted a comprehensive evaluation of pregnancy-related adverse events (AEs) associated with BP exposure, utilizing data from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). Methods AEs associated with BP exposure during pregnancy reported to the FAERS between 2004 and 2025 were analyzed. Disproportionality analyses were performed using four standard signal-detection methods: reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC), and empirical Bayesian geometric mean (EBGM). Results A total of 871 pregnancy-related AEs were identified. Alendronate accounted for the majority of exposures (n = 745). Pregnancy-related complications constituted the largest category of AEs (n = 751; 86%), followed by congenital, familial, and genetic disorders (n = 121; 14%), termination of pregnancy and risk of abortion (n = 40; 4.5%), and neonatal disorders (n = 39; 4.5%). AE reporting was higher with intravenous BPs than with oral agents, particularly for neonatal disorders (ROR025 = 3.35), fetal disorders (ROR025 = 2.50), and pregnancy termination or abortion-related events (ROR025 = 2.37). Conclusion BP exposure during pregnancy appears to be associated with an increased risk of pregnancy- and fetal-related complications. Intravenous agents showed higher reporting of pregnancy complications.