How do you decide on when to start or continue anti-VEGF injections during pregnancy?

The safety of anti-VEGF medications in pregnant women hasn't been adequately evaluated with regard to fetal safety. If at all possible, I don't initiate anti-VEGF injections during pregnancy. If a patient is currently on anti-VEGF therapy and then becomes pregnant, I hold treatment at that point.

Ideally, you'd want to wait until after delivery before initiating or restarting anti-VEGF therapy. If the patient is breastfeeding post-delivery, you may also want to evaluate delaying anti-VEGF therapy. Partnering with the patient and their OB/GYN is important to optimize care in this situation.