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Only tadalafil and sildenafil were reported as used in pregnancy. Two studies using tadalafil and eight sildenafil. Nine of ten studies were assessed at having of low risk of bias. PDE\u20105i use was associated with an increased risk of headaches (RR 1.41, 95% CI 0.97\u20132.05), flushing (RR 2.59, 95% CI 0.69\u20139.90) and nasal bleeding (RR 10.53, 95% CI 1.36\u201381.3); an increase in vaginal birth when used for non\u2010fetal growth restriction (FGR) indications (RR 1.24, 95% CI 1.00\u20131.55) and a reduction in risk of operative birth for intrapartum fetal compromise (RR 0.58, 95% CI 0.38\u20130.88). There was no evidence of any increase in risk of perinatal death (RR 0.89, 95% CI 0.56\u20131.43). However, use for the treatment of FGR increased the risk of persistent pulmonary hypertension of the newborn (PPHN) (RR 2.52, 95% CI 1.00\u20136.32).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This meta\u2010analysis suggests PDE\u20105i use in pregnancy is associated with mild maternal side effects and lower risk of operative birth for intrapartum fetal distress. Prolonged use for the treatment of FGR may increase the risk of PPHN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>PDE\u20105i use in pregnancy is associated with mild maternal side effects, lower operative birth for intrapartum fetal distress and a possible increase in persistent pulmonary hypertension of the newborn when used for the treatment of fetal growth restriction.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17163","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T10:39:25Z","timestamp":1648636765000},"page":"1817-1831","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Phosphodiesterase\u20105 inhibitors in pregnancy: Systematic review and meta\u2010analysis of maternal and perinatal safety and clinical 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