There's often a lowering or IOP during pregnancy anyway, so in early glaucoma you can often stop meds and watch them closely. I've had a couple of patients simply tell me that they're not going to take anything until after they're done breast-feeding, so then this is the only option anyway. With a little worse disease, I like to go for laser trabeculoplasty as my first option of treatment.
Big caveat here. I don't have my books with me right now, so if someone has access to a text in front of them, and they disagree with what's here, go with that.
Beta blockers are used systemically for HTN and congenital heart issues (in the mother), and are felt to be generally safe, but with some definite potential issues (respiratory depression, prolonged labor, hypotension, IUGR, fetal bradycardia, to name a few). Timolol does cross the placenta and into breast milk. It's class C in the first trimester and D in the 2nd and 3rd.
Prostaglandins are used to induce labor, and, theoretically, topical prostaglandin analogs could induce early labor. For this reason, I don't like to use them in this situation. They're class C.
Alphagan is a tough one. It's class B, which is good. However, it's also well known for causing respiratory and CNS depression in infants, and it is secreted in breast milk, so if you decided you could use it in pregnancy, you'd want to stop it after delivery.
The CAIs (topical and oral) are class C; there are some limb deformities at high doses with acetazolamide. Acetazolamide is secreted in breast milk, but I don't remember about the topical CAIs.
If I have a patient who has fairly advanced glaucoma, and wishes to get pregnant, but has not yet, then we talk about doing filtering surgery prior to pregnancy, and that's a long, involved discussion.
