Local Drug Delivery for Chronic Venous Disease During Pregnancy and the Postpartum Period: Therapeutic Gaps and Opportunities for Biopolymer-Based and Hybrid Polymeric Formulations—A Narrative Review

Chronic venous disease (CVD) often appears or worsens during pregnancy, yet evidence on the efficacy, maternal systemic exposure, and fetal or infant safety of available treatments remains limited. This narrative review, addressed to pharmaceutical scientists, formulation researchers and clinicians, integrates the natural history of CVD in pregnancy and postpartum, clinical data on local and systemic therapies, maternal–fetal–lactational determinants of local delivery, and the status of biopolymer-based and hybrid polymeric formulations for cutaneous and mucosal use, mostly non-invasive. Compression relieves symptoms but did not prevent new varices in a small randomized prevention trial; oral venoactive drugs lack an adequate safety base. In the sources reviewed, in which non-English publications were not specifically sought, no randomized trial of a topical pharmacological agent for lower-limb CVD in pregnancy or the puerperium was identified, and no study measuring milk or infant exposure after topical use of a venous product was identified. Heparin permeates intact human epidermis poorly, and placental transfer favors small, lipophilic, unbound molecules. Hydrogels, nanocarrier reservoirs, minimally invasive microneedles, active textiles and mucoadhesive gels each address a different compartment, but their evidence is preclinical or limited to non-pregnant adults. A pregnancy-adapted target product profile is proposed, and the principal exposure-related evidence gaps are identified.