2,397 research outputs found
ACE Inhibitor and Angiotensin Receptor Blocker Use During Pregnancy:Data from the ESC Registry Of Pregnancy and Cardiac Disease (ROPAC)
Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are not recommended during the second and third trimester because of the significant risk of congenital anomalies associated with their use. However, data are scarce, especially regarding their use in the first trimester and about the impact of stopping just before pregnancy. Our study illustrates the profile of the women who used ACE-Is or ARBs during pregnancy and evaluates the impact on perinatal outcomes. The Registry of Pregnancy and Cardiac Disease is a prospective, global registry of pregnancies in women with structural heart disease. Outcomes were compared between women who used ACE-Is or ARBs and those who did not. Multivariable regression analysis was performed to assess the effect of ACE-I or ARB use on the occurrence of congenital anomalies. ACE-Is (n = 35) and/or ARBs (n = 8) were used in 42 (0.7%) of the 5,739 Registry of Pregnancy and Cardiac Disease pregnancies. Women who used ACE-Is or ARBs more often came from a low-or-middle-income country (57% vs 40%, p = 0.021), had chronic hypertension (31% vs 6%, p <0.001), or a left ventricular ejection fraction <40% (33% vs 4%, p <0.001). In the multivariable analysis, ACE-I use during the first trimester was associated with an increased risk of congenital anomaly (odds ratio 3.2, 95% confidence interval 1.0 to 9.6). Therefore, ACE-Is should be avoided during pregnancy, also in the first trimester, because of a higher risk of congenital anomalies. However, there is no need to stop long before pregnancy. Preconception counseling is crucial to discuss the potential risks of these medications, to evaluate the clinical condition and, if possible, to change or stop the medication.</p
Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study
OBJECTIVE: To examine a reported association between use of angiotensin converting enzyme (ACE) inhibitors during the first trimester and risk of malformations in offspring.
DESIGN: A population based, retrospective cohort study linking automated clinical and pharmacy databases including comprehensive electronic medical records.
PARTICIPANTS: Pregnant women and their live born offspring (465,754 mother-infant pairs) in the Kaiser Permanente Northern California region from 1995 to 2008.
MAIN OUTCOME MEASURE: Congenital malformation in live births.
RESULTS: The prevalence of ACE inhibitor use in the first trimester only was 0.9/1000, and the use of other antihypertensive medications was 2.4/1000. After adjustment for maternal age, ethnicity, parity, and obesity, use of ACE inhibitors during the first trimester only seemed to be associated with increased risk of congenital heart defects in offspring compared with normal controls (those with neither hypertension nor use of any antihypertensives during pregnancy) (15/381 (3.9%) v 6232/400,021 (1.6%) cases, odds ratio 1.54 (95% confidence interval 0.90 to 2.62)). A similar association was observed for use of other antihypertensives (28/1090 (2.6%) cases of congenital heart defects, odds ratio 1.52 (1.04 to 2.21)). However, compared with hypertension controls (those with a diagnosis of hypertension but without use of antihypertensives) (708/29,735 (2.4%) cases of congenital heart defects), neither use of ACE inhibitors or of other antihypertensives in the first trimester was associated with increased congenital heart defects risk (odds ratios 1.14 (0.65 to 1.98) and 1.12 (0.76 to 1.64) respectively).
CONCLUSIONS: Maternal use of ACE inhibitors in the first trimester has a risk profile similar to the use of other antihypertensives regarding malformations in live born offspring. The apparent increased risk of malformations associated with use of ACE inhibitors (and other antihypertensives) in the first trimester is likely due to the underlying hypertension rather than the medications
Malformações fetais associadas ao uso de antagonista dos receptores de angiotensina II: Relato de Caso
Introduction: The potential risks related to drug exposure during pregnancy represent a vast chapter in modern obstetrics and data regarding the safety of antihypertensive drugs during pregnancy are relatively scarce. Case report: A 37-year-old patient discovered her fifth pregnancy at our hospital after 26 weeks and 4 days of gestation. She reported a history of hypertension and was currently being treated with Losartan. Hospitalization was recommended for the patient and further evaluation of fetal vitality was performed. On the fourth day an ultrasound was performed, resulting in a severe oligohydramnios, fetal centralization and abnormal ductus venosus. After 36 hours, the newborn died. Pathologic evaluation: At autopsy, the skullcap had large fontanels and deficient ossification. The kidneys were slightly enlarged. A microscopic examination detected underdevelopment of the tubules and the presence of some dilated lumens. Immunohistochemical detection of epithelial membrane antigen was positive. Immunoreactivity of CD 15 was also assayed to characterize the proximal tubules, and lumen collapse was observed in some regions. Discussion: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARAs) are among the most widely prescribed drugs for hypertension. They are often used by hypertensive women who are considering become pregnant. While their fetal toxicity in the second or third trimesters has been documented, their teratogenic effect during the first trimester has only recently been demonstrated. Conclusion: Constant awareness by physicians and patients should be encouraged, particularly in regard to the prescription of antihypertensive drugs in women of childbearing age who are or intend to become pregnant.Introdução: Os riscos relacionados à exposição de drogas durante a gestação representam um vasto capítulo na obstetrícia moderna e dados sobre a segurança de drogas anti-hipertensivas são relativamente escassos. Relato do caso: Paciente de 37 anos, hipertensa crônica, descobriu a gravidez com 26 semanas e 4 dias de gestação. Estava em uso regular de Losartana. Durante avaliação fetal ultrassonográfica, foi relatada a presença de grave oligoâmnio associado ao quadro de centralização fetal com alteração de ducto venoso, e, após 36 horas, verificou-se óbito neonatal. Necrópsia: Observou-se calota craniana com fontanelas amplas e ossificação deficiente. Rins levemente aumentados de volume e, à microscopia, hipodesenvolvimento de túbulos com presença de lúmen dilatado. Imunohistoquímica com expressão em túbulos distais de antígeno epitelial de membrana. Imunoperoxidade com expressão em túbulos proximais de CD 15 em células epiteliais e colapso de alguns lúmens fora observado. Discussão: Inibidores da conversão de angiotensina e antagonistas de receptor de angiotensina estão entre as drogas mais prescritas para hipertensão. Estas drogas são frequentemente prescritas para mulheres em idade fértil e que pretendem engravidar. Enquanto a toxicidade fetal destas, nos segundo e terceiro trimestres, já é conhecida, seus efeitos durante o primeiro trimestre foi apenas recentemente demostrado. Conclusão: A conscientização por parte de médicos e pacientes deve ser realizada de rotina, principalmente no que diz respeito à prescrição e utilização de drogas potencialmente teratogênicas ou fetotóxicas. Este cuidado deve ser redobrado para pacientes que estão em idade reprodutiva e que podem se tornar gestantes em uso rotineiro destas medicações.Universidade Federal de São Paulo (UNIFESP)Maternidade Escola de Vila Nova CachoeirinhaHospital Servidor Publico Estadual de São PauloUniversidade de São PauloUNIFESPSciEL
The Fetal Safety of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers
Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are known to cause fetal renal damage in pregnancy. Due to conflicting reports in the literature, their safety after first trimester exposure has been debated. Our aim was to determine whether the use of ACE inhibitors or ARBs in the first trimester of pregnancy is associated with an increased risk for major malformations or other adverse outcomes. All subjects were prospectively enrolled from among women contacting a teratogen information service. At initial contact, details of maternal medical history and exposures were collected and follow-up interviews were conducted to ascertain pregnancy outcomes. Two comparator groups, women with hypertension treated with other antihypertensives, and healthy controls were also recruited. Baseline maternal characteristics were not different among the three groups. There were no differences in rates of major malformations. Both the ACE-ARBs and disease-matched groups exhibited significantly lower birth weight and gestational ages than the healthy controls (P < 0.001 for both variables). There was a significantly higher rate of miscarriage noted in the ACE/ARB group (P < 0.001). These results suggest that ACE inhibitors/ARBs are not major human teratogens; however, they may be associated with an increased risk for miscarriage
How to assess and manage hypertension during and after pregnancy.
Hypertensive disorders of pregnancy are increasingly important complications
of which clinicians should have an up-to-date knowledge to facilitate prompt recognition,
diagnosis and management. These disorders affect a growing number of pregnancies
worldwide, with incidence rates likely to increase in the future commensurate with increasing
maternal age and maternal comorbidities independent of age, with consequent effects on
maternal and fetal/neonatal morbidity and mortality rates. This article mainly focuses on
management within the UK of these disorders, examining their current working definitions,
detection methods and recent developments in screening tool development. The current
NICE-recommended strategies for treating these disorders and minimizing their occurrence in
pregnancy are also explored. In addition, the association between adverse pregnancy outcome
and increased risk of future maternal and offspring cardiovascular disease is described, with
comments on future strategies to help minimize these potential risks
In-utero exposure to antihypertensive medication and neonatal and child health outcomes:A systematic review
Background: Although medication is generally avoided
wherever possible during pregnancy, pharmacotherapy is
required for the treatment of pregnancy associated
hypertension, which remains a leading cause of maternal
and fetal morbidity and mortality. The long-term effects to
the child of in-utero exposure to antihypertensive agents
remains largely unknown.
Objective: The aim of this study was to systematically
review published studies on adverse outcomes to the child
associated with in-utero exposure to antihypertensive
medications.
Methods: OVID, Scopus, EBSCO Collections, the Cochrane
Library, and Web of Science databases were searched for
relevant publications published between January 1950 and
October 2016 and a total of 688 potentially eligible studies
were identified.
Results: Following review, 47 primary studies were eligible
for inclusion. The Critical Appraisal Skills Programme
checklist was used to assess study quality. Five studies
were of excellent quality; the remainder were either
mediocre or poor. Increased risk of low birth weight, low
size for gestational age, preterm birth, and congenital
defects following in-utero exposure to all antihypertensive
agents were identified. Two studies reported an increased
risk of attention deficit hyperactivity disorder following
exposure to labetalol, and an increased risk of sleep
disorders following exposure to methyldopa and clonidine.
Conclusion: The current systematic review demonstrates a
paucity of relevant published high-quality studies. A small
number of studies suggest possible increased risk of
adverse child health outcomes; however, most published
studies have methodological weaknesses and/or lacked
statistical power thus preventing any firm conclusions
being drawn
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