Balestra, Brenno

Bianchetti, Mario

Esposito, Fabiana

Galfetti, Mariangela

Lava, Sebastiano

RERO DOC Digital Library

Arch Gynecol Obstet (2011) 284:1321DOI 10.1007/s00404-011-2027-2123LETTER TO THE EDITORFetopathy probably associated to self-medication with a blocker of the renin-angiotensin systemFabiana Esposito · Mariangela Galfetti · Sebastiano A. G. Lava · Brenno Balestra · Mario G. Bianchetti Received: 4 July 2011 / Accepted: 14 July 2011 / Published online: 27 July 2011© Springer-Verlag 2011To the Editor,Drugs that block the renin-angiotensin-aldosterone system,including converting enzyme inhibitors, angiotensin recep-tor blockers and, more recently, the direct renin inhibitoraliskiren are among the most widely prescribed antihyper-tensive agents [1, 2]. When prescribed in the second half ofpregnancy, these agents can cause a constellation of Wnd-ings that includes oligohydramnios, pulmonary hypoplasia,joint contractures, hypocalvaria, fetal growth retardation,kidney disease, arterial hypotension, and death. We reporton the adverse sequelae noted following maternal self-med-ication with an angiotensin receptor blocker [3].A 34-year-old woman aVected by systemic lupus erythe-matosus on medication with the antimalarial hydroxychlo-roquine, the -blocker metoprolol, the calcium-channelblocker nifedipine and the angiotensin receptor blockerlosartan became pregnant. Losartan was stopped and thedose of the remaining antihypertensive agents adjusted.In week 34 of gestation, oligohydramnios was noted andlater also fetal growth retardation. In week 37, because ofnonreactive fetal heart rate monitoring, a male newbornwas delivered by caesarean section without neonatal alarmindicators. Body weight (2.250 kg) and length (0.46 m)were below the 10th percentile for the gestational age.However, head circumference (0.330 m), mean blood pres-sure (from 35 to 45 mmHg) and the clinical examinationwere normal. Urinalysis was positive (++) for protein butcirculating creatinine (16 mol/l) and urea (4.1 mmol/l)were normal. Ultrasound evaluation showed bilateralhyperechogenic kidneys with normal size [4]. We were ini-tially unable to ascribe the aforementioned pathologicalhistory and Wndings to any particular cause. Detailed ques-tioning in retrospect revealed that the mother, unaware ofthe toxicity potential, had resumed losartan 50 mg/day inweek 32 of gestation without consulting any physician.Fetopathy induced by the use of drugs targeting therenin-angiotensin-aldosterone system has been so farreported among women who fail to stop the medicationafter conception (mostly because they are lost to follow-up)or, more rarely, among women inadvertently prescribed themedication during pregnancy [3]. To the best of our knowl-edge, this might be the Wrst case of fetopathy that resultsfrom self-medication [5].ConXict of interest None.References1. Zaman MA, Oparil S, Calhoun DA (2002) Drugs targeting the renin-angiotensin-aldosterone system. Nat Rev Drug Discov 1:621–6362. Gradman AH, Kad R (2008) Renin inhibition in hypertension. J AmColl Cardiol 51:519–5283. Quan A (2006) Fetopathy associated with exposure to angiotensinconverting enzyme inhibitors and angiotensin receptor antagonists.Early Hum Dev 82:23–284. Mercado-Deane MG, Beeson JE, John SD (2002) US of renalinsuYciency in neonates. Radiographics 22:1429–14385. Ruiz ME (2010) Risks of self-medication practices. Curr Drug Saf5:315–323F. Esposito · S. A. G. Lava · M. G. Bianchetti (&)Division of Pediatrics, Mendrisio and Bellinzona Hospitals, University of Bern, Bern, Switzerlande-mail: mario.bianchetti@pediatrician.chM. GalfettiDivision of Obstetrics and Gynecology, Ospedale Regionale Beata Vergine, Mendrisio, SwitzerlandB. BalestraDivision of Internal Medicine, Ospedale Regionale Beata Vergine, Mendrisio, Switzerland

Fetopathy probably associated to self-medication with a blocker of the renin-angiotensin system

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Fetopathy probably associated to self-medication with a blocker of the renin-angiotensin system

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