Sedman A
Angiotensin converting enzyme inhibitor fetopathy
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:181A 1996
It is now well know that ACE inhibitors cannot be used in pregnancy,
especially during late
pregnancy, as angiotensin II participates in regulation of uteroplacental
blood flow, and may play a
role in fetal growth. Certainly the AT2 receptor is widely expressed in
fetal tissues, and may
serve to control differentiation. Angiotensin is also required to maintain
GFR in the fetal kidneys
at the low perfusion pressures that are present. In patients who have been
given ACE inhibitors in
late pregnancy, profound fetal hypotension, anuria, and oligohydramnios and
growth retardation may
be present. Hypocalvaria is also common. The condition may be fatal to the
fetus.
The session by Sedman was an invited talk about this subject. One
interesting point was that these
adverse effects were not initially detected, as teratogenicity studies were
initially limited to
small animals. It appears that ACE inhibitor administration in the first
trimester is not
associated with adverse effects, although there is one report, at least,
where fetal anomalies were
present under such circumstances (Thorpe-Beeston et al., Br J Obstet Gynecol
1993:100:692). Sedman
cautioned against depriving young women of the benefits of ACE inhibitors,
especially young diabetic
women with microalbuminuria; but certainly all such women should be taking
contraceptive measures,
and the ACE inhibitors should be stopped if pregnancy is detected. There
appears to be no reason to
abort a fetus under such circumstances, as when exposure is limited to the
first trimester, fetal
anomalies appear to be uncommon. (John T. Daugirdas, M.D., University of
Illinois at Chicago)
To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
11th Scientific Meeting, American Society of Hypertension
H: Special problems :
Women